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Yangchen T, Rodriguez M, Baird J, Hallowell BD, Daly MM, Berk J, Gaither R, Wightman RS, Beaudoin FL, Chambers LC. Trends in recurrent overdose and treatment initiation following emergency department visits for opioid overdose between 2016 and 2021. Drug Alcohol Depend 2024; 262:111379. [PMID: 38968835 PMCID: PMC11329345 DOI: 10.1016/j.drugalcdep.2024.111379] [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: 12/04/2023] [Revised: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Overdose remains a pressing public health concern in the United States, particularly with the emergence of fentanyl and other potent synthetic opioids in the drug supply. We evaluated trends in recurrent overdose and opioid use disorder (OUD) treatment initiation following emergency department (ED) visits for opioid overdose to inform response efforts. METHODS This retrospective cohort study used electronic health record and statewide administrative data from Rhode Island residents who visited EDs for opioid overdose between July 1, 2016, and June 30, 2021, a period with fentanyl predominance in the local drug supply. The primary outcome was recurrent overdose in the 365 days following the initial ED visit. OUD treatment initiation within 180 days following the initial ED visit was considered as a secondary outcome. Trends in study outcomes were summarized by year of the initial ED visit. RESULTS Among 1745 patients attending EDs for opioid overdose, 20 % (n=352) experienced a recurrent overdose within 365 days, and this percentage was similar by year (p=0.12). Among patients who experienced any recurrent overdose, the median time to first recurrent overdose was 88 days (interquartile range=23-208), with 85 % (n=299/352) being non-fatal. Among patients not engaged in OUD treatment at their initial ED visit, 33 % (n=448/1370) initiated treatment within 180 days; this was similar by year (p=0.98). CONCLUSIONS Following ED visits for opioid overdose in Rhode Island from 2016-2021, the one-year risk of recurrent overdose and six-month treatment initiation rate remained stable over time. Innovative prevention strategies and improved treatment access are needed.
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Affiliation(s)
- Tenzin Yangchen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - McClaren Rodriguez
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Mackenzie M Daly
- Research, Data Evaluation, and Compliance Unit, Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Providence, RI, USA
| | - Justin Berk
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology. Addict Sci Clin Pract 2023; 18:67. [PMID: 37919755 PMCID: PMC10621088 DOI: 10.1186/s13722-023-00422-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. METHODS We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. RESULTS Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. CONCLUSIONS Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA.
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 5-53, New York, USA.
| | - Bianca D Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
| | - Ji E Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19102, USA
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
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Schiff DM, Partridge S, Gummadi NH, Gray JR, Stulac S, Costello E, Wachman EM, Jones HE, Greenfield SF, Taveras EM, Bernstein JA. Caring for Families Impacted by Opioid Use: A Qualitative Analysis of Integrated Program Designs. Acad Pediatr 2022; 22:125-136. [PMID: 33901729 PMCID: PMC8542059 DOI: 10.1016/j.acap.2021.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to 1) identify models of integrated care that offer medical care and social services for children and families impacted by opioid use disorder (OUD) in the postpartum year; and 2) describe how each program was developed, designed, and sustained, and explore facilitators and barriers to implementation of a dyadic, two-generation approach to care. METHODS In-depth semi-structured interviews (n = 23) were conducted with programs for women and children affected by OUD across North America. Using a phenomenologic approach, key program components and themes were identified. Following thematic saturation, these results were triangulated with experts in program implementation and with a subset of key informants to ensure data integrity. RESULTS Five distinct types of programs were identified that varied in the degree of medical and behavioral care for families. Three themes emerged unique to the provision of dyadic care: 1) families require supportive, frequent visits with a range of providers, but constraints around billable services limit care integration across the perinatal continuum; 2) individual program champions are critical, but degree and reach of interdisciplinary care is limited by siloed systems for medical and behavioral care; and 3) addressing dual, sometimes competing, responsibilities for both parental and infant health following recurrence of parental substance use presents unique challenges. CONCLUSIONS The key components of dyadic care models for families impacted by OUD included prioritizing care coordination, removing barriers to integrating medical and behavioral services, and ensuring the safety of children in homes with ongoing parental substance use while maintaining parental trust.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Shayla Partridge
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Nina H. Gummadi
- Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Jessica R. Gray
- Department of Medicine and Pediatrics, Massachusetts General Hospital, 55 Fruit St, Boston, MA
| | - Sara Stulac
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Eileen Costello
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Elisha M. Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Hendrée E. Jones
- UNC Florizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC
| | - Shelly F. Greenfield
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Division of Women’s Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114,Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, 715 Albany St, Boston, MA 02118
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