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McKendrick G, Stull SW, Sharma A, Dunn KE. Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder. Semin Neurol 2024; 44:419-429. [PMID: 38876459 DOI: 10.1055/s-0044-1787569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
There is an urgent need to expand access to treatment for persons with opioid use disorder (OUD). As neurologists may frequently encounter patients with chronic pain who have developed OUD, they are in a position to serve as advocates for treatment. Buprenorphine is the most scalable medication for OUD in the United States, yet expansion has plateaued in recent years despite growing treatment needs. Reluctance of providers to establish treatment with new patients, challenges with rural expansion, stigma related to buprenorphine-based care, and pharmacy pressures that incentivize low dispensing and inventories may have stalled expansion. This review introduces these challenges before outlining actionable and evidenced-based strategies that warrant investigation, including methods to improve patient access to care (remotely delivered care, mobile delivery programs, Bridge programs) and provider retention and confidence in prescribing (expert consults, Extension for Community Healthcare Outcomes, a telementoring model, hub-and-spoke services), as well as novel innovations (virtual reality, artificial intelligence, wearable technologies). Overall, fortifying existing delivery systems while developing new transformative models may be necessary to achieve more optimal levels of buprenorphine treatment expansion.
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Affiliation(s)
- Greer McKendrick
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel W Stull
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Bortz C, Armistead I, Bonaguidi A, Coyle DT. Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209342. [PMID: 38513975 DOI: 10.1016/j.josat.2024.209342] [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: 08/29/2023] [Revised: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents-safety events occurring in OTPs that are reportable to regulatory entities-across all Colorado OTPs during the COVID-19 pandemic. METHODS This study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15-December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15-December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. RESULTS OTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). CONCLUSIONS There was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.
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Affiliation(s)
- Cole Bortz
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Isaac Armistead
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
| | - Angela Bonaguidi
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - D Tyler Coyle
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA.
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St Vil NM, Haley DF, Montgomery B, Williams M, Watson L, Zhang S, Wingood GM. An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241246000. [PMID: 38605583 DOI: 10.1177/08862605241246000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.
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Affiliation(s)
| | | | | | | | | | - Shuaiqi Zhang
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA
| | - Gina M Wingood
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
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Kumari R, Chander S. Improving healthcare quality by unifying the American electronic medical report system: time for change. Egypt Heart J 2024; 76:32. [PMID: 38489094 PMCID: PMC10942963 DOI: 10.1186/s43044-024-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In recent years, innovation in healthcare technology has significantly improved the efficiency of the healthcare system. Advancements have led to better patient care and more cost-effective services. The electronic medical record (EMR) system, in particular, has enhanced interoperability and collaboration across healthcare departments by facilitating the exchange and utilization of patient data. The COVID-19 pandemic further accelerated this trend, leading to a surge in telemedicine services, which rely on electronic communication to deliver healthcare remotely. MAIN BODY Integrating artificial intelligence (AI) and machine learning (ML) in healthcare have been instrumental in analyzing vast data sets, allowing for identifying patterns and trends that can improve care delivery and pinpoint potential issues. The proposal of a unified EMR system in the USA aims to capitalize on these technological advancements. Such a system would streamline the sharing of patient information among healthcare providers, improve the quality and efficiency of care, and minimize the likelihood of errors in patient treatment. CONCLUSION A unified electronic medical record system represents a promising avenue for enhancing interoperability within the US healthcare sector. By creating a more connected and accessible network of patient information, it sets the stage for a transformation in healthcare delivery. This change is imperative for maintaining the momentum of progress in healthcare technology and realizing the full potential of recent advancements in patient care and system efficiency.
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Affiliation(s)
- Roopa Kumari
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA
| | - Subhash Chander
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA.
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Congia P, Carta E. Spatial and Environmental Correlates of Prevalence of Treatment for Substance Use Disorders, Retention, and SUD Services Utilization in South Sardinia. Psychiatr Q 2024; 95:121-135. [PMID: 38153599 DOI: 10.1007/s11126-023-10065-4] [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] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
This study explored the economic, social, and spatial correlates of treatment prevalence, retention, and service utilization for substance use disorder (SUD) in South Sardinia. Data from 1,667 patients with an ICD-10 diagnosis of SUD were extracted from the medical records of individuals assisted by three public addiction services in 2019. We used a spatial autoregressive model, a parametric proportional hazard model, and Poisson regression to examine the associations of spatial factors and residents' socioeconomic status with the prevalence of treatment at the census block level, treatment retention, and SUD service utilization at the individual level. The prevalence was higher among residents of areas closer to competent treatment centers, with the worst building conservation status, a lower percentage of high school and university graduates, and a higher percentage of unemployed, divorced, separated, or widowed residents. Men who were older at the time of their first treatment access; primary users of cocaine, cannabis, and alcohol; had higher education level; and who lived far from competent treatment centers and closer to drug trafficking centers interrupted their treatment earlier. Primary heroin users experienced more SUD treatment encounters. Living in economically and socially disadvantaged areas and near treatment facilities was associated with a higher prevalence, whereas living near drug-dealing centers and far from competent treatment centers was associated with a decrease in treatment retention.
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Affiliation(s)
- Pierpaolo Congia
- Department of Mental Health and Addiction, SER.D.2, ASSL Cagliari, Via Liguria, Cagliari, Italy.
| | - Eleonora Carta
- Department of Mental Health and Addiction, SER.D.2, ASSL Cagliari, Via Liguria, Cagliari, Italy
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McPherson SM, Smith CL, Hall L, Miguel AQ, Bowden T, Keever A, Schmidt A, Olson K, Rodin N, McDonell MG, Roll JM, LeBrun J. Mobile Medication Adherence Platform for Buprenorphine (MAP4BUP): A Phase I feasibility, usability and efficacy pilot randomized clinical trial. Drug Alcohol Depend 2024; 256:111099. [PMID: 38306822 PMCID: PMC10923156 DOI: 10.1016/j.drugalcdep.2024.111099] [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: 05/29/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM Poor medication adherence is one of the main barriers to the long-term efficacy of buprenorphine/naloxone (BUP/NAL). The aims of this pilot investigation were to examine if a Bluetooth-enabled pill cap and mobile application is a feasible, usable tool for increasing BUP/NAL adherence among people with an opioid use disorder. METHODS This pilot randomized clinical trial (RCT; total n = 41) lasted 12 weeks and was conducted in two office-based BUP/NAL provider locations in Spokane, WA and Coeur d'Alene, ID from January 2020 to September of 2021 with an 11-month gap due to COVID-19. Patients receiving BUP/NAL who consented to participate were randomized to receive the pill cap device (PLY group; n = 19) or a service as usual (SAU group; n = 22) group that included an identical but inactive cap for their bottle. The PLY group received reminders via text and voice, and the support of a "helper" (e.g., friend) to monitor pill cap openings. RESULTS Most participants in PLY group found the device both feasible (92.86 %) and usable (78.57 %). Most participants liked using the device (92.86 %) and were satisfied with the device (85.71 %). While not statistically different from one another, medication adherence per the Medication Possession Ratio was 75 % in the SAU group and 84 % in the PLY group. Pill cap openings were significantly higher in the PLY group with an average of 91.8 openings versus the SAU group's average of 56.7 (p < 0.05). CONCLUSION The devices was feasible, usable, and patients had high levels of satisfaction. The device was associated with increased pill openings.
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Affiliation(s)
- Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States.
| | - Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Luke Hall
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - André Q Miguel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Theresa Bowden
- Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States; College of Nursing, Washington State University, Spokane, WA, United States
| | - Abigail Keever
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Alex Schmidt
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | | | - Nicole Rodin
- Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States; College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Jeff LeBrun
- Optimize Health, 5601 22nd Ave NW #200, Seattle, WA, United States
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Kim J, Lee J, Thornhill TA, Dennett J, Lu H, Howell B, Grau LE, Fiellin DA, Heimer R, Gonsalves G. Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures. JAMA Netw Open 2024; 7:e240209. [PMID: 38376839 PMCID: PMC10879949 DOI: 10.1001/jamanetworkopen.2024.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/04/2024] [Indexed: 02/21/2024] Open
Abstract
Importance Transportation barriers have long been associated with poorer health outcomes; this burden is especially acute for individuals with opioid use disorder (OUD), a chronic disease often associated with low socioeconomic status. Conventional travel time analyses may not fully account for experiential components of travel, thereby understating the true travel burden and overstating treatment accessibility to opioid treatment programs (OTPs). Objective To develop a metric of feels-like accessibility for those using public transit to access OTPs that accounts for the realistic travel burden on individuals with OUD. Design, Setting, and Participants This cross-sectional study integrated high-resolution transit schedules and operating hours of OTPs to measure feels-like accessibility. Feels-like accessibility considers the differential outcomes of out-of-vehicle travel components and more realistically reflects individuals' transportation burden than conventional accessibility measures. Gini indices and spatial regression models were used to investigate inequities in accessibility. Geocoded data for residential addresses of 1018 overdose fatalities in Connecticut in 2019 were used as a proxy for the treatment needs of individuals with OUD. Data were analyzed between May and August 2023. Main Outcomes and Measures Conventional and feels-like accessibility scores. Exposures Fluctuations in public transit frequencies over the course of the day and the limited operating hours of the OTPs. Results Of the 1018 individuals in the study, the mean (SD) age at death was 43.7 (12.6) years, 784 individuals (77%) were men, 111 (11%) were African American, and 889 (87%) were White, with other racial and ethnic categories including 18 individuals (2%). A total of 264 individuals in the sample (26%) could not access an OTP within 180 minutes. For those who could access these facilities, the average 1-way travel time was 45.6 minutes, with individuals spending approximately 70% of their trip duration on out-of-vehicle travel components. The conventional accessibility metric underestimates individuals' travel burden to OTPs as well as the inequity in accessibility compared with the feels-like accessibility metric. For example, the median (range) conventional accessibility score, defined as the number of OTPs within 120 minutes of transit travel time, was 5.0 (0.0-17.0); the median (range) feels-like accessibility score, defined as the number of OTPs within 120 minutes of transit travel time weighted to account for in- and out-of-vehicle segments, was 1.0 (0.0-10.0). There is a considerable temporal variation in travel time and accessibility depending on the departure times. Conclusions and Relevance In this cross-sectional study of travel burdens, the calculated feels-like accessibility scores, which consider the differential outcomes of out-of-vehicle travel components (eg, walking and waiting), could better and more realistically reflect passengers' transportation burden. Policy recommendations derived from the conventional accessibility metric could be misleading, and decision-makers should use feels-like accessibility metrics that adequately capture individuals' travel burdens. In the context of access to OTPs, the findings from this study suggest that opening new OTP sites to address gaps in access due to distance to services or extending hours of operation at existing sites may ameliorate the travel burden for individuals.
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Affiliation(s)
- Junghwan Kim
- Department of Geography, College of Natural Resources and Environment, Virginia Tech, Blacksburg
| | - Jinhyung Lee
- Department of Geography and Environment, Faculty of Social Science, Western University, London, Ontario, Canada
| | - Thomas A. Thornhill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut
| | - Julia Dennett
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut
| | - Haidong Lu
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut
- Departments of Medicine and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin Howell
- Departments of Medicine and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lauretta E. Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David A. Fiellin
- Departments of Medicine and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gregg Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
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Gibbons JB, Li W, Stuart EA, Saloner B. Simulated impact of mobile opioid treatment program units on increasing access to methadone for opioid use disorder. Health Serv Res 2024. [PMID: 38191857 DOI: 10.1111/1475-6773.14271] [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] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To model the potential impact of mobile methadone unit implementation in Louisiana on net medication for opioid use disorder (MOUD) treatment rates. DATA SOURCES/STUDY SETTING We use secondary Louisiana Medicaid claims data between 2020 and 2021. STUDY DESIGN We simulate the impact of mobile methadone units in Louisiana using two approaches: (1) a "Poisson regression approach," which predicts the number of opioid use disorder (OUD) patients that might use methadone at mobile locations based on the underlying association between methadone use and proximity to a brick-and-mortar methadone clinic; (2) a "policy approach," which leverages local treatment uptake rates following the expansion of methadone coverage to Louisiana Medicaid beneficiaries in 2020 to estimate methadone use following mobile unit implementation. Models were run in cases where mobile methadone operators could choose their operation locations freely and in a separate instance where they were restricted to serving rural locations. DATA COLLECTION Our analytic sample includes 43,341 Louisiana Medicaid beneficiaries with one or more primary or secondary diagnoses for opioid dependence. PRINCIPAL FINDINGS We predict that 10 new mobile methadone units in Louisiana would increase the net MOUD treatment rate in the state by 0.54-2.39 percentage points. If these mobile units delivered Methadone exclusively to rural areas, they could increase rural MOUD treatment by 8.54-13.67 percentage points. Further, roughly 20% of all beneficiaries residing in rural areas being treated with methadone would be an average of 24 miles closer to a methadone treatment provider following mobile unit implementation. CONCLUSIONS Mobile methadone units represent a promising innovation in the delivery of methadone that is likely to increase methadone use, especially in underserved rural locations. However, we find significant variation in their impact conditional on where they choose to operate, and so careful location planning will be required to maximize their benefit.
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Affiliation(s)
- Jason B Gibbons
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wenshu Li
- Foundation Medicine, Cambridge, Massachusetts, USA
| | - Elizabeth A Stuart
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brendan Saloner
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Boyd J, Carter M, Baus A. Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth. J Prim Care Community Health 2024; 15:21501319241233198. [PMID: 38420885 PMCID: PMC10906046 DOI: 10.1177/21501319241233198] [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: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). METHODS We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. RESULTS We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. CONCLUSIONS This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.
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Affiliation(s)
- Jennifer Boyd
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Adam Baus
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
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Tatara E, Lin Q, Ozik J, Kolak M, Collier N, Halpern D, Anselin L, Dahari H, Boodram B, Schneider J. Spatial inequities in access to medications for treatment of opioid use disorder highlight scarcity of methadone providers under counterfactual scenarios. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289915. [PMID: 37292847 PMCID: PMC10246029 DOI: 10.1101/2023.05.12.23289915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Access to treatment and medication for opioid use disorder (MOUD) is essential in reducing opioid use and associated behavioral risks, such as syringe sharing among persons who inject drugs (PWID). Syringe sharing among PWID carries high risk of transmission of serious infections such as hepatitis C and HIV. MOUD resources, such as methadone provider clinics, however, are often unavailable to PWID due to barriers like long travel distance to the nearest methadone provider and the required frequency of clinic visits. The goal of this study is to examine the uncertainty in the effects of travel distance in initiating and continuing methadone treatment and how these interact with different spatial distributions of methadone providers to impact co-injection (syringe sharing) risks. A baseline scenario of spatial access was established using the existing locations of methadone providers in a geographical area of metropolitan Chicago, Illinois, USA. Next, different counterfactual scenarios redistributed the locations of methadone providers in this geographic area according to the densities of both the general adult population and according to the PWID population per zip code. We define different reasonable methadone access assumptions as the combinations of short, medium, and long travel distance preferences combined with three urban/suburban travel distance preference. Our modeling results show that when there is a low travel distance preference for accessing methadone providers, distributing providers near areas that have the greatest need (defined by density of PWID) is best at reducing syringe sharing behaviors. However, this strategy also decreases access across suburban locales, posing even greater difficulty in regions with fewer transit options and providers. As such, without an adequate number of providers to give equitable coverage across the region, spatial distribution cannot be optimized to provide equitable access to all PWID. Our study has important implications for increasing interest in methadone as a resurgent treatment for MOUD in the United States and for guiding policy toward improving access to MOUD among PWID.
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Affiliation(s)
- Eric Tatara
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Qinyun Lin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Nicholson Collier
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Dylan Halpern
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - John Schneider
- University of Chicago Medicine, Department of Infectious Disease, Chicago, IL, USA
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11
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Severson MA, Onanong S, Dolezal A, Bartelt-Hunt SL, Snow DD, McFadden LM. Analysis of Wastewater Samples to Explore Community Substance Use in the United States: Pilot Correlative and Machine Learning Study. JMIR Form Res 2023; 7:e45353. [PMID: 37883150 PMCID: PMC10636622 DOI: 10.2196/45353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Substance use disorder and associated deaths have increased in the United States, but methods for detecting and monitoring substance use using rapid and unbiased techniques are lacking. Wastewater-based surveillance is a cost-effective method for monitoring community drug use. However, the examination of the results often focuses on descriptive analysis. OBJECTIVE The objective of this study was to explore community substance use in the United States by analyzing wastewater samples. Geographic differences and commonalities of substance use were explored. METHODS Wastewater was sampled across the United States (n=12). Selected drugs with misuse potential, prescriptions, and over-the-counter drugs and their metabolites were tested across geographic locations for 7 days. Methods used included wastewater assessment of substances and metabolites paired with machine learning, specifically discriminant analysis and cluster analysis, to explore similarities and differences in wastewater measures. RESULTS Geographic variations in the wastewater drug or metabolite levels were found. Results revealed a higher use of methamphetamine (z=-2.27, P=.02) and opioids-to-methadone ratios (oxycodone-to-methadone: z=-1.95, P=.05; hydrocodone-to-methadone: z=-1.95, P=.05) in states west of the Mississippi River compared to the east. Discriminant analysis suggested temazepam and methadone were significant predictors of geographical locations. Precision, sensitivity, specificity, and F1-scores were 0.88, 1, 0.80, and 0.93, respectively. Finally, cluster analysis revealed similarities in substance use among communities. CONCLUSIONS These findings suggest that wastewater-based surveillance has the potential to become an effective form of surveillance for substance use. Further, advanced analytical techniques may help uncover geographical patterns and detect communities with similar needs for resources to address substance use disorders. Using automated analytics, these advanced surveillance techniques may help communities develop timely, tailored treatment and prevention efforts.
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Affiliation(s)
- Marie A Severson
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
| | - Sathaporn Onanong
- Water Sciences Laboratory & Nebraska Water Center, part of the Daugherty Water for Food Global Institute, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Alexandra Dolezal
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
| | - Shannon L Bartelt-Hunt
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Daniel D Snow
- Water Sciences Laboratory & Nebraska Water Center, part of the Daugherty Water for Food Global Institute, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Lisa M McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, Vermillion, SD, United States
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12
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Bradford AC, Maclean JC. Evictions and psychiatric treatment. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2023; 43:87-125. [PMID: 38249438 PMCID: PMC10798266 DOI: 10.1002/pam.22522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Stable housing is critical for health, employment, education, and other social outcomes. Evictions reflect a form of housing instability that is experienced by millions of Americans each year. Inadequately treated psychiatric disorders have the potential to influence evictions in several ways. For example, these disorders may impede labor market performance and thus the ability to pay rent, or increase the likelihood of risky and/or nuisance behaviors that can lead to a lease violation. We estimate the effect of local access to psychiatric treatment on eviction rates. We combine data on the number of psychiatric treatment centers that offer outpatient and residential care within a county with eviction rates in a two-way fixed-effects framework. Our findings imply that 10 additional psychiatric treatment centers in a county lead to a reduction of 2.1% in the eviction rate.
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Affiliation(s)
- Ashley C. Bradford
- Georgia Institute of Technology, School of Public Policy, Atlanta, GA, United States
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13
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Miller-Rosales C, Busch SH, Meara ER, King A, D’Aunno TA, Colla CH. Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders. Med Care Res Rev 2023; 80:410-422. [PMID: 37036056 PMCID: PMC10949918 DOI: 10.1177/10775587231162681] [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: 04/11/2023]
Abstract
Medications for opioid use disorder (MOUD) remain highly inaccessible despite demonstrated effectiveness. We examine the extent of screening for opioid use and availability of MOUD in a national cross-section of multi-physician primary care and multispecialty practices. Drawing on an existing framework to characterize the internal and environmental context, we assess socio-technical, organizational-managerial, market-based, and state-regulation factors associated with the use of opioid screening and offering of MOUD in a practice. A total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Having advanced health information technology functionality was positively associated with both screening for opioid use and offering MOUD in a practice, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models. These results suggest that improving access to information and expertise may enable physician practices to respond more effectively to the nation's ongoing opioid epidemic.
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Affiliation(s)
| | | | | | - Ashleigh King
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Thomas A. D’Aunno
- Wagner Graduate School of Public Service, New York University, New York, NY
| | - Carrie H. Colla
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Congressional Budget Office, Washington, DC
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14
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Winiker AK, Schneider KE, Hamilton White R, O'Rourke A, Grieb SM, Allen ST. A qualitative exploration of barriers and facilitators to drug treatment services among people who inject drugs in west Virginia. Harm Reduct J 2023; 20:69. [PMID: 37264367 PMCID: PMC10233537 DOI: 10.1186/s12954-023-00795-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: 03/15/2022] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The opioid overdose crisis in the USA has called for expanding access to evidence-based substance use treatment programs, yet many barriers limit the ability of people who inject drugs (PWID) to engage in these programs. Predominantly rural states have been disproportionately affected by the opioid overdose crisis while simultaneously facing diminished access to drug treatment services. The purpose of this study is to explore barriers and facilitators to engagement in drug treatment among PWID residing in a rural county in West Virginia. METHODS From June to July 2018, in-depth interviews (n = 21) that explored drug treatment experiences among PWID were conducted in Cabell County, West Virginia. Participants were recruited from locations frequented by PWID such as local service providers and public parks. An iterative, modified constant comparison approach was used to code and synthesize interview data. RESULTS Participants reported experiencing a variety of barriers to engaging in drug treatment, including low thresholds for dismissal, a lack of comprehensive support services, financial barriers, and inadequate management of withdrawal symptoms. However, participants also described several facilitators of treatment engagement and sustained recovery. These included the use of medications for opioid use disorder and supportive health care workers/program staff. CONCLUSIONS Our findings suggest that a range of barriers exist that may limit the abilities of rural PWID to successfully access and remain engaged in drug treatment in West Virginia. Improving the public health of rural PWID populations will require expanding access to evidence-based drug treatment programs that are tailored to participants' individual needs.
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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 St., Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD, 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD, 21205, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington, DC, 20052, USA
| | - Suzanne M Grieb
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD, 21205, USA
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15
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Yücel SG, Higgins CD, Gupta K, Palm M. Public transport access to drug treatment before and during COVID-19: Implications for the opioid epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104032. [PMID: 37172439 PMCID: PMC10130333 DOI: 10.1016/j.drugpo.2023.104032] [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: 10/19/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
Public transport disruptions caused by the COVID-19 pandemic had wide-ranging impacts on the ability of individuals to access health care. Individuals with opioid use disorder represent an especially vulnerable population due to the necessity of frequent, supervised doses of opioid agonists. Focused on Toronto, a major Canadian city suffering from the opioid epidemic, this analysis uses novel realistic routing methodologies to quantify how travel times to individuals\220 nearest clinics changed due to public transport disruptions from 2019 to 2020. Individuals seeking opioid agonist treatment face very constrained windows of access due to the need to manage work and other essential activities. We find that thousands of households in the most materially and socially deprived neighbourhoods crossed 30 and 20-minute travel time thresholds to their nearest clinic. As even small changes to travel times can lead to missed appointments and heighten the chances of overdose and death, understanding the distribution of those most impacted can help inform future policy measures to ensure adequate access to care.
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Affiliation(s)
- Shiv Gazi Yücel
- Transport Studies Unit, School of Geography and the Environment, University of Oxford, Oxford, United Kingdom.
| | | | - Kumar Gupta
- Office of the Chief Coroner of Ontario, Canada
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16
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Taylor JL, Wakeman SE, Walley AY, Kehoe LG. Substance use disorder bridge clinics: models, evidence, and future directions. Addict Sci Clin Pract 2023; 18:23. [PMID: 37055851 PMCID: PMC10101823 DOI: 10.1186/s13722-023-00365-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The opioid overdose and polysubstance use crises have led to the development of low-barrier, transitional substance use disorder (SUD) treatment models, including bridge clinics. Bridge clinics offer immediate access to medications for opioid use disorder (MOUD) and other SUD treatment and are increasingly numerous. However, given relatively recent implementation, the clinical impact of bridge clinics is not well described. METHODS In this narrative review, we describe existing bridge clinic models, services provided, and unique characteristics, highlighting how bridge clinics fill critical gaps in the SUD care continuum. We discuss available evidence for bridge clinic effectiveness in care delivery, including retention in SUD care. We also highlight gaps in available data. RESULTS The first era of bridge clinic implementation has yielded diverse models united in the mission to lower barriers to SUD treatment entry, and preliminary data indicate success in patient-centered program design, MOUD initiation, MOUD retention, and SUD care innovation. However, data on effectiveness in linking to long-term care are limited. CONCLUSIONS Bridge clinics represent a critical innovation, offering on-demand access to MOUD and other services. Evaluating the effectiveness of bridge clinics in linking patients to long-term care settings remains an important research priority; however, available data show promising rates of treatment initiation and retention, potentially the most important metric amidst an increasingly dangerous drug supply.
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Affiliation(s)
- Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA, 02118, USA.
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
| | - Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Second Floor, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Laura G Kehoe
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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17
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Pollack HA, Lee F, Paykin S, Aguilera JAR. Critical access medication for opioid use disorder (MOUD) treatment facilities in the continental United States. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100130. [PMID: 36994373 PMCID: PMC10040320 DOI: 10.1016/j.dadr.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/25/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Research objective Medication opioid use disorder (MOUD) treatment is the first-line approach to the treatment of opioid use disorder (OUD). This analysis seeks to identify "critical access" MOUD facilities that ensure geographic access for MOUD patients. Using public-source data and spatial analysis, we identify the top 100 "critical access" MOUD units across the continental U.S. Study design We use locational data from SAMHSA's Behavioral Health Treatment Services Locator and DATA 2000 waiver buprenorphine providers. We identify the closest MOUDs to each ZIP Code Tabulation Area (ZCTA)'s geographic centroid. We then construct a difference-in-distance metric by computing the difference in this distance measure between closest and second-closest MOUD, multiplied by ZCTA population, ranking MOUDs by difference-distance scores. Population studied All listed MOUD treatment facilities and all listed ZCTA's across the continental U.S., and all listed MOUD providers proximate to these areas. Principal findings We identified the top 100 critical access MOUD units in the continental United States. Many critical providers were in rural areas in the central United States, as well as a band extending east from Texas to Georgia. Twenty-three of the top 100 critical access providers were identified as providing naltrexone. Seventy-seven were identified as providing buprenorphine. Three were identified as providing methadone. Conclusions Significant areas of the United States are dependent on a single critical access MOUD provider. Implications for policy or practice Place-based supports may be warranted to support MOUD treatment access in areas dependent upon critical access providers.
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Affiliation(s)
- Harold A. Pollack
- Crown Family School of Social Work, Policy & Practice, University of Chicago. 969 East 60th St., Chicago, IL 60637, United States
- University of Chicago Urban Health Lab, 33 North Lasalle St., Chicago, IL 60602, United States
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Francis Lee
- Department of Medicine and Epidemiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Susan Paykin
- Center for Spatial Data Science, University of Chicago, 1155 East 60th St. Room 212, Chicago, IL 60637, United States
| | - Javier Andres Rojas Aguilera
- Center for Spatial Data Science, University of Chicago, 1155 East 60th St. Room 212, Chicago, IL 60637, United States
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18
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Leventelis C, Katsouli A, Stavropoulos V, Karasavvidou A, Papadopoulos P, Barmpas PT, Tasoulis S, Veskoukis AS, Tsironi M. The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:76-94. [PMID: 36793483 PMCID: PMC9893127 DOI: 10.1177/14550725221135574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment (MAT) programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. The aim of this study was to develop and validate the PANdemic Medication-Assisted Treatment Questionnaire (PANMAT/Q) to address the pandemic effect on the management and administration of MAT. In total, 463 patients under ΜΑΤ participated. Our findings indicate that PANMAT/Q has been successfully validated exerting reliability and validity. It can be completed within approximately 5 min, and its implementation in research settings is advocated. PANMAT/Q could serve as a useful tool to identify the needs of patients under MAT being at high risk of relapse and overdose.
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Affiliation(s)
- Christonikos Leventelis
- Christonikos Leventelis, Toxicology Scientist, Department of Nursing, University of Peloponnese, Tripoli, 22100, Greece.
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| | | | | | | | | | - Petros T. Barmpas
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Sotiris Tasoulis
- Department of Computer science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | | | - Maria Tsironi
- Nursing Department, University of Peloponnese, Panarcadian Hospital Erythrou, Tripoli, Greece
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19
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Sauer J, Stewart K. Geographic information science and the United States opioid overdose crisis: A scoping review of methods, scales, and application areas. Soc Sci Med 2023; 317:115525. [PMID: 36493502 DOI: 10.1016/j.socscimed.2022.115525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Opioid Overdose Crisis (OOC) continues to generate morbidity and mortality in the United States, outpacing other prominent accident-related reasons. Multiple disciplines have applied geographic information science (GIScience) to understand geographical patterns in opioid-related health measures. However, there are limited reviews that assess how GIScience has been used. OBJECTIVES This scoping review investigates how GIScience has been used to conduct research on the OOC. Specific sub-objectives involve identifying bibliometric trends, the location and scale of studies, the frequency of use of various GIScience methodologies, and what direction future research can take to address existing gaps. METHODS The review was pre-registered with the Open Science Framework ((https://osf.io/h3mfx/) and followed the PRISMA-ScR guidelines. Scholarly research was gathered from the Web of Science Core Collection, PubMed, IEEE Xplore, ACM Digital Library. Inclusion criteria was defined as having a publication date between January 1999 and August 2021, using GIScience as a central part of the research, and investigating an opioid-related health measure. RESULTS 231 studies met the inclusion criteria. Most studies were published from 2017 onward. While many (41.6%) of studies were conducted using nationwide data, the majority (58.4%) occurred at the sub-national level. California, New York, Ohio, and Appalachia were most frequently studied, while the Midwest, north Rocky Mountains, Alaska, and Hawaii lacked studies. The most common GIScience methodology used was descriptive mapping, and county-level data was the most common unit of analysis across methodologies. CONCLUSIONS Future research of GIScience on the OOC can address gaps by developing use cases for machine learning, conducting analyses at the sub-county level, and applying GIScience to questions involving illicit fentanyl. Research using GIScience is expected to continue to increase, and multidisciplinary research efforts amongst GIScientists, epidemiologists, and other medical professionals can improve the rigor of research.
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Affiliation(s)
- Jeffery Sauer
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
| | - Kathleen Stewart
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
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20
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Fujita AW, Loughry N, Moore DE, Carter AE, Hussen SA, Cooper H, Colasanti JA, Sheth AN. Prevalence, Distribution, and Characteristics Associated with Possession of Buprenorphine Waivers Among Infectious Diseases Physicians in the United States. Clin Infect Dis 2022; 76:1197-1204. [PMID: 36419250 DOI: 10.1093/cid/ciac909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use, thus ID physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown. METHODS This cross-sectional study merged data from several publicly available datasets from November 1, 2021 to January 15, 2022. Our primary outcome was proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine geographic distribution of waivered ID physicians. RESULTS We identified 6372 ID physicians in the US, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR 0.79, 95% CI 0.68-0.91). ID physicians practicing in counties with higher proportion of uninsured residents had lower odds of having a waiver (OR 0.75, 95% CI 0.62-0.90). Among counties with at least one ID physician (n = 729), only 11.2% had at least one waivered ID physician. CONCLUSIONS We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.
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Affiliation(s)
- Ayako Wendy Fujita
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Nora Loughry
- Division of General Internal Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - DeLante E Moore
- Department of Biostatistics, Rollins School of Public Health, Emory University Department of Medicine, Atlanta, GA, USA
| | - Andrea E Carter
- Division of General Internal Medicine, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA
| | - Sophia A Hussen
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral, Social, and Health Education Services, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
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21
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Pustz J, Srinivasan S, Larochelle MR, Walley AY, Stopka TJ. Relationships between places of residence, injury, and death: Spatial and statistical analysis of fatal opioid overdoses across Massachusetts. Spat Spatiotemporal Epidemiol 2022; 43:100541. [PMID: 36460457 DOI: 10.1016/j.sste.2022.100541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/13/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
Understanding the factors associated with where people who use opioids live, where their fatal overdoses occur, and where deaths are recorded can improve our knowledge of local risk environments and inform intervention planning. Through geospatial analyses of death certificate data between 2015 and 2017, we found that a majority of opioid-involved fatal overdoses in Massachusetts occurred at home. Age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.02-1.04), living in a census tract with a higher percentage of crowded households (AOR, 1.04; 95% CI, 1.01-1.08), households without vehicles (AOR, 1.01; 95% CI, 1.00-1.02), and Hispanic ethnicity (AOR, 0.56; 95% CI, 0.42-0.74) were independently associated with fatal overdose at home. Using geographically weighted regression, we identified locations where these associations were stronger and could benefit most from home-based and culturally sensitive overdose prevention efforts, including expanded overdose education and naloxone distribution.
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Affiliation(s)
- Jennifer Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States
| | - Sumeeta Srinivasan
- Department of Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Avenue, Medford, MA 02155, United States
| | - Marc R Larochelle
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States; Department of Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Avenue, Medford, MA 02155, United States; Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA 02155, United States; Clinical and Translational Science Institute, 35 Kneeland Street, 7(th) - 11(th) Floors, Boston, MA 02111, United States.
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22
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Tempalski B, Williams LD, Kolak M, Ompad DC, Koschinsky J, McLafferty SL. Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings. J Urban Health 2022; 99:701-716. [PMID: 35672547 PMCID: PMC9360264 DOI: 10.1007/s11524-022-00645-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.
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Affiliation(s)
- Barbara Tempalski
- Center for Community-Based Population Health Research, NDRI-USA, Inc., 31 West 34th Street, New York, NY 10001 USA
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607 USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, and the Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003 USA
| | - Julia Koschinsky
- Center for Spatial Data Science, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 USA
| | - Sara L. McLafferty
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, 1301 W Green Street, Urbana, IL 61801 USA
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Pasman E, Kollin R, Broman M, Lee G, Agius E, Lister JJ, Brown S, Resko SM. Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities. Addict Sci Clin Pract 2022; 17:35. [PMID: 35841076 PMCID: PMC9284487 DOI: 10.1186/s13722-022-00316-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Though methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers. Methods Patients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers. Results Most participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001). Conclusion This study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.
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Affiliation(s)
- Emily Pasman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.
| | - Rachel Kollin
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Michael Broman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Guijin Lee
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.,Center for Behavioral Health and Justice, Wayne State University, 5201 Cass Ave, Detroit, MI, 48202, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Jamey J Lister
- School of Social Work, Rutgers University, 120 Albany Street, Tower One, New Brunswick, NJ, 08901, USA
| | - Suzanne Brown
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Stella M Resko
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.,Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI, 48202, USA
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Bonifonte A, Garcia E. Improving geographic access to methadone clinics. J Subst Abuse Treat 2022; 141:108836. [PMID: 35870438 DOI: 10.1016/j.jsat.2022.108836] [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: 08/19/2021] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Opioid misuse is a nationwide public health crisis. Methadone treatment is proven to be highly successful in preventing opioid use disorder, reducing the use of illicit drugs, and preventing overdoses. Clients acquire methadone daily from clinics, making geographic access crucial for the initiation of and adherence to treatment. METHODS This work estimates unsatisfied methadone demand due to lack of geographic access at a census tract level and models the problem of identifying optimal locations to open new methadone clinics. The objective function of the model is a weighted combination of providing access to individuals with unmet methadone demand and improving the travel time of individuals currently attending a clinic. Data on existing methadone clinics and statewide methadone demand is acquired from Substance Abuse and Mental Health Services Administration (SAMHSA) surveys from 2019. Unsatisfied demand is estimated through a linear regression model after aggregating the population, heroin use, and satisfied methadone demand at the state level. RESULTS Nationwide, we find 18.2 % of the United States population does not have geographic access to a methadone clinic and estimate 77,973 individuals in these areas would attend a clinic if geographic access barriers were removed (95 % CI: 67,413-88,532). In a case study of six Midwestern states, we find that geography significantly contributes to the value of opening additional clinics and we see large differences in expected gains between states sharing similar characteristics such as population and satisfied methadone demand. The number of additional clients served by opening one new clinic ranges from 180 to 804 across these six states, representing between 8.4 % and 16.2 % of state unmet demand. Between 1.2 % and 14.1 % of existing clients were reassigned with a single newly opened clinic, with a one-way average travel distance improvement between 6.3 and 11.9 miles / person / day for these clients. CONCLUSIONS The results demonstrate the large unserved methadone demand in the United States, the significant improvement in methadone access for new and existing clients that can be achieved by opening new clinics, and the important role state-specific geography plays in these decisions.
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Affiliation(s)
- Anthony Bonifonte
- Data Analytics Department, Denison University, Granville, OH, United States of America.
| | - Erin Garcia
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, United States of America.
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Taylor JL, Laks J, Christine PJ, Kehoe J, Evans J, Kim TW, Farrell NM, White CS, Weinstein ZM, Walley AY. Bridge clinic implementation of "72-hour rule" methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care. Drug Alcohol Depend 2022; 236:109497. [PMID: 35607834 DOI: 10.1016/j.drugalcdep.2022.109497] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Methadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal for up to 72 h while arranging ongoing care. Our low-barrier bridge clinic implemented a new pathway to treat opioid withdrawal and facilitate OTP linkage utilizing the "72-hour rule." METHODS Patients presenting to a hospital-based bridge clinic were evaluated for OUD, opioid withdrawal, and treatment goals. Eligible patients were offered methadone opioid withdrawal management with rapid OTP referral. OTPs accepted patients as direct admissions. We described bridge clinic patients who received at least one dose of methadone between March-August 2021 and key clinical outcomes including OTP referral completion within 72 h. For the subset of patients referred to our two primary OTP partners, we described OTP linkage (i.e., attended at least one OTP visit within one month) and OTP retention at one month. RESULTS Methadone was administered during 150 episodes of care for 142 unique patients, the majority of whom were male (73%), white (67%), and used fentanyl (85%). In 92% of episodes (138/150), a plan for ongoing care was in place within 72 h. Among 121 referrals to two primary OTP partners, 87% (105/121) linked and 58% (70/121) were retained at one month. CONCLUSIONS Methadone administration for opioid withdrawal with direct OTP admission under the "72-hour rule" is feasible in an outpatient bridge clinic and resulted in high OTP linkage and 1-month retention rates. This model has the potential to improve methadone access.
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Affiliation(s)
- Jessica L Taylor
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Paul J Christine
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Jessica Kehoe
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - James Evans
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Theresa W Kim
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA; Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Cedric S White
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Zoe M Weinstein
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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Smith CL, Keever A, Bowden T, Olson K, Rodin N, McDonell MG, Roll JM, Smoody G, LeBrun J, Miguel AQ, McPherson SM. Patient Feedback on a Mobile Medication Adherence Application for Buprenorphine/Naloxone: Feasibility and Acceptability Study (Preprint). JMIR Form Res 2022; 7:e40437. [PMID: 37074780 PMCID: PMC10157459 DOI: 10.2196/40437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Opioid use disorders impact the health and well-being of millions of Americans. Buprenorphine and naloxone (BUP and NAL) can reduce opioid overdose deaths, decrease misuse, and improve quality of life. Unfortunately, poor medication adherence is a primary barrier to the long-term efficacy of BUP and NAL. OBJECTIVE We aimed to examine patient feedback on current and potential features of a Bluetooth-enabled pill bottle cap and associated mobile app for patients prescribed BUP and NAL for an opioid use disorder, and to solicit recommendations for improvement to effectively and appropriately tailor the technology for people in treatment for opioid use disorder. METHODS A convenience sample of patients at an opioid use disorder outpatient clinic were asked about medication adherence, opioid cravings, experience with technology, motivation for treatment, and their existent support system through a brief e-survey. Patients also provided detailed feedback on current features and features being considered for inclusion in a technology designed to increase medication adherence (eg, inclusion of a personal motivational factor, craving and stress tracking, incentives, and web-based coaching). Participants were asked to provide suggestions for improvement and considerations specifically applicable to people in treatment for opioid use disorder with BUP and NAL. RESULTS Twenty people with an opioid use disorder who were prescribed BUP and NAL participated (mean age 34, SD 8.67 years; 65% female; 80% White). Participants selected the most useful, second-most useful, and least useful features presented; 42.1% of them indicated that motivational reminders would be most useful, followed by craving and stress tracking (26.3%) and web-based support forums (21.1%). Every participant indicated that they had at least 1 strong motivating factor for staying in treatment, and half (n=10) indicated children as that factor. All participants indicated that they had, at some point in their lives, the most extreme craving a person could have; however, 42.1% indicated that they had no cravings in the last month. Most respondents (73.7%) stated that tracking cravings would be helpful. Most respondents (84.2%) also indicated that they believed reinforcers or prizes would help them achieve their treatment goals. Additionally, 94.7% of respondents approved of adherence tracking to accommodate this feature using smart packaging, and 78.9% of them approved of selfie videos of them taking their medication. CONCLUSIONS Engaging patients taking treatment for opioid use disorder with BUP and NAL allowed us to identify preferences and considerations that are unique to this treatment area. As the technology developer of the pill cap and associated mobile app is able to take into consideration or integrate these preferences and suggestions, the smart cap and associated mobile app will become tailored to this population and more useful for them, which may encourage patient use of the smart cap and associated mobile app.
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Affiliation(s)
- Crystal L Smith
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Abigail Keever
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Theresa Bowden
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | | | - Nicole Rodin
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - John M Roll
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Gillian Smoody
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
| | | | - Andre Qc Miguel
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Sterling M McPherson
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
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Young AM, Lancaster KE, Bielavitz S, Elman MR, Cook RR, Leichtling G, Freeman E, Estadt AT, Brown M, Alexander R, Barrie C, Conn K, Elzaghal R, Maybrier L, McDowell R, Neal C, Lapidus J, Waddell EN, Korthuis PT. Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R 2): a multisite, randomised, 12-month trial to compare efficacy of standard versus peer-based approaches to retain rural people who use drugs in research. BMJ Open 2022; 12:e064400. [PMID: 35705346 PMCID: PMC9204453 DOI: 10.1136/bmjopen-2022-064400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Rural communities bear a disproportionate share of the opioid and methamphetamine use disorder epidemics. Yet, rural people who use drugs (PWUD) are rarely included in trials testing new drug use prevention and treatment strategies. Numerous barriers impede rural PWUD trial engagement and advancing research methods to better retain rural PWUD in clinical trials is needed. This paper describes the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R2) study protocol to test the effectiveness of a peer-driven intervention to improve study retention among rural PWUD. METHODS AND ANALYSIS The PROUD-R2 study is being implemented in 21 rural counties in three states (Kentucky, Ohio and Oregon). People who are 18 years or older, reside in the study area and either used opioids or injected any drug to get high in the past 30 days are eligible for study inclusion. Participants are allocated in a 1:1 ratio to two arms, stratified by site to assure balance at each geographical location. The trial compares the effectiveness of two retention strategies. Participants randomised to the control arm provide detailed contact information and receive standard retention outreach by study staff (ie, contacts for locator information updates, appointment reminders). Participants randomised to the intervention arm are asked to recruit a 'study buddy' in addition to receiving standard retention outreach. Study buddies are invited to participate in a video training and instructed to remind their intervention participant of follow-up appointments and encourage retention. Assessments are completed by intervention, control and study buddy participants at 6 and 12 months after enrolment. ETHICS AND DISSEMINATION The protocol was approved by a central Institutional Review Board (University of Utah). Results of the study will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER NCT03885024.
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Affiliation(s)
- April M Young
- Epidemiology, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio, USA
| | | | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan R Cook
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Edward Freeman
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | | | - Rhonda Alexander
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Caiti Barrie
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kandi Conn
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Rhody Elzaghal
- Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa Maybrier
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Cathy Neal
- The Ohio State University, Columbus, Ohio, USA
| | - Jodi Lapidus
- Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth N Waddell
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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Mitchell P, Samsel S, Curtin KM, Price A, Turner D, Tramp R, Hudnall M, Parton J, Lewis D. Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior. Soc Sci Med 2022; 302:114992. [PMID: 35512612 DOI: 10.1016/j.socscimed.2022.114992] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Drug overdose is the leading cause of accidental death in the U.S. with deaths from opioid overdose occurring at a higher rate in rural areas. The gaps in the provision of healthcare services have been exacerbated by the opioid crisis leaving vulnerable populations without access to preventative care and education, harm reduction, both chronic and acute treatment of the symptoms of opioid use disorder (OUD), and long-term psychological support for those with OUD and their families. There has been a call in the literature -and a federal mandate-for increased access to opioid treatment facilities, but to date this access has not been operationalized using best practices in geography. Medication for Opioid Use Disorder (MOUD) with FDA-approved methadone or buprenorphine has been shown to increase treatment retention, reduce opioid use and associated health and societal harms, and reduce opioid related overdose, and as such is considered the most effective treatment for OUD. The objective of this study is to examine U.S. adults' spatial access to MOUD - specifically locations of certified Opioid Treatment Programs (OTPs) and DATA-waived Buprenorphine providers. A gravity-based variant of the enhanced two-step floating catchment area model is employed, where friction of distance is based on previously published willingness to travel distances for patients visiting OTPs, to assess how opioid agonist treatment accessibility varies across the nation. Findings suggest that there are extensive 'treatment deserts' where there is little to no physical access to MOUD, especially in rural areas. The significance of this work lies in the incorporation of treatment utilization behavior in the access metric, and the continued confirmation of gaps in access to OUD services despite federal efforts to improve accessibility.
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Affiliation(s)
- Penelope Mitchell
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA.
| | - Steven Samsel
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Kevin M Curtin
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ashleigh Price
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Daniel Turner
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ryan Tramp
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Matthew Hudnall
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Jason Parton
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Dwight Lewis
- Department of Management, University of Alabama, Tuscaloosa, AL, USA
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Janzow GE, Harding C, Flores M, Borodovsky J, Steinkamp J, Marsch LA, Schuman-Olivier Z. Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100045. [PMID: 36845988 PMCID: PMC9949338 DOI: 10.1016/j.dadr.2022.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Background Increasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensing during office-based B/N treatment. Methods In this multi-site randomized controlled trial, MySafeRx provided coaching and supervised self-administration of B/N by mobile recovery coaches (MRCs) via videoconference. Referred adults (ages 18-65) with OUD were randomized to 1) 42-days of adjunctive MySafeRx treatment (n = 13) or 2) a standard care control group (n = 14). Results The randomized sample was 63% female and 100% White. Twelve of 13 MySafeRx participants completed at least one MRC session. The mean system usability score reported by MySafeRx participants was 78.4 (n = 12). Participants indicated they would recommend MySafeRx to a friend (mean= 4.1 of 5), and that the dispenser (4.1 of 5) and videoconferencing (4.2 of 5) were easy to use. The MRC component had the highest acceptability (4.4 of 5). MRCs observed B/N self-administration for an average of 64.3% of the required study days (men: 68.9%; women: 57.9%). On average, men (n = 4) met with MRCs on 32±14 days versus 47±6 days for women (n = 8). Exploratory analyses did not show significant differences between intervention and control groups. Conclusions Despite the small sample, this study supports usability and acceptability of MySafeRx. Increased adherence monitoring, even with remote coaching had limited appeal, which impacted feasibility due to slow recruitment, especially as community prescribing with relaxed monitoring requirements became more widespread.
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Affiliation(s)
- Grace E. Janzow
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Cassandra Harding
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Michael Flores
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Jackson Steinkamp
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
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Vakkalanka JP, Lund BC, Ward MM, Arndt S, Field RW, Charlton M, Carnahan RM. Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans. J Gen Intern Med 2022; 37:1610-1618. [PMID: 34159547 PMCID: PMC8219175 DOI: 10.1007/s11606-021-06969-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Treatment for opioid use disorder (OUD) may include a combination of pharmacotherapies (such as buprenorphine) with counseling services if clinically indicated. Medication management or engagement with in-person counseling services may be hindered by logistical and financial barriers. Telehealth may provide an alternative mechanism for continued engagement. This study aimed to evaluate the association between telehealth encounters and time to discontinuation of buprenorphine treatment when compared to traditional in-person visits and to evaluate potential effect modification by rural-urban designation and in-person and telehealth combination treatment. METHODS A retrospective cohort study of Veterans diagnosed with OUD and treated with buprenorphine across all facilities within the Veterans Health Administration (VHA) between 2008 and 2017. Exposures were telehealth and in-person encounters for substance use disorder (SUD) and mental health, treated as time-varying covariates. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. RESULTS Compared to in-person encounters, treatment discontinuation was lower for telehealth for SUD (aHR: 0.69; 95%CI: 0.60, 0.78) and mental health (aHR: 0.69; 95%CI: 0.62, 0.76). There was no evidence of effect modification by rural-urban designation. Risk of treatment discontinuation appeared to be lower among those with telehealth only compared to in-person only for both SUD (aHR: 0.48, 95%CI: 0.37, 0.62) and for mental health (aHR: 0.46; 95%CI: 0.33, 0.65). CONCLUSIONS As telehealth demonstrated improved treatment retention compared to in-person visits, it may be a suitable option for engagement for patients in OUD management. Efforts to expand services may improve treatment retention and health outcomes for VHA and other health care systems.
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Affiliation(s)
- J Priyanka Vakkalanka
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA. .,Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Brian C Lund
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.,Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - R William Field
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Abell-Hart K, Rashidian S, Teng D, Rosenthal RN, Wang F. Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State. JMIR Public Health Surveill 2022; 8:e32133. [PMID: 35412467 PMCID: PMC9044159 DOI: 10.2196/32133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Opioid addiction and overdose have a large burden of disease and mortality in New York State (NYS). The medication naloxone can reverse an overdose, and buprenorphine can treat opioid use disorder. Efforts to increase the accessibility of both medications include a naloxone standing order and a waiver program for prescribing buprenorphine outside a licensed drug treatment program. However, only a slim majority of NYS pharmacies are listed as participating in the naloxone standing order, and less than 7% of prescribers in NYS have a buprenorphine waiver. Therefore, there is a significant opportunity to increase access. OBJECTIVE Identifying the geographic regions of NYS that are farthest from resources can help target interventions to improve access to naloxone and buprenorphine. To maximize the efficiency of such efforts, we also sought to determine where these underserved regions overlap with the largest numbers of actual patients who have experienced opioid overdose. METHODS We used address data to assess the spatial distribution of naloxone pharmacies and buprenorphine prescribers. Using the home addresses of patients who had an opioid overdose, we identified geographic locations of resource deficits. We report findings at the high spatial granularity of census tracts, with some neighboring census tracts merged to preserve privacy. RESULTS We identified several hot spots, where many patients live far from the nearest resource of each type. The highest density of patients in areas far from naloxone pharmacies was found in eastern Broome county. For areas far from buprenorphine prescribers, we identified subregions of Oswego county and Wayne county as having a high number of potentially underserved patients. CONCLUSIONS Although NYS is home to thousands of naloxone pharmacies and potential buprenorphine prescribers, access is not uniform. Spatial analysis revealed census tract areas that are far from resources, yet contain the residences of many patients who have experienced opioid overdose. Our findings have implications for public health decision support in NYS. Our methods for privacy can also be applied to other spatial supply-demand problems involving sensitive data.
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Affiliation(s)
- Kayley Abell-Hart
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Sina Rashidian
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Dejun Teng
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Richard N Rosenthal
- Department of Psychiatry, Stony Brook Medicine, Stony Brook, NY, United States
| | - Fusheng Wang
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
- Department of Computer Science, School of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
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Alibrahim A, Marsh JC, Amaro H, Kong Y, Khachikian T, Guerrero E. Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study. BMC Health Serv Res 2022; 22:478. [PMID: 35410215 PMCID: PMC8996398 DOI: 10.1186/s12913-022-07886-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commuting time to treatment has been shown to affect healthcare outcomes such as engagement and initiation. The purpose of this study is to extend this line of research to investigate the effects of driving time to opioid programs on treatment outcomes. METHODS We analyzed discharge survey data from 22,587 outpatient opioid use disorder treatment episodes (mainly methadone) in Los Angeles County and estimated the associated driving time to each episode using Google Maps. We used multivariable logistic regressions to examine the association between estimated driving time and odds of treatment completion after adjusting for possible confounders. RESULTS Findings show an average driving time of 11.32 min and an average distance of 11.18 km. We observed differences in estimated driving time across age, gender, and socioeconomic status. Young, male, less formally educated, and Medi-Cal-ineligible clients drove longer to treatment. A 10-min drive was associated with a 33% reduction in the completion of methadone treatment plans (p < .01). CONCLUSION This systemwide analysis provides novel time estimates of driving-based experiences and a strong relationship with completion rates in methadone treatment. Specifically, the result showing reduced treatment completion rates for drive times longer than 10 min may inform policies regarding the ideal geographic placement of methadone-based treatment programs and service expansion initiatives.
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Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering, College of Engineering & Petroleum, Kuwait University, Kuwait, Kuwait. .,Geo-Health Lab, Dasman Diabetes Institute, Kuwait, Kuwait.
| | - Jeanne C Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Hortensia Amaro
- Robert Stempel College Of Public Health and Social Work and Herbert Wertheim College of Medicine, Florida Internation University, Miami, USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, Fullerton, USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Erick Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, Los Angeles, USA
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Pustz J, Shrestha S, Newsky S, Taylor M, Fowler L, Van Handel M, Lingwall C, Stopka TJ. Opioid-Involved Overdose Vulnerability in Wyoming: Measuring Risk in a Rural Environment. Subst Use Misuse 2022; 57:1720-1731. [PMID: 35975873 DOI: 10.1080/10826084.2022.2112229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Between 2009 and 2019 opioid-involved fatal overdose rates increased by 45% and the average opioid dispensing rate in Wyoming was higher than the national average. The opioid crisis is shaped by a complex set of socioeconomic, geopolitical, and health-related variables. We conducted a vulnerability assessment to identify Wyoming counties at higher risk of opioid-related harm, factors associated with this risk, and areas in need of overdose treatment access to inform priority responses. METHODS We compiled 2016 to 2018 county-level aggregated and de-identified data. We created risk maps and ran spatial analyses in a geographic information system to depict the spatial distribution of overdose-related measures. We used addresses of opioid treatment programs and buprenorphine providers to develop drive-time maps and ran 2-step floating catchment area analyses to measure accessibility to treatment. We used a straightforward and replicable weighted ranks approach to calculate final county vulnerability scores and rankings from most to least vulnerable. FINDINGS We found Hot Springs, Carbon, Natrona, Fremont, and Sweetwater Counties to be most vulnerable to opioid-involved overdose fatalities. Opioid prescribing rates were highest in Hot Springs County (97 per 100 persons), almost two times the national average (51 per 100 persons). Statewide, there were over 90 buprenorphine-waivered providers, however accessibility to these clinicians was limited to urban centers. Most individuals lived further than a four-hour round-trip drive to the nearest methadone treatment program. CONCLUSIONS Identifying Wyoming counties with high opioid overdose vulnerabilities and limited access to overdose treatment can inform public health and harm reduction responses.
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Affiliation(s)
- Jennifer Pustz
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Shikhar Shrestha
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
| | | | - Melissa Taylor
- Public Health Division, Wyoming Department of Health, Cheyenne, WY
| | - Leslie Fowler
- Public Health Division, Wyoming Department of Health, Cheyenne, WY
| | | | - Cailyn Lingwall
- Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Thomas J Stopka
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
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Swann WL, DiNardi M, Schreiber TL. Association Between Interorganizational Collaboration in Opioid Response and Treatment Capacity for Opioid Use Disorder in Counties of Five States: A Cross-Sectional Study. Subst Abuse 2022; 16:11782218221111949. [PMID: 35845967 PMCID: PMC9284196 DOI: 10.1177/11782218221111949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022]
Abstract
Background: Local governments on the front lines of the opioid epidemic often collaborate
across organizations to achieve a more comprehensive opioid response.
Collaboration is especially important in rural communities, which can lack
capacity for addressing health crises, yet little is known about how local
collaboration in opioid response relates to key outputs like treatment
capacity. Purpose: This cross-sectional study examined the association between local
governments’ interorganizational collaboration activity and agonist
treatment capacity for opioid use disorder (OUD), and whether this
association was stronger for rural than for metropolitan communities. Methods: Data on the location of facilities providing buprenorphine and methadone were
merged with a 2019 survey of all 358 counties in 5 states (CO, NC, OH, PA,
and WA) that inquired about their collaboration activity for opioid
response. Regression analysis was used to estimate the effect of a
collaboration activity index and its constituent items on the capacity to
provide buprenorphine or methadone in a county and whether this differed by
urbanicity. Results: A response rate of 47.8% yielded an analytic sample of n = 171 counties,
including 77 metropolitan, 50 micropolitan, and 44 rural counties.
Controlling for covariates, a 1-unit increase in the collaboration activity
index was associated with 0.155 (95% CI = 0.005, 0.304) more methadone
facilities, ie, opioid treatment programs (OTPs), per 100 000 population. An
interaction model indicated this association was stronger for rural (average
marginal effect = 0.354, 95% CI = 0.110, 0.599) than for non-rural counties.
Separate models revealed intergovernmental data and information sharing,
formal agreements, and organizational reforms were driving the above
associations. Collaboration activity did not vary with the capacity to
provide buprenorphine at non-OTP facilities. Spatial models used to account
for spatial dependence occurring with OUD treatment capacity showed similar
results. Conclusion: Rural communities may be able to leverage collaborations in opioid response
to expand treatment capacity through OTPs.
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Affiliation(s)
- William L Swann
- School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Michael DiNardi
- Department of Economics, University of Rhode Island, Kingston, RI, USA
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Laks J, Kehoe J, Farrell NM, Komaromy M, Kolodziej J, Walley AY, Taylor JL. Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule. Addict Sci Clin Pract 2021; 16:73. [PMID: 34961554 PMCID: PMC8712102 DOI: 10.1186/s13722-021-00279-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The “72-hour rule” allows non-OTP providers to administer methadone for emergency opioid withdrawal management while arranging ongoing care. Low-barrier substance use disorder (SUD) bridge clinics provide rapid access to buprenorphine but offer an opportunity to treat acute opioid withdrawal while facilitating OTP linkage. We describe the case of a patient with OUD who received methadone for opioid withdrawal in a bridge clinic and linked to an OTP within 72 h. Case presentation A 54-year-old woman with severe OUD was seen in a SUD bridge clinic requesting OTP linkage and assessed with a clinical opiate withdrawal scale (COWS) score of 12. She reported daily nasal use of 1 g heroin/fentanyl. Prior OUD treatment included buprenorphine-naloxone, which was only partially effective. Her acute opioid withdrawal was treated with a single observed oral dose of methadone 20 mg. She returned the following day with persistent opioid withdrawal (COWS score 11) and was treated with methadone 40 mg. On day 3, the patient was successfully admitted to a local OTP, where she remained engaged 3 months later. Conclusions While patients continue to face substantial access barriers, bridge clinics can play an important role in treating opioid withdrawal, building partnerships with OTPs to initiate methadone on demand, and preventing life-threatening delays to methadone treatment. Federal policy reform is urgently needed to make methadone more accessible to people with OUD.
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Affiliation(s)
- Jordana Laks
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. .,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
| | - Jessica Kehoe
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA.,Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Miriam Komaromy
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | | | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Jessica L Taylor
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
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Population-based estimates of geographic accessibility of medication for opioid use disorder by substance use disorder treatment facilities from 2014 to 2020. Drug Alcohol Depend 2021; 229:109107. [PMID: 34656034 PMCID: PMC8981564 DOI: 10.1016/j.drugalcdep.2021.109107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/11/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Understanding whether individuals have geographic accessibility to a substance use disorder treatment facility and a treatment facility that offers medication treatment for opioid use disorder (MOUD) can inform efforts to address the ongoing opioid crisis. METHODS We used data from the National Directory of Drug and Alcohol Abuse Treatment Programs. First, we calculate the national share of treatment facilities that offer one type of MOUD or all forms of MOUD using a novel dataset of providers. Second, we quantify the share of counties with a treatment facility offering at least one type of MOUD. Finally, we calculate the share of the national population residing within a 10-mile radius of a treatment facility. RESULTS The share of counties with a treatment facility offering a MOUD as a form of treatment rose from 30% to 45% from 2014 to 2020 while the share of counties with facilities offering all three forms of MOUD increased from 4% to 9%. Over 83% of the population lives within 10 miles of a facility offering MOUD treatment, and 42% of the population have a treatment facility that offers all three forms of MOUD within a 10-mile radius. Much of the difference between the county- and population-based measures is explained by more population dense areas having higher rates of facilities providing MOUD. CONCLUSIONS While the share of facilities within a county offering a MOUD is relatively small, the share of the population within 10 miles of such a facility is higher.
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Clements AD, Cyphers N, Whittaker DL, McCarty B. Initial Validation and Findings From the Willing/Ready Subscale of the Church Addiction Response Scale. Front Psychol 2021; 12:733913. [PMID: 34733210 PMCID: PMC8558616 DOI: 10.3389/fpsyg.2021.733913] [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: 06/30/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing "What are your views about addiction?" (14 items), "What are your views about interacting with people who are addicted to drugs?" (11 items), and "What do you think the church's role is in addressing addiction?" (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable.
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Affiliation(s)
- Andrea D Clements
- Department of Psychology, East Tennessee State University, Johnson City, TN, United States.,Uplift Appalachia, Johnson City, TN, United States.,East Tennessee State University Ballad Health Strong BRAIN Institute, Johnson City, TN, United States
| | - Natalie Cyphers
- Division of Nursing, DeSales University, Center Valley, PA, United States
| | | | - Brett McCarty
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.,Duke Divinity School, Duke University, Durham, NC, United States
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Harder VS, Villanti AC, Heil SH, Smith ML, Gaalema DE, Meyer MC, Schafrick NH, Sigmon SC. Opioid use disorder treatment in rural settings: The primary care perspective. Prev Med 2021; 152:106765. [PMID: 34411588 PMCID: PMC8591995 DOI: 10.1016/j.ypmed.2021.106765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 08/14/2021] [Indexed: 12/13/2022]
Abstract
Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont's rural and non-rural counties between April-August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients' use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.
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Affiliation(s)
- Valerie S Harder
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, S-253 Given Courtyard, 89 Beaumont Avenue, Burlington, VT 05401, USA.
| | - Andrea C Villanti
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA
| | - Sarah H Heil
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
| | - M Lindsey Smith
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, 34 Bedford St., Portland, ME 04104, USA
| | - Diann E Gaalema
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
| | - Marjorie C Meyer
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner, M.D. College of Medicine, University of Vermont, 111 Colchester Ave, Main Campus, East Pavilion, Level 4, Burlington, VT 05401, USA
| | - Nathaniel H Schafrick
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA
| | - Stacey C Sigmon
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
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Goldsamt LA, Rosenblum A, Appel P, Paris P, Nazia N. The impact of COVID-19 on opioid treatment programs in the United States. Drug Alcohol Depend 2021; 228:109049. [PMID: 34600258 PMCID: PMC8461004 DOI: 10.1016/j.drugalcdep.2021.109049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The COVID-19 pandemic had the potential to severely disrupt the delivery of methadone and buprenorphine, as social distancing and other public health regulations made in-person services difficult to maintain. Federal and state regulators changed requirements regarding the dispensing of medication and in-person counseling at opioid treatment programs. Understanding staff and patient reactions to these changes can help determine whether they should be maintained. METHODS We interviewed 25 directors of OTP programs located throughout the United States. Note takers wrote summaries of each interview which were coded for topics and themes covered in the interview guide, including changes to clinic practices, take-home medications, telehealth, patient and staff reactions to new COVID-related protocols, and financial concerns for programs. RESULTS Most programs rapidly incorporated new regulatory requirements, and directors were generally positive about the impact of increased take-home doses of medication and increased reliance on telehealth. Some directors voiced concerns about these changes, and some reported that patients missed the daily clinical contact with staff. Directors also suggested that more time was needed to assess the full impact of these changes. Financial impacts varied, although many directors were quick to point out that the ongoing opioid epidemic has delivered a steady stream of new patients, thus offsetting potential financial losses. CONCLUSIONS Overall, this study demonstrated the generally positive view of OTP directors to the regulatory changes necessitated by the COVID-19 pandemic. More time is needed to fully evaluate the impact of these changes on clinical outcomes.
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Affiliation(s)
- Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA,Corresponding author
| | | | - Philip Appel
- Stop Stigma Now, 2 Washington Square, Suite #2 A, Larchmont, NY 10538, USA.
| | - Philip Paris
- Stop Stigma Now, 2 Washington Square, Suite #2 A, Larchmont, NY 10538, USA.
| | - Nasreen Nazia
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA.
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Clark AE, Goodwin SR, Marks RM, Belcher AM, Heinlein E, Bennett ME, Roche DJO. A Narrative Literature Review of the Epidemiology, Etiology, and Treatment of Co-Occurring Panic Disorder and Opioid Use Disorder. J Dual Diagn 2021; 17:313-332. [PMID: 34582313 PMCID: PMC9487392 DOI: 10.1080/15504263.2021.1965407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Panic disorder is a debilitating psychiatric disorder that often co-occurs with substance use disorders. Given the current opioid epidemic, the high reported rates of comorbid panic disorder and opioid use disorder are particularly concerning. In this narrative review, we describe the literature on panic disorder and opioid use disorder co-occurrence. METHODS 86 studies, 26 reviews, 2 commentaries, and 5 guidelines pertaining to opioid use disorder, panic disorder, and their comorbidity were identified using all EBSCO databases, PubMed, and Google Scholar. RESULTS First, we review epidemiological literature on the prevalence of the comorbid condition above and beyond each disorder on its own. Additionally, we discuss the challenges that complicate the differential diagnosis of panic disorder and opioid use disorder and contribute to difficulties establishing rates of comorbidity. Second, we review three theoretical models that have been proposed to explain high rates of co-occurring panic disorder and opioid use disorder: the precipitation hypothesis, the self-medication hypothesis, and the shared vulnerability hypothesis. Third, we outline how co-occurring panic and opioid use disorder may impact treatment for each condition. CONCLUSION Based on findings in the field, we provide recommendations for future research as well as treatment considerations for co-occurring panic and opioid use disorders.
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Affiliation(s)
- Ashton E Clark
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Shelby R Goodwin
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | | | | | - Emily Heinlein
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA.,Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, Maryland, USA
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Meteliuk A, Galvez S, Fomenko T, Kalandiia H, Iaryi V, Farnum SO, Islam Z, Altice FL, Madden LM. Successful transfer of stable patients on opioid agonist therapies from specialty addiction treatment to primary care settings in Ukraine: A pilot study. J Subst Abuse Treat 2021; 134:108619. [PMID: 34579978 DOI: 10.1016/j.jsat.2021.108619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In Ukraine, HIV is concentrated among people who inject drugs (PWID), and opioid agonist therapies (OAT) are the most effective approach to preventing HIV transmission. OAT coverage is well below internationally recommended levels, with OAT provided primarily in specialty addiction treatment clinics. Integrating OAT into primary care settings represents a promising practice for increasing OAT coverage. METHODS The study collected data prospectively from the first 50 stable patients transferred from the largest OAT site to 10 primary care clinics in Kiev; patients had negative urine drug tests for the previous six months. Participants completed the BASIS-24-the 24-item Behaviour and Symptom Identification Scale-to assess symptoms of psychiatric and social function across 6 domains: (1) depression and functioning, (2) relationships, (3) self-harm, (4) emotional lability, (5) psychosis, and (6) substance use before transfer and 6 months after transfer from May through November 2019. RESULTS Participants were on average 36 years old, mostly male (84.0%) and had some employment (64.0%). After six months, some employment increased to 88.0% and BASIS-24 scores significantly improved on four domains: depression (1.09 vs 0.73, p = 0.0005), relationships (2.15 vs 1.7, p < 0.0001), emotional liability (1.30 vs 1.00, p = 0.0209) and substance use (1.23 vs 1.07, p = 0073). CONCLUSIONS Stable OAT patients can be successfully transferred from specialty to primary care clinics without deterioration in mental health symptoms or functioning. Patients transferred to primary care showed significant improvement in their emotional well-being, their substance use, and their employment status.
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Affiliation(s)
- Anna Meteliuk
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Samy Galvez
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | | | - Hela Kalandiia
- Kyiv City Drug Addiction Clinical Hospital 'Sociotherapy', Kyiv, Ukraine
| | - Volodymyr Iaryi
- Kyiv City Drug Addiction Clinical Hospital 'Sociotherapy', Kyiv, Ukraine
| | | | - Zahedul Islam
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, United States.
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States
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Wei LC, Chan HY. Relationship between choice of opioid agonist therapy and distance from patients' residences in Taiwan, 2012-2014. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:590-598. [PMID: 34402338 DOI: 10.1080/00952990.2021.1955896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Choice of opioid agonist therapy (OAT) for opioid use disorder (OUD) can be impacted by variables such as age, sex, and socioeconomic status. However, it remains unknown whether accessibility of treatment affects patient choice of OAT. OBJECTIVES To investigate the association between distance to the treatment site and choice of OAT. METHODS Electronic records were collected for the last outpatient visits of individuals with OUD between January 1, 2012 and December 31, 2014. The address of each patient was processed using the Geographic Information System to obtain the distance between place of residence and the hospital. Multivariate logistic regression was used to assess the correlation between individual drug selection and distance of residence. Among the study population of 2804 patients (81.5% male), 74.1% were receiving methadone while 25.8% were receiving buprenorphine. The vast majority (95%) of all patients lived within 50 km of the hospital, so regression analysis was limited to this distance. Sensitivity analysis was estimated using robust Poisson regression. RESULTS Logistic regression revealed that every 1-km increase in distance from home to hospital increased the odds ratio of choosing sublingual buprenorphine tablets over methadone by 1.05 (p = .02, 95% confidence interval (CI) = 1.02-1.08). CONCLUSIONS Patients living closer to the treatment center were more likely to choose methadone as treatment, while patients living farther away were more likely to choose sublingual buprenorphine tablets. To mitigate the influence of travel distance on therapy choice, we recommend that more medical institutions participate in OAT services.
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Affiliation(s)
- Lien-Chung Wei
- Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Counseling and Industrial/Organizational Psychology, Ming-Chuan University, Taoyuan, Taiwan.,Division of Epidemiology, School of Public Health, UC Berkeley, Berkeley, CA, USA
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Nhim K, Khan T, Gruss S, Wozniak G, Kirley K, Schumacher P, Albright A. Facilitators to referrals to CDC's National Diabetes Prevention Program in primary care practices and pharmacies: DocStyles 2016-2017. Prev Med 2021; 149:106614. [PMID: 33989676 PMCID: PMC8562779 DOI: 10.1016/j.ypmed.2021.106614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 05/09/2021] [Indexed: 01/22/2023]
Abstract
Despite evidence of the effectiveness of behavioral change interventions for type 2 diabetes prevention, health care provider referrals to organizations offering the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) remain suboptimal. This study examined facilitators of LCP referrals among primary care providers and pharmacists (providers). We analyzed data on 1956 providers from 2016 to 2017 DocStyles web-based surveys. Pearson chi-square or Fisher's exact tests were used for bivariate associations between facilitators, provider characteristics, and their self-reported referral and bi-directional referral (where they received patient status updates back from the LCPs) to an LCP. Multiple logistic regressions were used to estimate the effects of facilitators to referral practices, controlling for providers' characteristics. Geocoding was done at the street level for in-person, public LCP class locations and at the zip code level for survey respondents to create a density measure for LCP availability within 10 miles. Overall, 21% of providers referred their patients with prediabetes to LCPs, and 6.4% engaged in bi-directional referral. Provider practices that established clinical-community linkages (CCLs) with LCPs (AOR = 4.88), used electronic health records (EHRs) to manage patients (AOR = 2.94), or practiced within 10 miles of an in-person, public LCP class location (AOR = 1.49) were more likely to refer. Establishing CCLs with LCPs (AOR = 8.59) and using EHRs (AOR = 1.86) were also facilitators of bi-directional referral. This study highlights the importance of establishing CCLs between provider settings and organizations offering the National DPP LCP, increasing use of EHRs to manage patients, and increasing availability of in-person LCP class locations near provider practices.
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Affiliation(s)
- Kunthea Nhim
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Tamkeen Khan
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Stephanie Gruss
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Gregory Wozniak
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Kate Kirley
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Patricia Schumacher
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Ann Albright
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
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Krawczyk N, Williams AR, Saloner B, Cerdá M. Who stays in medication treatment for opioid use disorder? A national study of outpatient specialty treatment settings. J Subst Abuse Treat 2021; 126:108329. [PMID: 34116820 PMCID: PMC8197774 DOI: 10.1016/j.jsat.2021.108329] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Maintenance treatments with medications for opioid use disorder (MOUD) are highly effective at reducing overdose risk while patients remain in care. However, few patients initiate medication and retention remains a critical challenge across settings. Much remains to be learned about individual and structural factors that influence successful retention, especially among populations dispensed MOUD in outpatient settings. METHODS We examined individual and structural characteristics associated with MOUD treatment retention among a national sample of adults seeking MOUD treatment in outpatient substance use treatment settings using the 2017 Treatment Episode Dataset-Discharges (TEDS-D). The study assessed predictors of retention in MOUD using multivariate logistic regression and accelerated time failure models. RESULTS Of 130,300 episodes of MOUD treatment in outpatient settings, 36% involved a duration of care greater than six months. The strongest risk factors for treatment discontinuation by six months included being of younger age, ages 18-29 ((OR):0.52 [95%CI:0.50-0.54]) or 30-39 (OR:0.57 [95%CI:0.55-0.59); experiencing homelessness (OR: 0.70 [95%CI:0.66-0.73]); co-using methamphetamine (OR:0.48 [95%CI:0.45-0.51]); and being referred to treatment by a criminal justice source (OR:0.55 [95%CI:0.52-0.59) or by a school, employer, or community source (OR:0.71 [95%CI:0.66-0.76). CONCLUSIONS Improving retention in treatment is a pivotal stage in the OUD cascade of care and is critical to reducing overdose deaths. Efforts should prioritize interventions to improve retention among patients who are both prescribed and dispended MOUD, especially youth, people experiencing homelessness, polysubstance users, and people referred to care by the justice system who have especially short stays in care.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, United States of America.
| | - Arthur Robin Williams
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, United States of America
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Magdalena Cerdá
- Department of Population Health, NYU Grossman School of Medicine, United States of America
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Amiri S, Hirchak K, McDonell MG, Denney JT, Buchwald D, Amram O. Access to medication-assisted treatment in the United States: Comparison of travel time to opioid treatment programs and office-based buprenorphine treatment. Drug Alcohol Depend 2021; 224:108727. [PMID: 33962300 DOI: 10.1016/j.drugalcdep.2021.108727] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Disparities in access to medication-assisted treatment are a major problem. This study estimated and compared drive time to the nearest opioid treatment program (OTP) and office-based buprenorphine treatment (OBBT) across the urban-rural continuum in the U.S. METHODS Drive time was calculated between the longitude and latitude of population weighted block group centroids and the longitude and latitude of the nearest OTP and OBBT. Rural-Urban Commuting Area (RUCA) codes were used for defining rurality. The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS The mean travel time to the nearest OBBT compared to OTP decreased by 7.18 min (95 % CI = 7.23-7.14) in metropolitan cores, 36.63 min (95 % CI = 37.12-36.15) in micropolitan cores, 38.84 min (95 % CI = 39.57-38.10) in small town cores, and 40.16 min (95 % CI = 40.81-39.50) in rural areas. Additionally, travel burden to the nearest OTP would be more than 60 min for 13,526,605 people and more than 90 min for 5,371,852 people. The travel burden to the nearest OBBT would be more than 60 min for 845,991 people and more than 90 min for 149,297 people. CONCLUSIONS The mean drive time to the closest OBBT was significantly smaller than the mean drive time to the closest OTP. Analysis of barriers to access is necessary to devising creative initiatives to improve access to critical opioid use disorder treatment services.
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Affiliation(s)
- Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Katherine Hirchak
- Behavioral Health Innovations, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G McDonell
- Behavioral Health Innovations, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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Siddiqi K, Freeman PR, Fanucchi LC, Slavova S. Rural-urban differences in hospitalizations for opioid use-associated infective endocarditis in Kentucky, 2016-2019. J Rural Health 2021; 38:604-611. [PMID: 34143913 DOI: 10.1111/jrh.12605] [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: 11/28/2022]
Abstract
PURPOSE In 2016, the US rate of opioid use-associated infective endocarditis (OUA IE) hospitalizations was 3.86/100,000 for rural and 3.49/100,000 for urban residents. This study estimates the Kentucky OUA IE hospitalization rates, 2016-2019, describing differences in rural-urban residency trends, demographics, relevant comorbidities, and discharge disposition. OUA IE hospitalization rates between counties with and without syringe services programs (SSPs) are also compared. METHODS We used Kentucky statewide inpatient discharge records from 2016 to 2019. An OUA IE hospitalization was identified by an infective endocarditis discharge diagnosis in any diagnosis field and a concurrent diagnosis indicating opioid use. Rurality was determined based on the 2013 Rural-Urban Continuum Codes (RUCC). FINDINGS Kentucky's rate of OUA IE hospitalizations in 2016 was 8.9/100,000, with no significant variation between rural and urban residents. By 2019, the average rate for urban residents doubled to 17.9/100,000, significantly higher than the rural resident rate, 13.2/100,000. There were no significant rural-urban differences in percentages of those with concurrent diagnoses of HIV (<1%) or HCV (>60%). Counties that established SSPs in 2017-2018 had a 39.4% increase in OUA IE rates from 2016 to 2019, while counties without SSPs had a 79.5% increase. CONCLUSION The estimated 2016 Kentucky rates of OUA IE hospitalizations are 2 times higher than reported national rates, highlighting Kentucky as one of the areas most affected by this particular opioid use disorder complication. Despite challenges and barriers to the effectiveness of SSPs as a harm reduction measure, our study suggests a positive effect that should be further investigated.
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Affiliation(s)
- Kamran Siddiqi
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Laura C Fanucchi
- Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky.,Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky
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Hyder A, Lee J, Dundon A, Southerland LT, All D, Hammond G, Miller HJ. Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county. PLoS One 2021; 16:e0250324. [PMID: 33979342 PMCID: PMC8115812 DOI: 10.1371/journal.pone.0250324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. Methods We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. Results A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Conclusions Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.
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Affiliation(s)
- Ayaz Hyder
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Jinhyung Lee
- Department of Geography and Environment, Faculty of Social Science, Western University, Social Science Centre, London, ON, Canada
| | - Ashley Dundon
- Division of Environmental Health, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Lauren T. Southerland
- Department of Emergency Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - David All
- Founder and CEO, Mount Ethos, Seattle, WA, United States of America
| | - Gretchen Hammond
- College of Social Work, The Ohio State University, Columbus, OH, United States of America
| | - Harvey J. Miller
- Center for Urban Regional Analysis, The Ohio State University, Columbus, OH, United States of America
- Department of Geography, The Ohio State University, Columbus, OH, United States of America
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Solomon KT, Bandara S, Reynolds IS, Krawczyk N, Saloner B, Stuart E, Connolly E. Association between availability of medications for opioid use disorder in specialty treatment and use of medications among patients: A state-level trends analysis. J Subst Abuse Treat 2021; 132:108424. [PMID: 34144299 DOI: 10.1016/j.jsat.2021.108424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Access to medication for opioid use disorder (MOUD) is a recognized public health challenge to improving the health of people with opioid use disorder (OUD) in many communities. Prior studies have shown that although MOUD availability has increased over time, particularly in some states, many substance use treatment facilities still do not offer medications. The relationship between greater availability of MOUD and use of MOUD among patients in treatment programs is not well understood. METHODS We used the National Survey of Substance Abuse Treatment Services to calculate the percent of specialty facilities per state providing MOUD from 2007 to 2018 and the Treatment Episode Data Set-Admissions (TEDS-A) to estimate the likelihood that a patient would have MOUD as part of their treatment plan during the same time period. We estimated models with patient-level TEDS-A data as the outcome and state-aggregated one-year lagged availability of MOUD in facilities as the main predictor, stratifying by treatment facility type (intensive outpatient, non-intensive outpatient, and residential). RESULTS We found that increasing MOUD availability at the facility level was associated with increased MOUD use in non-intensive and residential facilities at the patient level. Specifically, a 10 percentage point increase in MOUD availability was associated with a 4.5 percentage point increase in MOUD use among patients of non-intensive outpatient facilities (p-value = 0.03), and a 2.5 percentage points increase in residential facilities (p-value = 0.02). Non-Whites and patients in the Northeast had greater likelihoods of increased MOUD use in response to increased availability by facilities. CONCLUSION Increasing MOUD availability among specialty treatment facilities is likely to promote better access to MOUD for patients seeking treatment for OUD.
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Affiliation(s)
- Keisha T Solomon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sachini Bandara
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Noa Krawczyk
- New York University Grossman School of Medicine, NY, New York, USA
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Stuart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bozorgi P, Eberth JM, Eidson JP, Porter DE. Facility Attractiveness and Social Vulnerability Impacts on Spatial Accessibility to Opioid Treatment Programs in South Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4246. [PMID: 33923748 PMCID: PMC8073603 DOI: 10.3390/ijerph18084246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/20/2022]
Abstract
Opioid dependence and opioid-related mortality have been increasing in recent years in the United States. Available and accessible treatments may result in a reduction of opioid-related mortality. This work describes the geographic variation of spatial accessibility to opioid treatment programs (OTPs) and identifies areas with poor access to care in South Carolina. The study develops a new index of access that builds on the two-step floating catchment area (2SFCA) method, and has three dimensions: a facility attractiveness index, defined by services rendered incorporated into the Huff Model; a facility catchment area, defined as a function of facility attractiveness to account for variable catchment size; and a Social Vulnerability Index (SVI) to account for nonspatial factors that mitigate or compound the impacts of spatial access to care. Results of the study indicate a significant variation in access to OTPs statewide. Spatial access to OTPs is low across the entire state except for in a limited number of metropolitan areas. The majority of the population with low access (85%) live in areas with a moderate-to-high levels of social vulnerability. This research provides more realistic estimates of access to care and aims to assist policymakers in better targeting disadvantaged areas for OTP program expansion and resource allocation.
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Affiliation(s)
- Parisa Bozorgi
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- South Carolina Department of Health and Environmental Control (SCDHEC), Columbia, SC 29201, USA;
| | - Jan M. Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA;
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jeannie P. Eidson
- South Carolina Department of Health and Environmental Control (SCDHEC), Columbia, SC 29201, USA;
| | - Dwayne E. Porter
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
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Transporting to treatment: Evaluating the effectiveness of a mobile engagement unit. J Subst Abuse Treat 2021; 129:108377. [PMID: 34080548 DOI: 10.1016/j.jsat.2021.108377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Substance use treatment providers have increasingly developed novel engagement and low-threshold treatment services (such as mobile treatment units) to meet the needs of people with opioid use disorder (OUD). Use of these service models has outpaced the research on their effectiveness. The current study examines the effectiveness of a mobile engagement unit in connecting individuals with OUD to a treatment program. METHODS This retrospective cohort study included 468 Medicaid-enrolled individuals served through a managed care behavioral health system. Analyses used administrative data from 2018 to 2019 to compare the characteristics and service use of individuals transported to an intake appointment by a mobile engagement unit with individuals who arrived through typical referral routes such as walk-in, other providers, and court order. The authors employed a difference-in-differences analysis to adjust for prior service history. The outcomes of interest were any utilization of substance use treatment services. RESULTS The groups were virtually identical in age and gender, prior to matching, except for race where there was a lower proportion of Black individuals (17% versus 44%) and lower pre-service utilization of outpatient and methadone services by the mobile group. Following intake, mobile participants used significantly more outpatient substance use treatment services (23 percentage point relative increase) and methadone maintenance (32 percentage point relative increase) than the comparison group. CONCLUSIONS The results of this study suggest that mobile engagement units designed to identify and serve individuals with OUD in the community hold promise for reaching underserved high-risk populations and reduce barriers to treatment entry and recovery.
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