1
|
Price CU, Pike KC, Treadway A, Palmer J, Merrill JO. Immediate Effects of Mindful Awareness in Body-oriented Therapy as an Adjunct to Medication for Opioid Use Disorder. RESEARCH SQUARE 2024:rs.3.rs-4727162. [PMID: 39070653 PMCID: PMC11275983 DOI: 10.21203/rs.3.rs-4727162/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Objective While effective, medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. This study examined the pre-post effects of the mindfulness-based intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods People stabilized on medication for OUD (N = 303) from 6 community clinics in Northwestern United States were recruited and randomly assigned to MABT plus MOUD or MOUD only. In a mixed-methods study, we used an intent-to-treat approach to examine the proportion of days abstinent from non-prescribed opioids, and other substance use (primary outcomes) at baseline and 3 months post-intervention. Secondary outcomes included symptoms of mental health distress; emotional regulation difficulties; pain and physical symptom indicators; interoceptive awareness and mindfulness skills. Participant experience of MABT was collected through post-intervention surveys. Changes in outcomes were assessed using linear mixed models; content analysis was used to analyze the qualitative data. Results Levels of overall substance use were low and did not differ between groups. Significant improvements in PTSD symptoms, interoceptive awareness, pain severity, pain activity interference, and physical symptom frequency were found for those who received MABT compared to MOUD only. Conclusion In this stable MOUD population, substance use outcomes were not improved, however MABT demonstrated significant positive changes across multiple health outcomes critical for improving MOUD treatment. Clinical Trials Registration: NCT04082637 on 9/3/2019.
Collapse
|
2
|
Koller D, Friligkou E, Stiltner B, Pathak GA, Løkhammer S, Levey DF, Zhou H, Hatoum AS, Deak JD, Kember RL, Treur JL, Kranzler HR, Johnson EC, Stein MB, Gelernter J, Polimanti R. Pleiotropy and genetically inferred causality linking multisite chronic pain to substance use disorders. Mol Psychiatry 2024; 29:2021-2030. [PMID: 38355787 PMCID: PMC11324857 DOI: 10.1038/s41380-024-02446-3] [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: 07/10/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Individuals suffering from chronic pain develop substance use disorders (SUDs) more often than others. Understanding the shared genetic influences underlying the comorbidity between chronic pain and SUDs will lead to a greater understanding of their biology. Genome-wide association statistics were obtained from the UK Biobank for multisite chronic pain (MCP, Neffective = 387,649) and from the Million Veteran Program and the Psychiatric Genomics Consortium meta-analyses for alcohol use disorder (AUD, Neffective = 296,974), cannabis use disorder (CanUD, Neffective = 161,053), opioid use disorder (OUD, Neffective = 57,120), and problematic tobacco use (PTU, Neffective = 270,120). SNP-based heritability was estimated for each of the traits and genetic correlation (rg) analyses were performed to assess MCP-SUD pleiotropy. Bidirectional Mendelian Randomization analyses evaluated possible causal relationships. Finally, to identify and characterize individual loci, we performed a genome-wide pleiotropy analysis and a brain-wide analysis using imaging phenotypes available from the UK Biobank. MCP was positively genetically correlated with AUD (rg = 0.26, p = 7.55 × 10-18), CanUD (rg = 0.37, p = 8.21 × 10-37), OUD (rg = 0.20, p = 1.50 × 10-3), and PTU (rg = 0.29, p = 8.53 × 10-12). Although the MR analyses supported bi-directional relationships, MCP had larger effects on AUD (pain-exposure: beta = 0.18, p = 8.21 × 10-4; pain-outcome: beta = 0.07, p = 0.018), CanUD (pain-exposure: beta = 0.58, p = 2.70 × 10-6; pain-outcome: beta = 0.05, p = 0.014) and PTU (pain-exposure: beta = 0.43, p = 4.16 × 10-8; pain-outcome: beta = 0.09, p = 3.05 × 10-6) than the reverse. The genome-wide analysis identified two SNPs pleiotropic between MCP and all SUD investigated: IHO1 rs7652746 (ppleiotropy = 2.69 × 10-8), and CADM2 rs1248857 (ppleiotropy = 1.98 × 10-5). In the brain-wide analysis, rs7652746 was associated with multiple cerebellum and amygdala imaging phenotypes. When analyzing MCP pleiotropy with each SUD separately, we found 25, 22, and 4 pleiotropic variants for AUD, CanUD, and OUD, respectively. To our knowledge, this is the first large-scale study to provide evidence of potential causal relationships and shared genetic mechanisms underlying MCP-SUD comorbidity.
Collapse
Affiliation(s)
- Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain.
| | - Eleni Friligkou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Solveig Løkhammer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Alexander S Hatoum
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
| |
Collapse
|
3
|
Ma R, Romano E, Ashworth M, Smith TO, Vancampfort D, Scott W, Gaughran F, Stewart R, Stubbs B. The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104421. [PMID: 37952860 DOI: 10.1016/j.jpain.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain (CP) and mental illness (MI) are leading causes of years lived with disability and commonly co-occur. However, it remains unclear if available interventions are effective in improving pain outcomes in patients with co-existing CP and MI. This systematic review synthesised evidence for the effectiveness of interventions to improve pain outcomes for people with comorbid CP and clinically diagnosed MI. Ten electronic databases were searched from inception until May 2023. Randomised controlled trials (RCTs) were included if they evaluated interventions for CP-related outcomes among people with comorbid CP and clinically diagnosed MI. Pain-related and mental health outcomes were reported as primary and secondary outcomes, respectively. 26 RCTs (2,311 participants) were included. Four trials evaluated the effectiveness of cognitive-behavioural therapy, 6 mindfulness-based interventions, 1 interpersonal psychotherapy, 5 body-based interventions, 5 multi-component interventions, and 5 examined pharmacological-based interventions. Overall, there was considerable heterogeneity in sample characteristics and interventions, and included studies were generally of poor quality with insufficient trial details being reported. Despite the inconsistency in results, preliminary evidence suggests interventions demonstrating a positive effect on CP may include cognitive-behavioural therapy for patients with depression (with a small to medium effect size) and multi-component intervention for people with substance use disorders (with a small effect size). Despite the high occurrence/burden of CP and MI, there is a relative paucity of RCTs investigating interventions and none in people with severe MI. More rigorously designed RCTs are needed to further support our findings. PERSPECTIVE: This systematic review presents current evidence evaluating interventions for CP-related and MH outcomes for people with comorbid CP and clinically diagnosed MI. Our findings could potentially help clinicians identify the most effective treatments to manage these symptoms for this vulnerable patient group.
Collapse
Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Physiotherapy and Psychomotor Therapy Unit, University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; INPUT Pain Management Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| |
Collapse
|
4
|
Cooperman NA, Lu SE, Hanley AW, Puvananayagam T, Dooley-Budsock P, Kline A, Garland EL. Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:338-346. [PMID: 38061786 PMCID: PMC10704342 DOI: 10.1001/jamapsychiatry.2023.5138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Importance Methadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors. Objective To evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain. Design, Setting, and Participants This study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey. Interventions In usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care. Main Outcomes and Measure Primary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach. Results A total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori-specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 10 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P < .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P < .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care-only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care-only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care-only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks. Conclusions and Relevance This randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence. Trial Registration ClinicalTrials.gov Identifier: NCT04491968.
Collapse
Affiliation(s)
- Nina A Cooperman
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Shou-En Lu
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Adam W Hanley
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
| | - Thanusha Puvananayagam
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Patricia Dooley-Budsock
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Anna Kline
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
| |
Collapse
|
5
|
MacLean RR, Ankawi B, Driscoll MA, Gordon MA, Frankforter TL, Nich C, Szollosy SK, Loya JM, Brito L, Ribeiro MIP, Edmond SN, Becker WC, Martino S, Sofuoglu M, Heapy AA. Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment. JMIR Res Protoc 2024; 13:e54342. [PMID: 38506917 PMCID: PMC10993119 DOI: 10.2196/54342] [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] [Received: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. OBJECTIVE This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. METHODS Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. RESULTS The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. CONCLUSIONS Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54342.
Collapse
Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Brett Ankawi
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Mary A Driscoll
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Melissa A Gordon
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Charla Nich
- School of Medicine, Yale University, New Haven, CT, United States
| | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer M Loya
- School of Medicine, Yale University, New Haven, CT, United States
| | - Larissa Brito
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Sara N Edmond
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - William C Becker
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Alicia A Heapy
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| |
Collapse
|
6
|
Kacmarek CN, Smith HC, Kuehn M, Bennett ME, Belcher A, Fitzsimons H, Hall W, Greenblatt A, Li L, Travaglini LE. The impact of chronic pain and depression on medication for opioid use disorder treatment: A mixed-methods analysis. HEROIN ADDICTION AND RELATED CLINICAL PROBLEMS 2024; 26:15. [PMID: 39069987 PMCID: PMC11271030 DOI: 10.62401/2531-4122-2024-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Opioid use disorder (OUD) is associated with significant morbidity and mortality. Medication for opioid use disorder (MOUD) is a cost-effective treatment, but retention rates vary widely. Aim Mixed methods studies are needed to better understand how depression and pain impact the experience of OUD and MOUD treatment experiences. Methods Participants were recruited from an urban addiction treatment center in the United States. Along with demographic characteristics, current pain severity, pain interference, pain catastrophizing, and depression were assessed via self-report. Correlational analyses, multivariable logistic regression models, Fisher exact tests, and Wilcoxon signed rank tests were used to examine the impact of demographic characteristics, physical pain, and depression on multiple treatment outcomes: 90-day treatment engagement (total number of dispensed MOUD doses), retention (yes/no still in treatment at 90 days), and opioid use (positive/negative urinalysis for opioids at 90 days). Ten participants were interviewed about their history with physical pain, depression, opioid use, and OUD treatment experiences. Themes were identified using a rapid analysis, top-down approach. Results Fifty participants enrolled in the study and received buprenorphine (12%) or methadone (88%). Older age was associated with 90-day treatment engagement. Higher depression scores were associated with a positive opioid urinalysis at 90-day follow-up. In interviews, participants reported experiencing chronic physical pain and depression before and during their OUD and an interest in addressing mental and physical health in addiction treatment. Conclusions Addressing co-occurring physical and mental health concerns during MOUD treatment has the potential to improve the treatment experience and abstinence from opioids.
Collapse
Affiliation(s)
- Corinne N Kacmarek
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Hannah C Smith
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Maxwell Kuehn
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melanie E Bennett
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| | - Annabelle Belcher
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Heather Fitzsimons
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - William Hall
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron Greenblatt
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Addiction Research and Treatment, Baltimore, MD, USA
| | - Letitia E Travaglini
- US Department of Veterans Affairs Mental Illness Research Education and Clinical Center, Baltimore, MD, USA
| |
Collapse
|
7
|
Eide D, McDonald R, Hamina A, Clausen T, Odsbu I, Skurtveit S. Prescription high-risk polysubstance use among opioid maintenance treatment patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104196. [PMID: 37741700 DOI: 10.1016/j.drugpo.2023.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Among individuals receiving buprenorphine or methadone as opioid maintenance treatment (OMT), concomitant use of other central nervous system depressants, including prescription drugs, can increase risk of overdose. We aimed to 1) determine the prevalence of use of high-risk prescription drugs (opioid analgesics, benzodiazepines, benzodiazepine-related drugs, and gabapentinoids) among OMT patients, 2) calculate its associations with different mental health and pain-related diagnoses, and 3) compare prevalence of concomitant use with the general population. METHODS A national sample comprising all individuals filling at least one prescription of OMT drugs in Norway in 2019 was formed. Healthcare registry data were linked to investigate high-risk prescription drug use and different diagnoses. We calculated one-year prevalence of use, amount dispensed in defined daily doses (DDDs), and the number of prescribers for the different high-risk prescription drugs. Logistic regression was used to determine associations (adjusted odds ratios; aOR, 95% confidence intervals (CIs)) between diagnoses and use. Prevalence of use was calculated both in the OMT patient sample and the general population. RESULTS Among the OMT patient sample (n=7,299), 47.6% (n=3,476) filled prescriptions for benzodiazepines. For each high-risk prescription drug group, there was a median of 1-2 prescribers. Musculoskeletal diagnoses were the strongest factor for concomitant high-risk prescription drug use for both males (aOR 3.23, CI: 2.72-3.85) and females (aOR 3.07, CI: 2.42- 3.90). The 1-year prevalence of benzodiazepine use was 11.4 times higher for males and 7.1 times higher for females in OMT than the general population. The amount in DDDs was higher for every drug for OMT patients than the general population, particularly for benzodiazepines. CONCLUSIONS OMT patients frequently filled prescriptions for high-risk drugs, and in higher dosages than the general population. However, we found little evidence of 'doctor shopping.' Given that these prescription drugs carry overdose risk, particularly when combined with OMT drugs, our findings emphasize the continued need for education and caution to both prescribers and patients on their concomitant use with OMT.
Collapse
Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway.
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Aleksi Hamina
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Ingvild Odsbu
- Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway; Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| |
Collapse
|
8
|
Osilla KC, Meredith LS, Griffin BA, Martineau M, Hindmarch G, Watkins KE. Design of CLARO+ (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, Plus): A randomized trial of collaborative care to decrease overdose and suicide risk among patients with co-occurring disorders. Contemp Clin Trials 2023; 132:107294. [PMID: 37454728 PMCID: PMC10528487 DOI: 10.1016/j.cct.2023.107294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The United States is mired in two intertwined epidemics of death from suicide and overdose. Opioid use disorder (OUD) and mental illness contribute to both, and individuals with co-occurring disorders (CODs) are a complex population at high risk. Although universal prevention makes sense from a public health perspective, medical and behavioral health providers often lack the time to proactively address these issues with all patients. In this study, we build upon a parent study called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO), a model of collaborative care in which care coordinators deliver preventative measures to high-risk patients and coordinate care with the patients' care team, with the goal of increasing MOUD retention and decreasing risk of suicide and overdose. METHODS CLARO+ adds intervention components on overdose prevention, recognition, and response training; lethal means safety counseling; and an effort to mail compassionate messages called Caring Contacts. Both CLARO and CLARO+ have been implemented at 17 clinics in New Mexico and California, and this study seeks to determine the difference in effectiveness between the two versions of the intervention. This paper describes the design protocol for CLARO+. CONCLUSION CLARO+ is an innovative approach that aims to supplement existing collaborative care with additional suicide and overdose prevention strategies. CLINICALTRIALS gov: NCT04559893.
Collapse
Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304-5590, United States.
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Monique Martineau
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | | |
Collapse
|
9
|
Maremmani I, Dematteis M, Gorzelanczyk EJ, Mugelli A, Walcher S, Torrens M. Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. J Clin Med 2023; 12:5575. [PMID: 37685642 PMCID: PMC10488107 DOI: 10.3390/jcm12175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
Collapse
Affiliation(s)
- Icro Maremmani
- VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy;
- UniCamillus, International Medical University in Rome, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Maurice Dematteis
- Department of Pharmacology and Addiction Medicine, Grenoble-Alpes University Hospital, Grenoble Alpes University, Rue de la Chantourne, 38043 Grenoble, France;
| | - Edward J. Gorzelanczyk
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Faculty of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction ”Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NeuroFarBa), University of Florence, Via della Pergola, 50121 Firenze, Italy;
| | - Stephan Walcher
- CONCEPT Center for Addiction Medicine, Kaiserstrasse 1, D-80801 Munich, Germany;
| | - Marta Torrens
- Addiction Research Group, Hospital del Mar Research Institute Barcelona, 08003 Barcelona, Spain
| |
Collapse
|
10
|
Parisi A, Zgierska AE, Burzinski CA, Lennon RP, Jamison RN, Nakamura Y, Barrett B, Edwards RR, Garland EL. To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse. Drug Alcohol Depend 2023; 247:109890. [PMID: 37167796 PMCID: PMC10714486 DOI: 10.1016/j.drugalcdep.2023.109890] [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: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Individuals with chronic low back pain (CLBP) are commonly prescribed long-term opioid therapy (LTOT) for analgesia, placing this population at increased risk for opioid misuse and opioid use disorder. Acceptance of aversive experiences (e.g., chronic pain) and awareness of automatic thoughts and behaviors (i.e., automaticity) are two facets of dispositional mindfulness that may serve as protective mechanisms against opioid misuse risk. Therefore, the aim of the current study was to examine the differential contributions of these constructs to opioid misuse risk among adults with CLBP receiving LTOT. METHODS Data were obtained from a sample of 770 adults with opioid-treated CLBP. Bivariate correlations and hierarchical linear regression analyses were used to determine whether chronic pain acceptance and awareness of automatic thoughts and behaviors explained a statistically significant portion of variance in opioid misuse risk after accounting for the effects of other relevant confounders. RESULTS Hierarchical regression results revealed that chronic pain acceptance and awareness of automatic thoughts and behaviors contributed a significant portion in the variance of opioid misuse risk. Awareness of automatic thoughts and behaviors was negatively associated with opioid misuse risk, such that individuals with lower levels of awareness of automaticity were at higher risk of opioid misuse. By contrast, pain acceptance was not associated with opioid misuse. CONCLUSIONS Findings suggest that awareness of automaticity may buffer against opioid misuse risk. Interventions designed to strengthen awareness of automaticity (e.g., mindfulness-based interventions) might be especially efficacious among this population.
Collapse
Affiliation(s)
- Anna Parisi
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States
| | - Aleksandra E Zgierska
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Cindy A Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert P Lennon
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Robert N Jamison
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Yoshio Nakamura
- University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, 615 Arapeen Drive, Suite 200, Salt Lake City, UT84108, United States
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert R Edwards
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Eric L Garland
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States.
| |
Collapse
|
11
|
Braciszewski JM, Idu AE, Yarborough BJH, Stumbo SP, Bobb JF, Bradley KA, Rossom RC, Murphy MT, Binswanger IA, Campbell CI, Glass JE, Matson TE, Lapham GT, Loree AM, Barbosa-Leiker C, Hatch MA, Tsui JI, Arnsten JH, Stotts A, Horigian V, Hutcheson R, Bart G, Saxon AJ, Thakral M, Ling Grant D, Pflugeisen CM, Usaga I, Madziwa LT, Silva A, Boudreau DM. Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder. Psychiatr Serv 2022; 73:1330-1337. [PMID: 35707859 PMCID: PMC9722542 DOI: 10.1176/appi.ps.202100665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems. METHODS This retrospective study used 2014-2016 data from patients ages ≥16 years in six health systems. Diagnoses were obtained from electronic health records or claims data; opioid use disorder treatment with buprenorphine or injectable extended-release naltrexone was determined through prescription and procedure data. Adjusted prevalence of comorbid conditions among patients with opioid use disorder (with or without treatment), stratified by sex, was estimated by fitting logistic regression models for each condition and applying marginal standardization. RESULTS Females (53.2%, N=7,431) and males (46.8%, N=6,548) had a similar prevalence of opioid use disorder. Comorbid mental disorders among those with opioid use disorder were more prevalent among females (86.4% vs. 74.3%, respectively), whereas comorbid other substance use disorders (excluding nicotine) were more common among males (51.9% vs. 60.9%, respectively). These differences held for those receiving medication treatment for opioid use disorder, with mental disorders being more common among treated females (83% vs. 71%) and other substance use disorders more common among treated males (68% vs. 63%). Among patients with a single mental health condition comorbid with opioid use disorder, females were less likely than males to receive medication treatment for opioid use disorder (15% vs. 20%, respectively). CONCLUSIONS The high rate of comorbid conditions among patients with opioid use disorder indicates a strong need to supply primary care providers with adequate resources for integrated opioid use disorder treatment.
Collapse
Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Abisola E Idu
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Bobbi Jo H Yarborough
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Scott P Stumbo
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Jennifer F Bobb
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Katharine A Bradley
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Mark T Murphy
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Ingrid A Binswanger
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Cynthia I Campbell
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Joseph E Glass
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Theresa E Matson
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Gwen T Lapham
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Celestina Barbosa-Leiker
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Mary A Hatch
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Judith I Tsui
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Julia H Arnsten
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Angela Stotts
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Viviana Horigian
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Rebecca Hutcheson
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Gavin Bart
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Andrew J Saxon
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Manu Thakral
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Deborah Ling Grant
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Chaya Mangel Pflugeisen
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Ingrid Usaga
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Lawrence T Madziwa
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Angela Silva
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| | - Denise M Boudreau
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau)
| |
Collapse
|
12
|
Yoga & Pilates for those with chronic pain: A pilot study among women in substance use rehabilitation. J Bodyw Mov Ther 2022. [DOI: 10.1016/j.jbmt.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Gray E, Wilson M, Landis TT, Little-Gott A. "It's Like Your Whole Body Hates You": Experiences of Withdrawal, Distress, and Barriers to Relief Among Adults Receiving Methadone for Opioid Use Disorder. J Addict Nurs 2022; 33:309-316. [PMID: 37140418 DOI: 10.1097/jan.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT A qualitative descriptive study was conducted concurrent with a larger study investigating the effects of hyperbaric oxygen treatment on withdrawal symptoms for adults receiving daily methadone for opioid use disorder. The aims of this study were to (a) evaluate the perceptions of withdrawal symptoms and sleep characteristics of study participants and (b) explore the experiences of participation in the parent trial of hyperbaric oxygen treatment.Adults with opioid use disorder can experience distressing symptoms related to withdrawal as well as co-occurring symptoms; sleep impairment is frequently reported. Few studies have examined how adults who receive medication for opioid use disorder experience sleep. A preliminary study of adults receiving daily methadone found that withdrawal symptoms were improved after hyperbaric oxygen treatment. This study explores the narrative of opioid users who report their overall experiences with withdrawal and sleep as well as their experiences of hyperbaric therapy.A convenience sample of six participants was recruited, who represented a small subgroup of participants who completed the larger hyperbaric treatment study. Data were collected via semistructured interviews. Data were analyzed using the qualitative content analysis guidelines proposed by Schreier (2012). All participants described poor overall sleep hygiene and disturbed sleep. More than half of the respondents reported improved or eliminated withdrawal symptoms, and all reported improvement in sleep quality after participation in the sleep study.This companion study confirms that subjective sleep disturbance may be prevalent for adults with opioid use disorder. Participants felt the experience of hyperbaric oxygen treatment produced a positive effect on sleep.
Collapse
|
14
|
Jennings MV, Lee H, Rocha DB, Bianchi SB, Coombes BJ, Crist RC, Faucon AB, Hu Y, Kember RL, Mallard TT, Niarchou M, Poulsen MN, Straub P, Urman RD, Walsh CG, Davis LK, Smoller JW, Troiani V, Sanchez-Roige S. Identifying High-Risk Comorbidities Associated with Opioid Use Patterns Using Electronic Health Record Prescription Data. Complex Psychiatry 2022; 8:47-55. [PMID: 36545045 PMCID: PMC9669950 DOI: 10.1159/000525313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Opioid use disorders (OUDs) constitute a major public health issue, and we urgently need alternative methods for characterizing risk for OUD. Electronic health records (EHRs) are useful tools for understanding complex medical phenotypes but have been underutilized for OUD because of challenges related to underdiagnosis, binary diagnostic frameworks, and minimally characterized reference groups. As a first step in addressing these challenges, a new paradigm is warranted that characterizes risk for opioid prescription misuse on a continuous scale of severity, i.e., as a continuum. Methods Across sites within the PsycheMERGE network, we extracted prescription opioid data and diagnoses that co-occur with OUD (including psychiatric and substance use disorders, pain-related diagnoses, HIV, and hepatitis C) for over 2.6 million patients across three health registries (Vanderbilt University Medical Center, Mass General Brigham, Geisinger) between 2005 and 2018. We defined three groups based on levels of opioid exposure: no prescriptions, minimal exposure, and chronic exposure and then compared the comorbidity profiles of these groups to the full registries and to those with OUD diagnostic codes. Results Our results confirm that EHR data reflects known higher prevalence of substance use disorders, psychiatric disorders, medical, and pain diagnoses in patients with OUD diagnoses and chronic opioid use. Comorbidity profiles that distinguish opioid exposure are strikingly consistent across large health systems, indicating the phenotypes described in this new quantitative framework are robust to health systems differences. Conclusion This work indicates that EHR prescription opioid data can serve as a platform to characterize complex risk markers for OUD using existing data.
Collapse
Affiliation(s)
- Mariela V Jennings
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Hyunjoon Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel B Rocha
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania, USA
| | - Sevim B Bianchi
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Crist
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annika B Faucon
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Travis T Mallard
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Niarchou
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Peter Straub
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lea K Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanessa Troiani
- Geisinger Clinic, Geisinger, Danville, Pennsylvania, USA.,Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania, USA.,Neuroscience Institute, Geisinger, Danville, Pennsylvania, USA.,Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Sandra Sanchez-Roige
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | |
Collapse
|
15
|
Calcaterra SL, Lockhart S, Callister C, Hoover K, Binswanger IA. Opioid Use Disorder Treatment Initiation and Continuation: a Qualitative Study of Patients Who Received Addiction Consultation and Hospital-Based Providers. J Gen Intern Med 2022; 37:2786-2794. [PMID: 34981359 PMCID: PMC8722657 DOI: 10.1007/s11606-021-07305-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hospitalizations related to opioid use disorder (OUD) are rising. Addiction consultation services (ACS) increasingly provide OUD treatment to hospitalized patients, but barriers to initiating and continuing medications for OUD remain. We examined facilitators and barriers to hospital-based OUD treatment initiation and continuation from the perspective of patients and healthcare workers in the context of an ACS. METHODS In this qualitative study, we sought input using key informant interviews and focus groups from patients who received care from an ACS during their hospitalization and from hospitalists, pharmacists, social workers, and nurses who work in the hospital setting. A multidisciplinary team coded and analyzed transcripts using a directed content analysis. FINDINGS We conducted 20 key informant interviews with patients, nine of whom were interviewed following hospital discharge and 12 of whom were interviewed during a rehospitalization. We completed six focus groups and eight key informant interviews with hospitalists and hospital-based medical staff (n = 62). Emergent themes related to hospital-based OUD treatment included the following: the benefit of an ACS to facilitate OUD treatment engagement; expanded use of methadone or buprenorphine to treat opioid withdrawal; the triad of hospitalization, self-efficacy, and easily accessible, patient-centered treatment motivates change in opioid use; adequate pain control and stabilization of mental health conditions among patients with OUD contributed to opioid agonist therapy (OAT) continuation; and stable housing and social support are prerequisites for OAT uptake and continuation. CONCLUSION Modifiable factors which facilitate hospital-based OUD treatment initiation and continuation include availability of in-hospital addiction expertise to offer easily accessible, patient-centered treatment and the use of methadone or buprenorphine to manage opioid withdrawal. Further research and public policy efforts are urgently needed to address reported barriers to hospital-based OUD treatment initiation and continuation which include unstable housing, poorly controlled chronic medical and mental illness, and lack of social support.
Collapse
Affiliation(s)
- Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado, 8th Floor, Academic Office 1, Mailstop B180, 12631 E 17th Ave, Aurora, CO, 80045, USA.
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA.
| | - Steve Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, Univeristy of Colorado, School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Kaitlyn Hoover
- Clinical Science Graduate Program, University of Colorado, Aurora, CO, USA
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado, 8th Floor, Academic Office 1, Mailstop B180, 12631 E 17th Ave, Aurora, CO, 80045, USA
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Colorado Permanente Medical Group, Aurora, CO, USA
- Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| |
Collapse
|
16
|
Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders. Addict Sci Clin Pract 2022; 17:25. [PMID: 35395811 PMCID: PMC8991671 DOI: 10.1186/s13722-022-00302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background Opioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders. Methods Our adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019). Results We documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs. Conclusions We completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery. Trial registration NCT04559893, NCT04634279. Registered 08 September 2020, https://clinicaltrials.gov/ct2/show/NCT04559893
Collapse
|
17
|
Johnson BN, McKernan LC, Bruehl S. A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury. Curr Pain Headache Rep 2022; 26:405-414. [PMID: 35380406 DOI: 10.1007/s11916-022-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts. RECENT FINDINGS See Fig. 1. See Fig. 1.
Collapse
|
18
|
Baessler A, Smith PJ, Brolin TJ, Neel RT, Sen S, Zhu R, Bernholt D, Azar FM, Throckmorton TW. Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:608-615. [PMID: 34474138 DOI: 10.1016/j.jse.2021.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has proved to be a highly effective treatment for rotator cuff-deficient conditions and other end-stage shoulder pathologies. With value-based care emerging, identifying predictive factors of outcomes is of great interest. Although preoperative opioid use has been shown to predict inferior outcomes after anatomic total shoulder arthroplasty and rotator cuff repair, there is a paucity of data regarding its effect on outcomes after RTSA. We analyzed a series of RTSAs to determine the influence of preoperative opioid use on clinical and radiographic outcomes at a minimum of 2 years' follow-up. METHODS A retrospective review of primary RTSA patient data revealed 264 patients with ≥2 years of clinical and radiographic follow-up. Patients were classified as preoperative opioid users (71 patients) if they had taken narcotic pain medication for a minimum of 3 months prior to surgery or as opioid naive (193 patients) at the time of surgery. Assessments included preoperative and postoperative visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, strength, and range of motion, as well as complications and revisions. Radiographs were analyzed for signs of loosening or mechanical failure. The Mann-Whitney U and Fisher exact tests were used for comparisons between groups. Statistical significance was set at P < .05. RESULTS The mean patient age was 69.9 years, and the mean follow-up time was 2.8 years. Opioid users were significantly younger (66.1 years vs. 70.7 years, P < .001) at the time of surgery and had significantly higher preoperative rates of mood disorders, chronic pain disorders, and disability status (all P < .05). Postoperatively, opioid users had inferior visual analog scale pain scores (2.59 vs. 1.25, P < .001), American Shoulder and Elbow Surgeons scores (63.2 vs. 75.2, P < .001), active forward elevation (P < .001), and internal and external rotational shoulder strength (all P < .05) compared with opioid-naive patients. Periprosthetic radiolucency (8.45% vs. 2.07%, P = .026) and subsequent revision arthroplasty (14.1% vs. 4.66%, P = .014) occurred more frequently in opioid users than in opioid-naive patients. Both groups improved from baseline preoperatively to most recent follow-up in terms of functional outcomes and pain. CONCLUSION Preoperative opioid use portended markedly inferior clinical outcomes in patients undergoing RTSA. Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revision. Preoperative opioid use appears to be a significant marker for adverse outcomes after RTSA.
Collapse
Affiliation(s)
- Aaron Baessler
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Patrick J Smith
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Robert T Neel
- University of Tennessee Health Science Center School of Medicine, Memphis, TN, USA
| | - Saunak Sen
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rongshun Zhu
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
| |
Collapse
|
19
|
Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
Collapse
Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System. J Addict Med 2022; 16:65-71. [PMID: 35120065 PMCID: PMC8817063 DOI: 10.1097/adm.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Coprescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ coprescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. METHODS Using data from the California state Prescription Drug Monitoring Program during 2010 to 2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5202 patients (1978 with OUD, 3224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. RESULTS About 10.5% of the sample died on or before December 31, 2014. About 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15-1.55 per 10 mg/d increment) and opioids (OR = 1.04, 95%CI: 1.02-1.05 per 10 mg/d increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) = 3.83, 95%CI: 1.78-8.21). CONCLUSIONS Study findings highlight significant mortality associated with the coprescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.
Collapse
|
21
|
DeBar L, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial. Ann Intern Med 2022; 175:46-55. [PMID: 34724405 PMCID: PMC9802183 DOI: 10.7326/m21-1436] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic pain is common, disabling, and costly. Few clinical trials have examined cognitive behavioral therapy (CBT) interventions embedded in primary care settings to improve chronic pain among those receiving long-term opioid therapy. OBJECTIVE To determine the effectiveness of a group-based CBT intervention for chronic pain. DESIGN Pragmatic, cluster randomized controlled trial. (ClinicalTrials.gov: NCT02113592). SETTING Kaiser Permanente health care systems in Georgia, Hawaii, and the Northwest. PARTICIPANTS Adults (aged ≥18 years) with mixed chronic pain conditions receiving long-term opioid therapy. INTERVENTION A CBT intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorist, nurse, physical therapist, and pharmacist) versus usual care. MEASUREMENTS Self-reported pain impact (primary outcome, as measured by the PEGS scale [pain intensity and interference with enjoyment of life, general activity, and sleep]) was assessed quarterly over 12 months. Pain-related disability, satisfaction with care, and opioid and benzodiazepine use based on electronic health care data were secondary outcomes. RESULTS A total of 850 patients participated, representing 106 clusters of primary care providers (mean age, 60.3 years; 67.4% women); 816 (96.0%) completed follow-up assessments. Intervention patients sustained larger reductions on all self-reported outcomes from baseline to 12-month follow-up; the change in PEGS score was -0.434 point (95% CI, -0.690 to -0.178 point) for pain impact, and the change in pain-related disability was -0.060 point (CI, -0.084 to -0.035 point). At 6 months, intervention patients reported higher satisfaction with primary care (difference, 0.230 point [CI, 0.053 to 0.406 point]) and pain services (difference, 0.336 point [CI, 0.129 to 0.543 point]). Benzodiazepine use decreased more in the intervention group (absolute risk difference, -0.055 [CI, -0.099 to -0.011]), but opioid use did not differ significantly between groups. LIMITATION The inclusion of only patients with insurance in large integrated health care systems limited generalizability, and the clinical effect of change in scores is unclear. CONCLUSION Primary care-based CBT, using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care but did not reduce use of opioid medication. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.D.)
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland, Oregon, and Montana State University College of Nursing, Missoula, Montana (L.B.)
| | - Allison Bonifay
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Richard A Deyo
- Oregon Health & Science University School of Medicine, Portland, Oregon (R.A.D.)
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Francis J Keefe
- Duke University School of Medicine, Durham, North Carolina (F.J.K.)
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | - Ashli Owen-Smith
- Georgia State University School of Public Health and Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, Georgia (A.O.)
| | - David H Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| | | | - William M Vollmer
- Kaiser Permanente Center for Health Research, Portland, Oregon (M.M., A.B., C.R.E., M.C.L., C.M., D.H.S., W.M.V.)
| |
Collapse
|
22
|
Pandey M, Marwah R, McLean M, Paluck E, Oliver AM, Maierhoffer S, Rude D, Oakes L. Patient perspectives from the multi-disciplinary chronic pain clinic: a qualitative study. Pain Manag 2021; 12:383-396. [PMID: 34809470 DOI: 10.2217/pmt-2021-0072] [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: 11/21/2022] Open
Abstract
Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.
Collapse
Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Radhika Marwah
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada.,Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, S4P 2S5, Canada
| | - Maeve McLean
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Elan Paluck
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Amanda M Oliver
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Shelly Maierhoffer
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Darlene Rude
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; from 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
| | - Larry Oakes
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; from 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
| |
Collapse
|
23
|
Peck KR, Moxley-Kelly N, Badger GJ, Sigmon SC. Posttraumatic stress disorder in individuals seeking treatment for opioid use disorder in Vermont. Prev Med 2021; 152:106817. [PMID: 34599919 PMCID: PMC8641000 DOI: 10.1016/j.ypmed.2021.106817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) may be associated with poor outcomes in rural areas where access to mental health services and opioid agonist treatment (OAT) is limited. This study examined the characteristics associated with a history of PTSD among a sample of individuals seeking buprenorphine treatment for OUD in Vermont, the second-most rural state in the US. Participants were 89 adults with OUD who participated in one of two ongoing randomized clinical trials examining the efficacy of an interim buprenorphine dosing protocol for reducing illicit opioid use during waitlist delays to OAT. Thirty-one percent of participants reported a history of PTSD. Those who did (PTSD+; n = 28) and did not (PTSD-; n = 61) report a history of PTSD were similar on sociodemographic and drug use characteristics. However, the PTSD+ group was less likely to have received prior OUD treatment compared to the PTSD- group (p = .02) despite being more likely to have a primary care physician (p = .009) and medical insurance (p = .002). PTSD+ individuals also reported greater mental health service utilization, more severe psychiatric, medical and drug use consequences, and greater pain severity and interference vs. PTSD- individuals (ps < 0.05). These findings indicate that a history of PTSD is prevalent and associated with worse outcomes among individuals seeking treatment for OUD in Vermont. Dissemination of screening measures and targeted interventions may help address the psychiatric and medical needs of rural individuals with OUD and a history of PTSD.
Collapse
Affiliation(s)
- Kelly R Peck
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - Stacey C Sigmon
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| |
Collapse
|
24
|
Keenan KE, Rothberg MB, Herzig SJ, Lam S, Velez V, Martinez KA. Association between Opioids Prescribed to Medical Inpatients with Pain and Long-Term Opioid Use. South Med J 2021; 114:623-629. [PMID: 34599339 DOI: 10.14423/smj.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Opioid receipt during medical hospitalizations may be associated with subsequent long-term use. Studies, however, have not accounted for pain, which may explain chronic use. The objective of this study was to identify the association between opioid exposure during a medical hospitalization and use 6 to 12 months later. METHODS This was an observational cohort study using electronic health record data from 10 hospitals in the Cleveland Clinic Health System in 2016. Eligible patients were opioid-naïve adults with pain age 18 years and older, admitted to a medical service. Outcomes were opioid receipt during hospitalization and on discharge, and long-term opioid use, defined as ≥2 prescriptions for at least 30 pills 6 to 12 months posthospitalization. We estimated the odds of long-term opioid use by opioid exposure during the hospitalization. Models controlled for patient demographic and clinical characteristics, including patient-reported pain. RESULTS Among the 2971 patients in the sample, 64% received opioids during their hospitalization and 28% were discharged with opioids. Overall, 3% of patients had long-term use. Higher pain score was associated with greater odds of long-term use (adjusted odds ratio [aOR] per point increase 1.11; 95% confidence interval [CI] 1.03-1.19). No patient factors were associated with long-term use. Receipt of an opioid during a hospitalization only was not associated with long-term use (aOR 1.44, 95% CI 0.81-2.57), but receipt at discharge was (aOR 1.96, 95% CI 1.08-3.56). CONCLUSIONS Although opioid receipt at discharge was associated with long-term use, the number of patients this applied to was small. Pain severity was an important predictor of long-term use and should be accounted for in future studies.
Collapse
Affiliation(s)
- Kaitlin E Keenan
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Michael B Rothberg
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Shoshana J Herzig
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Simon Lam
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Vicente Velez
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Kathryn A Martinez
- From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
25
|
Finan PH, Letzen J, Epstein DH, Mun CJ, Stull S, Kowalczyk WJ, Agage D, Phillips KA, Pizzagalli DA, Preston KL. Reward Responsiveness in Patients with Opioid Use Disorder on Opioid Agonist Treatment: Role of Comorbid Chronic Pain. PAIN MEDICINE 2021; 22:2019-2027. [PMID: 33624802 DOI: 10.1093/pm/pnab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Evidence suggests that blunted reward responsiveness may account for poor clinical outcomes in both opioid use disorder (OUD) and chronic pain. Understanding how individuals with OUD and comorbid chronic pain (OUD+CP) respond to rewards is, therefore, of clinical interest because it may reveal a potential point of behavioral intervention. METHODS Patients with OUD (n = 28) and OUD+CP (n = 19) on opioid agonist treatment were compared on: 1) the Probabilistic Reward Task (an objective behavioral measure of reward response bias) and 2) ecological momentary assessment of affective responses to pleasurable events. RESULTS Both the OUD and the OUD+CP groups evidenced an increase in reward response bias in the Probabilistic Reward Task. The rate of change in response bias across blocks was statistically significant in the OUD group (B = 0.06, standard error [SE] = 0.02, t = 3.92, P < 0.001, 95% confidence interval [CI]: 0.03 to 0.09) but not in the OUD+CP group (B = 0.03, SE = 0.02, t = 1.90, P = 0.07, 95% CI: -0.002 to 0.07). However, groups did not significantly differ in the rate of change in response bias across blocks (B = 0.03, SE = 0.02, t = 1.21, P = 0.23, 95% CI: -0.02 to 0.07). Groups did not significantly differ on state measures of reward responsiveness (P's ≥0.50). CONCLUSIONS Overall, findings across objective and subjective measures were mixed, necessitating follow-up with a larger sample. The results suggest that although there is a reward response bias in patients with OUD+CP treated with opioid agonist treatment relative to patients with OUD without CP, it is modest and does not appear to translate into patients' responses to rewarding events as they unfold in daily life.
Collapse
Affiliation(s)
- Patrick H Finan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Janelle Letzen
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| | - Chung Jung Mun
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Samuel Stull
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| | - William J Kowalczyk
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| | - Daniel Agage
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| | | | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, Maryland
| |
Collapse
|
26
|
Fox LM, Shastry S, Harper-Brooks A, Ramdin C, Manini AF. Pilot survey of prescription opioid use patterns and engagement with harm-reduction strategies in emergency department patients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100062. [PMID: 35480608 PMCID: PMC9031431 DOI: 10.1016/j.rcsop.2021.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background The United States is experiencing an opioid epidemic. The aim of this pilot study was to describe patterns of prescription opioid medication (POM) use, examine factors associated with opioid misuse and overdose, and assess knowledge of take-home naloxone, and other harm-reduction strategies as well as participation in medications for opioid use disorder (MOUD) among emergency department (ED) patients that have been prescribed opioid medications. Methods This was a pilot survey of a convenience sample of adult ED patients with a past opioid prescription at one urban tertiary care hospital. The survey asked participants about patterns of opioid consumption, risk factors associated with opioid misuse, and knowledge of harm-reduction strategies. The survey tool consisted of mixed open- and closed-ended questions. Reported daily POM consumption was converted to milligram morphine equivalents (MME). Responses to survey questions were compared with daily MME in order to generate hypotheses for future research. Results 50 individuals completed a survey. Of these, 56% reported taking opioids daily, and 24% reported greater than 100 MME daily opioid consumption. Many subjects reported history of psychiatric illness (34%) and previous substance abuse treatment (24%). The majority of patients (66%) were not aware of take-home naloxone programs to treat opioid overdose. Conclusions In this pilot survey of ED patients with a pain-related chief complaint, many respondents reported risk factors for opioid misuse, and the majority of participants were unaware of the existence of important harm-reduction strategies, such as take-home naloxone programs, even among those with the highest daily POM use.
Collapse
Affiliation(s)
- Lindsay M. Fox
- Rutgers New Jersey Medical School, Department of Emergency Medicine, 185 South Orange Ave, MSB E 609, Newark, NJ 07103, United States of America
| | - Siri Shastry
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Corresponding author at: 555 West 57th, 5th Floor, New York, NY 10019, United States of America.
| | - Avis Harper-Brooks
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, 185 South Orange Ave, MSB E 609, Newark, NJ 07103, United States of America
| | - Alex F. Manini
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Division of Medical Toxicology, Elmhurst Hospital Center, New York, NY, United States of America
| |
Collapse
|
27
|
Glynn LH, Chen JA, Dawson TC, Gelman H, Zeliadt SB. Bringing chronic-pain care to rural veterans: A telehealth pilot program description. Psychol Serv 2021; 18:310-318. [PMID: 31944817 PMCID: PMC7927421 DOI: 10.1037/ser0000408] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Opioid-related harms disproportionately affect rural communities. Recent research-based policy changes have called for reductions in opioid prescribing and substitution of safe and effective alternatives to opioids for treating chronic pain, but such alternatives are often difficult to access in rural areas. Telehealth services can help address this disparity by bringing evidence-based, biopsychosocial chronic-pain services to rural and underserved patients with chronic pain. This article describes a 2-year pilot project for delivering chronic-pain care by pain specialists from central hubs at Veterans Health Administration (VA) medical centers to spokes at VA community-based outpatient clinics (CBOCs). The VA Puget Sound Pain Telehealth pilot program offered pain education classes, cognitive-behavioral therapy groups, opioid-safety education, and acupuncture education. The program delivered 501 encounters to patients from 1 hub to 4 CBOC spoke sites from 2016 to 2018, and supported training, administration, equipment acquisition, and grant-writing. The quality-improvement project was rolled out using existing local resources. We present initial findings about the patients who utilized Pain Telehealth, share lessons learned, and discuss future directions for expansion. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - Hannah Gelman
- Denver-Seattle Center of Innovation (COIN) for Veteran-Centered Value-Driven Care
| | - Steven B Zeliadt
- Denver-Seattle Center of Innovation (COIN) for Veteran-Centered Value-Driven Care
| |
Collapse
|
28
|
Stormshak EA, Matulis JM, Nash W, Cheng Y. The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories. Front Psychol 2021; 12:695967. [PMID: 34305753 PMCID: PMC8294463 DOI: 10.3389/fpsyg.2021.695967] [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: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.
Collapse
Affiliation(s)
- Elizabeth A Stormshak
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Jordan M Matulis
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Whitney Nash
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - Yijun Cheng
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| |
Collapse
|
29
|
Fritz JM, Davis AF, Burgess DJ, Coleman B, Cook C, Farrokhi S, Goertz C, Heapy A, Lisi AJ, McGeary DD, Rhon DI, Taylor SL, Zeliadt S, Kerns RD. Pivoting to virtual delivery for managing chronic pain with nonpharmacological treatments: implications for pragmatic research. Pain 2021; 162:1591-1596. [PMID: 33156148 PMCID: PMC8089114 DOI: 10.1097/j.pain.0000000000002139] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Alison F Davis
- Pain Management Collaboratory, Department of Psychiatry (dept. affiliation for Dr. Davis) Yale University School of Medicine, New Haven, CT, United States
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, United States. Dr. Burgess is now with Department of Medicine (dept. affiliation for Dr. Burgess) University of Minnesota Medical School, Minneapolis, MN, United States
| | - Brian Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States
| | - Chad Cook
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC, United States
| | - Shawn Farrokhi
- DoD-VA Extremity and Amputation Center of Excellence, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego, CA, United States
| | - Christine Goertz
- Department of Orthopaedics, Duke University School of Medicine, and Core Faculty Member, Duke-Margolis Center for Health Policy, Durham, NC, United States
| | - Alicia Heapy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States. Dr. Heapy is now with VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Health Services Research and Development Center of Innovation, West Haven/Yale School of Medicine, New Haven, CT, United States
| | - Anthony J Lisi
- Department of Veterans Affairs, and Associate Research Scientist, Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Donald D McGeary
- Departments of Rehabilitation Medicine and Psychiatry (Dept. affiliation for Dr. McGeary) University of Texas Health, San Antonio, TX, United States
| | - Daniel I Rhon
- Brooke Army Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Stephanie L Taylor
- VA HSR&D, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. Dr. McGeary is now with Departments of Medicine and Health Policy and Management, UCLA, Los Angeles, CA, United States
| | - Steven Zeliadt
- Veterans Administration Puget Sound Health Care System, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States. Dr. Kerns is now with VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, United States
| |
Collapse
|
30
|
Peck KR, Ochalek TA, Streck JM, Badger GJ, Sigmon SC. Impact of Current Pain Status on Low-Barrier Buprenorphine Treatment Response Among Patients with Opioid Use Disorder. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1205-1212. [PMID: 33585885 PMCID: PMC8139817 DOI: 10.1093/pm/pnab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/07/2020] [Accepted: 02/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Chronic non-cancer pain (CNCP) is prevalent among individuals with opioid use disorder (OUD). However, the impact of CNCP on buprenorphine treatment outcomes is largely unknown. In this secondary analysis, we examined treatment outcomes among individuals with and without CNCP who received a low-barrier buprenorphine maintenance regimen during waitlist delays to more comprehensive opioid treatment. METHODS Participants were 28 adults with OUD who received 12 weeks of buprenorphine treatment involving bimonthly clinic visits, computerized medication dispensing, and phone-based monitoring. At intake and monthly follow-up assessments, participants completed the Brief Pain Inventory, Beck Anxiety Inventory, Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), Addiction Severity Index, and staff-observed urinalysis. RESULTS Participants with CNCP (n = 10) achieved comparable rates of illicit opioid abstinence as those without CNCP (n = 18) at weeks 4 (90% vs 94%), 8 (80% vs 83%), and 12 (70% vs 67%) (P = 0.99). Study retention was also similar, with 90% and 83% of participants with and without CNCP completing the 12-week study, respectively (P = 0.99). Furthermore, individuals with CNCP demonstrated significant improvements on the BDI-II and Global Severity Index subscale of the BSI (P < 0.05). However, those with CNCP reported more severe medical problems and smaller reductions in legal problems relative to those without CNCP (P = 0.03). CONCLUSIONS Despite research suggesting that chronic pain may influence OUD treatment outcomes, participants with and without CNCP achieved similar rates of treatment retention and significant reductions in illicit opioid use and psychiatric symptomatology during low-barrier buprenorphine treatment.
Collapse
Affiliation(s)
- Kelly R Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Departments of Psychiatry, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Joanna M Streck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Gary J Badger
- Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Departments of Psychiatry, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| |
Collapse
|
31
|
Barry DT, Beitel M, Cutter CJ, Fiellin DA, Madden LM, Lipkind N, Bollampally P, Liong C, Schottenfeld RS. Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder. Drug Alcohol Depend 2021; 221:108608. [PMID: 33667784 PMCID: PMC8026725 DOI: 10.1016/j.drugalcdep.2021.108608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The study objective was to compare psychiatric comorbidity among patients seeking treatment for chronic pain and opioid use disorder (OUD) by order of condition onset (i.e., "Pain First," "OUD First," "Same Time"). METHODS Data from 170 patients entering two clinical trials of treatments for current comorbid chronic pain and OUD conducted between March 2009 and July 2013 were compared by order of condition onset. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders (Axis II) were performed by doctoral-level providers using a standardized training protocol. Age of onset group differences on specific diagnostic variables were examined using multinomial logistic regression. RESULTS Fifty-two percent were in the "Pain First" group (n = 89), 35 % in the "OUD First" group (n = 59), and 13 % in the "Same Time" group (n = 22). Compared with the Pain First group, the Same Time group was less likely to report heroin (vs. prescription opioids) as the primary drug used (OR = 0.20, 95 % CI = 0.06-0.72) or meet criteria for an Axis II disorder (OR = 0.24, 95 % CI = 0.07-0.83). Compared with the Pain First group, the OUD First group was more likely to meet criteria for a current nonopioid substance use disorder (OR = 3.20, 95 % CI = 1.22-8.40). CONCLUSIONS Our findings regarding differences in psychiatric comorbidity associated with order of condition onset indicate that varying pathways may exist for the emergence of chronic pain and OUD; further research should investigate potential treatment implications.
Collapse
Affiliation(s)
- Declan T Barry
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA.
| | - Mark Beitel
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Christopher J Cutter
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale Child Study Center, 230 South Frontage Road New Haven, CT 06519, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - David A Fiellin
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street New Haven, CT 06510, USA
| | - Lynn M Madden
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Nathan Lipkind
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Pooja Bollampally
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA; Yale School of Public Health, 60 College Street New Haven, CT 06510, USA
| | - Christopher Liong
- APT Foundation Pain Treatment Services, 495 Congress Avenue New Haven, CT 06519, USA
| | - Richard S Schottenfeld
- Yale School of Medicine, 333 Cedar Street New Haven, CT 06510, USA; Howard University College of Medicine and Hospital, 2041 Georgia Avenue NW, Washington, DC 20059, USA
| |
Collapse
|
32
|
Freda PJ, Moore JH, Kranzler HR. The phenomics and genetics of addictive and affective comorbidity in opioid use disorder. Drug Alcohol Depend 2021; 221:108602. [PMID: 33652377 PMCID: PMC8059867 DOI: 10.1016/j.drugalcdep.2021.108602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.
Collapse
Affiliation(s)
- Philip J. Freda
- University of Pennsylvania, Biostatistics, Epidemiology, & Informatics, The Perelman School of Medicine, University of Pennsylvania A201 R…, Philadelphia, Pennsylvania 19104, United States
| | - Jason H. Moore
- Edward Rose Professor of Informatics, Director, Institute for Biomedical Informatics, Director, Division of Informatics, Department of Biostatistics, Epidemiology, & Informatics, Senior Associate Dean for Informatics, The Perelman School of Medicine, University of Pennsylvania, Contact Information: D202 Richards Building, 3700 Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-6116
| | - Henry R. Kranzler
- Benjamin Rush Professor in Psychiatry, Department of Psychiatry, University of Pennsylvania, Treatment Research Center, 3535 Market Street, Suite 500, Philadelphia, PA 19104-6178
| |
Collapse
|
33
|
Meredith LS, Komaromy MS, Cefalu M, Murray-Krezan C, Page K, Osilla KC, Dopp AR, Leamon I, Tarhuni L, Hindmarch G, Jacobsohn V, Watkins KE. Design of CLARO (Collaboration Leading to Addiction Treatment and Recovery from other Stresses): A randomized trial of collaborative care for opioid use disorder and co-occurring depression and/or posttraumatic stress disorder. Contemp Clin Trials 2021; 104:106354. [PMID: 33713840 DOI: 10.1016/j.cct.2021.106354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) co-occurring with depression and/or posttraumatic stress disorder (PTSD) is common and, if untreated, may lead to devastating consequences. Despite the availability of evidence-based treatments for these disorders, receipt of treatment is low. Even when treatment is provided, quality is variable. Primary care is an important and underutilized setting for treating co-occurring disorders (COD) because OUD, depression and PTSD are frequently co-morbid with medical conditions and most people visit a primary care provider at least once a year. With rising rates of OUD and opioid-related fatalities, this is a critical treatment and quality gap in a vulnerable and stigmatized population. METHODS CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) is a multi-site, randomized pragmatic trial of collaborative care (CC) for co-occurring disorders in 13 rural and urban primary care clinics in New Mexico to improve care for patients with OUD and co-occurring depression and/or PTSD. CC, a service delivery approach that uses multi-faceted interventions, has not been tested with COD. We will enroll and randomize 900 patients to either CC adapted for COD (CC-COD) or enhanced usual care (EUC) and will collect patient data at baseline, 3-, and 6-month follow-up. Our primary outcomes are medications for OUD (MOUD) access, MOUD continuity of care, depression symptoms, and PTSD symptoms. DISCUSSION Although CC is effective for improving outcomes in primary care among patients with mental health conditions, it has not been tested for COD. This article describes the CLARO CC-COD intervention and clinical trial.
Collapse
Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, USA.
| | - Miriam S Komaromy
- Grayken Center for Addiction, Boston Medical Center, Boston, MA 02118, USA
| | - Matthew Cefalu
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | | | - Kimberly Page
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Karen Chan Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Lina Tarhuni
- University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Vanessa Jacobsohn
- First Choice Community Healthcare, 2001 North Centro Familiar, Albuquerque, NM 87105, USA
| | | | | |
Collapse
|
34
|
Cavazos-Rehg P, Xu C, Krauss MJ, Min C, Winograd R, Grucza R, Bierut LJ. Understanding barriers to treatment among individuals not engaged in treatment who misuse opioids: A structural equation modeling approach. Subst Abus 2021; 42:842-850. [PMID: 33617738 DOI: 10.1080/08897077.2021.1876199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Many individuals misusing opioids do not enter into treatment. The question of who enters into treatment for their opioid abuse and under what circumstances is complex and shaped by multiple factors. The objective of the current study is to explore the risk factors for wide-ranging and numerous barriers to treatment among social media users. Method: Opioid-related forums within a popular social media platform were used to recruit non-treatment engaged individuals (≥15 years) who had misused opioids in the past month (n = 144; 66% male; median age 28). Four treatment barrier factors were identified utilizing principle component analysis: (1) stigma, (2) awareness, (3) attitudinal, and (4) denial. A structural equation model (SEM) was then created to explore the risk factors for different types of barriers to OUD treatment. Results: The most common barriers among participants not engaged in treatment for their opioid misuse were the belief that one should be able to help themselves with their condition (66%), treatment was too expensive (63%), and worries about being labeled or judged (57%). Additionally, SEM results demonstrate stigma barriers, awareness, and attitudinal barriers were associated with mental health comorbidities, opioid abuse and dependence severity, and treatment history. Denial barriers, however, were only associated with treatment history, and structural/financial barriers were only associated with opioid abuse and dependence severity. Conclusions: Our research findings are relevant for underscoring the wide-ranging and numerous barriers to treatment faced by individuals misusing opioids that are especially concentrated among those who also struggle with comorbid mental illness.
Collapse
Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caroline Min
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, MO, USA
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
35
|
Kidorf M, Salazzo S, Brooner RK, Peirce J, Gandotra J, Leoutsakos JM. Impact of Personality Disorder on the Treatment of Psychiatric Disorders in People Receiving Methadone-Assisted Treatment. J Pers Disord 2021; 35:114-126. [PMID: 30920940 DOI: 10.1521/pedi_2019_33_429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study evaluates personality disorder as a moderator of psychiatric treatment response in people receiving methadone-assisted treatment. Participants (N = 125) were enrolled in a 12-week parent study that evaluated the impact of incentives on attendance to psychiatric care. All participants had a current DSM IV-R Axis I disorder and were classified based on presence of an Axis II disorder: Axis I-only (n = 46) versus Axis I + II (n = 79). All participants received an identical protocol of psychiatric and substance use disorder care. Although Axis I + II participants endorsed more psychiatric distress (on the Hopkins Symptom Checklist-Revised) throughout treatment, they reported significant reductions in distress that paralleled reductions reported by Axis I-only participants. Rates of substance use were low and similar across groups. Results support the benefits of integrated psychiatric and substance use care for people with opioid use disorder, with or without a co-occurring personality disorder.
Collapse
Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Robert K Brooner
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jim Gandotra
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
36
|
Delorme J, Bertin C, Delage N, Eschalier A, Ardid D, Authier N, Chenaf C. Prevalence of chronic pain in opioid-maintained patients using the capture-recapture method: a nationwide population-based study. Pain 2021; 162:195-202. [PMID: 32701648 DOI: 10.1097/j.pain.0000000000002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few studies all based on classical surveys have provided prevalence estimates of chronic pain (CP) in opioid-maintained patients (OMPs) but often had a limited patient sample size and a great variability in the prevalence estimates. This study sought to assess the prevalence of CP in the exhaustive population of OMPs using the capture-recapture method applied to the French nationwide health care database. Capture-recapture methods are increasingly used to estimate the prevalence of chronic conditions but have never been used in the specific context of CP in OMPs. Three large medical-administrative sources were used: the prescription drug database (A-list), the national hospital discharge database (M-list), and the pain center database (C-list). Between 2015 and 2016, 160,429 OMPs aged 15 years and older were identified and age- and sex-matched with 160,429 non-OMPs. All patients treated with analgesic drugs for ≥6 months (A-list) or diagnosed with CP (M- and C-list) were included. Capture-recapture analyses were performed to yield CP estimates with their 95% confidence intervals using log-linear models. In 2015 to 2016, 12,765 OMPs and 2938 non-OMPs with CP were captured. Most patients were male (67%) in OMPs and non-OMPs; median ages for OMPs and non-OMPs were 46 (interquartile range: 38-51) and 48 (41-53) years, respectively. The CP prevalence estimated in OMPs and non-OMPs ranged from 23.6% (14.9-46.2) to 32.1% (28.6-36.3) and from 7.28% (3.98-18.4) to 9.32% (7.42-12.1), respectively. This first study on CP in the exhaustive population of OMPs using the capture-recapture method demonstrated a high prevalence of CP in OMPs, 3- to 4-fold than in the general population.
Collapse
Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Noémie Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| |
Collapse
|
37
|
Scherrer JF, Salas J, Grucza R, Sullivan MD, Lustman PJ, Copeland LA, Ballantyne JC. Depression and Buprenorphine Treatment in Patients with Non-cancer Pain and Prescription Opioid Dependence without Comorbid Substance Use Disorders. J Affect Disord 2021; 278:563-569. [PMID: 33022442 DOI: 10.1016/j.jad.2020.09.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/02/2020] [Accepted: 09/15/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Depression occurs in 40% of patients with prescription opioid dependence (POD). Existing studies of the association between depression and buprenorphine (BUP) treatment for POD are inconsistent and often include patients with comorbid substance use disorders (SUD). We estimated the association between depression and BUP use in patients with pain and POD and free of comorbid SUD. METHODS Optum® de-identified Electronic Health Record dataset from 2010 to 2018 was used to identify 5,529 patients with chronic pain, with and without depression, receiving prescription opioids and free of substance use disorder diagnoses for one year before POD diagnoses. Unadjusted and adjusted Cox proportional hazard models and negative binomial regression models were computed to estimate the association between depression and time to BUP start, number of BUP prescriptions in the year after BUP start and time to >30 day BUP gap. RESULTS Patients' mean age was 52.4 (SD±15.3) years, 62% were female and 84% were white and 4.9% (n=270) started BUP. Depression was not associated with BUP initiation.. Among BUP starters, depression vs. no depression, was significantly associated with receiving 29% fewer BUP prescriptions (RR=0.71; 95%CI: 0.51-0.98) and an increased risk for > 30 day gap (HR=1.76; 95%CI:1.01-3.09). LIMITATIONS Missing data prevented measuring BUP dose. CONCLUSIONS Depression is likely associated with earlier BUP treatment dropout. Depression related medication non-adherence or possible worsening of depression following BUP taper could explain results. Research is needed to determine if depression severity is associated with BUP dose trajectories and multi-year BUP retention..
Collapse
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle WA. 98195
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO. 63110; The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, St. Louis, MO. 63106
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053; Department of Quantitative Health Sciences, Univ. of Mass. Medical School, Worcester, MA 01605
| | - Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA 98195
| |
Collapse
|
38
|
Mahoney CT, Moshier SJ, Keane TM, Marx BP. Heightened healthcare utilization & risk of mental disorders among Veterans with comorbid opioid use disorder & posttraumatic stress disorder. Addict Behav 2021; 112:106572. [PMID: 32861102 DOI: 10.1016/j.addbeh.2020.106572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022]
Abstract
Although Veterans with posttraumatic stress disorder (PTSD) are vulnerable to opioid misuse, there is limited research evaluating the psychosocial and medical sequalae experienced by Veterans with comorbid PTSD and opioid use disorder (OUD). Using data from a nationwide, longitudinal registry of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans oversampled for PTSD with a 1:1 ratio of men to women, we identified Veterans with lifetime diagnoses of comorbid PTSD and OUD (n = 40), PTSD and non-opioid substance use disorder (SUD; n = 386), PTSD only (n = 901), and non-opioid SUD only (n = 52) using medical record data. We then compared these groups on Veterans Affairs emergency, urgent care, and inpatient healthcare utilization, suicide risk, functional impairment, and the presence of comorbid mental conditions in the following 1-2 years. Relative to all other groups, Veterans with comorbid OUD and PTSD had increased likelihood of emergency room and inpatient care, probable somatoform and major depressive disorders, and greater functional impairment. Both the PTSD/OUD group and PTSD/non-opioid SUD group demonstrated increased suicidality, urgent care utilization, and probable generalized anxiety disorder relative to Veterans with PTSD only or non-opioid SUD only. Results suggest that comorbid OUD and PTSD are associated with greater likelihood of negative psychiatric and healthcare related outcomes, even relative to PTSD comorbid with other types of SUDs. Findings support the importance of concentrated and sustained efforts to improve prevention and intervention strategies for Veterans struggling with PTSD symptoms and opioid misuse.
Collapse
Affiliation(s)
- Colin T Mahoney
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | | | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, United States; National Center for PTSD, Behavioral Science Division, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
| |
Collapse
|
39
|
Sattler AF, Hooker SA, Levy R, Sherman MD. Psychosocial Needs of Parents Engaged in Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:2202-2213. [PMID: 34590964 DOI: 10.1080/10826084.2021.1981386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.
Collapse
Affiliation(s)
- Adam F Sattler
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Stephanie A Hooker
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA.,HealthPartners Institute, Bloomington, Minnesota, USA
| | - Robert Levy
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Michelle D Sherman
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| |
Collapse
|
40
|
Thakarar K, Kulkarni A, Lodi S, Walley AY, Lira MC, Forman LS, Colasanti JA, del Rio C, Samet JH. Emergency Department Utilization Among People Living With HIV on Chronic Opioid Therapy. J Int Assoc Provid AIDS Care 2021; 20:23259582211010952. [PMID: 33888001 PMCID: PMC8072919 DOI: 10.1177/23259582211010952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic pain among people with HIV (PWH) is a driving factor of emergency department (ED) utilization, and it is often treated with chronic opioid therapy (COT). We conducted a cross-sectional analysis of a prospective observational cohort of PWH on COT at 2 hospital-based clinics to determine whether COT-specific factors are associated with ED utilization among PWH. The primary outcome was an ED visit within 12 months after study enrollment. We used stepwise logistic regression including age, gender, opioid duration, hepatitis C, depression, prior ED visits, and Charlson comorbidity index. Of 153 study participants, n = 69 (45%) had an ED visit; 25% of ED visits were pain-related. High dose opioids, benzodiazepine co-prescribing, and lack of opioid treatment agreements were not associated with ED utilization, but prior ED visits (p = 0.002), depression (p = 0.001) and higher Charlson comorbidity score (p = 0.003) were associated with ED utilization. COT-specific factors were not associated with increased ED utilization among PWH.
Collapse
Affiliation(s)
- Kinna Thakarar
- Maine Medical Center Research Institute, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Amoli Kulkarni
- Boston Medical Center / Boston University School of Medicine, Boston, MA, USA
| | - Sara Lodi
- Boston University School of Public Health, Boston, MA, USA
| | - Alexander Y. Walley
- Boston Medical Center / Boston University School of Medicine, Boston, MA, USA
| | - Marlene C. Lira
- Boston Medical Center / Boston University School of Medicine, Boston, MA, USA
| | - Leah S. Forman
- Boston University School of Public Health, Boston, MA, USA
| | | | - Carlos del Rio
- Emory University, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Jeffrey H. Samet
- Boston Medical Center / Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
41
|
Parker MA, Villanti AC. Relationship between Comorbid Drug Use Disorders, Affective Disorders, and Current Smoking. Subst Use Misuse 2021; 56:93-100. [PMID: 33143491 PMCID: PMC8269958 DOI: 10.1080/10826084.2020.1840591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to identify subgroups of adults based on comorbid psychiatric disorders and to examine the relationship with current smoking. Method: The National Epidemiologic Survey on Alcohol and Related Conditions-III, 2012-2013, sampled, recruited, and assessed 36,309 adults, with interviews on drug use and other characteristics. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-5 Version (AUDADIS-5) was used to identify psychiatric conditions. Latent class models were developed based on various psychiatric diagnoses. Multinomial logistic regression estimated the significance of covariates in predicting class membership. Results: Four latent classes optimally distinguished the population: no comorbid conditions (63%), comorbid affective disorders (16%), those with alcohol use disorder (AUD; 17%), and a highly comorbid subgroup (i.e., co-occurring affective and drug use disorders; 4%). Current smoking was about twice as prevalent in the classes defined by psychiatric conditions compared to the group with no comorbid conditions. The highly comorbid class was more likely to be current smokers than the comorbid affective disorders class and the AUD class. Furthermore, the highly comorbid class was younger and had lower income, and the AUD class had a higher proportion of males than the other classes. Conclusions: Cigarette smoking was higher in the nearly 40% of respondents characterized by psychiatric disorders, particularly those with drug use disorders. Correlates of membership in these classes were consistent with known vulnerabilities for smoking, highlighting the need for mental health interventions and future research to explicitly address tobacco cessation in clinical settings based on psychiatric diagnoses.
Collapse
Affiliation(s)
- Maria A Parker
- Vermont Center on Behavior & Health, University of Vermont, Burlington, Vermont, USA.,School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Andrea C Villanti
- Vermont Center on Behavior & Health, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
42
|
Morie KP, Potenza MN, Beitel M, Oberleitner LM, Roos CR, Yip SW, Oberleitner DE, Gaeta M, Barry DT. Alexithymia and pain experience among patients using methadone-maintenance therapy. Drug Alcohol Depend 2021; 218:108387. [PMID: 33168339 PMCID: PMC8103623 DOI: 10.1016/j.drugalcdep.2020.108387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alexithymia, difficulty identifying and describing one's emotions coupled with a tendency to externalize, is a potentially important yet understudied treatment target for patients with opioid use disorder. The aim of this study was to examine the role of alexithymia in pain experience among individuals with opioid use disorder. METHODS One-hundred-and-sixty-four patients receiving methadone maintenance treatment completed a battery of self-report measures related to alexithymia, drug use, and pain experiences. Comparisons were performed on the full sample between those with or without clinically significant levels of alexithymia. For a subsample reporting pain (n = 138), intercorrelations were performed to test whether drug use history, pain catastrophizing, pain acceptance, and alexithymia were related to pain severity and pain interference. Regression analyses were performed to test for serial mediation of pain catastrophizing and pain acceptance on the relationship between alexithymia and pain interference in this subsample. RESULTS Individuals with alexithymia showed increased pain catastrophizing and interference, and intercorrelations indicated that increased alexithymia was associated with increased pain interference, more pain catastrophizing, and reduced pain acceptance. A serial regression model among a subset of patients with pain indicated that pain catastrophizing and pain acceptance mediated the effect of alexithymia on pain interference. CONCLUSIONS These findings suggest that alexithymia, as well as both pain catastrophizing and pain acceptance, contribute to interference associated with pain and are potentially important intervention targets among methadone-treated patients with pain.
Collapse
Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Pain Treatment Services, APT Foundation, Inc, New Haven, CT, USA
| | - Lindsay M Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychology, Western Connecticut State University, Danbury, CT, USA
| | - Corey R Roos
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | | | - Marina Gaeta
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Pain Treatment Services, APT Foundation, Inc, New Haven, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Pain Treatment Services, APT Foundation, Inc, New Haven, CT, USA
| |
Collapse
|
43
|
Delorme J, Pennel L, Brousse G, Daulouède JP, Delile JM, Lack P, Gérard A, Dematteis M, Kabore JL, Authier N, Chenaf C. Prevalence and Characteristics of Chronic Pain in Buprenorphine and Methadone-Maintained Patients. Front Psychiatry 2021; 12:641430. [PMID: 33981257 PMCID: PMC8107279 DOI: 10.3389/fpsyt.2021.641430] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic pain and substance use disorders frequently co-occur. Indeed, chronic pain is highly prevalent, affecting 23-68% of patients receiving opioid agonist treatments (OAT) worldwide. The majority of available estimates come from American studies, but data are still lacking in Europe. We aim to provide European estimates of the prevalence of chronic pain in patients receiving OAT using French data, since France is the first European country in terms of number of patients with OAT. The secondary objectives were to characterize the features and management of chronic pain, as well identify associated risk factors. We conducted a multicenter, cross-sectional study, recruiting patients treated either with buprenorphine or methadone in 19 French addiction centers, from May to July 2016. All participants had to complete a semi-directed questionnaire that collected sociodemographic and medical data, pain characteristics, and licit or illicit drug consumption. In total, 509 patients were included. The prevalence of chronic pain was estimated at 33.2% (95% CI: 29.1-37.3). Compared to non-chronic pain patients, chronic pain patients were older (38.4 vs. 36.1 years, p = 0.006), were more unemployed (66 vs. 52%, p = 0.003), had more psychiatric comorbidities (50 vs. 39%, p = 0.02), and split their OAT for pain management more frequently (24 vs. 7%, p = 0.009). Pain intensity was moderate or severe in 75% of chronic pain patients. Among patients with chronic pain, 15.4% were not prescribed, and did not self-medicate with, any analgesic drugs, 52.1% were prescribed analgesics (non-opioid analgesics, 76.3%; codeine, tramadol, opium, 27.2%; and morphine, fentanyl, oxycodone, 11.8%), and 32.5% exclusively self-medicated with analgesics. Moreover, 20.1% of patients with chronic pain also used illicit drugs for pain relief. On multivariate analysis, variables that remained significantly associated with chronic pain were age [OR = 1.03 (95% CI: 1.00-1.05], p = 0.02], anxiety [OR = 1.52 (1.15-2.02), p = 0.003], and depression [OR = 1.25 (1.00-1.55), p = 0.05]. Chronic pain is a highly prevalent condition in patients receiving OAT, and its appropriate management remains uncertain, since insufficient relief and frequent additional self-medications with analgesics or illicit drugs were reported by these patients. Increased awareness among caregivers is urgently needed regarding a systematic and careful assessment, along with an adequate management of chronic pain in patients receiving OAT.
Collapse
Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucie Pennel
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Georges Brousse
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Jean-Pierre Daulouède
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), BIZIA, Médecins du Monde, Centre Hospitalier de la côte Basque, Bayonne, France
| | - Jean-Michel Delile
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA) "Maurice Serisé", Comité d'Etude et d'Information sur la Drogue (CEID), Bordeaux, France
| | - Philippe Lack
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier de la Croix Rousse, Lyon, France
| | - Antoine Gérard
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Maurice Dematteis
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Kabore
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | |
Collapse
|
44
|
Bertin C, Delage N, Rolland B, Pennel L, Fatseas M, Trouvin AP, Delorme J, Chenaf C, Authier N. Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management. Neurosci Biobehav Rev 2020; 121:160-174. [PMID: 33358994 DOI: 10.1016/j.neubiorev.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.
Collapse
Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France; Fondation Institut Analgesia, Faculté de Médecine, F-63001, Clermont-Ferrand, France.
| | - Noémie Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Université de Lyon, UCBL1, INSERM U1028, CNRS UMR 5292, Bron, France
| | - Lucie Pennel
- Service Universitaire de Pharmaco-Addictologie - CSAPA, CHU Grenoble Alpes, UFR de médecine, Université Grenoble-Alpes, 38043 Grenoble, France
| | - Mélina Fatseas
- University of Bordeaux, 33076 Bordeaux Cedex, France; CNRS-UMR 5287- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France; CHU de Bordeaux, France
| | - Anne-Priscille Trouvin
- Centre d'Evaluation et Traitement de la Douleur, Université Paris Descartes, Hôpital Cochin, Paris, France; U987, INSERM, Boulogne Billancourt, France
| | - Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France; Fondation Institut Analgesia, Faculté de Médecine, F-63001, Clermont-Ferrand, France
| |
Collapse
|
45
|
Streck JM, Sigmon SC, Priest J, Bergeria CL, Davis DR, Hughes JR, Villanti AC, Tidey JW, Heil SH, Gaalema DE, Stitzer ML, Higgins ST. Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities. Exp Clin Psychopharmacol 2020; 28:714-723. [PMID: 32027158 PMCID: PMC7415473 DOI: 10.1037/pha0000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
46
|
Quinlan J, Willson H, Grange K. Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids. Br J Pain 2020; 15:120-128. [PMID: 34055333 DOI: 10.1177/2049463720974053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background It is clear that the risks of opioids in chronic pain outweigh the benefits, creating a drive for clinicians to support patients taper and stop long-term opioids. However, it is not known how patients who have been taking these medicines for months or years feel about reducing them. Using quantitative and qualitative data, this study describes the psychological complexity of these patients and examines their hopes and fears before opioid reduction. Methods Sixty patients attending the opioid clinic completed psychological and pain questionnaires, providing quantitative data, just before they commenced opioid tapering. They scored the severity of opioid side effects and completed a free text framework to express their beliefs about stopping or continuing opioids. A phenomenological approach was used to identify common qualitative themes. Results Most patients were taking opioid doses above the UK recommended maximum dose and reported severe pain with high pain interference. Over 80% of patients described significant depression and 60% significant anxiety. Negative themes around stopping opioids were more common than positive ones, with 63% patients fearing increased pain. A quarter of patients referred to addiction and 16% feared withdrawal. Five patients hoped for a better quality of life; seven feared a worse one. Opioid side effects were common and severe. Conclusion Patients with chronic pain taking long-term opioids demonstrate high psychological distress and low self-efficacy. Their concerns around opioid tapering relate to pain, quality of life and withdrawal. Identifying and addressing patients' individual concerns should increase the likelihood of successful opioid tapering.
Collapse
Affiliation(s)
- Jane Quinlan
- Nuffield Division of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Pain Management Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Heather Willson
- Pain Management Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katheryn Grange
- Nuffield Division of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
47
|
Lamvu G, Soliman AM, Johns B, Vora JB, Estes SJ. Impact of pain and nonpain co-morbidities on opioid use in women with endometriosis. J Comp Eff Res 2020; 10:17-27. [PMID: 33140993 DOI: 10.2217/cer-2020-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: To evaluate impact of co-morbidities on opioid use in endometriosis. Patients & m ethods: This was a retrospective analysis of data obtained from the Symphony Health database (July 2015-June 2018), which contains medical and pharmacy claims information on 79,947 women with endometriosis. Relative risk (RR) of postdiagnosis opioid use and supply duration associated with baseline co-morbidities were determined. Results: Women with endometriosis using opioids at baseline were 61% more likely to receive opioids postdiagnosis (RR: 1.61; 95% CI: 1.59-1.63). Risk of prolonged opioid supply postdiagnosis was highest for those with prolonged supply at baseline (RR: 21.14; 20.14-22.19), and was 1.32 (1.26-1.38) for patients with ≥1 co-morbidity, 1.37 (1.31-1.43) for pain co-morbidities and 1.07 (1.04-1.11) for psychiatric co-morbidities. Conclusion: Risk of opioid use after endometriosis diagnosis was greater in patients who used opioids before diagnosis. Risk of prolonged opioid use was greater if co-morbidities existed before diagnosis.
Collapse
Affiliation(s)
- Georgine Lamvu
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | | | | | | | | |
Collapse
|
48
|
Ashrafioun L, Zerbo KRA, Bishop TM, Britton PC. Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care. Psychol Med 2020; 50:2107-2112. [PMID: 31522694 DOI: 10.1017/s0033291719002307] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care. METHODS The cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects. RESULTS Adjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54). CONCLUSIONS The current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| | - Kotwoallama R A Zerbo
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
| | - Todd M Bishop
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| | - Peter C Britton
- Department of Veterans Affairs Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY14424, USA
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY14642, USA
| |
Collapse
|
49
|
Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
| |
Collapse
|
50
|
Liao CC, Lin CL, Liao KR, Li JM. Long-Term Beneficial Effects of Acupuncture with Reduced Risk of Depression Development Following Trigeminal Neuralgia: A Nationwide Population-Based Cohort Study. Neuropsychiatr Dis Treat 2020; 16:2961-2973. [PMID: 33311982 PMCID: PMC7725145 DOI: 10.2147/ndt.s284857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Existing evidence has shown that patients with trigeminal neuralgia (TN) have a higher risk of developing depression than the normal population. Clinically, acupuncture has been widely used to alleviate pain in TN. However, few studies have explored the use of acupuncture to prevent depression in TN. Therefore, this study aimed to apply national real-world data to investigate the long-term effect of acupuncture on the risk of depression in patients with TN. METHODS We recruited participants with newly diagnosed TN from the Taiwanese National Health Insurance Research Database between January 1, 2000 and December 31, 2010, and categorized them into either the acupuncture cohort or non-acupuncture cohort using the 1:1 propensity score-matched method. All patients in the two cohorts were followed up until the end of 2013. Cox proportional hazards regression analysis was used to compare the incidence of depression between the two cohorts. RESULTS In total, 776 patients with newly diagnosed TN in each cohort with similar baseline characteristics were enrolled in the study. The acupuncture cohort had a reduced risk of depression compared to the non-acupuncture cohort (adjusted hazard ratio, 0.47; 95% confidence interval, 0.31-0.70). Kaplan-Meier analysis also revealed that the cumulative incidence of depression was significantly lower in the acupuncture cohort during the 13-year follow-up period (Log rank test, p < 0.001). In particular, the beneficial effect of acupuncture was a decrease in the risk of depression among TN patients aged 50-69 years who had also used carbamazepine. CONCLUSION This study demonstrated that acupuncture is associated with a reduction in the risk of depression during long-term follow-up in patients with TN. The results provide new insights for clinical practitioners as well as for health resource allocation.
Collapse
Affiliation(s)
- Chung-Chih Liao
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan.,College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Ke-Ru Liao
- Department of Neurology, Yuanlin Christian Hospital, Yuanlin 51052, Taiwan
| | - Jung-Miao Li
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.,Department of Chinese Medicine, Show Chwan Memorial Hospital, Changhua 50008, Taiwan
| |
Collapse
|