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Hoffman KA, Graves C, Rowe K, Worth J, Pertl K, Laidler J, Korthuis P, McCarty D. Engaging the Great Circle: a qualitative study of the Confederated Tribes of Grand Ronde’s mobile medication unit. Ann Med 2024; 56:2306492. [PMID: 38271558 PMCID: PMC10812851 DOI: 10.1080/07853890.2024.2306492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The Confederated Tribes of the Grand Ronde Community of Oregon began a Mobile Medication Unit (MMU) as part of their Great Circle Recovery Opioid Treatment Program (OTP) to address elevated rates of opioid use disorder (OUD) among American Indians and Alaska Natives in Oregon. The MMU provides methadone or buprenorphine for individuals with OUD, enrolled in the OTP, who are living either on the reservation or in surrounding rural communities. An implementation study describes the service through document review and qualitatively assesses patient and staff experiences and the perceived barriers and facilitators to mobile services. METHODS Semi-structured qualitative interviews with patients (n = 11), MMU staff (n = 5), and the state opioid treatment authority (n = 1) gathered details on the initiative's development and operations. Provider interviews probed implementation experiences. Patient interviews focused on their experiences with the MMU and staff, changes in quality of life and recommendations for enhancing treatment. Interviews were transcribed and analysed using a Thematic Analysis approach. RESULTS Staff themes identified two driving forces (i.e. staff desire for an inclusive approach to wellness that is accessible to all community members; the catalysts for the MMU), two steps toward MMU development (i.e. Tribal approvals and support; the construction and maintenance of community relationships) and two perspectives on MMU implementation and impact (i.e. initial implementation barriers; facilitators and observations of how the MMU reduced stigma associated with agonist therapy). Patients' themes noted the MMU's professional and 'caring' environment, accessible rural locations and general suggestions including culturally responsive ancillary services. CONCLUSION The Great Circle MMU enhanced access to opioid agonist therapy for people with OUD (i.e. American Indians/Alaska Natives, and non-natives) living in rural communities. The Confederated Tribes of Grand Ronde operates the first Tribally owned OTP MMU, grounded in cultural humility and committed to Tribal members and the great circle of the larger community.
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Affiliation(s)
- Kim A. Hoffman
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Chantell Graves
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kelly Rowe
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Jennifer Worth
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kellie Pertl
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - James Laidler
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - P. Todd Korthuis
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Dennis McCarty
- Department of Medicine, OR Health and Science University, Portland, OR, USA
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Jain L, Kaur J, Ayub S, Ansari D, Ahmed R, Dada AQ, Ahmed S. Fentanyl and xylazine crisis: Crafting coherent strategies for opioid overdose prevention. World J Psychiatry 2024; 14:760-766. [PMID: 38984339 PMCID: PMC11230091 DOI: 10.5498/wjp.v14.i6.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/06/2024] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
The United States is in the throes of a severe opioid overdose epidemic, primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine, a veterinary sedative often mixed with fentanyl. The high potency and long duration of fentanyl is compounded by the added risks from xylazine, heightening the lethal danger faced by opioid users. Measures such as enhanced surveillance, public awareness campaigns, and the distribution of fentanyl-xylazine test kits, and naloxone have been undertaken to mitigate this crisis. Fentanyl-related overdose deaths persist despite these efforts, partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies. A multifaceted approach is imperative in effectively combating the opioid overdose epidemic. This approach should include expansion of treatment access, broadening the availability of medications for opioid use disorder, implementation of harm reduction strategies, and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.
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Affiliation(s)
- Lakshit Jain
- Department of Psychiatry, University of Connecticut, Farmington, CT 06032, United States
| | - Jasleen Kaur
- Addiction Services Division, Connecticut Valley Hospital, Middletown, CT 06457, United States
| | - Shahana Ayub
- Department of Psychiatry, Institute of Living, Hartford, CT 06102, United States
| | - Danya Ansari
- Department of Medicine, Islamabad Medical and Dental College, Islamabad 44000, Pakistan
| | - Rizwan Ahmed
- Department of Medicine, Liaquat College of Medicine and Dentistry, Karachi 75290, Pakistan
| | - Abdul Qadir Dada
- Department of Medicine, Trinity School of Medicine, Roswell, GA 30075, United States
| | - Saeed Ahmed
- Addiction Services and Dual Diagnosis Unit, Saint Francis Hospital and Medical Center, Hartford, CT 06105, United States
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Stewart RE, Christian HP, Cardamone NC, Abrams C, Drob C, Mandell DS, Metzger D, Lowenstein M. Mobile service delivery in response to the opioid epidemic in Philadelphia. Addict Sci Clin Pract 2023; 18:71. [PMID: 38031174 PMCID: PMC10687974 DOI: 10.1186/s13722-023-00427-5] [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: 05/02/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. METHODS From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit's services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. RESULTS MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. CONCLUSIONS MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services.
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Affiliation(s)
- Rebecca E Stewart
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Hanna P Christian
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Caroline Drob
- The Health Federation of Philadelphia, Philadelphia, PA, USA
| | - David S Mandell
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Metzger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Margaret Lowenstein
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Kennalley AL, Fanelli JL, Furst JA, Mynarski NJ, Jarvis MA, Nichols SD, McCall KL, Piper BJ. Dynamic changes in methadone utilisation for opioid use disorder treatment: a retrospective observational study during the COVID-19 pandemic. BMJ Open 2023; 13:e074845. [PMID: 37973543 PMCID: PMC10661065 DOI: 10.1136/bmjopen-2023-074845] [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: 04/19/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Opioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown to be effective in reducing the risk of overdose and improving overall health and quality of life. This study analysed the distribution of methadone for the treatment of OUD across the USA over the past decade and through the COVID-19 pandemic. DESIGN Retrospective observational study using secondary data analysis of the Drug Enforcement Administration and Medicaid Databases. SETTING USA. PARTICIPANTS Patients who were dispensed methadone at US opioid treatment programmes (OTPs). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the overall pattern in methadone distribution and the number of OTPs in the USA per year. The secondary outcome was Medicaid prescriptions for methadone. RESULTS Methadone distribution for OUD has expanded significantly over the past decade, with an average state increase of +96.96% from 2010 to 2020. There was a significant increase in overall distribution of methadone to OTP from 2010 to 2020 (+61.00%, p<0.001) and from 2015 to 2020 (+26.22%, p<0.001). However, the distribution to OTPs did not significantly change from 2019 to 2021 (-5.15%, p=0.491). There was considerable state-level variation in methadone prescribing to Medicaid patients with four states having no prescriptions. CONCLUSIONS There have been dynamic changes in methadone distribution for OUD. Furthermore, pronounced variation in methadone distribution among states was observed, with some states having no OTPs or Medicaid coverage. New policies are urgently needed to increase access to methadone treatment, address the opioid epidemic in the USA and reduce overdose deaths.
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Affiliation(s)
- Amy L Kennalley
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Jessica L Fanelli
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - John A Furst
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Nicholas J Mynarski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Margaret A Jarvis
- Division of Addiction Medicine, Department of Psychiatry, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Stephanie D Nichols
- Department of Pharmacy Practice, University of New England, Portland, Maine, USA
| | - Kenneth L McCall
- Department of Pharmacy Practice, Binghamton University, Binghamton, New York, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
- Center for Pharmacy Innovation and Outcomes, Danville, Pennsylvania, USA
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Messmer SE, Elmes AT, Jimenez AD, Murphy AL, Guzman M, Watson DP, Poorman E, Mayer S, Infante AF, Keller EG, Whitfield K, Jarrett JB. Outcomes of a mobile medical unit for low-threshold buprenorphine access targeting opioid overdose hot spots in Chicago. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209054. [PMID: 37088399 PMCID: PMC10330226 DOI: 10.1016/j.josat.2023.209054] [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: 12/30/2022] [Revised: 03/08/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Opioid overdoses in Chicago are unevenly distributed, affecting medically underserved neighborhoods most acutely. Innovations in reaching patients perceived to be hard-to-reach (e.g., unstably housed, marginalized), especially in these underserved neighborhoods, are urgently needed to combat the overdose crisis. This study characterizes the pilot year of a mobile medical unit partnership between a large urban academic center and a community-based harm reduction organization in Chicago. METHODS This is a retrospective cohort study of all patients who were seen on a mobile medical unit focused on providing low-threshold buprenorphine and primary care in areas with high opioid overdose rates on Chicago's West Side. Treatment episodes were accrued between July 1, 2021, and June 30, 2022 in the first year of operation. The main outcomes were number of patients seen, demographic characteristics of patients, and reason(s) for visit over time. RESULTS The study saw 587 unique patients on the mobile medical unit between July 1, 2021, and June 30, 2022. Approximately 64.6 % were African American, and more than half lacked active insurance or could not confirm insurance status at the time of visit. The most common reason for initial visit was COVID-19 vaccination (42.4 %), and the most common reason for follow-up visit was buprenorphine treatment (51.0 %). Eleven patients initially presented for other health concerns and later returned to initiate buprenorphine. CONCLUSIONS The mobile medical unit successfully reached nearly 600 patients in traditionally medically underserved Chicago neighborhoods with the highest overdose rates. The mobile unit's integrated approach met a variety of health needs, including buprenorphine initiation, with a unique opportunity for postoverdose initiation. Several patients initiated buprenorphine after presenting for different health concerns, showing the potential of an integrated approach to build on past mobile outreach programs and reach people with opioid use disorder who are not yet ready to initiate treatment.
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Affiliation(s)
- Sarah E Messmer
- University of Illinois at Chicago, Department of Medicine, Westside Research Office Building, Rm 256, 1747 W Roosevelt Rd, Chicago, IL 60608, USA.
| | - Abigail T Elmes
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, 833 S. Wood St, Chicago, IL 60612, USA.
| | - Antonio D Jimenez
- University of Illinois at Chicago, School of Public Health, Community Outreach Intervention Projects, 1603 W Taylor St, Rm 851, Chicago, IL 60612, USA.
| | - Albert Leon Murphy
- University of Illinois at Chicago, School of Public Health, Community Outreach Intervention Projects, 1603 W Taylor St, Chicago, IL 60612, USA.
| | - Miriam Guzman
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, USA.
| | - Dennis P Watson
- Chestnut Health Systems & University of Illinois at Chicago, Center for Dissemination and Implementation Science, 221 W Walton St, Chicago, IL 60610, USA.
| | - Elisabeth Poorman
- University of Illinois at Chicago, Department of Medicine, 840 S Wood St, Chicago, IL 60612, USA.
| | - Stockton Mayer
- University of Illinois at Chicago, Department of Medicine, 808 S Wood St, Rm 888, MC 735, Chicago, IL 60612, USA.
| | - Alexander F Infante
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, 833 S. Wood St, Chicago, IL 60612, USA.
| | - Eden G Keller
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, 833 S. Wood St, Chicago, IL 60612, USA.
| | - Kevin Whitfield
- University of Illinois at Chicago, School of Public Health, Community Outreach Intervention Projects, 1603 W Taylor St, Chicago, IL 60612, USA.
| | - Jennie B Jarrett
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice & American Medical Association, 833 S. Wood St, Chicago, IL 60612, USA.
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El-Tallawy SN, Perglozzi JV, Ahmed RS, Kaki AM, Nagiub MS, LeQuang JK, Hadarah MM. Pain Management in the Post-COVID Era-An Update: A Narrative Review. Pain Ther 2023; 12:423-448. [PMID: 36853484 PMCID: PMC9971680 DOI: 10.1007/s40122-023-00486-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
An extensive computer search (from January 2020 to January 2023) was conducted including literature from the PubMed, Scopus, MEDLINE, Web of Science, and EMBASE databases. According to preset criteria, a total of 58 articles were included in this review article. Generally, any patient who becomes infected with COVID-19 can develop post-COVID-19 conditions. The course of COVID-19 is divided into three main stages: acute COVID-19 (up to 4 weeks), post-acute COVID-19 (from 4 to 12 weeks), and post-COVID (from 12 weeks to 6 months). If a more protracted course of COVID (over 6 months) is demonstrated, the term "long-COVID" is used. Although the acute stage of COVID-19 infection most commonly manifests with acute respiratory symptoms, one very common symptom of the disease is pain, while the most common symptoms of post-COVID syndrome are shortness of breath, dry cough, fatigue, loss of olfactory and gustatory function, tightness and chest pain, sleep and mood disturbances, body aches, muscle and joint pain, sore throat, fever, and persistent headaches. All observations demonstrated a high incidence of chronic pain syndromes of various localization in the post- and long-COVID period. Post-COVID chronic pain might include a newly developed chronic pain as a part of post-viral syndrome; worsening of preexisting chronic pain due to the associated changes in the medical services, or a de novo chronic pain in healthy individuals who are not infected with COVID. Chronic pain during and post-COVID-19 pandemic is an important health issue due to the significant impacts of pain on the patients, health care systems, and society as well. Therefore, it is important that patients with chronic pain receive effective treatment according to their specific needs. Accordingly, the main goal of this review article is to provide a broad description about the post-COVID pain and to explore the impact of long COVID-19 on chronic pain patients, and also to give brief reports about the prevalence, risk factors, possible mechanisms, different presentations, and the management tools through a systematic approach.
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Affiliation(s)
- Salah N. El-Tallawy
- Anesthesia and Pain Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Faculty of Medicine, Minia University and NCI, Cairo University, Giza, Egypt
| | | | - Rania S. Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah M. Kaki
- Anesthesiology and Pain Medicine, International Medical Center, Jeddah, Saudi Arabia
| | | | | | - Mamdouh M. Hadarah
- Anesthesia and Pain Management, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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