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Gaeta Gazzola M, Carmichael ID, Thompson E, Beitel M, Madden LM, Saeed G, Hoffman K, Hammouri M, Hsaio C, Barry DT. A Quantitative Examination of Illness Models Among People With Opioid Use Disorder Receiving Methadone Treatment. J Addict Med 2024:01271255-990000000-00292. [PMID: 38446859 DOI: 10.1097/adm.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Few studies have examined illness models among people with addiction. We investigated illness models and their associations with demographics and treatment beliefs among patients receiving methadone treatment for opioid use disorder. METHODS From January 2019 to February 2020, patients receiving methadone treatment at outpatient opioid treatment programs provided demographics and rated using 1 to 7 Likert-type scales agreement with addiction illness models (brain disease model, chronic medical condition model [CMCM], and no explanation [NEM]) and treatment beliefs. Pairwise comparisons and multivariate regressions were used to examine associations between illness models, demographics, and treatment beliefs. Statistical significance was set at P < 0.05. RESULTS A total of 450 patients participated in the study. Forty percent self-identified as female, 13% as Hispanic, and 78% as White; mean age was 38.5 years. Brain disease model was the most frequently endorsed illness model (46.2%), followed by CMCM (41.7%) and NEM (21.9%). In multivariate analyses, agreement with brain disease model was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, and methadone is lifesaving, whereas agreement with CMCM was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, 12-step is the best treatment, taking methadone daily is important, and methadone is lifesaving. In multivariate analyses, agreement with NEM was negatively significantly associated with beliefs that methadone would be effective, counseling is important, taking methadone daily is important, and methadone is lifesaving. DISCUSSION Many patients in methadone treatment endorsed medicalized addiction models. Agreement with addiction illness models appear to be related to treatment beliefs.
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Affiliation(s)
- Marina Gaeta Gazzola
- From the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (MGG, MB, CH, DTB); The APT Foundation, Inc., New Haven, Connecticut (MGG, ET, MB, LMM, CH, DTB); Department of Emergency Medicine, NYU Langone School of Medicine/NYC Health and Hospitals Bellevue, New York, New York (MGG); Department of Statistics, University of California at Berkeley, Berkeley, California (IDC); Department of Pathology and Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, California (IDC); Rutgers New Jersey Medical School, Rutgers, New Jersey (ET); Department of Internal Medicine, Oregon Health and Science University, Portland OR (KH); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (LMM, GS); Child Study Center, Yale School of Medicine, New Haven, Connecticut (MB, DTB); and University of Jordan, Amman, Jordan (MH)
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [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: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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Bromberg DJ, Madden LM, Fraenkel L, Muthulingam D, Rhoades D, Dvoriak S, Dumchev K, Pykalo I, Altice FL. Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey. PLOS Glob Public Health 2024; 4:e0002725. [PMID: 38277422 PMCID: PMC10817130 DOI: 10.1371/journal.pgph.0002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024]
Abstract
Scaling up opioid agonist therapies (OAT) is the most effective strategy to control combined HIV and opioid epidemics, especially in Eastern Europe and Central Asia (EECA), where HIV incidence and mortality continue to increase. Patient concerns about OAT, however, have undermined scale-up. The objective of this study is to understand Ukrainian opioid use disorder patient preferences about OAT to guide the development of an evidence-informed decision aid for clinical decision-making. We conducted a conjoint-based choice (CBC) survey. Participants were asked to about their preferences relating to 7 attributes of OAT (cost, dosing frequency, concerns about withdrawal symptoms, adverse side effects, improvements in quality of life, precipitation of withdrawal and legislative requirements to be registered as a drug dependent person) and 20 attribute levels for receiving OAT under differing potential treatment constraints. Data were analyzed using Hierarchical Bayesian models. Using respondent-driven sampling and random sampling, we recruited 2,028 people who inject drugs with opioid use disorder. Relative importance (RIS) and partial-worth utility scores (PWUS) were used to assess preferences for attributes and thresholds within each attribute. Cost and dosing frequency were the most important attributes (RIS = 39.2% and RIS = 25.2%, respectively) to potential patients, followed by concerns about withdrawal symptoms (RIS = 10.8%), adverse side effects (RIS = 9.0%), quality-of-life improvement (RIS = 7.5%), precipitation of euphoria (5.2%) and requirement to be registered as a drug- dependent person (RIS = 3.1%). The monthly cost-threshold for willingness-to-pay was 1,900 UAH ($70 USD). In Ukraine, where both governmental and private OAT clinics have emerged and provide markedly different delivery strategies, preferences are mostly driven by out-of-pocket expenses, despite many patients being willing to pay for OAT. Programmatic demands (flexibility and ease of acquiring medications) remain an important consideration while for a minority, clinical concerns about withdrawal symptoms, adverse side effects and OAT impact on life play a smaller role.
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Affiliation(s)
- Daniel J. Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Lynn M. Madden
- APT Foundation, New Haven, Connecticut, United States of America
- Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Liana Fraenkel
- Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Dharushana Muthulingam
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Delaney Rhoades
- Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Dvoriak
- European Institute of Public Health Policy, Kyiv, Ukraine
| | | | - Iryna Pykalo
- European Institute of Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- APT Foundation, New Haven, Connecticut, United States of America
- Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Galvez SJ, Altice FL, Meteliuk A, Ivasiy R, Machavariani E, Farnum SO, Fomenko T, Islam Z, Madden LM. Corrigendum: High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine. Front Public Health 2024; 11:1359708. [PMID: 38274528 PMCID: PMC10809844 DOI: 10.3389/fpubh.2023.1359708] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1231581.].
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Affiliation(s)
- Samy J. Galvez
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Frederick L. Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
| | - Anna Meteliuk
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Eteri Machavariani
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | | | | | - Zahedul Islam
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Lynn M. Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
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Galvez SJ, Altice FL, Meteliuk A, Ivasiy R, Machavariani E, Farnum SO, Fomenko T, Islam Z, Madden LM. High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine. Front Public Health 2023; 11:1231581. [PMID: 38098837 PMCID: PMC10720365 DOI: 10.3389/fpubh.2023.1231581] [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: 05/30/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Background The COVID-19 pandemic resulted in marked disruptions in healthcare delivery in Ukraine related to emergency guidance in response to treating opioid use disorder (OUD). Patients with OUD, a group with high levels of comorbid medical and psychiatric disorders, and prescribed opioid agonist therapies (OAT) were rapidly shifted to take-home dosing if they were deemed clinically stable. The impact of these shifts on patient stress and related substance use during the pandemic, however, is unknown. Methods In early May 2020, 269 randomly selected OAT patients in Ukraine were surveyed to assess their stress level and substance use using the validated Perceived Stress Scale and examined correlates of severe perceived stress. Results Overall, 195 (72.5%) met criteria for moderate to severe levels of stress, which was independently correlated with having started OAT within the past 12 months (aOR: 1.33; 95%CI: 1.15-1.55), living in a large metropolitan area (aOR: 1.31; 95%CI: 1.18-1.46), having been asked by others to share their medication (aOR: 1.13; 95%CI: 1.02-1.25), and having an increase of over 10 min in transportation time to get to treatment (aOR: 1.16; 95%CI: 1.04-1.29). Twenty seven (10%) patients felt at high risk of relapse, while 24 (8.9%) patients reported purchasing drugs. Conclusion During a time of great uncertainty soon after emergency guidance to the COVID-19 pandemic, there was extraordinary high levels of perceived stress reported. In response to emergency guidance, OAT patients should be screened for perceived stress and certain subgroups should be targeted for additional psychosocial support.
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Affiliation(s)
- Samy J. Galvez
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Frederick L. Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
| | - Anna Meteliuk
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Eteri Machavariani
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | | | | | - Zahedul Islam
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Lynn M. Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
- APT Foundation, New Haven, CT, United States
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Muthulingam D, Hassett TC, Madden LM, Bromberg DJ, Fraenkel L, Altice FL. Preferences in medications for patients seeking treatment for opioid use disorder: A conjoint analysis. J Subst Use Addict Treat 2023; 154:209138. [PMID: 37544510 DOI: 10.1016/j.josat.2023.209138] [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] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The opioid epidemic continues to be a public health crisis that has worsened during the COVID-19 pandemic. Medications for opioid use disorder (MOUD) are the most effective way to reduce complications from opioid use disorder (OUD), but uptake is limited by both structural and individual factors. To inform strategies addressing individual factors, we evaluated patients' preferences and trade-offs in treatment decisions using conjoint analysis. METHOD We developed a conjoint analysis survey evaluating patients' preferences for FDA-approved MOUDs. We recruited patients with OUD presenting to initiate treatment. This survey included five attributes: induction, location and route of administration, impact on mortality, side effects, and withdrawal symptoms with cessation. Participants performed 12 choice sets, each with two hypothetical profiles and a "none" option. We used Hierarchical Bayes to identify relative importance of each attribute and part-worth utility scores of levels, which we compared using chi-squared analysis. We used the STROBE checklist to guide our reporting of this cross-sectional observational study. RESULTS Five-hundred and thirty participants completed the study. Location with route of administration was the most important attribute. Symptom relief during induction and withdrawal was a second priority. Mortality followed by side effects had lowest relative importance. Attribute levels with highest part-worth utilities showed patients preferred monthly pick-up from a pharmacy rather than daily supervised dosing; and oral medications more than injection/implants, despite the latter's infrequency. CONCLUSION We measured treatment preferences among patients seeking to initiate OUD treatment to inform strategies to scale MOUD treatment uptake. Patients prioritize the route of administration in treatment preference-less frequent pick up, but also injections and implants were less preferred despite their convenience. Second, patients prioritize symptom relief during the induction and withdrawal procedures of medication. These transition periods influence the sustainability of treatment. Although health professionals prioritize mortality, it did not drive decision-making for patients. To our knowledge, this is the largest study on patients' preferences for MOUD among treatment-seeking people with OUD to date. Future analysis will evaluate patient preference heterogeneity to further target program planning, counseling, and decision aid development.
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Affiliation(s)
- Dharushana Muthulingam
- Washington University School of Medicine, Division of Infectious Disease, 4523 Clayton Ave., CB 8051, St. Louis, MO, 63110, United States of America.
| | - Thomas C Hassett
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America
| | - Daniel J Bromberg
- Yale School of Public Health, New Haven, CT, United States of America
| | - Liana Fraenkel
- Yale School of Medicine, Section of Rheumatology, New Haven, CT, United States of America
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America; Yale School of Public Health, New Haven, CT, United States of America; University of Malaya, Kuala Lumpur, Malaysia
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Brooks R, Wegener M, Freeman B, Fowles C, Madden LM, Tetrault JM, Nichols L, Altice FL, Villanueva M. Improving HIV and HCV Testing in Substance Use Disorder Programs (SUDs) That Provide Medications for Opiate Use Disorder (MOUD): Role of Addressing Barriers and Implementing Universal and Site-Specific Approaches. Health Promot Pract 2023; 24:1018-1028. [PMID: 37439759 DOI: 10.1177/15248399231169791] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Introduction. National strategies to end the HIV epidemic and eliminate hepatitis c (HCV) through a syndemic approach require improvements in testing for HIV and HCV. Given the intersection of the opioid crisis with HIV and HCV acquisition, substance use disorder (SUD) treatment centers providing medications for opiate use disorder (MOUD) provide a critical opportunity to expand testing. Rates of testing in MOUD clinics have been suboptimal. Method. We employed the Nominal Group Technique (NGT), Ishikawa cause and effect diagrams, and individualized Quality Improvement (QI) efforts at two SUD clinics (SUD A and B) in Connecticut (CT) as part of an HRSA-funded grant focused on improving HCV cure in persons with HIV/HCV coinfection. Baseline and longitudinal data were collected on rates of HIV and HCV testing and positivity as well as linkage to treatment. Results. Between April 1, 2019, and May 31, 2021, for SUD A and B respectively, HIV testing increased from 13% to 90% and 33% to 83%; HCV testing increased from 4% to 90% and 30% to 82%, with few reported cases of HIV/HCV coinfection. HCV testing revealed new and prior diagnoses at both sites, with subsequent referrals for treatment. Qualitative assessments identified best practices which included the institution of formal policies and procedures, streamlining of testing logistics, designation of a site champion, and broadening relevant education to staff and clients. Conclusion. Strategic assessment of barriers and facilitators to HIV and HCV testing at MOUD clinics can lead to improved testing and referral rates that are key to improving the cascade of care for both diseases.
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Affiliation(s)
- Ralph Brooks
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Cathy Fowles
- Recovery Network of Programs, Inc. (RNP), Bridgeport, CT, USA
| | - Lynn M Madden
- Yale University School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
| | - Jeanette M Tetrault
- Yale University School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
| | - Lisa Nichols
- Yale University School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
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Carr MM, Mannes ZL, Oberleitner LMS, Oberleitner DE, Beitel M, Gaeta Gazzola M, Madden LM, Zheng X, Barry DT. The impact of body image dissatisfaction on psychological distress and health-related quality of life among patients in methadone treatment. Am J Addict 2023; 32:460-468. [PMID: 37188650 PMCID: PMC10524388 DOI: 10.1111/ajad.13432] [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: 08/26/2022] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Minimal research has examined body image dissatisfaction (BID) among patients receiving methadone maintenance treatment (MMT). We tested associations between BID and MMT quality indicators (psychological distress, mental and physical health-related quality of life [HRQoL]) and whether these associations varied by gender. METHODS One hundred and sixty-four participants (n = 164) in MMT completed self-report measures of body mass index (BMI), BID, and MMT quality indicators. General linear models tested if BID was associated with MMT quality indicators. RESULTS Patients were primarily non-Hispanic White (56%) men (59%) with an average BMI in the overweight range. Approximately 30% of the sample had moderate or marked BID. Women and patients with a BMI in the obese range reported higher BID than men and patients with normal weight, respectively. BID was associated with higher psychological distress, lower physical HRQoL, and was unrelated to mental HRQoL. However, there was a significant interaction in which the association between BID and lower mental HRQoL was stronger for men than women. DISCUSSION AND CONCLUSIONS Moderate or marked BID is present for about three in 10 patients. These data also suggest that BID is tied to important MMT quality indicators, and that these associations can vary by gender. The long-term course of MMT may allow for assessing and addressing novel factors influencing MMT outcomes, including BID. SCIENTIFIC SIGNIFICANCE This is one of the first studies to examine BID among MMT patients, and it highlights MMT subgroups most at risk for BID and reduced MMT quality indicators due to BID.
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Affiliation(s)
- Meagan M. Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT 06516
- Yale School of Medicine, New Haven, CT
| | | | - Lindsay M. S. Oberleitner
- Yale School of Medicine, New Haven, CT
- The APT Foundation, Inc., New Haven, CT
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | | | - Mark Beitel
- Yale School of Medicine, New Haven, CT
- The APT Foundation, Inc., New Haven, CT
| | | | - Lynn M. Madden
- Yale School of Medicine, New Haven, CT
- The APT Foundation, Inc., New Haven, CT
| | - Xiaoying Zheng
- Yale School of Medicine, New Haven, CT
- The APT Foundation, Inc., New Haven, CT
| | - Declan T. Barry
- Yale School of Medicine, New Haven, CT
- The APT Foundation, Inc., New Haven, CT
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Nikitin BM, Bromberg DJ, Madden LM, Stöver H, Teltzrow R, Altice FL. Leveraging existing provider networks in Europe to eliminate barriers to accessing opioid agonist maintenance therapies for Ukrainian refugees. PLOS Glob Public Health 2023; 3:e0002168. [PMID: 37440470 DOI: 10.1371/journal.pgph.0002168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Russia's invasion of Ukraine caused a major refugee crisis, particularly impacting Central and Eastern Europe. Ukraine has one of the highest prevalence rates of opioid use disorder (OUD) in Europe, which increases the risk of HIV spread due to injection drug use. Opioid agonist maintenance therapies (OAMT) are a gold standard treatment for OUD and the prevention of HIV spread. Refugees who were displaced and previously maintained on OAMT in Ukraine require reliable care continuity, but OAMT is often highly regulated making it difficult to access. Using an implementation science lens, we sought to understand the barriers and facilitators that might impede OAMT continuity. We performed 23 semi-structured interviews with displaced patients with OUD and providers of OAMT and harm reduction. Interview participants were purposively sampled to include individuals from the highest-impacted countries: Poland, Germany, Czechia, Slovakia, Romania, and Hungary. Interviews focused on existing provider networks and barriers that refugees on OAMT faced during displacement. Though networks existed, there was little collaboration between providers and key stakeholders, such as NGOs, in overcoming barriers. Moreover, existing formal networks were not leveraged for rapid problem-solving. We found that despite existing networks, providers encountered substantial barriers to successfully coordinating access and retention in OAMT for refugees. Owing to insufficiently leveraged coordination between providers, clinics frequently turned patients away due to insufficient capacity, language barriers, and financial coverage issues. The limited geographic distribution of clinics in larger countries, such as Poland and Germany, further inhibited refugees from accessing and remaining on treatment. To support countries and providers in responding to a rapidly evolving crisis, collaborative learning combined with rapid cycle change projects used by the Network for the Improvement of Addiction Treatment (NIATx) model could be deployed to promote collaboration between providers both nationally and throughout the European Union to guide continuity of OAMT.
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Affiliation(s)
| | | | - Lynn M Madden
- Yale School of Medicine, New Haven, CT, United States of America
- APT Foundation, New Haven, CT, United States of America
| | - Heino Stöver
- Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | | | - Frederick L Altice
- Yale School of Medicine, New Haven, CT, United States of America
- APT Foundation, New Haven, CT, United States of America
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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gaeta Gazzola M, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2023:1-11. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - David E Oberleitner
- Department of Research, APT Foundation, New Haven, CT, USA
- Psychology Department, University of Bridgeport, Bridgeport, CT, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Xiaoying Zheng
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lynn M Madden
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
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11
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Hoffman KA, Thompson E, Gaeta Gazzola M, Oberleitner LMS, Eller A, Madden LM, Marcus R, Oberleitner DE, Beitel M, Barry DT. "Just fighting for my life to stay alive": a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories. Addict Sci Clin Pract 2023; 18:16. [PMID: 36944998 PMCID: PMC10031976 DOI: 10.1186/s13722-023-00377-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD. AIM To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community. METHODS From January-December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants' community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach. RESULTS The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration. CONCLUSIONS In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.
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Affiliation(s)
- Kim A Hoffman
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
- APT Foundation, New Haven, CT, USA.
| | - Emma Thompson
- APT Foundation, New Haven, CT, USA
- Rutgers New Jersey Medical School, Rutgers, Newark, NJ, USA
| | - Marina Gaeta Gazzola
- APT Foundation, New Haven, CT, USA
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Lindsay M S Oberleitner
- APT Foundation, New Haven, CT, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Anthony Eller
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ruthanne Marcus
- APT Foundation, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David E Oberleitner
- APT Foundation, New Haven, CT, USA
- Department of Psychology, University of Bridgeport, Bridgeport, CT, USA
| | - Mark Beitel
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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12
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Bromberg DJ, Madden LM, Meteliuk A, Ivasiy R, Galvez de Leon SJ, Klyucharyov K, Altice FL. "Medications for opioid use disorder during the war in Ukraine: a more comprehensive view on the government response-Authors' reply". Lancet Reg Health Eur 2023; 26:100583. [PMID: 36747509 PMCID: PMC9898775 DOI: 10.1016/j.lanepe.2023.100583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Daniel J. Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA
| | - Lynn M. Madden
- APT Foundation, New Haven, CT, USA
- Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Anna Meteliuk
- International Charitable Foundation “Alliance for Public Health”, Kyiv, Ukraine
| | - Roman Ivasiy
- Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Samy J. Galvez de Leon
- Yale Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA
- Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Frederick L. Altice
- Yale Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
- Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Corresponding author.
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Molfenter T, Kim H, Kim JS, Kisicki A, Knudsen HK, Horst J, Brown R, Madden LM, Toy A, Haram E, Jacobson N. Enhancing Use of Medications for Opioid Use Disorder Through External Coaching. Psychiatr Serv 2023; 74:265-271. [PMID: 36196533 PMCID: PMC10836327 DOI: 10.1176/appi.ps.202100675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This randomized controlled trial tested whether external coaching influences addiction treatment providers' utilization of medications to treat opioid use disorder (MOUDs). METHODS This study recruited 75 unique clinical sites in Florida, Ohio, and Wisconsin, including 61 sites in specialty treatment agencies and 14 behavioral health sites within health systems. The trial used external coaching to increase use of MOUDs in the context of a learning collaborative and compared it with no coaching and no learning collaborative (control condition). Outcome measures of MOUD capacity and utilization were monthly tabulations of licensed buprenorphine slots (i.e., the number of patients who could be treated based on the buprenorphine waiver limits of the site's providers), buprenorphine use, and injectable naltrexone administration. RESULTS The coaching and control arms showed no significant difference at baseline. Although buprenorphine slots increased in both arms during the 30-month trial, growth increased twice as fast at the coaching sites, compared with the control sites (average monthly rate of 6.1% vs. 3.0%, respectively, p<0.001). Buprenorphine use showed a similar pattern; the monthly growth rate in the coaching arm was more than twice the rate in the control arm (5.3% vs. 2.4%, p<0.001). Coaching did not have an impact on injectable naltrexone, which grew less than 1% in both arms over the trial period. CONCLUSIONS External coaching can increase organizational capacity for and growth of buprenorphine use. Future research should explore the dimensions of coaching practice, dose, and delivery modality to better understand and enhance the coaching function.
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Affiliation(s)
- Todd Molfenter
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Hanna Kim
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Jee-Seon Kim
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Abby Kisicki
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Hannah K Knudsen
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Julie Horst
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Randy Brown
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Lynn M Madden
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Alex Toy
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Eric Haram
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Nora Jacobson
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
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14
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Fleddermann K, Jacobson N, Horst J, Madden LM, Haram E, Molfenter T. Opening the "black box" of organizational coaching for implementation. BMC Health Serv Res 2023; 23:106. [PMID: 36726102 PMCID: PMC9893536 DOI: 10.1186/s12913-022-08948-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Organizational coaching to promote the implementation of evidence-informed interventions is becoming more popular in healthcare organizations. In order to open the "black box" of coaching for implementation, we first developed, then tested the rigor and utility of a model of coaching for implementation. METHODS Interviews with nine experienced coaches were conducted and inductively coded to develop a model of coaching for implementation. Later, forty coaching calls with behavioral health organizations in Ohio, Wisconsin, and Florida were analyzed with directed content analysis using a priori codes based on this model. RESULTS The coaching work that occurred during these calls aligned closely with the model of coaching for implementation developed by our team. Most coaching work was devoted to building capacity; almost as much work focused on building relationships. Very little coaching work was dedicated to building sustainability. Use of tools for organizational change and implementation remained relatively consistent across all coaching periods. CONCLUSION Understanding what occurs during a successful coaching intervention will improve the effectiveness of coaching as an implementation strategy. Future research should focus on which processes and patterns make coaching more likely to promote specific implementation outcomes.
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Affiliation(s)
- Kathryn Fleddermann
- grid.14003.360000 0001 2167 3675Department of Industrial and Systems Engineering, University of Wisconsin–Madison, 1513 University Ave, 53706 Madison, WI USA
| | - Nora Jacobson
- grid.14003.360000 0001 2167 3675Institute for Clinical and Translational Research, School of Nursing, University of Wisconsin–Madison, 53705 Madison, WI USA
| | - Julie Horst
- grid.14003.360000 0001 2167 3675Department of Industrial and Systems Engineering, University of Wisconsin–Madison, 1513 University Ave, 53706 Madison, WI USA
| | - Lynn M Madden
- grid.422797.d0000 0004 0558 5300APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT USA
| | - Eric Haram
- Haram Consulting, LLC, 413 River Road, ME 04008 Bowdoinham, United States
| | - Todd Molfenter
- grid.14003.360000 0001 2167 3675Department of Industrial and Systems Engineering, University of Wisconsin–Madison, 1513 University Ave, 53706 Madison, WI USA
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15
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Gazzola MG, Maclean E, Beitel M, Carmichael ID, Cammack KM, Eggert KF, Roehrich T, Madden LM, Jegede O, Zheng X, Bergman E, Barry DT. What's in a Name? Terminology Preferences Among Patients Receiving Methadone Treatment. J Gen Intern Med 2023; 38:653-660. [PMID: 36163526 PMCID: PMC9971370 DOI: 10.1007/s11606-022-07813-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite recognition of the importance of substance use disorder (SUD) terminology, few studies examine terminology preferences among patients with SUDs. OBJECTIVE To examine preferences of patients with opioid use disorder (OUD) concerning the terminology used by addiction counselors. DESIGN From January 1, 2019, to February 28, 2020, participants were recruited consecutively from 30-day treatment review sessions at outpatient methadone treatment programs in the Northeastern United States to complete a cross-sectional survey. PARTICIPANTS Participants were English-speaking adult patients with OUD enrolled in methadone treatment. MAIN MEASURES Participants completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate their preferences for (a) the presenting problem, (b) collective nouns referring to those with the presenting problem, and (c) personal descriptors. We used univariate analysis of covariance (ANCOVA) to examine the associations between demographics (i.e., age, sex, and race) and terminology preferences and ordinal logit regression to explore the association between 12-step program partiality and preference for the term "addict." KEY RESULTS We surveyed 450 patients with mean age of 38.5 (SD = 11.1) years; 59.6% self-identified as male, 77.6% as White, and 12.7% as Hispanic. The highest-rated preferences for presenting problem were "addiction," "substance use," and "substance abuse." The highest-rated collective noun terms were "client," "patient," and "guest." "Person with an addiction," "person with substance use disorder," and "substance-dependent person" were the highest-rated personal descriptors. There were significant differences in terminological preference based on race and age. Twelve-step program partiality was associated with greater preference for the term "addict" (F = 21.22, p < .001). CONCLUSIONS Terminology preferences among people receiving methadone treatment aligned with existing guidelines recommending that clinicians use medically accurate and destigmatizing terminology when referring to substance use disorders and the persons who have them. Demographic differences emerged in terminological preferences, warranting further examination.
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Affiliation(s)
- Marina Gaeta Gazzola
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Emma Maclean
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- The University of the South, Sewanee, TN, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Iain D Carmichael
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Kathryn F Eggert
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Teresa Roehrich
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Xiaoying Zheng
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Yale University, New Haven, CT, USA
| | - Emma Bergman
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Quinnipiac School of Medicine, Hamden, CT, USA
| | - Declan T Barry
- Yale School of Medicine, New Haven, CT, USA.
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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16
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Ivasiy R, Galvez de Leon SJ, Meteliuk A, Fomenko T, Pykalo I, Bromberg DJ, Madden LM, Farnum SO, Islam Z, Altice FL. Responding to health policy recommendations on managing opioid use disorder during Russia's invasion of Ukraine: Divergent responses from the frontline to the west. Front Public Health 2023; 10:1044677. [PMID: 36711398 PMCID: PMC9880308 DOI: 10.3389/fpubh.2022.1044677] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Russia's invasion of Ukraine on February 24, 2022, followed by Ukraine's Martial law, has disrupted the routine delivery of healthcare services, including opioid agonist treatment (OAT) programs. Directors (chief addiction treatment physicians) of these programs in each region had flexibility with implementing a series of adaptations to their practice to respond to war disruptions like mass internal displacement and legislation updates allowing more flexibility with OAT distribution policies and take-home dosing regulations. We conducted 8 in-depth interviews with directors from seven regions of Ukraine to describe their experiences providing OAT during a specific time during the war and the local crisis-response approach under the emergency policy updates. We categorized their experiences according to the level of exposure to conflict in each region and displacement of patients across the country, which may provide future guidance for OAT provision during the conflict.
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Affiliation(s)
- Roman Ivasiy
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
| | | | - Anna Meteliuk
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Tetiana Fomenko
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute of Public Health Policy, Kyiv, Ukraine,*Correspondence: Iryna Pykalo ✉
| | - Daniel J. Bromberg
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States,Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Lynn M. Madden
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States,APT Foundation, New Haven, CT, United States
| | | | - Zahedul Islam
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Frederick L. Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States,APT Foundation, New Haven, CT, United States,Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Gaeta Gazzola M, Carmichael ID, Christian NJ, Zheng X, Madden LM, Barry DT. A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States. Subst Abus 2023; 44:62-72. [PMID: 37226909 DOI: 10.1177/08897077231167291] [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] [Indexed: 05/26/2023]
Abstract
BACKGROUND Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement. METHODS Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates. RESULTS There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables (P's < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853, P < 0.001, 95% CI = [-0.114, -0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435, P < 0.001, 95% CI = [-0.371, -0.316], OR = 0.709) after accounting for covariates. CONCLUSIONS Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.
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Affiliation(s)
- Marina Gaeta Gazzola
- APT Foundation, Inc., New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Emergency Medicine, NYU Langone Health/NYC Health and Hospitals Bellevue Hospital Center, New York, NY, USA
| | - Iain D Carmichael
- Department of Statistics, University of California at Berkeley, Berkeley, CA, USA
- Department of Pathology and Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Xiaoying Zheng
- APT Foundation, Inc., New Haven, CT, USA
- New York University School of Medicine, New York, NY, USA
| | - Lynn M Madden
- APT Foundation, Inc., New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, Inc., New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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18
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Eller AJ, DiDomizio EE, Madden LM, Oliva JD, Altice FL, Johnson KA. Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection. Ann Med 2022; 54:1714-1724. [PMID: 35775786 PMCID: PMC9377256 DOI: 10.1080/07853890.2022.2084154] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The syndemic between opioid use disorder (OUD), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) results in excessive burdens on the healthcare system. Integrating these siloed systems of care is critical to address all three conditions adequately. In this implementation project, we assessed the data capacity of the health system to measure a cascade of care (COC) across HIV, HCV and OUD services in five states to help guide public health planning. MATERIALS AND METHODS Data for this study were gathered from publicly available datasets and reports from government (SAMSHA, CMS, HRSA and CDC) sites. We created, where possible, COCs for HIV, HCV, and OUD spanning population estimate, diagnosis, treatment initiation, treatment retention, and patient outcomes for each of five states in the study. RESULTS The process of data collection showed that baseline COCs examining the intersections of OUD, HIV, and HCV cannot be produced and that there are missing data in all states examined. Collection of specific data points is not consistent across all states. States are better at reporting HIV cascades due to federal requirements. Only gross estimates could be made for OUD cascades in all states because data are separated by payer source, leaving no central point of data collection from all sources. Data for HCV were not publicly available. CONCLUSION It is difficult to assess the strategies needed or the progress made towards increasing treatment access and decreasing the burden of disease without the ability to construct an accurate baseline. Using integrated COCs with relevant benchmarks can not only guide public health planning, but also provide meaningful targets for intervention.KEY MESSAGESWhile HIV COCs are available for most states at least annually, they are not disaggregated for populations with co-occurring OUD or HCV.Data to calculate HCV COC are not available and data to calculate OUD COC are partially available, but only for specific payers.States do not have systems in place to measure the scope of the syndemic or to identify targets for quality improvement activities.
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Affiliation(s)
- Anthony J. Eller
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- CONTACT Anthony J. Eller Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth E. DiDomizio
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn M. Madden
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer D. Oliva
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
| | - Frederick L. Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kimberly A. Johnson
- Center for Health & Pharmaceutical Law, Seton Hall University School of Law, Newark, NJ, USA
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Madden LM, Farnum SO, Bromberg DJ, Barry DT, Mazhnaya A, Fomenko T, Meteliuk A, Marcus R, Rozanova J, Poklad I, Dvoriak S, Altice FL. The development and initial validation of the Russian version of the BASIS-24. Addict Sci Clin Pract 2022; 17:65. [PMID: 36435811 PMCID: PMC9701377 DOI: 10.1186/s13722-022-00343-0] [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: 03/30/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Efficient and linguistically appropriate instruments are needed to assess response to addiction treatment, including severity of addiction/mental health status. This is critical for Russian-speaking persons in Eastern Europe and Central Asia (EECA) where Medications for Opioid Use Disorder (MOUD) remain underscaled to address expanding and intertwined opioid, HIV, HCV and tuberculosis epidemics. We developed and conducted a pilot validation of a Russian version of the 24-item Behavior and Symptom Identification Scale (BASIS-24), an addiction/mental health severity instrument with six subscales, previously validated in English. METHODS Using the Mapi approach, we reviewed, translated, and back-translated the content to Russian, pilot-tested the Russian-version (BASIS-24-R) among new MOUD patients in Ukraine (N = 283). For a subset of patients (n = 44), test-rest was performed 48 h after admission to reassess reliability of BASIS-24-R. Exploratory principal component analysis (PCA) assessed underlying structure of BASIS-24-R. RESULTS Cronbach alpha coefficients for overall BASIS-24-R and 5 subscales exceeded 0.65; coefficient for Relationship subscale was 0.42. The Pearson correlation coefficients for overall score and all subscales on the BASIS-24-R exceeded 0.8. Each item loaded onto factors that corresponded with English BASIS-24 subscales ≥ 0.4 in PCA. CONCLUSION Initial version of BASIS-24-R appears statistically valid in Russian. Use of the BASIS-24-R has potential to guide MOUD treatment delivery in the EECA region and help to align addiction treatment with HIV prevention goals in a region where HIV is concentrated in people who inject opioids and where healthcare professionals have not traditionally perceived MOUD as effective treatment, particularly for those with mental health co-morbidities.
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Affiliation(s)
- Lynn M. Madden
- grid.422797.d0000 0004 0558 5300APT Foundation, Inc, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
- grid.47100.320000000419368710Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Scott O. Farnum
- grid.422797.d0000 0004 0558 5300APT Foundation, Inc, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
| | - Daniel J. Bromberg
- grid.47100.320000000419368710Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT 06510 USA
| | - Declan T. Barry
- grid.422797.d0000 0004 0558 5300APT Foundation, Inc, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06510 USA
- grid.47100.320000000419368710Child Study Center, Yale University School of Medicine, 230 S Frontage Road, New Haven, CT 06519 USA
| | - Alyona Mazhnaya
- grid.47100.320000000419368710Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
- grid.77971.3f0000 0001 1012 5630School of Public Health, National University of Kyiv-Mohyla Academy, Hryhoriya Skovorody Street, Kiev, 2 04655 Ukraine
| | - Tetiana Fomenko
- grid.511905.9ICF Alliance for Public Health, 24 Bulvarno-Kudriavska Street, Kyiv, 01601 Ukraine
| | - Anna Meteliuk
- grid.511905.9ICF Alliance for Public Health, 24 Bulvarno-Kudriavska Street, Kyiv, 01601 Ukraine
| | - Ruthanne Marcus
- grid.47100.320000000419368710Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Julia Rozanova
- grid.47100.320000000419368710Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Iurii Poklad
- Chernihiv Regional Narcological Dispensary, 3 Shchorsa Street, Chernihiv, 14005 Ukraine
| | - Sergii Dvoriak
- European Institute of Public Health Policy, 1 Malopidvalna Street, Office 10, Kiev, 01054 Ukraine
| | - Frederick L. Altice
- grid.422797.d0000 0004 0558 5300APT Foundation, Inc, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
- grid.47100.320000000419368710Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT 06510 USA
- grid.47100.320000000419368710Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
- grid.10347.310000 0001 2308 5949Centre of Excellence On Research in AIDS (CERiA), University of Malaya, Malaysia Level 17, Wisma R&DJalan Pantai Baharu, 59990 Kuala Lumpur, Malaysia
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Altice FL, Bromberg DJ, Klepikov A, Barzilay EJ, Islam Z, Dvoriak S, Farnum SO, Madden LM. Collaborative learning and response to opioid misuse and HIV prevention in Ukraine during war. Lancet Psychiatry 2022; 9:852-854. [PMID: 36244353 PMCID: PMC9806953 DOI: 10.1016/s2215-0366(22)00318-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Division of Epidemiology and Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; APT Foundation, New Haven, CT, USA.
| | - Daniel J Bromberg
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Division of Epidemiology and Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Adriy Klepikov
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Ezra J Barzilay
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Zahedul Islam
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Lynn M Madden
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, New Haven, CT, USA
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21
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Bromberg DJ, Madden LM, Meteliuk A, Ivasiy R, de Leon SJG, Klyucharyov K, Altice FL. Medications for opioid use disorder during war in Ukraine: Innovations in public and private clinic cooperation. Lancet Reg Health Eur 2022; 20:100490. [PMID: 35991325 PMCID: PMC9386492 DOI: 10.1016/j.lanepe.2022.100490] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Lynn M. Madden
- APT Foundation, New Haven, Connecticut, USA
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut, USA
| | - Anna Meteliuk
- International Charitable Foundation ‘Alliance for Public Health’, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut, USA
| | - Samy J. Galvez de Leon
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut, USA
| | | | - Frederick L. Altice
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
- APT Foundation, New Haven, Connecticut, USA
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut, USA
- Corresponding author at: Yale School of Medicine, Section of Infectious Diseases, 135 College Street, Suite, 323, New Haven, CT 06510, USA.
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22
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Ivasiy R, Madden LM, Farnum SO, Shumskaya N, de Leon SJG, Bromberg DJ, Kurmanalieva A, Duishenaliev A, Tokubaev R, Altice FL. Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years. Drug Alcohol Depend Rep 2022; 4:100075. [PMID: 36267100 PMCID: PMC9581459 DOI: 10.1016/j.dadr.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Methadone maintenance treatment (MMT) is the most effective and cost-effective strategy to control HIV in Central Asian countries, where the epidemic is concentrated among people who inject drugs (PWID) who use opioids. Methods Using data from a prospective observational database of all people initiated on MMT in Kyrgyzstan since 2008, we analyzed a more contemporary subset of data for all persons receiving MMT from January 2017 through June 2021 after the national treatment guidelines were changed. Retention on MMT was assessed at 1, 6, 12, and 24 months and predictive variables included were dosage levels, HIV status, and type of clinical setting using survival analysis. Predictors of treatment dropout were estimated using Cox multivariate regression models. Results Among the 940 MMT patients, the proportion receiving low (<40mg), medium (40-85mg), and high (>85mg) dosage levels was 37.9%, 42.2%, and 19.9%, respectively. Increasing MMT dosage level was significantly (p<0.0001) correlated with retention at 1 (90%, 98%, 100%), 6 (42%, 63%, 95%), 12 (33%, 55%, 89%), and 24 (16%, 45%, 80%) months, respectively, with no differences between community and correctional settings. Significant predictors of dropout at 12 months included low (aHR=8.0; 95%CL=5.8-11.0) and medium (aHR=3.5; 95%CL=2.5-4.9) methadone dosage level relative to high dose, receiving MMT in three administrative regions relative to the capital Bishkek, and lower in the tuberculosis-specialized clinic in Bishkek. Clients with HIV receive higher average MMT doses (79.5mg vs 63.1mg; p<0.0001), but MMT retention did not differ after controlling for dosage in this group. Conclusions The proportion of patients receiving optimal dosage was low (19.9%). An implementation strategy that focused on getting a larger proportion of MMT on the optimal dosage to promote retention could potentially improve the quality of existing treatment and promote further scale-up of MMT in Kyrgyzstan.
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Affiliation(s)
- Roman Ivasiy
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, USA
| | - Lynn M. Madden
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- APT Foundation, New Haven, USA
| | - Scott O. Farnum
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- APT Foundation, New Haven, USA
| | - Natalia Shumskaya
- Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, Bishkek, Kyrgyzstan
| | - Samy J. Galvez de Leon
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
| | - Daniel J. Bromberg
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, USA
| | - Ainura Kurmanalieva
- Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, Bishkek, Kyrgyzstan
| | | | | | - Frederick L. Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Corresponding author at: Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, 135 College Street, Suite 355, New Haven, CT 06511 USA.
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23
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Madden LM, Oliva J, Eller A, DiDomizio E, Roosa M, Blanchard L, Kil N, Altice FL, Johnson K. Pregnant Women and Opioid Use Disorder: Examining the Legal Landscape for Controlling Women's Reproductive Health. Am J Law Med 2022; 48:209-222. [PMID: 36715261 DOI: 10.1017/amj.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Women with opioid use disorder ("OUD") are more likely than other women to experience sexual assault, unintentional pregnancy, transactional sex and coercion regarding reproductive health care choices than women without OUD. Laws described as family friendly may be punitive rather than helpful to women and rarely apply to men. Laws regarding reproductive health and OUD are unevenly enforced and therefore biased against poor, minority women. As part of a larger study oriented toward strengthening systems of care related to the intersection of HIV and OUD, we conducted an analysis of state laws related to pregnant and postpartum women with OUD. Data on disparities in child removals and pregnant women's use of evidence-based treatment for OUD by income and race were captured for the five states with the most restrictive laws in both categories. Laws that were purportedly designed to improve reproductive health outcomes for women with OUD and/or their children often have the opposite of the expressed intended outcome. There is a relationship between restrictive reproductive choice and coercive OUD treatment policy for women. Restrictive state regulations for pregnant women with OUD persist despite negative outcomes for maternal and child health. Altering coercive and/or criminalizing regulation and redefining 'family friendly' may improve outcomes for individuals and families.
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Affiliation(s)
- Lynn M Madden
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Jenn Oliva
- Seton Hall University Law School, Newark, NJ, USA
| | - Anthony Eller
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | | | - Mat Roosa
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Lisa Blanchard
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Natalie Kil
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Kimberly Johnson
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
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24
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Oles W, Alexander M, Kumar N, Howell B, O’Connor PG, Madden LM, Barry DT. Characterizing the social support and functioning of a low-threshold medication for opioid use disorder treatment cohort at intake. BMC Psychiatry 2022; 22:236. [PMID: 35366844 PMCID: PMC8976510 DOI: 10.1186/s12888-022-03884-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the growing morbidity and mortality rates associated with opioid use disorder, a large gap still exists between treatment need and capacity. Low-threshold clinics utilizing medication for opioid use disorder (MOUD) treatment can increase treatment access but are understudied, and little is known about how patient demographic characteristics are associated with their social support and functioning in these settings. METHODS We used multivariate regression to estimate associations between demographic characteristics and self-reported social support or functioning indicators among patients receiving MOUD in a low-threshold clinic using several validated instruments administered at intake: Behavior and Symptom Identification Scale, Brief Pain Inventory, and Life Events Checklist for DSM-5. Patients initiating MOUD treatment between April 1 and December 31, 2017, with complete surveys were included (N=582). RESULTS Patients were primarily male (62%), aged 34 or older (53%), non-Hispanic White (79%), separated or not married (86%), and unemployed (64%). Over 20% did not live in a house or apartment in the past month. Women were more likely to "get along" with people outside their family or in social situations and to identify their partner as their source of support. Women, non-White, and older patients were at higher risk of social functioning-disrupting events (physical/sexual assaults or experiencing chronic pain), while employment and housing were protective against exposure to these trauma-related events. However, employment and housing also decreased the odds of talking with others about substance use. The aforementioned results were obtained from multivariate logistic regression models and were significant to p<0.05. CONCLUSIONS Variation in support and functioning by demographic characteristics suggests that treatment facilities may benefit from adopting strategies that take baseline disparities in support and functioning into account.
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Affiliation(s)
- William Oles
- grid.47100.320000000419368710Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT USA
| | - Marcus Alexander
- Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT, USA.
| | - Navin Kumar
- grid.47100.320000000419368710Human Nature Lab, Yale Institute for Network Science, Yale University, New Haven, CT USA ,grid.47100.320000000419368710Department of Sociology, Yale University, New Haven, CT USA
| | - Benjamin Howell
- grid.47100.320000000419368710Section of General Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA ,grid.281208.10000 0004 0419 3073VA Connecticut Healthcare System, New Haven, CT USA
| | - Patrick G. O’Connor
- grid.47100.320000000419368710Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA
| | - Lynn M. Madden
- grid.47100.320000000419368710Section of Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT USA ,grid.422797.d0000 0004 0558 5300APT Foundation, New Haven, CT USA
| | - Declan T. Barry
- grid.422797.d0000 0004 0558 5300APT Foundation, New Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Du CX, Shi J, Tetrault JM, Madden LM, Barry DT. Primary care and medication management characteristics among patients receiving office-based opioid treatment with buprenorphine. Fam Pract 2022; 39:234-240. [PMID: 34893825 PMCID: PMC8947790 DOI: 10.1093/fampra/cmab166] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Office-based opioid treatment (OBOT) is an evidence-based treatment model for opioid use disorder (OUD) offered by both addiction and general primary care providers (PCPs). Calls exist for more PCPs to offer OBOT. Few studies have been conducted on the primary care characteristics of OBOT patients. OBJECTIVE To characterize medical conditions, medications, and treatment outcomes among patients receiving OBOT with buprenorphine for OUD, and to describe differences among patients by age and by time in care. METHODS This study is a retrospective review of medical records on or before 4/29/2019 at an outpatient primary care clinic within a nonprofit addiction treatment setting. Inclusion criterion was all clinic patients actively enrolled in the OBOT program. Patients not prescribed buprenorphine or with no OBOT visits were excluded. RESULTS Of 355 patients, 42.0% had another PCP. Common comorbid conditions included chronic pain and psychiatric diagnosis. Few patients had chronic viral hepatitis or HIV. Patients reported a median of 4 medications. Common medications were cardiovascular, antidepressant, and nonopioid pain agents. Older patients had a higher median number of medications. There was no significant difference in positive opioid urine toxicology (UT) based on age, chronic pain status, or psychoactive medications. Patients retained >1 year were less likely to have positive opioid UT. CONCLUSION Clinical needs of many patients receiving OBOT are similar to those of the general population, supporting calls for PCPs to provide OBOT.
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Affiliation(s)
- Cindy Xinxin Du
- Yale University School of Medicine, New Haven, CT, United States
| | - Julia Shi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
- The APT Foundation Inc., New Haven, CT, United States
| | - Jeanette M Tetrault
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
- The APT Foundation Inc., New Haven, CT, United States
| | - Lynn M Madden
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
- The APT Foundation Inc., New Haven, CT, United States
| | - Declan T Barry
- The APT Foundation Inc., New Haven, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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DiMeola KA, Haynes J, Barone M, Beitel M, Madden LM, Cutter CJ, Raso A, Gaeta M, Zheng X, Barry DT. A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment. J Addict Med 2022; 16:229-234. [PMID: 34145187 PMCID: PMC8678387 DOI: 10.1097/adm.0000000000000877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance. METHODS Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]). RESULTS About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion. CONCLUSIONS Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.
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Affiliation(s)
- Kimberly A DiMeola
- APT Foundation, Inc., New Haven, CT (KAD, JH, MB, MB, LMM, CJC, AR, MG, XZ, DTB), Yale School of Medicine, New Haven, CT (MB, LMM, CJC, AR, MG, DTB), Yale College, New Haven, CT (XZ)
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Barry DT, Oberleitner DE, Beitel M, Oberleitner LMS, Gazzola MG, Eller A, Madden LM, Zheng X, Bergman E, Tamberelli JF. A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students. Subst Use Misuse 2022; 57:1523-1533. [PMID: 35787230 DOI: 10.1080/10826084.2022.2091787] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students. METHODS Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness. RESULTS Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition. CONCLUSIONS Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut, USA
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Anthony Eller
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaoying Zheng
- APT Foundation, Inc, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| | - Emma Bergman
- APT Foundation, Inc, New Haven, Connecticut, USA.,Quinnipiac School of Medicine, Hamden, Connecticut, USA
| | - Joseph F Tamberelli
- APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Knudsen HK, Brown R, Jacobson N, Horst J, Kim JS, Kim H, Madden LM, Haram E, Molfenter T. Prescribers' satisfaction with delivering medications for opioid use disorder. Subst Abuse Treat Prev Policy 2021; 16:78. [PMID: 34663379 PMCID: PMC8521499 DOI: 10.1186/s13011-021-00413-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Expanding access to medications for opioid use disorder (MOUD), such as buprenorphine and extended release (XR) naltrexone, is critical to addressing the US opioid epidemic, but little is known about prescriber satisfaction with delivering these two types of MOUD. The current study describes the satisfaction of prescribers delivering buprenorphine and XR-naltrexone while examining whether satisfaction is associated with current patient census and organizational environment. METHODS As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 41 MOUD prescribers in Florida, Ohio, and Wisconsin completed a web-based survey. The survey included measures of prescriber satisfaction with delivering buprenorphine treatment and XR-naltrexone. In addition, the survey measured several prescriber characteristics and their perceptions of the organizational environment. RESULTS Prescribers were generally satisfied with their work in delivering these two types of MOUD. Prescribers reporting a greater number of patients (r = .46, p = .006), those who would recommend the center to others (r = .56, p < .001), and those reporting positive relationships with staff (r = .56, p < .001) reported significantly greater overall satisfaction with delivering buprenorphine treatment. Prescribers who more strongly endorsed feeling overburdened reported lower overall buprenorphine satisfaction (r = -.37, p = .02). None of the prescriber characteristics or perceptions of the organizational environment were significantly associated with overall satisfaction with delivering XR-naltrexone treatment. CONCLUSIONS The generally high levels of satisfaction with both types of MOUD is notable given that prescriber dissatisfaction can lead to turnover and impact intentions to leave the profession. Future research should continue to explore the prescriber characteristics and organizational factors associated with satisfaction in providing different types of MOUD. REGISTRATION ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482 .
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave., Room 204, KY 40508 Lexington, USA
| | - Randy Brown
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, WI 53715-1896 Madison, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, 4116 Signe Skott Cooper Hall, 701 Highland Ave, WI 53705 Madison, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, WI 53706 Madison, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, 1025 West Johnson St, WI 53706-1706 Madison, USA
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin-Madison, 1025 West Johnson St, WI 53706-1706 Madison, USA
| | - Lynn M. Madden
- Department of Internal Medicine, Yale University, APT Foundation, 1 Long Wharf Drive, Suite 321, CT 06511 New Haven, USA
| | - Eric Haram
- Haram Consulting, 413 River Road, ME 04008 Bowdoinham, USA
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, WI 53706 Madison, USA
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Becker SJ, Murphy CM, Hartzler B, Rash CJ, Janssen T, Roosa M, Madden LM, Garner BR. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial. Addict Sci Clin Pract 2021; 16:61. [PMID: 34635178 PMCID: PMC8505014 DOI: 10.1186/s13722-021-00268-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). METHODS A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff's extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff's intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). DISCUSSION There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. TRIAL REGISTRATION This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1.
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Affiliation(s)
- Sara J. Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Cara M. Murphy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Bryan Hartzler
- Addictions, Drug, & Alcohol Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105 USA
| | - Carla J. Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Mat Roosa
- Roosa Consulting, LLC, 3 Bradford Drive, Syracuse, NY 13224 USA
| | - Lynn M. Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
| | - Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd.Research Triangle Park, P.O. Box 12194, Durham, NC 27709 USA
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30
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Meteliuk A, Galvez S, Fomenko T, Kalandiia H, Iaryi V, Farnum SO, Islam Z, Altice FL, Madden LM. Successful transfer of stable patients on opioid agonist therapies from specialty addiction treatment to primary care settings in Ukraine: A pilot study. J Subst Abuse Treat 2021; 134:108619. [PMID: 34579978 DOI: 10.1016/j.jsat.2021.108619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In Ukraine, HIV is concentrated among people who inject drugs (PWID), and opioid agonist therapies (OAT) are the most effective approach to preventing HIV transmission. OAT coverage is well below internationally recommended levels, with OAT provided primarily in specialty addiction treatment clinics. Integrating OAT into primary care settings represents a promising practice for increasing OAT coverage. METHODS The study collected data prospectively from the first 50 stable patients transferred from the largest OAT site to 10 primary care clinics in Kiev; patients had negative urine drug tests for the previous six months. Participants completed the BASIS-24-the 24-item Behaviour and Symptom Identification Scale-to assess symptoms of psychiatric and social function across 6 domains: (1) depression and functioning, (2) relationships, (3) self-harm, (4) emotional lability, (5) psychosis, and (6) substance use before transfer and 6 months after transfer from May through November 2019. RESULTS Participants were on average 36 years old, mostly male (84.0%) and had some employment (64.0%). After six months, some employment increased to 88.0% and BASIS-24 scores significantly improved on four domains: depression (1.09 vs 0.73, p = 0.0005), relationships (2.15 vs 1.7, p < 0.0001), emotional liability (1.30 vs 1.00, p = 0.0209) and substance use (1.23 vs 1.07, p = 0073). CONCLUSIONS Stable OAT patients can be successfully transferred from specialty to primary care clinics without deterioration in mental health symptoms or functioning. Patients transferred to primary care showed significant improvement in their emotional well-being, their substance use, and their employment status.
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Affiliation(s)
- Anna Meteliuk
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Samy Galvez
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | | | - Hela Kalandiia
- Kyiv City Drug Addiction Clinical Hospital 'Sociotherapy', Kyiv, Ukraine
| | - Volodymyr Iaryi
- Kyiv City Drug Addiction Clinical Hospital 'Sociotherapy', Kyiv, Ukraine
| | | | - Zahedul Islam
- Alliance for Public Health of Ukraine, Kyiv, Ukraine
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, United States.
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States
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31
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Qin Y, Price C, Rutledge R, Puglisi L, Madden LM, Meyer JP. Women's Decision-Making about PrEP for HIV Prevention in Drug Treatment Contexts. J Int Assoc Provid AIDS Care 2021; 19:2325958219900091. [PMID: 31918605 PMCID: PMC7099671 DOI: 10.1177/2325958219900091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite pre-exposure prophylaxis’s (PrEP) efficacy for HIV prevention, uptake has been
low among women with substance use disorders (SUDs) and attributed to women’s lack of
awareness. In semistructured interviews with 20 women with SUD and 15 key stakeholders at
drug treatment centers, we assessed PrEP awareness and health-related decision-making.
Women often misestimated their own HIV risk and were not aware of PrEP as a personally
relevant option. Although women possessed key decision-making skills, behavior was
ultimately shaped by their level of motivation to engage in HIV prevention. Motivation was
challenged by competing priorities, minimization of perceived risk, and anticipated
stigma. Providers were familiar but lacked experience with PrEP and were concerned about
women’s abilities to action plan in early recovery. HIV prevention for women with SUD
should focus on immediately intervenable targets such as making PrEP meaningful to women
and pursuing long-term systemic changes in policy and culture. Efforts can be facilitated
by partnering with drug treatment centers to reach women and implement PrEP
interventions.
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Affiliation(s)
- Yilu Qin
- Internal Medicine Primary Care Residency Program, HIV Training Track, Yale School of Medicine, New Haven, CT, USA
| | - Carolina Price
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Ronnye Rutledge
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa Puglisi
- Department of Medicine, Section of General Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,APT Foundation Inc, New Haven, CT, USA
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
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32
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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Oberleitner LMS, Madden LM, Muthulingam D, Marcus R, Oberleitner DE, Beitel M, Gaeta M, Tamberelli JF, Barry DT. A qualitative investigation of addiction counselors' perceptions and experiences implementing an open-access model for treating opioid use disorder. J Subst Abuse Treat 2020; 121:108191. [PMID: 33357602 DOI: 10.1016/j.jsat.2020.108191] [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: 03/26/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500. METHODS Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported. RESULTS Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure"). CONCLUSIONS Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.
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Affiliation(s)
- Lindsay M S Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Lynn M Madden
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - Dharushana Muthulingam
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA; Washington University, Division of Infectious Disease, St. Louis, MO 63112, USA
| | - Ruthanne Marcus
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - David E Oberleitner
- The APT Foundation, Inc., New Haven, CT 06519, USA; University of Bridgeport, Department of Psychology, Bridgeport, CT 06604, USA
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA
| | - Marina Gaeta
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Joseph F Tamberelli
- Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Declan T Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA.
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Meteliuk A, Galvez de Leon SJ, Madden LM, Pykalo I, Fomenko T, Filippovych M, Farnum SO, Dvoryak S, Islam ZM, Altice FL. Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine. J Subst Abuse Treat 2020; 121:108164. [PMID: 33191004 PMCID: PMC7769928 DOI: 10.1016/j.jsat.2020.108164] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
On March 16, 2020, Ukraine's Ministry of Health issued nonspecific interim guidance to continue enrolling patients in opioid agonist therapies (OAT) and transition existing patients to take-home dosing to reduce community COVID-19 transmission. Though the number of OAT patients increased modestly, the proportion receiving take-home dosing increased from 57.5% to 82.2%, which translates on average to 963,952 fewer clinic interactions annually (range: 728,652-1,016,895) and potentially 80,329 (range: 60,721-84,741) fewer hours of in-person clinical encounters. During the transition, narcologists (addiction specialists) expressed concerns about overdoses, the guidance contradicting existing legislation, and patient dropout, either from incarceration or inadequate public transportation. Though clinicians did observe some overdoses, short-term overall mortality remained similar to the previous year. As the country relaxes the interim guidance, we do not know to what extent governmental guidance or clinical practice will change to adopt the new guidance permanently or revert to pre-guidance regulations. Some future considerations that have come from COVID-19 are should dosing schedules continue to be flexible, should clinicians adopt telehealth, and should there be more overdose education and naloxone distribution? OAT delivery has improved and become more efficient, but clinicians should plan long-term should COVID-19 return in the near future. If the new efficiencies are maintained, it will free the workforce to further scale up OAT.
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Affiliation(s)
| | - Samy J Galvez de Leon
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | | | | | - Sergii Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, United States.
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35
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Knudsen HK, Brown R, Jacobson N, Horst J, Kim JS, Collier E, Starr S, Madden LM, Haram E, Molfenter T. Pharmacotherapy, Resource Needs, and Physician Recruitment Practices in Substance Use Disorder Treatment Programs. J Addict Med 2020; 13:28-34. [PMID: 30095565 PMCID: PMC6349477 DOI: 10.1097/adm.0000000000000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Effective pharmacological treatments for opioid use disorder (OUD) continue to be underutilized, particularly within specialty substance use disorder (SUD) treatment organizations. Few studies have examined whether specific practices to recruit prescribers, financial needs, and human resource needs facilitate or impede the implementation of pharmacotherapy. METHODS Surveys were completed by administrators from 160 treatment programs in Florida, Ohio, and Wisconsin. Respondents described availability of five pharmacotherapies for treating OUD, organizational resource needs, current use of physician recruitment practices, and buprenorphine treatment slots. RESULTS The mostly commonly available medications were injectable naltrexone (65.4%; n = 102), buprenorphine-naloxone (55.7%; n = 88), and tablet naltrexone (50.0%; n = 78). Adopters of each of the 5 pharmacotherapies reported significantly greater physician outreach than organizations that did not provide these medications. The mean number of buprenorphine slots was 94.1 (SD 205.9). There were unique correlates of adoption (ie, any slots) and availability (number of slots) of buprenorphine. Physician outreach activities were correlated with the likelihood of nonadoption, whereas medical resource needs (ie, needing more physicians to prescribe pharmacotherapy) and dedicated resources for physician recruitment were associated with the number of slots. CONCLUSIONS Physician recruitment activities differentiated those organizations that had existing pharmacotherapy treatment capacity (ie, any slots) from those that had no capacity. Efforts to address the medical resource needs of treatment organizations, and also strategies that encourage organizations to devote resources to recruiting prescribers may hold promise for increasing access to these lifesaving treatments.
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Affiliation(s)
- Hannah K Knudsen
- University of Kentucky, Department of Behavioral Science and Center on Drug and Alcohol Research, Lexington, KY (HKK); University of Wisconsin-Madison, Department of Family Medicine and Community Health, Madison, WI (RB); University of Wisconsin-Madison, Institute for Clinical and Translational Research, Madison, WI (NJ); University of Wisconsin-Madison, Department of Industrial and Systems Engineering, Madison, WI (JH, TM); University of Wisconsin-Madison, Department of Educational Psychology, Madison, WI (J-SK); Wisconsin Department of Health Services, Madison, WI (EC); Ohio Department of Mental Health and Addiction Services, Columbus, OH (SS); APT Foundation, New Haven, CT (LMM); Haram Consulting, Bowdoinham, ME (EH)
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Tan J, Altice FL, Madden LM, Zelenev A. Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study. Lancet HIV 2019; 7:e121-e128. [PMID: 31879250 DOI: 10.1016/s2352-3018(19)30373-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 10/14/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverage among PWID, we did an optimisation assessment using current OAT procurement and allocation, then modelled the effect of increased OAT scale-up on HIV incidence and mortality for 23 administrative regions of Ukraine. METHODS We developed a linear optimisation model to estimate efficiency gains that could be achieved based on current procurement of OAT. We also developed a dynamic, compartmental population model of HIV transmission that included both injection and sexual risk to estimate the effect of OAT scale-up on HIV infections and mortality over a 10-year horizon. The compartmental population model was calibrated to HIV prevalence and incidence among PWID for 23 administrative regions of Ukraine. Sources for regional data included the SyrEx database, the Integrated Biological and Behavioral Survey, the Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, the Public Health Center of the Ministry of Health of Ukraine, and the Ukrainian Census. FINDINGS Under a status-quo scenario (OAT coverage of 2·7% among PWID), the number of new HIV infections among PWID in Ukraine over the next 10 years was projected to increase to 58 820 (95% CI 47 968-65 535), with striking regional differences. With optimum allocation of OAT without additional increases in procurement, OAT coverage could increase from 2·7% to 3·3% by increasing OAT doses to ensure higher retention levels. OAT scale-up to 10% and 20% over 10 years would, respectively, prevent 4368 (95% CI 3134-5243) and 10 864 (7787-13 038) new HIV infections and reduce deaths by 7096 (95% CI 5078-9160) and 17 863 (12 828-23 062), relative to the status quo. OAT expansion to 20% in five regions of Ukraine with the highest HIV burden would account for 56% of new HIV infections and 49% of deaths prevented over 10 years. INTERPRETATION To optimise HIV prevention and treatment goals in Ukraine, OAT must be substantially scaled up in all regions. Increased medication procurement is needed, combined with optimisation of OAT dosing. Restricting OAT scale-up to some regions of Ukraine could benefit many PWID, but the regions most affected are not necessarily those with the highest HIV burden. FUNDING National Institute on Drug Abuse.
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Affiliation(s)
- Jiale Tan
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Lynn M Madden
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; APT Foundation, New Haven, CT, USA
| | - Alexei Zelenev
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
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Beitel M, Oberleitner L, Muthulingam D, Oberleitner D, Madden LM, Marcus R, Eller A, Bono MH, Barry DT. Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation. Subst Abus 2019. [PMID: 29522381 DOI: 10.1080/08897077.2018.1449051] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap. METHODS Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory. RESULTS Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision). CONCLUSIONS Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.
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Affiliation(s)
- Mark Beitel
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Pain Treatment Services , The APT Foundation , Inc., New Haven , Connecticut , USA
| | - Lindsay Oberleitner
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA
| | - Dharushana Muthulingam
- c Department of Internal Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - David Oberleitner
- d Department of Psychology , University of Bridgeport , Bridgeport , Connecticut , USA
| | - Lynn M Madden
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Pain Treatment Services , The APT Foundation , Inc., New Haven , Connecticut , USA
| | - Ruthanne Marcus
- c Department of Internal Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Anthony Eller
- b Pain Treatment Services , The APT Foundation , Inc., New Haven , Connecticut , USA.,f Yale School of Public Health , New Haven , Connecticut , USA
| | - Madeline H Bono
- b Pain Treatment Services , The APT Foundation , Inc., New Haven , Connecticut , USA.,e Department of Psychology , New York University, New York , New York , USA
| | - Declan T Barry
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Pain Treatment Services , The APT Foundation , Inc., New Haven , Connecticut , USA
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Oberleitner DE, Marcus R, Beitel M, Muthulingam D, Oberleitner LMS, Madden LM, Eller A, Barry DT. "Day-to-day, it's a roller coaster. It's frustrating. It's rewarding. It's maddening and it's enjoyable": A qualitative investigation of the lived experiences of addiction counselors. Psychol Serv 2019; 18:287-294. [PMID: 31580103 DOI: 10.1037/ser0000394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychologists in medication for addiction treatment (MAT) settings routinely oversee the work of addiction counselors as supervisors, administrators, and human resource specialists. Limited research has explored the lived experiences of counselors who work in programs that have scaled-up MAT in response to the opioid crisis in the U.S. Thirty-one addiction counselors who worked in MAT programs that had scaled-up treatment capacity were interviewed about 3 facets of their lived experiences: work roles, work motivation, and perceived responses of others to their work. Interviews were taped and transcribed. An interdisciplinary team reviewed and coded the transcripts using grounded theory analysis. The main work roles that emerged were counselor, educator, and advocate. Counselors described multiple factors related to intrinsic motivation for their work: family and personal history, altruism, enjoyment of challenges and client complexity, and witnessing and facilitating change. Factors related to extrinsic motivation were workplace opportunities and positive feedback. The main themes concerning responses of nonclients were positive feedback; others' narratives; negative feedback focused on the stigma associated with the treatment, the clients who receive it, and the counselors who provide it; and responses to anticipated negative feedback. Responses from clients were largely positive and focused on appreciation and respect. Psychologists in MAT settings can enhance the lived experiences of addiction counselors by helping them to savor positive feedback from clients and others, to recognize and appreciate their unique skillsets, and to recognize and address (not internalize) the multiple sources of stigma they encounter as addiction counselors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Mark Beitel
- Department of Psychiatry and Child Study Center, Yale School of Medicine
| | | | | | - Lynn M Madden
- Department of Internal Medicine, Yale School of Medicine
| | | | - Declan T Barry
- Department of Psychiatry and Child Study Center, Yale School of Medicine
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Mun CJ, Beitel M, Oberleitner L, Oberleitner DE, Madden LM, Bollampally P, Barry DT. Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone-maintained patients. J Clin Psychol 2019; 75:2233-2247. [PMID: 31454081 DOI: 10.1002/jclp.22842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The present study examined whether pain catastrophizing and pain acceptance, two important targets of psychosocial interventions for chronic pain, are uniquely associated with pain severity and pain interference among patients on methadone maintenance treatment (MMT). METHOD A total of 133 MMT patients who reported experiencing some pain during the previous week completed a battery of self-report measures. Multiple regression was used to test whether pain catastrophizing and pain acceptance are related to pain severity and pain interference above and beyond covariates including demographics, emotional distress, and current methadone dose. RESULTS Both pain acceptance and catastrophizing were significantly associated with pain severity and pain interference while controlling for covariates. CONCLUSIONS Consistent with previous literature on patients with chronic pain but without opioid use disorder, our findings suggest that both pain catastrophizing and pain acceptance are potentially important intervention targets among MMT patients with co-occurring opioid use disorder and chronic pain.
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Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - Lindsay Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut.,Department of Internal Medicine-AIDS, Yale School of Medicine, New Haven, Connecticut
| | - Pooja Bollampally
- APT Foundation, Inc, New Haven, Connecticut.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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40
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Knudsen HK, Brown R, Jacobson N, Horst J, Kim JS, Collier E, Starr S, Madden LM, Haram E, Toy A, Molfenter T. Physicians' satisfaction with providing buprenorphine treatment. Addict Sci Clin Pract 2019; 14:34. [PMID: 31446893 PMCID: PMC6709557 DOI: 10.1186/s13722-019-0163-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Buprenorphine is a critically important treatment for addressing the opioid epidemic, but there are virtually no studies of physicians’ job satisfaction with providing buprenorphine. Physicians’ job satisfaction has been linked to burnout and turnover as well as patients’ adherence to treatment recommendations, so it is important to understand how physicians’ satisfaction with providing buprenorphine treatment compares to their overall job satisfaction. Methods As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 55 physicians working in 38 organizations in Florida, Ohio, and Wisconsin completed a baseline web-based survey. Study measures included global job satisfaction, career satisfaction, and specialty satisfaction. Physicians who were waivered to prescribe buprenorphine were asked to rate their satisfaction with their current buprenorphine practice. Results Overall, physicians were generally satisfied with their jobs, their careers, and their specialties. When waivered physicians (n = 40) were compared to non-waivered physicians (n = 15) on 13 satisfaction items, there were no statistically significant differences. Among waivered physicians, ratings for buprenorphine work were significantly lower than ratings for general medical practice for finding such work personally rewarding, being pleased with such work, and overall satisfaction. Conclusions Although waivered and non-waivered physicians both reported high global job satisfaction, these data suggest that some waivered physicians may view their buprenorphine work as somewhat less satisfying than their global medical practice. Given that job dissatisfaction is a risk factor for turnover and burnout, managers of treatment organizations should consider whether strategies may be able to mitigate some sources of lower satisfaction in the context of buprenorphine treatment. Trial registration ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave., Room 204, Lexington, KY, 40508, USA.
| | - Randy Brown
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct., Madison, WI, 53715-1896, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, 4116 Signe Skott Cooper Hall, 701 Highland Ave., Madison, WI, 53705, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
| | - Jee-Seon Kim
- , 1067 Educational Sciences, 1025 West Johnson St., Madison, WI, 53706-1706, USA
| | | | - Sanford Starr
- Ohio Department of Mental Health and Addiction Services, 30 E. Broad St., 8th Floor, Columbus, OH, 43215, USA
| | - Lynn M Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT, 06511, USA.,Department of Internal Medicine, Yale University, New Haven, USA
| | - Eric Haram
- Haram Consulting, 413 River Road, Bowdoinham, ME, 04008, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
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Baldassarri SR, Fiellin DA, Savage ME, Madden LM, Beitel M, Dhingra LK, Fucito L, Camenga D, Bollampally P, Barry DT. Electronic cigarette and tobacco use in individuals entering methadone or buprenorphine treatment. Drug Alcohol Depend 2019; 197:37-41. [PMID: 30769264 PMCID: PMC6637405 DOI: 10.1016/j.drugalcdep.2018.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although smoking is prevalent among populations with opioid use disorder (OUD), few studies have examined electronic cigarette (EC) use in individuals seeking opioid agonist therapy (OAT). The aim of this study was to evaluate the prevalence and correlates of EC use among individuals seeking OAT. METHODS 782 patients seeking OAT for OUD completed surveys assessing current and past EC use, reasons for use, current and past cigarette smoking, nicotine dependence, psychiatric distress, trauma, and pain. Bivariate and multivariate models evaluated correlates of daily EC use, past-30-day EC use, and current cigarette smoking. RESULTS 6% of patients reported daily EC use, 18% reported past-30-day use, 62% reported EC use history, and 85% reported current cigarette smoking. 46% reported using ECs to quit or cut down smoking. In multivariate analyses, daily EC use was associated with higher odds of being a former smoker (OR 21; CI 1.7-273) and lower odds of ever smoking more than 100 cigarettes (OR 0.07; CI 0.01-0.32), while EC use in the past 30 days was associated with lower odds of being Caucasian (OR 0.55; CI 0.34-0.89), ever smoking more than 100 cigarettes (OR 0.13; CI 0.02-0.67), and history of chronic pain (OR 0.59; CI 0.38-0.90), and higher odds of reporting psychiatric distress (OR 1.5; CI 1.1-2.2). CONCLUSIONS EC use is common among people with OUD who smoke cigarettes. Those with daily use had higher odds of being former smokers than current smokers. Interventions using ECs may be effective to help reduce harms and mortality in OUD.
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Affiliation(s)
- Stephen R. Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - David A. Fiellin
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Mary Ellen Savage
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,APT Foundation, New Haven, CT
| | - Lynn M Madden
- APT Foundation, New Haven, CT,Department of Internal Medicine – AIDS, Yale School of Medicine, New Haven, CT
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,APT Foundation, New Haven, CT
| | - Lara K. Dhingra
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY,MJHS Institute for Innovation in Palliative Care, New York, NY
| | - Lisa Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Deepa Camenga
- APT Foundation, New Haven, CT,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Pooja Bollampally
- APT Foundation, New Haven, CT,Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT
| | - Declan T. Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Child Study Center, Yale School of Medicine, New Haven, CT,APT Foundation, New Haven, CT
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Muthulingam D, Bia J, Madden LM, Farnum SO, Barry DT, Altice FL. Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support. J Subst Abuse Treat 2019; 100:18-28. [PMID: 30898324 DOI: 10.1016/j.jsat.2019.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The opioid crisis requires rapid scale-up of evidence-based interventions to treat opioid use disorder (OUD), of which pharmacologic therapies with methadone, buprenorphine or long-acting naltrexone are most effective. With recently-developed formulations, there are unprecedented treatment options. Even when pharmacologic treatment is accessible, however, uptake remains low, suggesting individual-level barriers. Decision aids are an evidence-based strategy that may overcome these barriers. This study aims to inform such a tool by describing and rank-ordering patients' considerations when deciding whether to start medication and, if starting, choosing a medication. METHODS Adults with OUD (N = 81) attending an addiction treatment center or syringe exchange program completed focus groups using nominal group technique, a consensus method that generates and ranks response. The qualitative component generates a broad array of responses, followed by rank-ordering to prioritize responses. Responses to questions about starting any medications and the pros and cons of five specific medications were ranked and coded. RESULTS The decision to initiate pharmacologic therapy and choose among medications was influenced by six key attributes in decreasing priority: (1) benefits, (2) side effects of treatment, (3) medication delivery strategies, (4) convenience, (5) how expectations for treatment are met, and (6) how medication (especially methadone) can represents trading one addiction for another. CONCLUSIONS Pharmacologic properties, logistical factors, and managing expectations were important themes in decision-making for starting, choosing, and staying on medications, and to a lesser degree, negative views about medications, specifically OAT, as an addiction itself. Desire for more control over treatment persisted in all themes. This study identified specific knowledge gaps, expectations, and priorities which are important for developing a decision aid for OUD treatment relevant to the target group. Nominal group technique is an established mixed-methodology that we have applied to a new population and purpose, that of conducting needs assessment for decision aid development.
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Affiliation(s)
- Dharushana Muthulingam
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
| | - Joshua Bia
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Lynn M Madden
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Scott O Farnum
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, Inc, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Barry DT, Beitel M, Cutter CJ, Fiellin DA, Kerns RD, Moore BA, Oberleitner L, Madden LM, Liong C, Ginn J, Schottenfeld RS. An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug Alcohol Depend 2019; 194:460-467. [PMID: 30508769 PMCID: PMC6312460 DOI: 10.1016/j.drugalcdep.2018.10.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 12/28/2022]
Abstract
AIMS The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. METHODS In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19). RESULTS Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ2 (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ2 (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC. CONCLUSIONS We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.
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Affiliation(s)
- Declan T. Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,APT Foundation Pain Treatment Services, New Haven, CT 06519
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,APT Foundation Pain Treatment Services, New Haven, CT 06519
| | - Christopher J. Cutter
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,APT Foundation Pain Treatment Services, New Haven, CT 06519
| | - David A. Fiellin
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06519
| | - Robert D. Kerns
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,VA Connecticut Healthcare System, West Haven, CT 06516
| | - Brent A. Moore
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,VA Connecticut Healthcare System, West Haven, CT 06516
| | - Lindsay Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,APT Foundation Pain Treatment Services, New Haven, CT 06519
| | - Lynn M. Madden
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511,APT Foundation Pain Treatment Services, New Haven, CT 06519
| | | | - Joel Ginn
- APT Foundation Pain Treatment Services, New Haven, CT 06519
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Madden LM, Farnum SO, Eggert KF, Quanbeck AR, Freeman RM, Ball SA, Schottenfeld RS, Shi JM, Savage ME, Barry DT. An investigation of an open-access model for scaling up methadone maintenance treatment. Addiction 2018; 113:1450-1458. [PMID: 29453891 DOI: 10.1111/add.14198] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/03/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023]
Abstract
AIMS To examine retrospectively patient and programmatic outcomes following the development and implementation of an 'open-access' model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. DESIGN Medical and administrative records were abstracted to compare data for 1 year before and 9 years after initiating the implementation of an open-access treatment model in May 2007. SETTING Methadone maintenance treatment center in Connecticut, USA. PARTICIPANTS Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n = 2594) of the sample were men and 80% (n = 3133) reported that they were white. INTERVENTION The Network for the Improvement of Addiction Treatment-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity. MEASUREMENTS Census, waiting time, retention, non-medical opioid use, patient mortality and financial sustainability (net income and state-block grants as proportions of revenue). FINDINGS In the 9 years following the initial implementation of the open-access model, patient census increased by 183% from 1431 to 4051, and average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state-block grant revenues declined 14% and the proportion of total revenue from state-block grant revenue decreased from 49 to 24%. CONCLUSIONS An open-access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes.
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Affiliation(s)
- Lynn M Madden
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | | | | | | | | | - Samuel A Ball
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Richard S Schottenfeld
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Julia M Shi
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Mary Ellen Savage
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
| | - Declan T Barry
- Yale University School of Medicine, New Haven, CT, USA.,The APT Foundation, Inc., New Haven, CT, USA
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Butner JL, Bone C, Ponce Martinez CC, Kwon G, Beitel M, Madden LM, Bono MH, Eller A, Barry DT. Training addiction counselors to deliver a brief psychoeducational intervention for chronic pain among patients in opioid agonist treatment: A pilot investigation. Subst Abus 2018. [DOI: 10.1080/08897077.2018.1449052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jenna L. Butner
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Curtis Bone
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Caridad C. Ponce Martinez
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Grace Kwon
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Madeline H. Bono
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- New York University, Department of Psychology, New York, New York, USA
| | - Anthony Eller
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Declan T. Barry
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
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Beitel M, Oberleitner L, Kahn M, Kerns RD, Liong C, Madden LM, Ginn J, Barry DT. Drug Counselor Responses to Patients’ Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment. Pain Medicine 2017; 18:2152-2161. [DOI: 10.1093/pm/pnw327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Beitel M, Stults-Kolehmainen M, Cutter CJ, Schottenfeld RS, Eggert K, Madden LM, Kerns RD, Liong C, Ginn J, Barry DT. Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain. Am J Addict 2016; 25:125-31. [PMID: 26824197 DOI: 10.1111/ajad.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity may improve chronic pain, anxiety, and depression, which are prevalent among patients in methadone maintenance treatment (MMT), but relatively little is known about the physical activity levels or interest in exercise of patients in MMT. METHODS We used a brief self-report instrument to assess physical activity levels, chronic pain, psychiatric distress, and interest in exercise group participation among 303 adults seeking MMT. RESULTS Most (73%) reported no moderate or vigorous intensity physical activity in the past week; 27% met recommended physical activity levels, and 24% reported interest in exercise group participation. Participants with (compared to those without) chronic pain had higher levels of psychiatric distress and were less likely to meet recommended levels of physical activity (p < .05), but did not differ significantly in their interest in participating in an exercise group. Participants who met recommended levels of physical activity in the past week were more likely to be men and had lower levels of depression than others (p < .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT.
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Affiliation(s)
- Mark Beitel
- Yale University School of Medicine, New Haven, Connecticut.,APT Foundation Pain Treatment Services, New Haven, Connecticut
| | | | - Christopher J Cutter
- Yale University School of Medicine, New Haven, Connecticut.,APT Foundation Pain Treatment Services, New Haven, Connecticut
| | | | - Kathy Eggert
- APT Foundation Pain Treatment Services, New Haven, Connecticut
| | - Lynn M Madden
- Yale University School of Medicine, New Haven, Connecticut.,APT Foundation Pain Treatment Services, New Haven, Connecticut
| | - Robert D Kerns
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | | | - Joel Ginn
- APT Foundation Pain Treatment Services, New Haven, Connecticut
| | - Declan T Barry
- Yale University School of Medicine, New Haven, Connecticut.,APT Foundation Pain Treatment Services, New Haven, Connecticut
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Prescott DL, Madden LM, Dennis M, Tisher P, Wingate C. Reducing mechanical restraints in acute psychiatric care settings using rapid response teams. J Behav Health Serv Res 2007; 34:96-105. [PMID: 17103042 DOI: 10.1007/s11414-006-9036-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the use of rapid response teams to reduce the use of mechanical restraints (i.e., restricting a person's movement through the use of a mechanical device such as a backboard, net, or papoose) in an acute psychiatric care setting. Rapid response teams have proven highly effective for emergent medical patients, but have not typically been used in behavioral health care settings. Utilizing a rapid cycle process improvement approach, a response team was convened following each episode of mechanical restraint in an inpatient psychiatric treatment facility. Initial results, during a 6-week rapid cycle change process, showed that mechanical restraints were reduced by 36.4% when compared with a 6-week baseline and when compared with a 1-year baseline. Changes in hospital census during the implementation process did not appear to account for the reduction in restraints. Rapid response teams and rapid cycle process improvement are discussed as useful change vehicles for behavioral health care organizations.
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Affiliation(s)
- David L Prescott
- Acadia Hospital, 268 Stillwater Avenue, PO Box 422, Bangor, ME 04402-0422, USA.
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Schinzer WC, Bergren MS, Aldrich DS, Chao RS, Dunn MJ, Jeganathan A, Madden LM. Characterization and interconversion of polymorphs of premafloxacin, a new quinolone antibiotic. J Pharm Sci 1997; 86:1426-31. [PMID: 9423158 DOI: 10.1021/js970063o] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The quinolone antibiotic premafloxacin crystallizes in at least five solid modifications, including three anhydrous phases (Forms I-III), a hydrate, and a methanolate. The anhydrous phases were studied by optical microscopy, X-ray powder diffraction, HPLC, hot-stage microscopy, dynamic moisture sorption gravimetry, differential scanning calorimetry, thermal gravimetry, and solution and isothermal calorimetry. Dry samples of Form I converted to Form II and ultimately to Form III through a sequence of melts and recrystallizations. Form III was stable to its melting temperature near 200 degrees C. Humidified samples of Form I converted directly to Form III via a moisture-mediated solid-state phase transformation at temperatures as low as 40 degrees C. The calorimetric and solubility data confirmed that Form III was lower in free energy and enthalpy than Form I at room temperature. Our investigation revealed that Form I was not crystallized directly from solution. Rather, Form I was the product of facile solid-state desolvation of the methanol solvate.
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