Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice

The Medications for Opioid Use Disorder Study: Methods and Initial Outcomes From an 18-Month Study of Patients in Treatment for Opioid Use Disorder

OBJECTIVE

Opioid use disorder (OUD) affects approximately 5.6 million people in the United States annually, yet rates of the use of effective medication for OUD (MOUD) treatment are low. We conducted an observational cohort study from August 2017 through May 2021, the MOUD Study, to better understand treatment engagement and factors that may influence treatment experiences and outcomes. In this article, we describe the study design, data collected, and treatment outcomes.

METHODS

We recruited adult patients receiving OUD treatment at US outpatient facilities for the MOUD Study. We collected patient-level data at 5 time points (baseline to 18 months) via self-administered questionnaires and health record data. We collected facility-level data via questionnaires administered to facility directors at 2 time points. Across 16 states, 62 OUD treatment facilities participated, and 1974 patients enrolled in the study. We summarized descriptive data on the characteristics of patients and OUD treatment facilities and selected treatment outcomes.

RESULTS

Approximately half of the 62 facilities were private, nonprofit organizations; 62% focused primarily on substance use treatment; and 20% also offered mental health services. Most participants were receiving methadone (61%) or buprenorphine (32%) and were predominately non-Hispanic White (68%), aged 25-44 years (62%), and female (54%). Compared with patient-reported estimates at baseline, 18-month estimates suggested that rates of abstinence increased (55% to 77%), and rates of opioid-related overdoses (7% to 2%), emergency department visits (9% to 4%), and arrests (15% to 7%) decreased.

CONCLUSIONS

Our results demonstrated the benefits of treatment retention not only on abstinence from opioid use but also on other quality-of-life metrics, with data collected during an extended period. The MOUD Study produced rich, multilevel data that can lay the foundation for an evidence base to inform OUD treatment and support improvement of care and patient outcomes.

Waiting times disparities for medication-assisted therapy among opioid use disorder treatment population in the United States

Opioid use disorder (OUD) treatment has been described as beneficial in reducing the burden of OUD and its related complications. Thus far, there is a paucity of literature on the time-to-treatment differences from the period of seeking treatment to when the patient starts treatment. Hence, it is deemed a form of barrier to the accessibility of OUD treatment programs. We aim to study the relationship between accessibility for medication-assisted treatment and the disparity concerning days waiting to enter OUD treatment. The treatment episode data set (TEDS) was utilized for this study. The full sample of 2018 TEDS-D (N = 382,547) is representative of OUD patients that utilized SUD treatment facilities within the 50 states of the United States. Univariate and multivariable logistic analysis of the independent variables, and other covariates with the dependent variables were explored to estimate the adjusted odds ratio relationship. Medication-assisted opioid therapy use among respondents was significantly different with waiting 1-7 days [AOR = 1.321 (95% CI = 1.248-1.400)] and >7 days [AOR = 0.729 (95% CI = 0.665-0.799)] to enter OUD treatment compared to waiting for less than a day. Among adults seeking OUD treatment admissions, our study showed that waiting times vary with MAT use as there was early entry compared to >1week wait time. Similarly, significant associations were reported across different sociodemographic attributes except for biological sex.

Endogenous opiates and behavior: 2020

This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

PURPOSE

Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.

METHODS

Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training.

RESULTS

Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ² = 15.73, P <.001).

CONCLUSIONS

The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Buprenorphine/Naloxone (Suboxone®) is an efficacious treatment for opioid use disorder (OUD) due to its more convenient dosing, superior safety profile, and decreased incidence of negative side effects when compared to other forms of medications for opioid use disorder (MOUD). In the United States, updated legislation in 2021 entitled, "The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder", released by the Department of Health and Human Services, creates an exemption for the previously required Drug Addiction Treatment Act of 2000 (DATA) waiver for buprenorphine prescribing for clinicians. This legislation was born out of a need for making MOUD more accessible for patients living with OUD as rates of opioid-related deaths in the United States have continued to rise and have increased disproportionately during the time period of the COVID-19 pandemic. This legislation has the potential to improve access to MOUD across all geographic locations, but may have the most profound impact in rural areas where significant disparities and challenges still exist in patients’ ability to access buprenorphine. The purpose of this literature review is to 1) examine how MOUD prescribing has changed after previous legislation changes, 2) explore the current state of buprenorphine access for treatment of OUD in rural America, 3) detail existing barriers in patients' ability to access MOUD, and 4) discuss future directions and considerations as a result of new legislation. This literature review found several existing barriers to receiving MOUD such as increasing costs, insufficient education, significant stigma, and the need for more innovative methods of delivery. We also found that there is currently a large opportunity for growth in the number of rural clinicians able to prescribe buprenorphine, particularly in primary care, that may now occur as a result of this new legislation. Overall, this legislation has the potential to have a positive impact on combating OUD, especially in rural areas, and may be a critical step towards ending the current opioid epidemic in the United States as these described barriers are addressed.