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Lee S, Sun L, Vakkalanka JP. Evaluation of medications used for opioid use disorder in emergency departments: A cross-sectional analysis of the 2020 National Hospital Ambulatory Medical Care Survey. Am J Emerg Med 2024; 82:52-56. [PMID: 38795424 DOI: 10.1016/j.ajem.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/17/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024] Open
Abstract
INTRODUCTION Opioid use disorder (OUD) is a significant health issue impacting millions in the United States (US). Medications used for OUD (MOUD) (e.g., buprenorphine, methadone, naltrexone) and medications for overdose and symptom management (e.g., naloxone, clonidine) have been shown to be safe and effective tools in clinical management. MOUD therapy in Emergency Departments (EDs) improves patient outcomes and enhances engagement with formal addiction treatment; however, provider factors and institutional barriers have created hurdles to ED-based MOUD treatment and heterogeneity in ED based OUD care. We used a nationally representative dataset, the National Hospital Ambulatory Medical Care Survey (NHAMCS) to characterize MOUD prescribing practices across patient demographics, geographic regions, payers, providers, and comorbidities in EDs. METHODS NHAMCS is a survey conducted by the US Census Bureau assessing utilization of ambulatory healthcare services nationally. Survey staff compile encounter records from a nationally representative sample of EDs. We conducted a cross-sectional study using this data to assess visits in 2020 among patients aged 18-64 presenting with an opioid overdose or OUD. We estimated the proportion of patients who had any MOUD, clonidine, or naloxone treatment and 95% confidence intervals (CI). We modeled the association between patient demographic, location, comorbidities, and provider characteristics with receipt of MOUD treatment as unadjusted odds ratios (OR) and 95% CI. RESULTS There was a weighted frequency of 469,434 patients who were discharged from EDs after being seen for OUD or overdose. Naloxone, clonidine, and buprenorphine were the most frequent treatments administered and/or prescribed for OUDs or overdose. Overall, 54,123 (11.5%, 95%CI 0-128,977) patients who were discharged from the ED for OUDs or overdose received at least one type of MOUD. Hispanic race, (OR 17.9, 95%CI 1.33-241.90) and Western region (OR43.77, 95%CI 2.97-645.27) were associated with increased odds of receiving MOUDs, while arrival by ambulance was associated with decreased odds of receiving MOUDs (OR0.01, 95%CI 0.001-0.19). Being seen by an APP or physician assistant was associated with MOUD treatment (OR 16.68, 95%CI: 1.41-152.33; OR: 13.84, 95%CI: 3.58-53.51, respectively). CONCLUSION Our study findings suggest that MOUD and other medications for opioid overdose are infrequently used in the ED setting. This finding was especially notable in race, geographic region, mode of arrival, and those seen by APP, underscoring the need for further study into the root causes of these disparities. Our study provides a foundational understanding of MOUD patterns, guiding future research as the landscape of OUD treatment continues to shift.
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Affiliation(s)
- Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Leon Sun
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Forsgren E, Steiger A, Perez Y, Salazar D, McCollough M, Taira BR. Patient perspectives on emergency department initiation of medication for alcohol use disorder. Acad Emerg Med 2024; 31:471-480. [PMID: 37326129 DOI: 10.1111/acem.14758] [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: 03/17/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a leading cause of preventable death and is a frequent diagnosis in the emergency department (ED). Treatment in the ED, however, typically focuses on managing the sequelae of AUD, such as acute withdrawal, rather than addressing the underlying addiction. For many patients, these ED encounters are a missed opportunity to connect with medication for AUD. In 2020, our ED created a pathway to offer patients with AUD treatment with naltrexone (NTX) during their ED visit. The aim of this study was to identify what barriers and facilitators patients perceive to NTX initiation in the ED. METHODS Adopting the theoretical framework of the behavior change wheel (BCW), we conducted qualitative interviews with patients to elicit their perspectives on ED initiation of NTX. Interviews were coded and analyzed using both inductive and deductive approaches. Themes were categorized according to patients' capabilities, opportunities, and motivations. Barriers were then mapped through the BCW to design interventions that will improve our treatment pathway. RESULTS Twenty-eight patients with AUD were interviewed. Facilitators of accepting NTX included having recently experienced sequelae of AUD, rapid management of withdrawal symptoms by the ED provider, having a choice between intramuscular and oral formulations of the medication, and experiencing positive interactions in the ED that destigmatized the patient's AUD. Barriers to accepting treatment included lack of provider knowledge about NTX, dependence on alcohol as self-treatment for psychiatric trauma and physical pain, perceived discriminatory treatment and stigma about AUD, aversion to potential side effects, and lack of access to continued treatment. CONCLUSIONS Initiation of treatment of AUD with NTX in the ED is acceptable to patients and can be facilitated by knowledgeable ED providers who create a destigmatizing environment, effectively manage withdrawal symptoms, and connect patients to providers who will continue treatment.
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Affiliation(s)
- Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Athreya Steiger
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yesenia Perez
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - David Salazar
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Maureen McCollough
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Breena R Taira
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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McHugh CM, Iorfino F, Zmicerevska N, Song YJC, Skinner A, Scott EM, Hickie IB. Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study. BJPsych Open 2023; 9:e76. [PMID: 37092680 PMCID: PMC10134286 DOI: 10.1192/bjo.2023.43] [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: 04/25/2023] Open
Abstract
BACKGROUND Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. AIMS To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. METHOD State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. RESULTS There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6-2.6) but higher for males (5.3, 95% CI 3.8-7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13-9.09) and psychiatric admission (HR 4.01, 95% CI 1.81-8.88) were the strongest predictors of mortality. CONCLUSION Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
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Affiliation(s)
- Catherine M McHugh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Murphy CE, Coralic Z, Wang RC, Montoy JCC, Ramirez B, Raven MC. Extended-Release Naltrexone and Case Management for Treatment of Alcohol Use Disorder in the Emergency Department. Ann Emerg Med 2023; 81:440-449. [PMID: 36328851 DOI: 10.1016/j.annemergmed.2022.08.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility of initiating treatment for alcohol use disorder with extended-release naltrexone and case management services in the emergency department (ED) and measure the intervention's impact on daily alcohol consumption and quality of life. METHODS This is a 12-week prospective open-label single-arm study of a multimodal treatment for alcohol use disorder consisting of monthly extended-release naltrexone injections and case management services initiated at an urban academic ED. Participants were actively drinking adult patients in ED with known or suspected alcohol use disorder and an AUDIT-C score more than 4. The main feasibility outcomes included the rates of participant enrollment, retention in the study, and continuing treatment after study completion. Efficacy outcomes were the change in daily alcohol consumption (drinks per day; 14 g ethanol per drink), measured by a 14-day timeline followback, and the change in quality of life measured with a single-item Kemp quality of life scale. RESULTS One hundred seventy-nine patients were approached, and 32 were enrolled (18%). Of the 32 enrolled patients, 25 (78%) completed all visits, and 22 (69%) continued naltrexone after the trial. The mean baseline daily alcohol consumption was 7.6 drinks per day (interquartile range, 4.5, 13.4), and the mean quality of life was 3.6 (SD 1.7) on a 7-point scale. The median daily alcohol consumption change was -7.5 drinks per day (Hodges-Lehmann 95% confidence interval -8.6, -5.9). The mean quality of life change was 1.2 points (95% confidence interval 0.5, 1.9; P<.01). CONCLUSION We found that initiation of treatment of alcohol use disorder with extended-release naltrexone and case management is feasible in an ED setting and observed significant reductions in drinking with improved quality of life in the short term. Multicenter randomized controlled trials are needed to further validate these findings.
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Affiliation(s)
- Charles E Murphy
- Department of Emergency Medicine, University of California, San Francisco, CA.
| | - Zlatan Coralic
- Department of Emergency Medicine, University of California, San Francisco, CA; Department of Pharmacy, University of California, San Francisco, CA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, CA
| | | | - Bianca Ramirez
- Department of Emergency Medicine, University of California, San Francisco, CA
| | - Maria C Raven
- Department of Emergency Medicine, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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Factors Associated With the Presence of Co-occurring Pain and Substance Use Disorder Programs in Substance Use Treatment Facilities. J Addict Med 2023; 17:e72-e77. [PMID: 35972137 DOI: 10.1097/adm.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The rise in deaths related to substance use has caused a push toward linking patients to pharmacological maintenance treatment and, when appropriate, to residential substance use treatment facilities. One of the underlying issues in a subset of patients with substance use disorder (SUD) is chronic pain. We evaluated the prevalence and characteristics of those facilities that offer treatment programs tailored for patients with co-occurring pain and SUD. METHODS This study was a retrospective review of data collected by the National Survey of Substance Abuse Treatment Services in 2019. The National Survey of Substance Abuse Treatment Services is sent annually to all substance use treatment facilities and collects information on their characteristics and services. We calculated prevalence of chronic pain programs, reported characteristics, and did a binomial logistic regression to determine predictors of a facility offering such a program. RESULTS Of 15,945 respondents, 2990 (18.8%) of facilities offered a tailored program for patients with co-occurring pain and SUDs. Characteristics that were best predictors included the following: facility has a tailored program for veterans ( P < 0.001), serves only clients with opioid use disorder ( P = 0.03), and provides maintenance services with methadone or buprenorphine for treating opioid use disorder ( P = 0.009). CONCLUSION As of 2019, only a small percentage of substance use treatment facilities reported having a program that treats patients with co-occurring pain and SUD. Given the known high prevalence of co-occurring pain and SUD, further understanding of the role of these programs and barriers to implementation may enhance acceptance in treatment programs.
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Reichert J, Adams S, Taylor J, del Pozo B. Guiding officers to deflect citizens to treatment: an examination of police department policies in Illinois. HEALTH & JUSTICE 2023; 11:7. [PMID: 36750519 PMCID: PMC9906953 DOI: 10.1186/s40352-023-00207-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The U.S. overdose crisis has motivated police departments to enact policies allowing officers to directly deflect individuals to substance use disorder treatment and other services shown to reduce recidivism and subsequent overdose risk, as well as refer people who voluntarily present at police facilities with a desire for treatment. As a new way of operating, and one that relies on an officer's use of discretion for successful implementation, the practice benefits from guidance through written directives, training, and supervisory support. However, there is little information on the establishment, content, and execution of police department deflection policies, which hampers the implementation and dissemination of this promising practice. We analyzed 16 policies of Illinois police department deflection programs. Using content analysis methodology, we coded the policies for language and terminology, as well as program components and procedures. We aimed to examine how the policies were written, as well as the content intending to guide officers in their work. RESULTS We found the policies and programs had notable differences in length, detail, terminology, and reading level. Only one policy mentioned the use of any type of addiction treatment medication, many used stigmatizing language (e.g., "abuse" and "addict"), and few mentioned "harm reduction" or training in the practice of deflection. Many policies restricted participation in deflection (i.e., no minors, outstanding warrants, current withdrawal symptoms), and critically, a majority of policies allowed police officers to exclude people from participation based on their own judgment. CONCLUSIONS We recommend police departments consider the readability of their policies and reduce barriers to deflection program participation to engage a larger pool of citizens in need of substance use disorder treatment. Since there is limited research on police policies generally, and the field of deflection is relatively new, this study offers insight into the content of different department policies and more specifically, how officers are directed to operate deflection programs.
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Affiliation(s)
- Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, 60 E. Van Buren St., Suite 650, Chicago, IL 60605 USA
| | - Sharyn Adams
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, 60 E. Van Buren St., Suite 650, Chicago, IL 60605 USA
| | - Jirka Taylor
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202 USA
| | - Brandon del Pozo
- The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903 USA
- Rhode Island Hospital, 593 Eddy Street, 02903 Providence, USA
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Bernstein SL, Dziura J, Weiss J, Brooks AH, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy. Ann Emerg Med 2023; 81:209-221. [PMID: 36585318 PMCID: PMC9868063 DOI: 10.1016/j.annemergmed.2022.08.018] [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: 06/21/2021] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Center for Implementation Science, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Avis H Brooks
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, New Haven, CT; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, PA
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Eldridge LA, Meyerson BE, Agley J. Pilot implementation of the PharmNet naloxone program in an independent pharmacy. J Am Pharm Assoc (2003) 2023; 63:374-382.e12. [PMID: 36209035 DOI: 10.1016/j.japh.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The U.S. overdose epidemic has continued to escalate with more than 100,000 deaths per year in the past several years, most of which involve opioids. Widespread availability of naloxone is part of a national solution to the crisis, and community pharmacies are well-poised to facilitate such distribution and provide additional harm reduction services. OBJECTIVES The primary objectives of this study were to (a) examine the usability of each of the separate intervention components prepared for PharmNet, (b) observe intervention fidelity through regularly scheduled site visits, and (c) explore the association between PharmNet implementation and the volume of naloxone sales and distribution in the pilot site. PRACTICE DESCRIPTION Here, we describe a carefully designed and tailored pharmacy harm reduction intervention called PharmNet that is designed to maximize harm reduction impact while minimizing utilization of pharmacist resources. It is a pragmatic awareness, service provision, and referral program that was developed through careful, iterative feasibility studies with pharmacists. PRACTICE INNOVATION PharmNet procedures include tools and steps to create awareness (e.g., yard signs and messaging for patients, reminder tools for pharmacists), facilitation of naloxone delivery from nonprofits, and provision of referral cards featuring local resources. EVALUATION METHODS Evaluation included direct data collection and randomly scheduled fidelity site visits. RESULTS The intervention was associated with an increase of 3.33 naloxone doses/mo being dispensed at cost (34.4% relative increase) and an overall increase of 9.33 naloxone doses/mo being dispensed via any mechanism (96.48% relative increase). Around 2.85 referral cards were issued to patients daily. Intervention fidelity was moderate, and the study provides valuable information for how to modify the study prior to a randomized trial. CONCLUSION With modifications informed by this pilot study, the PharmNet intervention merits a randomized trial to determine whether it causes increased naloxone dispensing in independent community pharmacies.
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Iheanacho T, Maciejewski KR, Ogudebe F, Chumo F, Slade T, Leff R, Ngaruiya C. Prevalence and correlates of depression and substance use disorders in emergency department populations: A cross-sectional study at East Africa's largest public hospital. Afr J Emerg Med 2022; 12:307-314. [PMID: 35892005 PMCID: PMC9307521 DOI: 10.1016/j.afjem.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa. Methods This study utilized the World Health Organization's STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics. Results Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the "moderate" to "severe" range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use ("severe range" = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a "severe" PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers. Conclusions Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Corresponding author.
| | - Kaitlin R. Maciejewski
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | | | - Faith Chumo
- Department of History of Science, Medicine and Public Health, Yale College, New Haven, CT, USA
| | - Tracie Slade
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Cancer-related emergency and urgent care: expanding the research agenda. EMERGENCY CANCER CARE 2022; 1:4. [PMID: 35844668 PMCID: PMC9194780 DOI: 10.1186/s44201-022-00005-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
Purpose of review Cancer-related emergency department (ED) visits often result in higher hospital admission rates than non-cancer visits. It has been estimated many of these costly hospital admissions can be prevented, yet urgent care clinics and EDs lack cancer-specific care resources to support the needs of this complex population. Implementing effective approaches across different care settings and populations to minimize ED and urgent care visits improves oncologic complication management, and coordinating follow-up care will be particularly important as the population of cancer patients and survivors continues to increase. The National Cancer Institute (NCI) and the Office of Emergency Care (OECR) convened a workshop in December 2021, “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” to highlight progress, knowledge gaps, and research opportunities. This report describes the current landscape of cancer-related urgent and emergency care and includes research recommendations from workshop participants to decrease the risk of oncologic complications, improve their management, and enhance coordination of care. Recent findings Since 2014, NCI and OECR have collaborated to support research in cancer-related emergency care. Workshop participants recommended a number of promising research opportunities, as well as key considerations for designing and conducting research in this area. Opportunities included better characterizing unscheduled care services, identifying those at higher risk for such care, developing care delivery models to minimize unplanned events and enhance their care, recognizing cancer prevention and screening opportunities in the ED, improving management of specific cancer-related presentations, and conducting goals of care conversations. Summary Significant progress has been made over the past 7 years with the creation of the Comprehensive Oncologic Emergency Research Network, broad involvement of the emergency medicine and oncology communities, establishing a proof-of-concept observational study, and NCI and OECR’s efforts to support this area of research. However, critical gaps remain.
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Morse AK, Askovic M, Sercombe J, Dean K, Fisher A, Marel C, Chatterton ML, Kay-Lambkin F, Barrett E, Sunderland M, Harvey L, Peach N, Teesson M, Mills KL. A systematic review of the efficacy, effectiveness and cost-effectiveness of workplace-based interventions for the prevention and treatment of problematic substance use. Front Public Health 2022; 10:1051119. [PMID: 36419993 PMCID: PMC9676969 DOI: 10.3389/fpubh.2022.1051119] [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: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Employee alcohol and other drug use can negatively impact the workplace, resulting in absenteeism, reduced productivity, high turnover, and worksite safety issues. As the workplace can influence employee substance use through environmental and cultural factors, it also presents a key opportunity to deliver interventions, particularly to employees who may not otherwise seek help. This is a systematic review of workplace-based interventions for the prevention and treatment of problematic substance use. Five databases were searched for efficacy, effectiveness and/or cost-effectiveness studies and reviews published since 2010 that measured use of psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in employees aged over 18. Thirty-nine articles were identified, 28 describing primary research and 11 reviews, most of which focused solely on alcohol use. Heterogeneity between studies with respect to intervention and evaluation design limited the degree to which findings could be synthesized, however, there is some promising evidence for workplace-based universal health promotion interventions, targeted brief interventions, and universal substance use screening. The few studies that examined implementation in the workplace revealed specific barriers including lack of engagement with e-health interventions, heavy use and reluctance to seek help amongst male employees, and confidentiality concerns. Tailoring interventions to each workplace, and ease of implementation and employee engagement emerged as facilitators. Further high-quality research is needed to examine the effectiveness of workplace substance use testing, Employee Assistance Programs, and strategies targeting the use of substances other than alcohol in the workplace. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227598, PROSPERO [CRD42021227598].
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Affiliation(s)
- Ashleigh K. Morse
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Mina Askovic
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Jayden Sercombe
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Kate Dean
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Alana Fisher
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
- eCentre Clinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | | | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Logan Harvey
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Natalie Peach
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Katherine L. Mills
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
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Whiteside LK, D'Onofrio G, Fiellin DA, Edelman EJ, Richardson L, O'Connor P, Rothman RE, Cowan E, Lyons MS, Fockele CE, Saheed M, Freiermuth C, Punches BE, Guo C, Martel S, Owens PH, Coupet E, Hawk KF. Models for Implementing Emergency Department-Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers. Ann Emerg Med 2022; 80:410-419. [PMID: 35752520 PMCID: PMC9588652 DOI: 10.1016/j.annemergmed.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022]
Abstract
There has been a substantial rise in the number of publications and training opportunities on the care and treatment of emergency department (ED) patients with opioid use disorder over the past several years. The American College of Emergency Physicians recently published recommendations for providing buprenorphine to patients with opioid use disorder, but barriers to implementing this clinical practice remain. We describe the models for implementing ED-initiated buprenorphine at 4 diverse urban, academic medical centers across the country as part of a federally funded effort termed "Project ED Health." These 4 sites successfully implemented unique ED-initiated buprenorphine programs as part of a comparison of implementation facilitation to traditional educational dissemination on the uptake of ED-initiated buprenorphine. Each site describes the elements central to the ED process, including screening, treatment initiation, referral, and follow-up, while harnessing organizational characteristics, including ED culture. Finally, we discuss common facilitators to program success, including information technology and electronic medical record integration, hospital-level support, strong connections with outpatient partners, and quality improvement processes.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - David A Fiellin
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - E Jennifer Edelman
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick O'Connor
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael S Lyons
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Callan E Fockele
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caroline Freiermuth
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Brittany E Punches
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Clara Guo
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Shara Martel
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Patricia H Owens
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Edouard Coupet
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kathryn F Hawk
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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13
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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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14
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Philippine T, Forsgren E, DeWitt C, Carter I, McCollough M, Taira BR. Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder. BMC Health Serv Res 2022; 22:456. [PMID: 35392901 PMCID: PMC8988541 DOI: 10.1186/s12913-022-07862-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers. Methods Using an implementation science approach based on the Behavior Change Wheel framework, we conducted qualitative interviews with staff to interrogate their perspectives on ED initiation of AUD treatment. Subjects included physicians, nurses, nurse practitioners, clinical social workers, and pharmacists. Interviews were thematically coded using both inductive and deductive approaches and constant comparative analysis. Themes were further categorized as relating to providers’ capabilities, opportunities, or motivations. Barriers were then mapped to corresponding intervention functions. Results Facilitators at our institution included time allotted for continuing education, the availability of clinical social workers, and favorable opinions of MAT based on previous experiences implementing buprenorphine for opioid use disorder. Capability barriers included limited familiarity with naltrexone and difficulty determining which patients are candidates for therapy. Opportunity barriers included the limited supply of naltrexone and a lack of clarity as to who should introduce naltrexone and assess readiness for change. Motivation barriers included a sense of futility in treating patients with AUD and stigmas associated with alcohol use. Evidence-based interventions included multi-modal provider education, a standardized treatment algorithm and order set, selection of clinical champions, and clarification of roles among providers on the team. Conclusions A large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07862-1.
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Affiliation(s)
| | - Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | | | - Inanna Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maureen McCollough
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Breena R Taira
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
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15
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Ford JH, Rao D, Gilson A, Kaur A, Garneau HC, Saldana L, McGovern MP. Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders. J Dual Diagn 2022; 18:101-110. [PMID: 35387577 PMCID: PMC9503325 DOI: 10.1080/15504263.2022.2052225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients "wait no longer" to receive integrated treatment and medications for their COD.
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Affiliation(s)
- James H. Ford
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Deepika Rao
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Aaron Gilson
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Arveen Kaur
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Helene Chokron Garneau
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304
| | | | - Mark P. McGovern
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304
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16
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Emergency department utilization for substance use disorders and mental health conditions during COVID-19. PLoS One 2022; 17:e0262136. [PMID: 35025921 PMCID: PMC8757912 DOI: 10.1371/journal.pone.0262136] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.
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17
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Identifying barriers to emergency department-initiated buprenorphine: A spatial analysis of treatment facility access in Michigan. Am J Emerg Med 2021; 51:393-396. [PMID: 34826787 DOI: 10.1016/j.ajem.2021.11.014] [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: 06/15/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVES Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. METHODS Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers. RESULTS Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p < 0.0001) and annual patient volumes (58,616 vs. 17,484; p < 0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p = 0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress. CONCLUSION Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.
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Abstract
In recent years the prescription opioid overdose epidemic has decreased, but has been more than offset by increases in overdose caused by fentanyl and fentanyl analogues. Opioid overdose patients should receive naloxone if they have significant respiratory depression and/or loss of protective airway reflexes. Patients who receive naloxone should be observed for recurrent opioid effects. Patients with opioid overdose may be admitted to the intensive care unit for naloxone infusions, treatment of noncardiogenic pulmonary edema, autonomic instability, or sequelae of hypoxia-ischemia or cardiac arrest. Primary and secondary prevention are important to reduce the number of people with life-threatening opioid overdose.
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Natera G, Gelberg L, Arroyo M, Andersen RM, Orozco R, Bojórquez I, Rico MW. Substance Use among Women Attending Primary Healthcare Community Centers: a Binational Comparison for the Development of Brief Intervention Programs. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-019-00190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Guo J, Lo-Ciganic WH, Yang Q, Huang JL, Weiss JC, Cochran G, Malone DC, Kuza CC, Gordon AJ, Donohue JM, Gellad WF. Predicting Mortality Risk After a Hospital or Emergency Department Visit for Nonfatal Opioid Overdose. J Gen Intern Med 2021; 36:908-915. [PMID: 33481168 PMCID: PMC8041978 DOI: 10.1007/s11606-020-06405-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survivors of opioid overdose have substantially increased mortality risk, although this risk is not evenly distributed across individuals. No study has focused on predicting an individual's risk of death after a nonfatal opioid overdose. OBJECTIVE To predict risk of death after a nonfatal opioid overdose. DESIGN AND PARTICIPANTS This retrospective cohort study included 9686 Pennsylvania Medicaid beneficiaries with an emergency department or inpatient claim for nonfatal opioid overdose in 2014-2016. The index date was the first overdose claim during this period. EXPOSURES, MAIN OUTCOME, AND MEASURES Predictor candidates were measured in the 180 days before the index overdose. Primary outcome was 180-day all-cause mortality. Using a gradient boosting machine model, we classified beneficiaries into six subgroups according to their risk of mortality (< 25th percentile of the risk score, 25th to < 50th, 50th to < 75th, 75th to < 90th, 90th to < 98th, ≥ 98th). We then measured receipt of medication for opioid use disorder (OUD), risk mitigation interventions (e.g., prescriptions for naloxone), and prescription opioids filled in the 180 days after the index overdose, by risk subgroup. KEY RESULTS Of eligible beneficiaries, 347 (3.6%) died within 180 days after the index overdose. The C-statistic of the mortality prediction model was 0.71. In the highest risk subgroup, the observed 180-day mortality rate was 20.3%, while in the lowest risk subgroup, it was 1.5%. Medication for OUD and risk mitigation interventions after overdose were more commonly seen in lower risk groups, while opioid prescriptions were more likely to be used in higher risk groups (both p trends < .001). CONCLUSIONS A risk prediction model performed well for classifying mortality risk after a nonfatal opioid overdose. This prediction score can identify high-risk subgroups to target interventions to improve outcomes among overdose survivors.
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Affiliation(s)
- Jingchuan Guo
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Qingnan Yang
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA
| | - James L Huang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Jeremy C Weiss
- Carnegie Mellon University, Heinz College, Pittsburgh, PA, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Courtney C Kuza
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA.
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Health Equity Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Dezfulian C, Orkin AM, Maron BA, Elmer J, Girotra S, Gladwin MT, Merchant RM, Panchal AR, Perman SM, Starks MA, van Diepen S, Lavonas EJ. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e836-e870. [PMID: 33682423 DOI: 10.1161/cir.0000000000000958] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.
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Nguemeni Tiako MJ, Culhane J, South E, Srinivas SK, Meisel ZF. Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine. JAMA Netw Open 2020; 3:e2029043. [PMID: 33306115 PMCID: PMC7733157 DOI: 10.1001/jamanetworkopen.2020.29043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. OBJECTIVE To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. EXPOSURES State-level NAS incidence and county-level uninsured rates and rurality. MAIN OUTCOMES AND MEASURES Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. RESULTS Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). CONCLUSIONS AND RELEVANCE Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Medical student, Yale School of Medicine, New Haven, Connecticut
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jennifer Culhane
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Eugenia South
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, University of Pennsylvania, Philadelphia
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Abstract
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
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Affiliation(s)
- Chad D Morris
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
| | - Christine E Garver-Apgar
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA
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Greenberg MR, Greco NM, Batchelor TJ, Miller AH, Doherty T, Aziz AS, Yee SZ, Arif F, Crowley LM, Casey EW, Kruklitis RJ. Physician-directed smoking cessation using patient "opt-out" approach in the emergency department: A pilot program. J Am Coll Emerg Physicians Open 2020; 1:782-789. [PMID: 33145519 PMCID: PMC7593453 DOI: 10.1002/emp2.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Using a physician-directed, patient "opt-out" approach to prescriptive smoking cessation in the emergency department (ED) setting, we set out to describe patient actions as they related to smoking cessation behaviors. METHODS A convenience sample of smokers at 2 Pennsylvania hospital EDs who met inclusion/exclusion criteria were approached to participate in a brief intervention known as screening, treatment initiation, and referral (STIR) counseling that included phone follow-up. Demographic information, current smoking status, and specific physician prescription and follow-up recommendations were collected. Approximately 3 months later, patients were contacted to determine current smoking status and actions taken since their ED visit. RESULTS One hundred six patients were approached and 7 (6.6%) opted out of the intervention. Patients who did not opt out were evaluated for appropriate use of smoking cessation-related medications; 35 (35.4%) opted out of the prescription(s) and 6 (6.1%) were not indicated. Twenty-one (21.2%) patients opted out of ambulatory referral follow-ups with primary care and/or tobacco treatment program; one (1.0%) was not indicated for referral. Nineteen (32.8%) patients who received prescription(s) for smoking cessation-related medications initially also followed the prescription(s). Seventeen (22.1%) patients participated in referral follow-up. CONCLUSION In this small ED pilot, using the STIR concepts in an opt-out method, few smokers opted out of the smoking cessation intervention. About one-third of the patients declined prescriptions for smoking cessation-related medications and less than one-quarter declined ambulatory referrals for follow-up. These findings support a willingness of patients to participate in STIR and the benefits of intervention in this setting.
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Affiliation(s)
- Marna Rayl Greenberg
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Natalie M. Greco
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Timothy J. Batchelor
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Andrew H.F. Miller
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Theodore Doherty
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Ali S. Aziz
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Stephanie Z. Yee
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Faiza Arif
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Lauren M. Crowley
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | | | - Robert J. Kruklitis
- Department of MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
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Chawarski MC, Hawk K, Edelman EJ, O'Connor P, Owens P, Martel S, Coupet E, Whiteside L, Tsui JI, Rothman R, Cowan E, Richardson L, Lyons MS, Fiellin DA, D'Onofrio G. Use of Amphetamine-Type Stimulants Among Emergency Department Patients With Untreated Opioid Use Disorder. Ann Emerg Med 2020; 76:782-787. [PMID: 32782084 DOI: 10.1016/j.annemergmed.2020.06.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE Concurrent use of amphetamine-type stimulants among individuals with opioid use disorder can exacerbate social and medical harms, including overdose risk. The study evaluated rates of amphetamine-type stimulant use among patients with untreated opioid use disorder presenting at emergency departments in Baltimore, MD; New York, NY; Cincinnati, OH; and Seattle, WA. METHODS Emergency department (ED) patients with untreated opioid use disorder (N=396) and enrolled between February 2017 and January 2019 in a multisite hybrid type III implementation science study were evaluated for concurrent amphetamine-type stimulant use. Individuals with urine tests positive for methamphetamine, amphetamine, or both were compared with amphetamine-type stimulant-negative patients. RESULTS Overall, 38% of patients (150/396) were amphetamine-type stimulant positive; none reported receiving prescribed amphetamine or methamphetamine medications. Amphetamine-type stimulant-positive versus -negative patients were younger: mean age was 36 years (SD 10 years) versus 40 years (SD 12 years), 69% (104/150) versus 46% (114/246) were white, 65% (98/150) versus 54% (132/246) were unemployed, 67% (101/150) versus 49 (121/246) had unstable housing, 47% (71/150) versus 25% (61/245) reported an incarceration during 1 year before study admission, 60% (77/128) versus 45% (87/195) were hepatitis C positive, 79% (118/150) versus 47% (115/245) reported drug injection during 1 month before the study admission, and 42% (62/149) versus 29% (70/244) presented to the ED for an injury. Lower proportions of amphetamine-type stimulant-positive patients had cocaine-positive urine test results (33% [50/150] versus 52% [129/246]) and reported seeking treatment for substance use problems as a reason for their ED visit (10% [14/148] versus 19% [46/246]). All comparisons were statistically significant at P<.05 with the false discovery rate correction. CONCLUSION Amphetamine-type stimulant use among ED patients with untreated opioid use disorder was associated with distinct sociodemographic, social, and health factors. Improved ED-based screening, intervention, and referral protocols for patients with opioid use disorder and amphetamine-type stimulant use are needed.
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Affiliation(s)
- Marek C Chawarski
- Yale School of Medicine, Department of Psychiatry, New Haven, CT; Yale School of Medicine, Department of Emergency Medicine, New Haven, CT.
| | - Kathryn Hawk
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | - E Jennifer Edelman
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| | - Patrick O'Connor
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Patricia Owens
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | - Shara Martel
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | - Edouard Coupet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | | | - Judith I Tsui
- University of Washington, Department of Emergency Medicine, Seattle, WA
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD
| | - Ethan Cowan
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
| | - Lynne Richardson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
| | - Michael S Lyons
- University of Cincinnati Department of Emergency Medicine, Cincinnati, OH
| | - David A Fiellin
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale School of Medicine, Department of Internal Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
| | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
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26
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Monico LB, Oros M, Smith S, Mitchell SG, Gryczynski J, Schwartz R. One million screened: Scaling up SBIRT and buprenorphine treatment in hospital emergency departments across Maryland. Am J Emerg Med 2020; 38:1466-1469. [DOI: 10.1016/j.ajem.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
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27
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Kidd JD, Smith JL, Hu MC, Turrigiano EM, Bisaga A, Nunes EV, Levin FR. Medical Student Attitudes Toward Substance Use Disorders Before and After a Skills-Based Screening, Brief Intervention, and Referral to Treatment (SBIRT) Curriculum. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:455-461. [PMID: 32636697 PMCID: PMC7335270 DOI: 10.2147/amep.s251391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based framework for assessing and addressing risky substance use. This study evaluated the substance-related attitudes of medical students who participated in an Enhanced Pre-Clinical SBIRT Curriculum designed to reduce stigma, help students empathize with the experiences of people using alcohol and drugs, understand substance use in-context, and feel more optimistic about efforts to prevent and treat substance use disorders (SUDs). METHODS Students (N=118; 73.8% of eligible) completed the Attitudes and Opinions Survey for alcohol and drugs before and after this 2-year, multi-modality curriculum. The authors classified attitudes as "positive" or "negative" and grouped students by pre-post attitudinal change: persistently negative, persistently positive, negative-to-positive, positive-to-negative. Using chi-square tests, the authors assessed differences by sex, race/ethnicity, and whether students had a family member or friend with an SUD. RESULTS Most students (>90%) reported persistently positive attitudes regarding physicians in recovery, societal contributions of patients with SUDs; ability to learn from such patients; and general attitudes toward SUD treatment. This skewed distribution precluded the investigation of subgroup differences. Fewer students reported persistently positive attitudes regarding SUD patients' healthcare utilization (alcohol 58.5%; drug 57.8%) and impact on other patients' care (alcohol 73.7%; drug 72.4%), compared to other attitudinal domains (at p-values < 0.0001 in the McNemar's tests). Approximately, 1 in 5 students reported more negative healthcare utilization attitudes on follow-up. There were no demographic differences in these two attitudinal domains. CONCLUSION Unlike previous studies of medical student attitudes, most students who participated in the Enhanced Pre-Clinical SBIRT Curriculum reported an enduring appreciation for the educational and societal contributions of patients with SUDs. Attitudes toward healthcare utilization and the impact of patients with SUDs on the care of other patients were more resistant to change, possibly due to the predominance of acute-care inpatient settings in clinical training.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer L Smith
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eva M Turrigiano
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Adam Bisaga
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
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28
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The Deadly Trio: Heroin, FentaNYL, and Carfentanil. J Emerg Nurs 2020; 46:26-33. [DOI: 10.1016/j.jen.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 01/04/2023]
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29
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Rates of and Factors Associated With Patient-reported Illicit Drug Use Screening by Health Care Professionals in the United States From 2013 to 2015. J Addict Med 2020; 14:63-68. [DOI: 10.1097/adm.0000000000000537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Johnson EC, Huffman AE, Yoder HA, Bordelon NM, Sewczak-Claude G, Smith DT. Educational Intervention Changes College Students' Attitudes toward Prescription Opioid Drug Use. Subst Use Misuse 2020; 55:367-376. [PMID: 31608735 DOI: 10.1080/10826084.2019.1673418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: More than 47,000 people in the United States died from opioid drug overdoses in 2017. Among college students, opioid drugs are the second most abused drug. Objective: This study aimed to examine if an educational intervention impacted college students' attitudes towards prescription opioid drugs (POD). Methods: Two hundred forty-two participants (72 males, 21 ± 3 years) from an American university participated. After collecting demographic data (questionnaire 1; Q1), investigators recited a narrative in which the protagonist was injured and prescribed POD. Next, participants rated their agreement on 10 Likert prompts and two visual analog scales (VAS) before (Q2) and after (Q3) an educational intervention, then noted (Q4) which topics were most or least influential in any changed responses. Results: 7/10 Likert prompts (all p < 0.002) and both VAS (both p < 0.001) changed between Q2 and Q3. Educational intervention topics related to risk were most influential and topics related to alternative therapies were least influential. Conclusion/Importance: Educational interventions may be beneficial for college students. Any interventions that are employed should focus on risks associated with POD use.
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Affiliation(s)
- Evan C Johnson
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA
| | - Ainsley E Huffman
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA.,Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Hillary A Yoder
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA.,Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Nicole M Bordelon
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA.,Department of Kinesiology, Auburn University, Auburn, Alabama, USA
| | | | - Derek T Smith
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA
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31
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Schneider KE, Webb L, Boon D, Johnson RM. Adolescent Anabolic-Androgenic Steroid Use in Association with Other Drug Use, Injection Drug Use, and Team Sport Participation. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020; 29:246-251. [PMID: 36540327 PMCID: PMC9762502 DOI: 10.1080/1067828x.2022.2052219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction The majority of epidemiologic research on adolescent non-medical anabolic-androgenic steroid (AAS) use was conducted in the 1990s and early 2000s, indicating a need to update evidence for the modern era. We aim to understand the prevalence of AAS use among US adolescents and assess associations between AAS use, sports participation, other drug use, and injection drug use (IDU). Methods Using data from the 2017 National Youth Risk Behavior Survey, we estimated the prevalence of AAS use and tested for associations between AAS use, sports participation, and drug use, overall and by sex. Results The prevalence of AAS use was 2.98%. The prevalence among boys (3.46%) was higher than among girls (2.41%). AAS use was high among youth with lifetime heroin use (64.41%) and IDU (64.42%). There was no association between AAS and team sport participation (p=0.61). Conclusions Our results indicate that adolescent AAS use is an aspect of polysubstance use rather than a substance used solely for performance enhancement in sports. Research with adolescents should be mindful of the overlap of heroin and AAS use among youth with IDU.
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Affiliation(s)
| | - Lindsey Webb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Denali Boon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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32
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Emergency Department Initiation of Buprenorphine for Opioid Use Disorder: Current Status, and Future Potential. CNS Drugs 2019; 33:1147-1154. [PMID: 31552608 DOI: 10.1007/s40263-019-00667-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients experiencing the consequences of opioid use often present to the emergency department (ED) at times of crisis, such as following overdose or when in withdrawal. This highlights the important role of the ED in recognizing opioid use disorder and engaging these patients into ongoing treatment. Given the limited ability of the healthcare system to provide timely addiction treatment, initiation of therapy in the ED, with referral to long-term care, is associated with improved outcomes. The primary evidence-based treatment used in EDs for this indication is buprenorphine. Although clinicians may find the initiation of buprenorphine therapy daunting, it is straightforward and well-tolerated, and many of the barriers are surmountable. This article addresses these barriers, which include stigma, complicated pharmacology, and confusing regulations, and provides a basis for the use of buprenorphine in acute care clinical practice.
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Maragh-Bass AC, Fields JC, Catanzarite Z, Knowlton AR. "We get tunnel vision": Emergency medical service providers' views on the opioid epidemic in Baltimore City. J Opioid Manag 2019; 15:295-306. [PMID: 31637682 PMCID: PMC11502992 DOI: 10.5055/jom.2019.0515] [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: 11/05/2022]
Abstract
OBJECTIVE To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting. DESIGN Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs. SETTING Baltimore City. PARTICIPANTS Twenty-two Baltimore City Fire Department EMS providers. INTERVENTIONS Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches. MAIN OUTCOME MEASURE Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison. RESULTS Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs. CONCLUSIONS EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie C Fields
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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34
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Meyerson BE, Agley JD, Jayawardene W, Eldridge LA, Arora P, Smith C, Vadiei N, Kennedy A, Moehling T. Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C. Res Social Adm Pharm 2019; 16:699-709. [PMID: 31611071 DOI: 10.1016/j.sapharm.2019.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence-based harm reduction intervention components which might benefit pharmacy patients have not been integrated and studied. OBJECTIVE To investigate the feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C called PharmNet. METHODS Indiana managing pharmacists were surveyed in 2018 to assess the feasibility and acceptability of an intervention for opioid misuse screening, brief intervention, syringe and naloxone dispensing, and referrals provision. The Consolidated Framework for Implementation Research informed the survey development and analysis. RESULTS The sample included 303 (30.8%) pharmacists; 215 (70.9%) provided detailed written comments. Intervention Characteristics: 83.3% believed PharmNet would benefit patients, and that staff could deliver the intervention with adequate training (70.0%). Inner Setting: While 77.2% believed their pharmacy culture supported practice change, 57.5% of chain pharmacists believed their pharmacies would not have time for PharmNet. Outer Setting: 73.3% believed additional addiction and overdose screening is needed in their community, and pharmacies should offer new services to help reduce opioid overdose and addiction among their patients (79.5%). A vast majority (97.7%) were asked by patients in the past 2 years about syringe related issues; 67.7% were asked about syringes for non-prescription injection drug use. Individuals Involved: While 62.4% believed PharmNet was within pharmacy scope of practice and 90.1% were comfortable consulting about syringe use, pharmacists reported that they had limited control over the implementation environment. PROCESS 38.0% of pharmacists indicated interest in advising the development of PharmNet. CONCLUSIONS An implementation trial of a modified version of PharmNet is likely feasible; yet will be challenged by structural pressures particularly in chain pharmacies. Successful implementation will involve the development of resources and policy components to manage outer and inner setting characteristics and align the intervention to the implementation environment.
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Affiliation(s)
- B E Meyerson
- Indiana University School of Public Health-Bloomington, Indiana, USA; Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Indiana, USA; Southwest Institute for Research on Women, University of Arizona, Tucson, AZ, USA.
| | - J D Agley
- Indiana University School of Public Health-Bloomington, Indiana, USA; Institute for Research on Addictive Behavior, Indiana University School of Public Health-Bloomington, Indiana, USA
| | - W Jayawardene
- Indiana University School of Public Health-Bloomington, Indiana, USA; Institute for Research on Addictive Behavior, Indiana University School of Public Health-Bloomington, Indiana, USA
| | - L A Eldridge
- Indiana University School of Public Health-Bloomington, Indiana, USA; Institute for Research on Addictive Behavior, Indiana University School of Public Health-Bloomington, Indiana, USA
| | - P Arora
- College of Pharmacy and Health Sciences Butler University, Indianapolis, IN, USA
| | - C Smith
- College of Pharmacy and Health Sciences Butler University, Indianapolis, IN, USA
| | - N Vadiei
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - A Kennedy
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - T Moehling
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Public Health Graduate Program, Purdue University, West Lafayette, IN, USA
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- Indiana University School of Public Health-Bloomington, Indiana, USA
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Abstract
The ongoing syndemic of substance use disorder and human immunodeficiency virus infection threatens progress made in preventing new infections and improving outcomes among those infected. To address this challenge effectively, human immunodeficiency virus physicians must take an increased role in the screening, diagnosis, and treatment of substance use disorders. Such treatment decreases human immunodeficiency virus risk behaviors and improves human immunodeficiency virus and substance use disorder-related outcomes. An effective response to this syndemic requires increased access to adjuvant interventions and a radical movement away from the current stigmatization and criminalization of those suffering from substance use disorders.
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Affiliation(s)
- Christopher M Bositis
- Greater Lawrence Family Health Center, 34 Haverhill Street, Lawrence, MA 01841, USA.
| | - Joshua St Louis
- Lawrence Family Medicine Residency, 34 Haverhill Street, Lawrence, MA 01841, USA
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Wyse J, Robbins JL, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Gaither JR, Gordon K, Skanderson M, Barry DT, Crystal S, Justice A, Kraemer KL. Predictors of timely opioid agonist treatment initiation among veterans with and without HIV. Drug Alcohol Depend 2019; 198:70-75. [PMID: 30878769 PMCID: PMC6836871 DOI: 10.1016/j.drugalcdep.2019.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV. METHODS We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter. RESULTS 4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 - 0.62), PWH (aOR = 0.79, 95% CI 0.68-0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34-1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48-2.08), diagnosis year 2005-2008 relative to 2000-2004 (aOR = 1.24, 95% CI 1.05-1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27-1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. CONCLUSIONS PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
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Affiliation(s)
- Jessica Wyse
- VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA,School of Public Health, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Jonathan L. Robbins
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Adam J. Gordon
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA,VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148, USA
| | - Ajay Manhapra
- Advanced PACT Pain Clinic, Hampton VA Medical Center, 100 Emancipation Dr, Hampton, VA 23667, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Brent A. Moore
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Julie R. Gaither
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kirsha Gordon
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA
| | - Melissa Skanderson
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Declan T. Barry
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA,APT Foundation, Pain Treatment Services, 1 Long Wharf Dr, New Haven, CT 06511, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ 08901, USA
| | - Amy Justice
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Kevin L. Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA 15213, USA,VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15213, USA
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Biroscak BJ, Pantalon MV, Dziura JD, Hersey DP, Vaca FE. Use of non-face-to-face modalities for emergency department screening, brief intervention, and referral to treatment (ED-SBIRT) for high-risk alcohol use: A scoping review. Subst Abus 2019; 40:20-32. [PMID: 30829126 PMCID: PMC6579646 DOI: 10.1080/08897077.2018.1550465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this review was to examine and chart the "scope" of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non-face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003-2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: "screening" (e.g., computer tablet screening), "brief intervention" (e.g., text message-based brief interventions), and "referral to treatment" (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies-including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.
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Affiliation(s)
- Brian J Biroscak
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Michael V Pantalon
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - James D Dziura
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Denise P Hersey
- b Department of Clinical Information Services, Cushing/Whitney Medical Library , Yale University , New Haven , Connecticut , USA
| | - Federico E Vaca
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
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38
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Piloting an Addictions Medicine Consultation Team in Kingston, Ontario, Canada: Results of an Inpatient Needs Assessment. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Samuels EA, D'Onofrio G, Huntley K, Levin S, Schuur JD, Bart G, Hawk K, Tai B, Campbell CI, Venkatesh AK. A Quality Framework for Emergency Department Treatment of Opioid Use Disorder. Ann Emerg Med 2019; 73:237-247. [PMID: 30318376 PMCID: PMC6817947 DOI: 10.1016/j.annemergmed.2018.08.439] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
Emergency clinicians are on the front lines of responding to the opioid epidemic and are leading innovations to reduce opioid overdose deaths through safer prescribing, harm reduction, and improved linkage to outpatient treatment. Currently, there are no nationally recognized quality measures or best practices to guide emergency department quality improvement efforts, implementation science researchers, or policymakers seeking to reduce opioid-associated morbidity and mortality. To address this gap, in May 2017, the National Institute on Drug Abuse's Center for the Clinical Trials Network convened experts in quality measurement from the American College of Emergency Physicians' (ACEP's) Clinical Emergency Data Registry, researchers in emergency and addiction medicine, and representatives from federal agencies, including the National Institute on Drug Abuse and the Centers for Medicare & Medicaid Services. Drawing from discussions at this meeting and with experts in opioid use disorder treatment and quality measure development, we developed a multistakeholder quality improvement framework with specific structural, process, and outcome measures to guide an emergency medicine agenda for opioid use disorder policy, research, and clinical quality improvement.
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Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. https://twitter.com/LizSamuels
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Kristen Huntley
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gavin Bart
- Addiction Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
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Nguemeni Tiako MJ, Mori M, Bin Mahmood SU, Shioda K, Mangi A, Yun J, Geirsson A. Recidivism Is the Leading Cause of Death Among Intravenous Drug Users Who Underwent Cardiac Surgery for Infective Endocarditis. Semin Thorac Cardiovasc Surg 2019; 31:40-45. [DOI: 10.1053/j.semtcvs.2018.07.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023]
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Newhouse R, Janney M, Gilbert A, Agley J, Bakoyannis G, Ferren M, Mullins CD, Johantgen M, Schwindt R, Thoele K. Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach. Addict Sci Clin Pract 2018; 13:28. [PMID: 30587235 PMCID: PMC6307302 DOI: 10.1186/s13722-018-0130-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use. METHODS This study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes. DISCUSSION This study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders. Trial registration ClinicalTrials.gov NCT03560076.
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Affiliation(s)
- Robin Newhouse
- Indiana University School of Nursing, 600 Barnhill Drive, NU 132, Indianapolis, IN 46202 USA
| | - Michelle Janney
- Indiana University Health, Fairbanks Hall, 340 West 10th Street, Indianapolis, IN 46202 USA
| | - Anne Gilbert
- Indiana University Health, Methodist Hospital, 1701 N. Senate Blvd, Indianapolis, IN 46202 USA
| | - Jon Agley
- Institute for Research on Addictive Behavior, Indiana University School of Public Health - Bloomington, 501 N. Morton Street, Suite 110, Bloomington, IN, 47404 USA
| | - Giorgos Bakoyannis
- Indiana University Fairbanks School of Public Health and School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Melora Ferren
- Indiana University Health, Fairbanks Hall, 340 West 10th Street, Indianapolis, IN 46202 USA
| | - C. Daniel Mullins
- University of Maryland School of Pharmacy, Saratoga Building, 12th Floor, 220 Arch Street, Baltimore, MD 21201 USA
| | - Meg Johantgen
- University of Maryland School of Nursing, 655 W. Lombard Street, Baltimore, MD 21201 USA
| | - Rhonda Schwindt
- The George Washington University School of Nursing, 1919 Pennsylvania Ave. NW, Ste. 500, Washington, DC 20006 USA
| | - Kelli Thoele
- Indiana University School of Nursing, 600 Barnhill Drive, NU 132, Indianapolis, IN 46202 USA
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42
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Tobacco Use in South African Emergency Centre Patients: Opportunities for Intervention. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Simpson SA. A Survey of Clinical Approaches to Suicide Risk Assessment for Patients Intoxicated on Alcohol. PSYCHOSOMATICS 2018; 60:197-203. [PMID: 30093244 DOI: 10.1016/j.psym.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicidal ideation and alcohol use are common among emergency department patients. It is unclear at what point a suicide risk assessment should occur among patients who present with acute alcohol intoxication. OBJECTIVE This study aims to describe practice patterns among expert practitioners for timing the suicide risk assessment for an intoxicated patient. METHODS An online survey was sent to emergency psychiatrists and behavioral health specialists on 2 national listserves including that of the Academy of Consultation-Liaison Psychiatry's Emergency Psychiatry Special Interest Group. RESULTS Sixty respondents had a mean of 16 ± 12years (mean ± standard deviation) out of specialty training and had extensive experience and comfort in managing this patient presentation. All respondents were board-certified and most (68%) practiced in academic settings. The most common practice for conducting a safety risk assessment in alcohol-intoxicated patients was to proceed once the patient was clinically sober (58%). Other practices included retesting the patient until a specific blood alcohol concentration was reached (19%) or waiting a certain time after presentation based on the initial blood alcohol concentration (15%). Some (8%) evaluated actively-intoxicated patients for suicide risk. Practice varied slightly based on the location of practice,type of practice, and where the clinician trained. DISCUSSION Expert clinicians most often describe using a clinical assessment to determine sobriety before completing a suicidal risk assessment, although alternative practices remain common. While advantages and disadvantages vary among different approaches, the quality and evidence base underlying these practices are questioned.
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Affiliation(s)
- Scott A Simpson
- Psychiatric Emergency Services, Denver Health Medical Center, University of Colorado School of Medicine, Department of Psychiatry, Denver, CO.
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Orsini MM, Milroy JJ, Wyrick DL, Sanders L. Polysubstance Use Among First-Year NCAA College Student-Athletes. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2018. [DOI: 10.1080/1067828x.2018.1444524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - David L. Wyrick
- University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lindsey Sanders
- University of North Carolina Greensboro, Greensboro, NC, USA
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A police-led addiction treatment referral program in Gloucester, MA: Implementation and participants' experiences. J Subst Abuse Treat 2017; 82:41-47. [PMID: 29021114 DOI: 10.1016/j.jsat.2017.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The increasing rates of opioid use disorder and resulting overdose deaths are a public health emergency, yet only a fraction of individuals in need receive treatment. OBJECTIVE To describe the implementation of and participants' experiences with a novel police-led addiction treatment referral program. METHODS Follow-up telephone calls to participants in the Gloucester Police Department's Angel Program from June 2015-May 2016. Open-ended survey questionnaires assessed experiences of program participants and their close contacts, confirmed police-reported placement, and queried self-reported substance use and treatment outcomes. RESULTS Surveys were completed by 198 of 367 individuals (54% response rate) who participated 214 times. Reasons for participation included: the program was a highly-visible entry point to the treatment system, belief that placement would be obtained, poor prior treatment system experiences, and external pressure to seek treatment. Most participants reported positive experiences citing the welcoming, non-judgmental services. In 75% (160/214) of the encounters, entry into referral placement was confirmed. Participants expressed frustration when they did not meet program entry requirements and had difficulty finding sustained treatment following initial program placement. At a mean follow-up time of 6.7months, 37% of participants reported abstinence since participation, with no differences between participants who entered referral placement versus those who did not. CONCLUSIONS A police-led referral program was feasible to implement and acceptable to participants. The program was effective in finding initial access to treatment, primarily through short-term detoxification services. However, the program was not able to overcome a fragmented treatment system focused on acute episodic care which remains a barrier to long-term recovery.
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