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Springgate B, Matta I, True G, Doran H, Torres WV, Stevens E, Holland E, Mott K, Ardoin TR, Nixdorff N, Haywood C, Meyers D, Johnson A, Tatum T, Palinkas LA. Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209469. [PMID: 39094901 DOI: 10.1016/j.josat.2024.209469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs. METHODS The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains. RESULTS MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers. CONCLUSIONS The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.
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Affiliation(s)
- Benjamin Springgate
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Isha Matta
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Gala True
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Hanna Doran
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | | | - Elyse Stevens
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Elizabeth Holland
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Karlee Mott
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Tiffany R Ardoin
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Neil Nixdorff
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA, USA.
| | - Arthur Johnson
- Lower Ninth Ward Center for Sustainable Engagement and Development, New Orleans, LA, USA.
| | - Thad Tatum
- Formerly Incarcerated Peers Support Group, New Orleans, LA, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
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Nyaku AN, Zerbo EA, Chen C, Milano N, Johnston B, Chadwick R, Marcello S, Baston K, Haroz R, Crystal S. A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program. BMC Health Serv Res 2024; 24:179. [PMID: 38331802 PMCID: PMC10851589 DOI: 10.1186/s12913-024-10648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing. METHODS Participants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing. RESULTS Of the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment. CONCLUSION More than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.
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Affiliation(s)
- Amesika N Nyaku
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB I689, Newark, NJ, 07103, USA.
| | - Erin A Zerbo
- Private Practice, Montclair, NJ, 07042, USA
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Clement Chen
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Nicole Milano
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Barbara Johnston
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Randall Chadwick
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Stephanie Marcello
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Kaitlan Baston
- Department of Internal Medicine, Cooper Medical School of Rowan University, Three Cooper Plaza, Camden, NJ, 08103, USA
| | - Rachel Haroz
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, 3rd Floor, New Brunswick, NJ, 08901, USA
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Kelley AT, Wilcox J, Baylis JD, Crossnohere NL, Magel J, Jones AL, Gordon AJ, Bridges JFP. Increasing Access to Buprenorphine for Opioid Use Disorder in Primary Care: an Assessment of Provider Incentives. J Gen Intern Med 2023; 38:2147-2155. [PMID: 36471194 PMCID: PMC10361924 DOI: 10.1007/s11606-022-07975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary care providers (PCPs) are essential to increasing access to office-based buprenorphine medication treatment for opioid use disorder (B-MOUD). Barriers to B-MOUD prescribing are well-documented, but there is little information regarding incentives to overcome these barriers. OBJECTIVE To identify optimal incentives for PCPs to promote B-MOUD prescribing and compare incentive preferences across provider and practice characteristics. DESIGN We surveyed PCPs using best-worst scaling (BWS) to prioritize seven potential incentives for B-MOUD prescribing (monetary compensation, paid vacation, protected time, professional development, reduced workload, service recognition, clinical resources). We then used a direct elicitation approach to determine preferred incentive levels (e.g., monetary thresholds) and types (e.g., specific clinical resources). PARTICIPANTS Primary care physicians and advanced practice providers (APPs) at a large Department of Veterans Affairs healthcare system. MAIN MEASURES B-MOUD prescribing incentive preferences and relative preference levels using descriptive statistics and conditional logistic regression with relative importance scale transformation (coefficients sum to 100, higher coefficient=greater importance). KEY RESULTS Fifty-three PCPs responded (73% response), including 47% APPs and 36% from community-based clinics. Reduced workload (relative importance score=26.8), protected time (18.7), and clinical resources (16.8) were significantly more preferred (Ps < 0.001) than professional development (10.5), paid vacation (10.3), or service recognition (1.5). Relative importance of monetary compensation varied between physicians (12.6) and APPs (17.5) and between PCPs located at a medical center (11.4) versus community clinic (22.3). APPs were more responsive than physicians to compensation increases of $5000 and $12,000 but less responsive to $25,000; trends were similar for medical center versus community clinic PCPs. The most frequently requested clinical resource was on-demand consult access to an addiction specialist. CONCLUSIONS Interventions promoting workload reductions, protected time, and clinical resources could increase access to B-MOUD in primary care. Monetary incentives may be additionally needed to improve B-MOUD prescribing among APPs and within community clinics.
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Affiliation(s)
- A Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 50 North Medical Drive, 5R341, Salt Lake City, UT, 84132, USA.
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jordynn Wilcox
- Office of the Director, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jacob D Baylis
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Norah L Crossnohere
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John Magel
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Adeniran E, Quinn M, Wallace R, Walden RR, Labisi T, Olaniyan A, Brooks B, Pack R. A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100152. [PMID: 37069961 PMCID: PMC10105485 DOI: 10.1016/j.dadr.2023.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
Background Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. Methods A systematic search was conducted with the following databases: "PubMed including MEDLINE", "CINAHL", "Web of Science", "ABI/Inform", and "PsycINFO." We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Results Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). Conclusions This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.
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Affiliation(s)
- Esther Adeniran
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
- Corresponding author at: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Richard Wallace
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Rachel R. Walden
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Titilola Labisi
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Afolakemi Olaniyan
- Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Billy Brooks
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Robert Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
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Smart R, Grant S, Gordon AJ, Pacula RL, Stein BD. Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder. JAMA HEALTH FORUM 2022; 3:e223285. [PMID: 36218944 PMCID: PMC10041351 DOI: 10.1001/jamahealthforum.2022.3285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Importance In the US, recent legislation and regulations have been considered, proposed, and implemented to improve the quality of treatment for opioid use disorder (OUD). However, insufficient empirical evidence exists to identify which policies are feasible to implement and successfully improve patient and population-level outcomes. Objective To examine expert consensus on the effectiveness and the ability to implement state-level OUD treatment policies. Evidence Review This qualitative study used the ExpertLens online platform to conduct a 3-round modified Delphi process to convene 66 stakeholders (health care clinicians, social service practitioners, addiction researchers, health policy decision-makers, policy advocates, and persons with lived experience). Stakeholders participated in 1 of 2 expert panels on 14 hypothetical state-level policies targeting treatment engagement and linkage, evidence-based and integrated care, treatment flexibility, and monitoring or support services. Participants rated policies in round 1, discussed results in round 2, and provided final ratings in round 3. Participants used 4 criteria associated with either the effectiveness or implementability to rate and discuss each policy. The effectiveness panel (n = 29) considered policy effects on treatment engagement, treatment retention, OUD remission, and opioid overdose mortality. The implementation panel (n = 34) considered the acceptability, feasibility, affordability, and equitability of each policy. We measured consensus using the interpercentile range adjusted for symmetry analysis technique from the RAND/UCLA appropriateness method. Findings Both panels reached consensus on all items. Experts viewed 2 policies (facilitated access to medications for OUD and automatic Medicaid enrollment for citizens returning from correctional settings) as highly implementable and highly effective in improving patient and population-level outcomes. Participants rated hub-and-spoke-type policies and provision of financial incentives to emergency departments for treatment linkage as effective; however, they also rated these policies as facing implementation barriers associated with feasibility and affordability. Coercive policies and policies levying additional requirements on individuals with OUD receiving treatment (eg, drug toxicology testing, counseling requirements) were viewed as low-value policies (ie, decreasing treatment engagement and retention, increasing overdose mortality, and increasing health inequities). Conclusions and Relevance The findings of this study may provide urgently needed consensus on policies for states to consider either adopting or deimplementing in their efforts to address the opioid overdose crisis.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, California.,Drug Policy Research Center, RAND Corporation, Santa Monica, California
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.,Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Bradley D Stein
- Behavioral and Policy Sciences Department, RAND Corporation, Pittsburgh, Pennsylvania
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Mauro PM, Gutkind S, Annunziato EM, Samples H. Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019. JAMA Netw Open 2022; 5:e223821. [PMID: 35319762 PMCID: PMC8943638 DOI: 10.1001/jamanetworkopen.2022.3821] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/03/2022] [Indexed: 01/23/2023] Open
Abstract
Importance Medication for opioid use disorder (MOUD) is the criterion standard treatment for opioid use disorder (OUD), but nationally representative studies of MOUD use in the US are lacking. Objective To estimate MOUD use rates and identify associations between MOUD and individual characteristics among people who may have needed treatment for OUD. Design, Setting, and Participants Cross-sectional, nationally representative study using the 2019 National Survey on Drug Use and Health in the US. Participants included community-based, noninstitutionalized adolescent and adult respondents identified as individuals who may benefit from MOUD, defined as (1) meeting criteria for a past-year OUD, (2) reporting past-year MOUD use, or (3) receiving past-year specialty treatment for opioid use in the last or current treatment episode. Main Outcomes and Measures The main outcomes were treatment with MOUD compared with non-MOUD services and no treatment. Associations with sociodemographic characteristics (eg, age, race and ethnicity, sex, income, and urbanicity); substance use disorders; and past-year health care or criminal legal system contacts were analyzed. Multinomial logistic regression was used to compare characteristics of people receiving MOUD with those receiving non-MOUD services or no treatment. Models accounted for predisposing, enabling, and need characteristics. Results In the weighted sample of 2 206 169 people who may have needed OUD treatment (55.5% male; 8.0% Hispanic; 9.9% non-Hispanic Black; 74.6% non-Hispanic White; and 7.5% categorized as non-Hispanic other, with other including 2.7% Asian, 0.9% Native American or Alaska Native, 0.2% Native Hawaiian or Pacific Islander, and 3.8% multiracial), 55.1% were aged 35 years or older, 53.7% were publicly insured, 52.2% lived in a large metropolitan area, 56.8% had past-year prescription OUD, and 80.0% had 1 or more co-occurring substance use disorders (percentages are weighted). Only 27.8% of people needing OUD treatment received MOUD in the past year. Notably, no adolescents (aged 12-17 years) and only 13.2% of adults 50 years and older reported past-year MOUD use. Among adults, the likelihood of past-year MOUD receipt vs no treatment was lower for people aged 50 years and older vs 18 to 25 years (adjusted relative risk ratio [aRRR], 0.14; 95% CI, 0.05-0.41) or with middle or higher income (eg, $50 000-$74 999 vs $0-$19 999; aRRR, 0.18; 95% CI, 0.07-0.44). Compared with receiving non-MOUD services, receipt of MOUD was more likely among adults with at least some college (vs high school or less; aRRR, 2.94; 95% CI, 1.33-6.51) and less likely in small metropolitan areas (vs large metropolitan areas, aRRR, 0.41; 95% CI, 0.19-0.93). While contacts with the health care system (85.0%) and criminal legal system (60.5%) were common, most people encountering these systems did not report receiving MOUD (29.5% and 39.1%, respectively). Conclusions and Relevance In this cross-sectional study, MOUD uptake was low among people who could have benefited from treatment, especially adolescents and older adults. The high prevalence of health care and criminal legal system contacts suggests that there are critical gaps in care delivery or linkage and that cross-system integrated interventions are warranted.
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Affiliation(s)
- Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Erin M. Annunziato
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Hillary Samples
- Center for Health Sciences Research, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Stein BD, Saloner B, Kerber R, Sorbero M, Gordon AJ. Subsequent Buprenorphine Treatment Following Emergency Physician Buprenorphine Prescription Fills: A National Assessment 2019 to 2020. Ann Emerg Med 2022; 79:441-450. [PMID: 35305851 PMCID: PMC9038689 DOI: 10.1016/j.annemergmed.2022.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
STUDY OBJECTIVE Buprenorphine treatment for opioid use disorder provided in the emergency department with subsequent buprenorphine treatment by community prescribers is associated with improved outcomes, but the frequency with which this occurs is unknown. We examined the rates of subsequent buprenorphine treatment for buprenorphine-naïve individuals filling buprenorphine prescriptions from emergency physicians and initiated buprenorphine treatment and how such rates varied before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Using pharmacy claims capturing an estimated 92% of prescriptions filled at US retail pharmacies, we identified buprenorphine prescriptions filled between February 1, 2019, and November 30, 2020, written by emergency physicians. In this observational study, we calculated the rate at which patients subsequently filled buprenorphine prescriptions from other nonemergency clinicians, the frequency with which subsequent filled prescriptions were from different types of prescribers, and the changes in the rates of subsequent prescriptions following the declaration of the COVID-19 public health emergency. RESULTS We identified 22,846 prescriptions written by emergency physicians and filled by buprenorphine-naïve patients. They were most commonly paid for by Medicaid and were in metropolitan counties; 28.5% of patients subsequently filled buprenorphine prescriptions written by other clinicians. Adult primary care physicians and advanced practice providers (eg, physician assistants and nurse practitioners) were responsible for most of the subsequent prescriptions. The rates of subsequent prescriptions were 3.5% lower after the COVID-19 public health emergency declaration. CONCLUSION The majority of patients filling buprenorphine prescriptions written by emergency physicians do not subsequently fill prescriptions written by other clinicians, and the rates of subsequent prescriptions were lower after the declaration of the COVID-19 public health emergency. These findings highlight the need for a system of care that improves buprenorphine treatment continuity of care for patients with opioid use disorder from emergency settings to community treatment providers.
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Crystal S, Nowels M, Samples H, Olfson M, Williams AR, Treitler P. Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients. Drug Alcohol Depend 2022; 232:109269. [PMID: 35038609 PMCID: PMC8943804 DOI: 10.1016/j.drugalcdep.2022.109269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions. METHODS We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12-64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose. RESULTS Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year. Index overdoses involving heroin/synthetic opioids were associated with higher repeat overdose risk than those involving prescription/other opioids only (HR = 1.44, 95% CI = 1.22-1.71). Risk was higher for males and those with baseline opioid use disorder diagnosis or ED visits. Only 21.7% received MOUD at any point in the year following overdose. MOUD was associated with a large decrease in repeat overdose risk among those with index overdose involving heroin/synthetic opioids (HR = 0.30, 95% CI = 0.20-0.46). Among those receiving MOUD at any point in follow-up, 10.5% (112/1065) experienced repeat overdose versus 22.1% (848/3833) for those without MOUD. CONCLUSIONS Repeat overdose was common among individuals with medically-treated opioid overdose. Risk factors for repeat overdose varied by type of opioid involved in index overdose, with differential implications for intervention. MOUD following index opioid overdose involving heroin/synthetic opioids was associated with reduced repeat overdose risk.
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Affiliation(s)
- Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Molly Nowels
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Hillary Samples
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Mark Olfson
- Vagelos College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722W 168th St., New York, NY 10032, USA.
| | - Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, USA.
| | - Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA.
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