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Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, Romo E, Dowd P, Walters SM, Young AM, Zule W, Friedmann PD, Go VF, Baker R, Fredericksen RJ. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study. Soc Sci Med 2024; 346:116660. [PMID: 38484417 PMCID: PMC10997882 DOI: 10.1016/j.socscimed.2024.116660] [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: 07/05/2023] [Revised: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In 2020, 2.8 million people required substance use disorder (SUD) treatment in nonmetropolitan or 'rural' areas in the U.S. Among this population, only 10% received SUD treatment from a specialty facility, and 1 in 500 received medication for opioid use disorder (MOUD). We explored the context surrounding barriers to SUD treatment in the rural United States. METHODS We conducted semi-structured, in-depth interviews from 2018 to 2019 to assess barriers to SUD treatment among people who use drugs (PWUD) across seven rural U.S. study sites. Using the social-ecological model (SEM), we examined individual, interpersonal, organizational, community, and policy factors contributing to perceived barriers to SUD treatment. We employed deductive and inductive coding and analytical approaches to identify themes. We also calculated descriptive statistics for participant characteristics and salient themes. RESULTS Among 304 participants (55% male, mean age 36 years), we identified barriers to SUD treatment in rural areas across SEM levels. At the individual/interpersonal level, relevant themes included: fear of withdrawal, the need to "get things in order" before entering treatment, close-knit communities and limited confidentiality, networks and settings that perpetuated drug use, and stigma. Organizational-level barriers included: strict facility rules, treatment programs managed like corrections facilities, lack of gender-specific treatment programs, and concerns about jeopardizing employment. Community-level barriers included: limited availability of treatment in local rural communities, long distances and limited transportation, waitlists, and a lack of information about treatment options. Policy-level themes included insurance challenges and system-imposed barriers such as arrest and incarceration. CONCLUSION Our findings highlight multi-level barriers to SUD treatment in rural U.S. communities. Salient barriers included the need to travel long distances to treatment, challenges to confidentiality due to small, close-knit communities where people are highly familiar with one another, and high-threshold treatment program practices. Our findings point to the need to facilitate the elimination of treatment barriers at each level of the SEM in rural America.
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Affiliation(s)
- T J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - A T Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - J C Schleicher
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J Bresett
- Southern Illinois University at Carbondale, Dept of Public Health, Carbondale, IL, USA
| | - E Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - P Dowd
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - S M Walters
- New York University's Grossman School of Medicine, New York, NY, USA
| | - A M Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Zule
- RTI International, Research Triangle, NC, USA
| | - P D Friedmann
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - V F Go
- University, of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - R Baker
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA
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Lin C, Zhu Y, Mooney LJ, Ober A, Clingan SE, Baldwin LM, Calhoun S, Hser YI. Referral of patients from rural primary care clinics to telemedicine vendors for opioid use disorder treatment: A mixed-methods study. J Telemed Telecare 2024:1357633X231226261. [PMID: 38258323 DOI: 10.1177/1357633x231226261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Rural primary care clinics can expand their medication treatment for opioid use disorder (MOUD) capacity by coordinating care with external telemedicine (TM) vendors specializing in addiction medicine. This study used mixed methods to identify factors that influence patient referrals from rural primary care clinics to TM vendors for MOUD. METHODS Between July/August 2020 and January/February 2021, 582 patients with OUD were identified across six primary care sites; that included 68 referred to an external TM vendor to receive MOUD. Mixed effects logistic regression identified individual and site-level factors associated with being referred to the TM vendor. Clinic providers and staff participated in in-depth interviews and focus groups to discuss their considerations for referring patients to the TM vendor. RESULTS Patient referrals were positively associated with local household broadband coverage (OR = 2.55, p < 0.001) and negatively associated with local population density (OR = 0.01, p = 0.003) and the number of buprenorphine prescribers in the county (OR = 0.85, p < 0.001). Clinic personnel expressed appreciation for psychiatric expertise and the flexibility to access MOUD brought by the TM vendor. Perceived concerns about TM referral included a lack of trust with external providers, uncertainty about TM service quality, workflow delays, and patients' technological and insurance challenges. CONCLUSION This study revealed several clinic-level factors that may potentially influence patient referral to TM vendor services for MOUD. To facilitate the referral process and utilization of TM vendors, efforts should be made to foster open communication and trust between clinic providers and TM vendors, streamline workflows, and improve Internet access for patients.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Ober AJ, Dopp AR, Clingan SE, Curtis ME, Lin C, Calhoun S, Larkins S, Black M, Hanano M, Osterhage KP, Baldwin LM, Saxon AJ, Hichborn EG, Marsch LA, Mooney LJ, Hser YI. Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209194. [PMID: 37863356 DOI: 10.1016/j.josat.2023.209194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor. METHODS We conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale. RESULTS Perceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff. CONCLUSIONS Rural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD.
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Affiliation(s)
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, CA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Sherry Larkins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Hser YI, Zhu Y, Baldwin LM, Mooney LG, Saxon AJ. Medication treatment for opioid use disorder among rural primary care patients. J Rural Health 2024; 40:195-199. [PMID: 37495899 PMCID: PMC10811271 DOI: 10.1111/jrh.12785] [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: 04/20/2023] [Revised: 06/18/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To investigate the prevalence of opioid use disorder (OUD) and medication treatment for OUD (MOUD) receipt in rural primary care settings and identify characteristics associated with MOUD among patients with OUD. METHODS Secondary analyses based on electronic health records of all adult patients who visited 1 of the 6 rural primary care clinic sites from October 2019 to January 2021. Mixed effects logistic regression was conducted to assess MOUD receipt (Y/N) in relation to patient characteristics (eg, demographics, other substance use disorders [SUDs], mental health disorders, and chronic pain) and the number of MOUD prescribers per clinic. FINDINGS The prevalence of OUD varied from 0.7% to 8.2% (Mean [SD] = 3.3% [95% CI: 0.4, 6.1]) among 36,762 primary care patients across 6 clinic sites. Among 1,164 patients with OUD, on average 50.1% received MOUD (95% CI: 28.0, 72.3). Patients in clinics with more than 3 MOUD prescribers had more than 3 times the odds of receiving MOUD (OR = 3.42; 95% CI, 1.22-9.62) as those in clinics with fewer than 3 prescribers. MOUD was positively associated with younger age (18-30 [OR = 6.97; 95% CI, 3.37-14.42], 31-64 [OR = 5.03; 95% CI, 2.64-9.57], relative to those 65 and older), having other co-occurring SUDs (OR = 3.77; 95% CI, 2.57-5.52), being male (OR = 1.50; 95% CI, 1.12-2.01), and negatively associated with having chronic pain disorders (OR = 0.69; 95% CI, 0.50-0.94). CONCLUSIONS The prevalence of OUD and MOUD are high but vary considerably across rural primary care clinics; primary care MOUD prescribers play a key role on MOUD access in rural settings.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Larissa G. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Clingan SE, Cousins SJ, Lin C, Nguyen TE, Hser YI, Mooney LJ. Perceptions of COVID-19 risk during the pandemic: perspectives from people seeking medication for opioid use disorder. Ann Med 2023; 55:480-489. [PMID: 36692029 PMCID: PMC9879168 DOI: 10.1080/07853890.2023.2169342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The Coronavirus Disease 2019 (COVID-19) pandemic has had devastating consequences for persons with opioid use disorder (OUD). Yet, little is known about how people seeking treatment for OUD perceive the risks of COVID-19 and how their perception interplays with their health behaviours. METHODS In-depth interviews were conducted from September 2021 to March 2022 with 32 patients seeking medication treatment for OUD (MOUD) in Southern California. All interviews were conducted virtually and lasted between one and two hours. Interviews were recorded and transcribed verbatim. Two qualitative researchers independently conducted a content analysis of the transcripts to identify themes. RESULTS Three primary themes were identified: (1) perceptions and beliefs about COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed in their beliefs of susceptibility to contracting COVID-19 and the severity of the disease if contracted. Some participants reported taking precautions to mitigate their chances of acquiring COVID-19, and other participants reported that COVID was not a big concern as substance use took priority. For many of the participants, COVID-19 concerns were overshadowed by the risk of overdosing on substances and other risky substance use behaviour. Most of the participants (n = 23; 72%) had received at least one COVID-19 vaccine by the time of the interview, but over half (n = 19; 59%) expressed vaccine hesitancy. Vaccine hesitancy was driven by concerns about the unknown long-term side effects and potential interactions of the vaccine with MOUD. CONCLUSIONS Our study provides insight into COVID-19 prevention measures as well as vaccination perceptions and hesitancy among people who received treatment for OUD.Key messagesParticipants expressed diverse perceptions of the seriousness of COVID-19, with some taking precautions to mitigate their chances of acquiring COVID-19 and others perceiving that the risk of contracting COVID-19 was less than the risk of overdosing.Substance use, social isolation, vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring phenomena that have potentially overlapping relationships that can influence behaviours that impact health and well-being.
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Affiliation(s)
- Sarah E. Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sarah J. Cousins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tram E. Nguyen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Ventuneac A, Dickerson SS, Dharia A, George SJ, Talal AH. Scaling and Sustaining Facilitated Telemedicine to Expand Treatment Access Among Underserved Populations: A Qualitative Study. Telemed J E Health 2023; 29:1862-1869. [PMID: 37252770 DOI: 10.1089/tmj.2022.0534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Background: Opioid treatment programs are an essential component of the management of opioid use disorder (OUD). They have also been proposed as "medical homes" to expand health care access for underserved populations. We utilized telemedicine as a method to increase access for hepatitis C virus (HCV) care among people with OUD. Methods: We interviewed 30 staff and 15 administrators regarding the integration of facilitated telemedicine for HCV into opioid treatment programs. Participants provided feedback and insight for sustaining and scaling facilitated telemedicine for people with OUD. We utilized hermeneutic phenomenology to develop themes related to telemedicine sustainability in opioid treatment programs. Results: Three themes emerged on sustaining the facilitated telemedicine model: (1) Telemedicine as a Technical Innovation in Opioid Treatment Programs, (2) Technology Transcending Space and Time, and (3) COVID-19 Disrupting the Status Quo. Participants identified skilled staff, ongoing training, technology infrastructure and support, and an effective marketing campaign as key to maintaining the facilitated telemedicine model. Participants highlighted the study-supported case manager's role in managing the technology to transcend temporal and geographical challenges for HCV treatment access for people with OUD. COVID-19 fueled changes in health care delivery, including facilitated telemedicine, to expand the opioid treatment program's mission as a medical home for people with OUD. Conclusions: Opioid treatment programs can sustain facilitated telemedicine to increase health care access for underserved populations. COVID-19-induced disruptions promoted innovation and policy changes recognizing telemedicine's role in expanding health care access to underserved populations. ClinicalTrials.gov Identifier: NCT02933970.
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Affiliation(s)
- Ana Ventuneac
- START Treatment & Recovery Centers, Brooklyn, New York, USA
| | - Suzanne S Dickerson
- Division of Biobehavioral Health & Clinical Sciences, School of Nursing, University at Buffalo, Buffalo, New York, USA
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Saliyah J George
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Savinkina A, Jurecka C, Gonsalves G, Barocas JA. Mortality, incarceration and cost implications of fentanyl felonization laws: A modeling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104175. [PMID: 37729682 PMCID: PMC10840895 DOI: 10.1016/j.drugpo.2023.104175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Opioid overdose continues to be a major cause of death in the United States. One effort to control opioid use has been to implement policies that enhance criminalization of opioid possession. Laws to further criminalize possession of fentanyl have been enacted or are under consideration across the country, including at the national level. OBJECTIVE Estimate the long-term effects on opioid death and incarceration resulting from increasingly strict fentanyl possession laws . DESIGN We built a Markov simulation model to explore the potential outcomes of a 2022 Colorado law which made possession of >1 g of drug with any amount of fentanyl a Level 4 drug felony (and escalation of the previous law, where >4 g of any drug with any amount of fentanyl in possession was considered a felony). The model simulates a cohort of people with fentanyl possession moving through the criminal justice system, exploring the probability of overdose and incarceration under different scenarios, including various fentanyl possession policies and potential interventions. SETTING Colorado PARTICIPANTS: A simulated cohort of people in possession of fentanyl. MEASUREMENTS Number of opioid overdose deaths, people incarcerated, and associated costs over 5 years. RESULTS When >4 g of a drug containing any amount of fentanyl is considered a felony in Colorado, the model predicts 5460 overdose deaths (95% CrI 410-9260) and 2,740 incarcerations for fentanyl possession (95% CrI: 230-10,500) over 5 years. When the policy changes so that >1 g possession of drug with fentanyl is considered a felony, opioid overdose deaths increase by 19% (95% CRI: 16-38%) and incarcerations for possession increase by 98% (CrI: 85-98%). Diversion programs and MOUD in prison help alleviate some of the increases in death and incarceration, but do not completely offset them. LIMITATIONS The mathematical model is meant to offer broad assessment of the impact of these policies, not forecast specific and exact numerical outcomes. CONCLUSIONS Our model shows that lowering thresholds for felony possession of fentanyl containing drugs can lead to more opioid overdose deaths and incarceration.
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Affiliation(s)
- Alexandra Savinkina
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, United States.
| | - Cole Jurecka
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gregg Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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Tay Wee Teck J, Gittins R, Zlatkute G, Oteo Pérez A, Galea-Singer S, Baldacchino A. Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants. JMIR Ment Health 2023; 10:e47186. [PMID: 37851506 PMCID: PMC10620637 DOI: 10.2196/47186] [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] [Received: 03/10/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. OBJECTIVE This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. METHODS The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. RESULTS The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. CONCLUSIONS Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.
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Affiliation(s)
- Joseph Tay Wee Teck
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Giedre Zlatkute
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Alberto Oteo Pérez
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Alexander Baldacchino
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Tay Wee Teck J, Butner JL, Baldacchino A. Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review. J Telemed Telecare 2023:1357633X231195607. [PMID: 37661829 DOI: 10.1177/1357633x231195607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
- Forward Leeds and Humankind Charity, Durham, UK
| | - Jenna L Butner
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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Sehrawat O, Noseworthy PA, Siontis KC, Haddad TC, Halamka JD, Liu H. Data-Driven and Technology-Enabled Trial Innovations Toward Decentralization of Clinical Trials: Opportunities and Considerations. Mayo Clin Proc 2023; 98:1404-1421. [PMID: 37661149 DOI: 10.1016/j.mayocp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 09/05/2023]
Abstract
Traditional trial designs have well-recognized inefficiencies and logistical barriers to participation. Decentralized trials and digital health solutions have been suggested as potential solutions and have certainly risen to the challenge during the pandemic. Clinical trial designs are now increasingly data driven. The use of distributed clinical data networks and digitization has helped to fundamentally upgrade existing research systems. A trial design may vary anywhere from fully decentralized to hybrid to traditional on-site. Various decentralization components are available for stakeholders to increase the reach and pace of their trials, such as electronic informed consent, remote interviews, administration, outcome assessment, monitoring, and laboratory and imaging modalities. Furthermore, digital health technologies can be included to enrich study conduct. However, careful consideration is warranted, including assessing verification and validity through usability studies and having various contingencies in place through dedicated risk assessment. Selecting the right combination depends not just on the ability to handle patient care and the medical know-how but also on the availability of appropriate technologic infrastructure, skills, and human resources. Throughout this process, quality of evidence generation and physician-patient relation must not be undermined. Here we also address some knowledge gaps, cost considerations, and potential impact of decentralization and digitization on inclusivity, recruitment, engagement, and retention. Last, we mention some future directions that may help drive the necessary change in the right direction.
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Affiliation(s)
- Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | | | | | - John D Halamka
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN.
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11
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Hser YI, Mooney LJ, Baldwin LM, Ober A, Marsch LA, Sherman S, Matthews A, Clingan S, Fei Z, Zhu Y, Dopp A, Curtis ME, Osterhage KP, Hichborn EG, Lin C, Black M, Calhoun S, Holtzer CC, Nesin N, Bouchard D, Ledgerwood M, Gehring MA, Liu Y, Ha NA, Murphy SM, Hanano M, Saxon AJ. Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study. J Rural Health 2023; 39:780-788. [PMID: 37074350 PMCID: PMC10718290 DOI: 10.1111/jrh.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Seth Sherman
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Abigail Matthews
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Sarah Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Zhe Fei
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, California, USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Katie P. Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Emily G. Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | | | - Noah Nesin
- Penobscot Community Health Care, Bangor, Maine, USA
| | | | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | | | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Neul Ah Ha
- Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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12
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Parker DG, Zentner D, Burack JA, Wendt DC. The impact of the COVID-19 pandemic on medications for opioid use disorder services in the U.S. and Canada: a scoping review. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2181147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel G. Parker
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Daysi Zentner
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Jacob A. Burack
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dennis C. Wendt
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Abidogun TM, Cole TO, Massey E, Kleinman M, Greenblatt AD, Seitz-Brown CJ, Magidson JF, Belcher AM. Patient experiences of COVID-19-induced changes to methadone treatment in a large community-based opioid treatment program in Baltimore. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208946. [PMID: 36880915 PMCID: PMC9822549 DOI: 10.1016/j.josat.2022.208946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 12/30/2022] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Following the March 2020 federal declaration of a COVID-19 public health emergency, in line with recommendations for social distancing and decreased congregation, federal agencies issued sweeping regulation changes to facilitate access to medications for opioid use disorder (MOUD) treatment. These changes allowed patients new to treatment to receive multiple days of take-home medications (THM) and to use remote technology for treatment encounters-allowances that previously had been reserved exclusively for "stable" patients who met minimum adherence and time-in-treatment criteria. The impact of these changes on low-income, minoritized patients (frequently the largest recipients of opioid treatment program [OTP]-based addiction care), however, is not well characterized. We aimed to explore the experiences of patients who were enrolled in treatment prior to COVID-19 OTP regulation changes, with the goal of understanding patients' perceptions of the impact of these changes on treatment. METHODS This study included semistructured, qualitative interviews with 28 patients. We used a purposeful sampling method to recruit individuals who were active in treatment just before COVID-19-related policy changes went into effect, and who were still in treatment several months later. To ensure a diverse array of perspectives, we interviewed individuals who either had or had not experienced challenges with methadone medication adherence from 3/24/21 to 6/8/21, approximately 12-15 months following the onset of COVID-19. Interviews were transcribed and coded using thematic analysis. RESULTS Participants were majority male (57 %), Black/African American (57 %), with a mean age of 50.1 (SD = 9.3). Fifty percent received THM prior to COVID-19, which increased to 93 % during the pandemic. COVID-19 program changes had mixed effects on treatment and recovery experiences. Themes identified convenience, safety, and employment as reasons for preferring THM. Challenges included difficulty with managing/storing medications, experiencing isolation, and concern about relapse. Furthermore, some participants reported that telebehavioral health encounters felt less personal. CONCLUSIONS Policymakers should consider patients' perspectives to foster a more patient-centered approach to methadone dosing that is safe, flexible, and accommodating to a diverse array of patients' needs. Additionally, technical support should be provided to OTPs to ensure interpersonal connections are maintained in the patient-provider relationship beyond the pandemic.
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Affiliation(s)
- Tolulope M Abidogun
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Thomas O Cole
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - Ebonie Massey
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Mary Kleinman
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Aaron D Greenblatt
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America.
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14
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Teck JTW, Zlatkute G, Perez A, Dritschel H, Ghosh A, Potenza MN, Ambekar A, Ekhtiari H, Stein D, Khazaal Y, Arunogiri S, Torrens M, Ferri M, Galea-Singer S, Baldacchino A. Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory. Lancet Psychiatry 2023; 10:50-64. [PMID: 36526346 DOI: 10.1016/s2215-0366(22)00374-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to understand key factors in TMOUD implementation that might explain variations in uptake. We did a scoping review using three English language databases for articles reporting on the implementation of TMOUD services. 57 peer-reviewed articles were identified, subjected to open coding and thematic analysis, and further interpreted through normalisation process theory (NPT). NPT was originally used to evaluate telehealth innovations and has been applied extensively to describe, assess, and develop the implementation potential of a broad range of complex health-care interventions. By categorising our findings according to the four core NPT constructs of coherence, cognitive participation, collective action, and reflexive monitoring, we aim to rationalise the current evidence base to show the workability of TMOUD in practice. We find that variations in TMOUD models in practice depend on organisations' attitudes towards risk, clinicians' tensions around giving up control over standard practices, organisation-level support in overcoming operational and technological challenges, and evaluation methods that might neglect a potential widening of the digital divide.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; Forward Leeds and Humankind Charity, Durham, UK.
| | - Giedre Zlatkute
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Alberto Perez
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Heidi Dritschel
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA; the Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dan Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Research Center, Institute of Mental Health, Montréal University, Montréal, QC, Canada
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Melbourne, VIC, Australia
| | - Marta Torrens
- School of Medicine, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Susanna Galea-Singer
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK; NHS Fife Addiction Services, Leven, UK
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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15
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Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2023; 242:109711. [PMID: 36462230 PMCID: PMC9683518 DOI: 10.1016/j.drugalcdep.2022.109711] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic. METHODS A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services. RESULTS Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints. CONCLUSION The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.
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16
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Na PJ, Bommersbach TJ, Petrakis IL, Rhee TG. National trends of suicidal ideation and mental health services use among US adults with opioid use disorder, 2009-2020. EClinicalMedicine 2022; 54:101696. [PMID: 36267498 PMCID: PMC9576812 DOI: 10.1016/j.eclinm.2022.101696] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The substantial increase in deaths by overdose and potential underlying suicidal intent in such deaths suggest the importance of understanding trends of suicidal ideation in individuals with opioid use disorder (OUD). This study aimed to examine the trends and correlates of past-year suicidal ideation (SI) and mental health service use among US adults with past-year OUD from 2009 to 2020. METHODS We used data from the National Survey on Drug Use and Health. Participants included non-institutionalized US civilians aged ≥18 with past-year OUD (n=5386). SI was measured by self-reported thoughts of killing oneself. Mental health service utilization was assessed with questions concerning receipt of any past-year outpatient or inpatient mental health services or prescription medications. We examined the prevalence and correlates of SI and adjusted odds ratios (aORs) for changes over time adjusting for potentially confounding sociodemographic and clinical characteristics. Further, trends in utilization of mental health services were explored. FINDINGS From 2009 to 2020, the prevalence of SI increased from 22.8% to 29.8% (average annual percent change, 3.64% [95% CI, 1.01-2.10%]) in adults with OUD. Subgroups including individuals aged 18-25 (aOR, 1.72 [95% CI, 1.09-2.71]; P=0.020), residing in non-metropolitan areas (aOR, 1.43 [95% CI, 1.04-1.97]; P = 0.029), with co-occurring past-year major depressive episode (aOR, 5.28 [95% CI, 4.27-6.53]; P < 0.001) and alcohol (aOR, 1.55 [95% CI, 1.23-1.97]; P < 0.001), cocaine (aOR, 1.42 [95% CI, 1.03-1.97]; P = 0.034), and sedative use disorders (aOR, 1.48 [95% CI, 1.11-1.98]; P = 0.008) were associated with SI after adjusting for covariates. No significant change in mental health service use was observed. Individuals with SI were 2.5 times more likely to report an unmet need for treatment compared to individuals without SI (53.6% vs 21.4%; P < 0.001). INTERPRETATION The prevalence of SI in adults with OUD increased substantially without a corresponding change in mental health service use. These results underscore the potential benefit of routine screening for suicidality and improved access to care for individuals with OUD, especially those with co-occurring depression and/or polysubstance use. FUNDING None reported.
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Affiliation(s)
- Peter J. Na
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, CT, United States
| | | | - Ismene L. Petrakis
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, CT, United States
| | - Taeho Greg Rhee
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, CT, United States
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States
- Corresponding author at: 100 York St, STE 2J, New Haven, CT 06511, USA.
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Kamath CC, Kelpin SS, Patten CA, Rummans TA, Kremers HM, Oesterle TS, Williams MD, Breitinger SA. Shaping the Screening, Behavioral Intervention, and Referral to Treatment (SBIRT) Model for Treatment of Alcohol Use Disorder in the COVID-19 Era. Mayo Clin Proc 2022; 97:1774-1779. [PMID: 36202491 PMCID: PMC9293785 DOI: 10.1016/j.mayocp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/15/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Celia C Kamath
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Sydney S Kelpin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery (H.M.K.), Mayo Clinic, Rochester, MN
| | - Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mark D Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Sung ML, Black AC, Blevins D, Henry BF, Cates-Wessel K, Dawes MA, Drexler K, Hagle H, Molfenter T, Levin FR, Becker WC, Edelman EJ. Adaptations to Opioid Use Disorder Care During the COVID-19 Pandemic: A National Survey of Prescribers. J Addict Med 2022; 16:505-513. [PMID: 35020698 PMCID: PMC9271533 DOI: 10.1097/adm.0000000000000948] [Citation(s) in RCA: 3] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Among opioid use disorder (OUD)-treating providers, to characterize adaptations used to provide medications for OUD (MOUD) and factors associated with desire to continue virtual visits post-COVID-19 pandemic. METHODS In a national electronic survey of OUD-treating prescribers (July-August 2020), analyses restricted to X-waivered buprenorphine prescribers providing outpatient, longitudinal care for adults with OUD, quantitative and qualitative analyses of survey items and free text responses were conducted. RESULTS Among 797 respondents, 49% were men, 57% ≥50 years, 76% White, 68% physicians. Respondents widely used virtual visits to continue prescribing existing MOUD regimens (79%), provide behavioral healthcare (71%), and initiate new MOUD prescriptions (49%). Most prescribers preferred to continue/expand use of virtual visits after COVID-19. In multivariable models, factors associated with preference to continue/expand virtual visits to initiate MOUD postpandemic were treating a moderate number of patients prepandemic (aOR = 1.67; 95%[CI] = 1.06,2.62) and practicing in an urban setting (aOR = 2.17; 95%[CI] = 1.48,3.18). Prescribing buprenorphine prepandemic (aOR = 2.06; 95%[CI] = 1.11,3.82) and working in an academic medical center (aOR = 2.47; 95%[CI] = 1.30,4.68) were associated with preference to continue/expand use of virtual visits to continue MOUD postpandemic. Prescribing naltrexone extended-release injection prepandemic was associated with preference to continue/expand virtual visits to initiate and continue MOUD (aOR = 1.51; 95%[CI] = 1.10,2.07; aOR = 1.74; 95%[CI] = 1.19,2.54). Qualitative findings suggest that providers appreciated virtual visits due to convenience and patient accessibility, but were concerned about liability and technological barriers. CONCLUSIONS Surveyed prescribers widely used virtual visits to provide MOUD with overall positive experiences. Future studies should evaluate the impact of virtual visits on MOUD access and retention and clinical outcomes.
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Affiliation(s)
- Minhee L. Sung
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Anne C. Black
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Derek Blevins
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Brandy F. Henry
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Kathryn Cates-Wessel
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Michael A. Dawes
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Karen Drexler
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Holly Hagle
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Todd Molfenter
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - Frances R. Levin
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - William C. Becker
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
| | - E. Jennifer Edelman
- From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
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19
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Korthuis PT, Cook RR, Foot CA, Leichtling G, Tsui JI, Stopka TJ, Leahy J, Jenkins WD, Baker R, Chan B, Crane HM, Cooper HL, Feinberg J, Zule WA, Go VF, Estadt AT, Nance RM, Smith GS, Westergaard RP, Van Ham B, Brown R, Young AM. Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities. JAMA Netw Open 2022; 5:e2226544. [PMID: 35969400 PMCID: PMC9379740 DOI: 10.1001/jamanetworkopen.2022.26544] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
Importance Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. Objective To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses. Design, Setting, and Participants From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022. Exposures Use of methamphetamine alone, opioids alone, or both. Main Outcomes and Measures Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses. Results Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ22 = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone. Conclusions and Relevance These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.
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Affiliation(s)
- P. Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Ryan R. Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Canyon A. Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | | | - Judith I. Tsui
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Robin Baker
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Brian Chan
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Heidi M. Crane
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Hannah L. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown
- Department of Medicine, Infectious Diseases, West Virginia University School of Medicine, Morgantown
| | | | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill
| | - Angela T. Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Robin M. Nance
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Gordon S. Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Ryan P. Westergaard
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brent Van Ham
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Randall Brown
- Department of Family Medicine & Community Health, University of Wisconsin School of Medicine & Public Health, Madison
| | - April M. Young
- Department of Epidemiology, University of Kentucky, Lexington
- Center on Drug and Alcohol Research, University of Kentucky, Lexington
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20
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Durand L, Keenan E, Boland F, Harnedy N, Delargy Í, Scully M, Mayock P, Ebbitt W, Vázquez MO, Corrigan N, Killeen N, Pate M, Byrne P, Cousins G. Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103768. [PMID: 35738029 PMCID: PMC9212711 DOI: 10.1016/j.drugpo.2022.103768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/30/2022]
Abstract
BACKGROUND Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. The contingency guidelines deviated, across multiple clinical domains, from pre-pandemic clinical guidelines published in 2016. The objectives of this study are to (1) identify changes introduced to OAT clinical guidelines in Ireland during the pandemic; and (2) develop consensus on whether the new recommendations should be retained beyond the pandemic, using a national Delphi consensus methodology. METHODS Clinical guidance recommendations ('statements') were generated by comparing the newly established contingency guidelines with the national 2016 Clinical Guidelines for OAT. Over two rounds of on-line Delphi testing, a panel of experts (people currently accessing OAT, psychiatrists, general practitioners, community pharmacists, a nurse, a psychologist and support/key workers) independently rated their agreement with each statement and provided comments. Statements with a median score of 4 or 5 and a lower quartile of ≥4 were classified as having reached consensus. RESULTS Forty-eight panel members were recruited, with a high participation level at Round 2 (90%, n=43). Consensus was achieved for 12 of the 19 statements at Round 1. The 7 remaining statements were revised, with 2 new statements, resulting in 9 statements at Round 2. Four statements reached consensus at Round 2. The final list includes 16 clinical guidance statements; 9 relating to assessment, 3 to OAT drug choice and dosing, 1 to take-away doses, 2 to overdose prevention and 1 to the continuation of e-prescriptions. CONCLUSIONS A wide range of stakeholders involved in the delivery and receipt of OAT agreed on 16 clinical guidance statements for inclusion in OAT clinical guidelines as we move beyond the pandemic, rather than reverting to pre-pandemic guidelines. The agreed statements relate to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Notably, consensus was not achieved for OAT drug dosage and frequency of urine testing during the stabilisation and maintenance phase of care.
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Affiliation(s)
- Louise Durand
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland
| | - Eamon Keenan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Fiona Boland
- RCSI Data Science Centre and Department of General practice, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, D02 DH60, Ireland
| | - Norma Harnedy
- HSE Addiction Services, PO Box 486, Corporate House, Mungret Street, Limerick, V94 PV34, Ireland
| | - Íde Delargy
- Irish College of General Practitioners, Lincoln Place, Dublin 2, D02 XR68, Ireland
| | - Mike Scully
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, 3/4 Foster place, Trinity College Dublin Dublin 2, Ireland
| | - William Ebbitt
- National Drug Treatment Centre, 30/31 Pearse street, Dublin 2, D02 NY26, Ireland
| | - María Otero Vázquez
- UISCE, National Advocacy Service for People who use Drugs in Ireland, 8 Cabra road, Dublin 7, D07 T1W2, Ireland
| | - Nicola Corrigan
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Nicki Killeen
- Health Service Executive, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, D20 KH63, Ireland
| | - Muriel Pate
- Health Service Executive, National Quality and Patient Safety Directorate, Dr. Steeven's Hospital, Dublin 8, D08 W2A8, Ireland
| | - Paula Byrne
- Merchants Quay Ireland Head Office, Merchants Court, 24 Merchants Quay, Dublin 8, D08 × 7YK, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, First Floor, Ardilaun House (Block B), 111 St Stephen's Green, Dublin 2, D02 VN51, Ireland.
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21
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Shapira B, Rosca P. Transformation of substance use disorder treatment services during COVID-19 - A lasting change? JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Barak Shapira
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
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22
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Saxon AJ, Edelman EJ. Introduction to the Special Series: National Drug Abuse Treatment Clinical Trials Network and the Opioid Use Disorder Care Continuum-20 years of research informing practice. Addict Sci Clin Pract 2022; 17:7. [PMID: 35109940 PMCID: PMC8809224 DOI: 10.1186/s13722-022-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S. Columbian Wy., Seattle, WA, 98108, USA.
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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23
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Sugarman DE, Busch AB, McHugh RK, Bogunovic OJ, Trinh CD, Weiss RD, Greenfield SF. Patients' perceptions of telehealth services for outpatient treatment of substance use disorders during the COVID-19 pandemic. Am J Addict 2021; 30:445-452. [PMID: 34405475 PMCID: PMC8429128 DOI: 10.1111/ajad.13207] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives The rapid scale‐up of telehealth services for substance use disorders (SUDs) during the COVID‐19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management. Methods Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23‐item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics. Results Participants were predominately male, White, and well‐educated. The majority (86.2%) were “very satisfied” or “satisfied” with the quality of telehealth care. “Very satisfied” ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%). Discussion and Conclusions Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy. Scientific Significance This is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID‐19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in‐person treatment, there was variability with respect to the preferred mode of treatment delivery.
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Affiliation(s)
- Dawn E Sugarman
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alisa B Busch
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivera J Bogunovic
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine D Trinh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelly F Greenfield
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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