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Meyerson BE, Treiber D, Brady BR, Newgass K, Bondurant K, Bentele KG, Samorano S, Arredondo C, Stavros N. Dialing for doctors: Secret shopper study of Arizona methadone and buprenorphine providers, 2022. J Subst Use Addict Treat 2024; 160:209306. [PMID: 38296033 DOI: 10.1016/j.josat.2024.209306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Methadone and buprenorphine are effective and safe treatments for opioid use disorder (OUD) and also reduce overdose and all-cause mortality. Identifying and reaching providers of medication for opioid use disorder (MOUD) has proven difficult for prospective patients and researchers. OBJECTIVES To assess the accuracy of government-maintained lists of Arizona (AZ) providers prescribing MOUD, and the extent to which these providers are accessible for treatment. METHODS A two-phase study used a listing of 2376 AZ MOUD providers obtained from the U.S. Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration. Phase 1 assessed the accuracy of the listing using internet confirmatory research from May-October 2022. Phase 2 used the resulting list of 838 providers to assess provider availability, type of MOUD treatment provided, and accepted payment through secret shopper calls between November 16 and 30, 2022. RESULTS Just over half (52.2 %, n = 1240) of providers were removed from the original listing during Phase 1. One quarter (25.9 %) were no longer in practice. Among the 833 eligible for the secret shopper Phase 2 study, 36.6 % (n = 307) were reached and identified as providing MOUD. A vast majority (88.1 %) of MOUD providers indicating treatment type were accepting new patients, however methadone was identified far more frequently than was likely permitted or provided for OUD. Providers were 5.5 times more likely to accept new patients if they accepted cash payment for services, and 4.9 times more likely if they accepted Medicaid. Rural areas remained underserved. CONCLUSIONS The active population of MOUD providers is far smaller than surmised. DEA and SAMHSA provider listings are not sufficiently accurate for survey research sampling. Other means of representative sampling will need to be devised, and trusted lists of providers for prospective patients should be promoted, publicly available, and regularly maintained for accuracy. Providers that offer treatment should assure that public-facing staff have basic information about the practice, the treatment offered, and conditions for taking new patients. Concerted efforts must assure rural access at the most local levels to reduce patient travel burden.
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Affiliation(s)
- B E Meyerson
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ, United States of America; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States of America.
| | - D Treiber
- Sonoran Prevention Works, Phoenix, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - B R Brady
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States of America; School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States of America
| | - K Newgass
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Southwest Recovery Alliance, Phoenix, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - K Bondurant
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - K G Bentele
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Southwest Institute for Research on Women, College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, United States of America
| | - S Samorano
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - C Arredondo
- Drug Policy Research and Advocacy Board, AZ, United States of America; El Rio Community Health Center, Tucson, AZ, United States of America
| | - N Stavros
- Drug Policy Research and Advocacy Board, AZ, United States of America; Community Medical Services, Phoenix, AZ, United States of America
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Meyerson BE, Bentele KG, Brady BR, Stavros N, Russell DM, Mahoney AN, Garnett I, Jackson S, Garcia RC, Coles HB, Granillo B, Carter GA. Insufficient Impact: Limited Implementation of Federal Regulatory Changes to Methadone and Buprenorphine Access in Arizona During COVID-19. AJPM Focus 2024; 3:100177. [PMID: 38312524 PMCID: PMC10835120 DOI: 10.1016/j.focus.2023.100177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Introduction This study examined the impact of federal regulatory changes on methadone and buprenorphine treatment during COVID-19 in Arizona. Methods A cohort study of methadone and buprenorphine providers from September 14, 2021 to April 15, 2022 measured the proportion of 6 treatment accommodations implemented at 3 time periods: before COVID-19, during Arizona's COVID-19 shutdown, and at the time of the survey completion. Accommodations included (1) telehealth, (2) telehealth buprenorphine induction, (3) increased multiday dosing, (4) license reciprocity, (5) home medications delivery, and (6) off-site dispensing. A multilevel model assessed the association of treatment setting, rurality, and treatment with accommodation implementation time. Results Over half (62.2%) of the 74-provider sample practiced in healthcare settings not primarily focused on addiction treatment, 19% practiced in methadone clinics, and 19% practiced in treatment clinics not offering methadone. Almost half (43%) were unaware of the regulatory changes allowing treatment accommodation. Telehealth was most frequently reported, increasing from 30% before COVID-19 to 80% at the time of the survey. Multiday dosing was the only accommodation substantially retracted after COVID-19 shutdown: from 41% to 23% at the time of the survey. Providers with higher patient limits were 2.5-3.2 times as likely to implement telehealth services, 4.4 times as likely to implement buprenorphine induction through telehealth, and 15.2-20.9 times as likely to implement license reciprocity as providers with lower patient limits. Providers of methadone implemented 12% more accommodations and maintained a higher average proportion of implemented accommodations during the COVID-19 shutdown period but were more likely to reduce the proportion of implemented accommodations (a 17-percentage point gap by the time of the survey). Conclusions Federal regulatory changes are not sufficient to produce a substantive or sustained impact on provider accommodations, especially in methadone medical treatment settings. Practice change interventions specific to treatment settings should be implemented and studied for their impact.
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Affiliation(s)
- Beth E Meyerson
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Comprehensive Center for Pain and Addiction, The University of Arizona Health Sciences, Tucson, Arizona
| | - Keith G Bentele
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Benjamin R Brady
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Comprehensive Center for Pain and Addiction, The University of Arizona Health Sciences, Tucson, Arizona
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, Michigan
| | - Nick Stavros
- Community Medical Services, Phoenix, Arizona
- Drug Policy Research and Advocacy Board, Tucson, Arizona
| | - Danielle M Russell
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Drug Policy Research and Advocacy Board, Tucson, Arizona
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Arlene N Mahoney
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Drug Policy Research and Advocacy Board, Tucson, Arizona
- Southwest Recovery Alliance, Phoenix, Arizona
| | - Irene Garnett
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Drug Policy Research and Advocacy Board, Tucson, Arizona
| | | | | | | | - Brenda Granillo
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Gregory A Carter
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona
- Department of Community and Health Systems, Indiana University School of Nursing, Indiana University, Bloomington, Indiana
- Rural Center for AIDS/STD Prevention, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
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Russell DM, Meyerson BE, Mahoney AN, Garnett I, Ferrell C, Newgass K, Agley JD, Crosby RA, Bentele KG, Vadiei N, Frank D, Linde-Krieger LB. Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023. Harm Reduct J 2024; 21:49. [PMID: 38388463 PMCID: PMC10885601 DOI: 10.1186/s12954-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. METHODS A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. RESULTS Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. CONCLUSIONS Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales, limiting pharmacist discretion for syringe sales, and targeting pharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.
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Affiliation(s)
- Danielle M Russell
- Arizona State University, Tempe, AZ, USA
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Beth E Meyerson
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA.
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA.
| | - Arlene N Mahoney
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Irene Garnett
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Ferrell
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- CAN Community Health, Phoenix, AZ, USA
| | - Kylee Newgass
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Jon D Agley
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Richard A Crosby
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Keith G Bentele
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Institute for Research On Women, University of Arizona, Tucson, AZ, USA
| | - Nina Vadiei
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - David Frank
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- School of Global Public Health, New York University, New York, USA
| | - Linnea B Linde-Krieger
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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Meyerson BE, Russell DM, Downer M, Alfar A, Garnett I, Lowther J, Lutz R, Mahoney A, Moore J, Nuñez G, Samorano S, Brady BR, Bentele KG, Granillo B. Opportunities and Challenges : Hepatitis C Testing and Treatment Access Experiences Among People in Methadone and Buprenorphine Treatment During COVID-19, Arizona, 2021. AJPM Focus 2023; 2:100047. [PMID: 37789937 PMCID: PMC10546500 DOI: 10.1016/j.focus.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The purpose of this study was to characterize hepatitis C virus screening and treatment access experiences among people in treatment for opioid use disorder in Arizona during COVID-19. Methods Arizonans receiving treatment for opioid use disorder from methadone clinics and buprenorphine providers during COVID-19 were interviewed about hepatitis C virus testing, curative treatment, and knowledge about screening recommendations. Interviews were conducted with 121 people from August 4, 2021 to October 10, 2021. Qualitative data were coded using the categories of hepatitis C virus testing, knowledge of screening recommendations, diagnosis, and experiences seeking curative treatment. Data were also quantitated for bivariate testing with outcome variables of last hepatitis C virus test, diagnosis, and curative treatment process. Findings were arrayed along an adapted hepatitis C virus cascade framework to inform program and policy improvements. Results Just over half of the sample reported ever having tested for hepatitis C virus (51.2%, n=62) and of this group, 58.1% were tested in the past 12 months. Among those who were ever tested, 54.8% reported a hepatitis C virus diagnosis and 16.1% reported either being in treatment or having been declared cured of the hepatitis C virus. Among those who were diagnosed with hepatitis C, 14.7% indicated that they unsuccessfully tried to access curative treatment and would not attempt to again. Reasons cited for not accessing or receiving curative treatment included beliefs about treatment safety, barriers created by access requirements, natural resolution of the infection, and issues with healthcare coverage and authorization. Conclusions Structural barriers continue to prevent curative hepatitis C virus treatment access. Given that methadone and buprenorphine treatment providers serve patients who are largely undiagnosed or treated for hepatitis C virus, opportunities exist for them to screen their patients regularly and provide support for and/or navigation to hepatitis C virus curative treatment.
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Affiliation(s)
- Beth E. Meyerson
- Family & Community Medicine, College of Medicine Tucson, The University of Arizona, Tucson, Arizona
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | | | | | - Amirah Alfar
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Irene Garnett
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - John Lowther
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | | | | | - Julie Moore
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Greg Nuñez
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Savannah Samorano
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Benjamin R. Brady
- Comprehensive Pain and Addiction Center, The University of Arizona, Tucson, Arizona
- Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson; Arizona
| | - Keith G. Bentele
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Brenda Granillo
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Arizona Drug Policy Research & Advocacy Board
- Family & Community Medicine, College of Medicine Tucson, The University of Arizona, Tucson, Arizona
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
- School of Social Transformation, Arizona State University, Tempe, Arizona
- Southwest Recovery Alliance, Phoenix, Arizona
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
- CAN Community Health Services, Phoenix, Arizona
- Comprehensive Pain and Addiction Center, The University of Arizona, Tucson, Arizona
- Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson; Arizona
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Agley J, Meyerson BE, Eldridge LA, Crosby RA, Bentele KG, Jun M, Vadiei N, Kennedy A, Anderson K. Exploration of pharmacist comfort with harm reduction behaviors: Cross-sectional latent class analysis. J Am Pharm Assoc (2003) 2021; 62:432-440. [PMID: 34742654 DOI: 10.1016/j.japh.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pharmacists are positioned to play important roles in implementing evidence-based prevention and harm reduction approaches for opioid misuse and related health care outcomes such as human immunodeficiency virus (HIV) and hepatitis C. More research is needed to understand how best to facilitate harm reduction practices among pharmacists. OBJECTIVES This hypothesis-generating study investigated (1) whether subgroups (latent classes) were observable among pharmacists based on self-reported comfort with specific harm reduction behaviors, (2) whether having reported expertise in key content areas was associated with any latent classes that might be identified, and (3) whether comfort and training were associated with actually having dispensed syringes for likely nonprescription drug use. METHODS This was a statewide census of community managing pharmacists in Arizona conducted from December 2018 to May 2019. Participants reported their degree of comfort with 10 harm reduction behaviors, their expertise (e.g., recent continuing pharmacy education or specialization) in selected content areas, and their syringe dispensing behavior. Additional sociodemographic information was also collected. Subgroups related to harm reduction were computed using latent class analysis, and associations between study variables were assessed using the Fisher's exact tests. RESULTS Data suggested the existence of 4 latent, comfort-based harm reduction classes: high comfort, moderate comfort, and clinical comfort, and opioid prevention only. Reported expertise in pre-exposure prophylaxis for HIV was likely associated with harm reduction class. However, class membership was not associated with reporting having dispensed nonprescription syringes, although the single comfort item for syringe dispensing, by itself, was associated therewith. CONCLUSION Comfort with harm reduction likely clusters, so pharmacists may be broadly comfortable with topics or methods of harm reduction; however, comfort with a specific harm reduction pharmacy practice may be a better predictor of engaging in that behavior than harm reduction comfort class. In contrast, strategies to improve comfort, such as intervention development, might successfully be informed by pharmacists' latent class.
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