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Grekin P, Saxon A, Iles-Shih M. Misrepresentation of Options for Treatment of Opioid Use Disorder in the General Hospital. Am J Psychiatry 2024; 181:169-170. [PMID: 38298082 DOI: 10.1176/appi.ajp.20230656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Paul Grekin
- Department of Psychiatry & Behavioral Sciences, University of Washington, School of Medicine (Grekin, Saxon, Iles-Shih); Evergreen Treatment Services, Seattle (Grekin); Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle (Saxon)
| | - Andrew Saxon
- Department of Psychiatry & Behavioral Sciences, University of Washington, School of Medicine (Grekin, Saxon, Iles-Shih); Evergreen Treatment Services, Seattle (Grekin); Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle (Saxon)
| | - Matt Iles-Shih
- Department of Psychiatry & Behavioral Sciences, University of Washington, School of Medicine (Grekin, Saxon, Iles-Shih); Evergreen Treatment Services, Seattle (Grekin); Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle (Saxon)
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Idrisov B, Hallgren KA, Michaels A, Soth S, Darnton J, Grekin P, Woolworth S, Saxon AJ, Tsui JI. Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study. JMIR Hum Factors 2023; 10:e42654. [PMID: 37440298 PMCID: PMC10375394 DOI: 10.2196/42654] [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: 09/26/2022] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. OBJECTIVE The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. METHODS Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program. RESULTS Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). CONCLUSIONS A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal.
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Affiliation(s)
- Bulat Idrisov
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Alyssa Michaels
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA, United States
| | - James Darnton
- Evergreen Treatment Services, Seattle, WA, United States
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
| | - Paul Grekin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
- Evergreen Treatment Services, Seattle, WA, United States
| | | | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Judith I Tsui
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
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Darnton JB, Bhatraju EP, Beima-Sofie K, Michaels A, Hallgren KA, Soth S, Grekin P, Woolworth S, Tsui JI. "Sign Me Up": a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic. Addict Sci Clin Pract 2023; 18:21. [PMID: 36991506 PMCID: PMC10052285 DOI: 10.1186/s13722-023-00372-3] [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: 09/29/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)-a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. METHODS We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. RESULTS We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. CONCLUSIONS VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities.
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Affiliation(s)
- James B Darnton
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Elenore P Bhatraju
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Alyssa Michaels
- Division of HIV, ID, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Paul Grekin
- Evergreen Treatment Services, Seattle, WA, 98134, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | | | - Judith I Tsui
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA.
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Hallgren KA, Darnton J, Soth S, Blalock KL, Michaels A, Grekin P, Saxon AJ, Woolworth S, Tsui JI. Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic. J Subst Abuse Treat 2022; 143:108896. [PMID: 36215911 PMCID: PMC9531364 DOI: 10.1016/j.jsat.2022.108896] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/20/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Methadone is one of the most utilized treatments for opioid use disorder. However, requirements for observing methadone dosing can impose barriers to patients and increase risk for respiratory illness transmission (e.g., COVID-19). Video observation of methadone dosing at home could allow opioid treatment programs (OTPs) to offer more take-home doses while ensuring patient safety through remote observation of ingestion. METHODS Between April and August 2020, a clinical pilot program of video observation of methadone take-home dosing via smartphone was conducted within a multisite OTP agency. Participating patients completed a COVID-19 symptom screener and submitted video recordings of themselves ingesting all methadone take-home doses. Patients who followed these procedures for a two-week trial period could continue participating in the full pilot program and potentially receive more take-home doses. This retrospective observational study characterizes patient engagement and compares clinical outcomes with matched controls. RESULTS Of 44 patients who initiated the two-week trial, 33 (75 %) were successful and continued participating in the full pilot program. Twenty full pilot participants (61 %) received increased take-home doses. Full pilot participants had more days with observed dosing over a 60-day period than matched controls (mean = 53.2 vs. 16.6 days, respectively). Clinical outcomes were similar between pilot participants and matched controls. CONCLUSIONS Video observation of methadone take-home dosing implemented during the COVID-19 pandemic was feasible. This model has the potential to enhance safety by increasing rates of observed methadone dosing and reducing infection risks and barriers associated with relying solely on face-to-face observation of methadone dosing.
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Affiliation(s)
- Kevin A. Hallgren
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Corresponding author at: Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Box 356560, 1959 NE Pacific St., Seattle, WA 98195, United States
| | - James Darnton
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Kendra L. Blalock
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Alyssa Michaels
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Paul Grekin
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Andrew J. Saxon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - Steve Woolworth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Judith I. Tsui
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
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Bhatraju EP, Fuller C, Grekin P, Rockman S, Peavy KM. Mortality in an Opioid Treatment Program. J Psychoactive Drugs 2021; 54:93-98. [PMID: 33840354 DOI: 10.1080/02791072.2021.1909189] [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] [Indexed: 10/21/2022]
Abstract
This retrospective study examined mortality in an Opioid Treatment Program (OTP) with policies designed to admit and retain patients with as few barriers as possible. Methadone provided in the context of an OTP is known to decrease mortality and morbidity. Historically, patients have been discharged or turned away because of continued substance use. We examined patient deaths over three years in an OTP serving approximately 2400 patients daily. Demographics and causes of death were gathered from electronic health records and medical examiner reports. Pairwise comparisons were used to compare drug poisoning versus non-drug poisoning deaths. There were 155 deaths during the study period. The average age was 54, and half of the participants had positive results on their most recent drug screen. Forty one (26%) died from "drug poisoning." Drug poisoning deaths were more common among patients who: 1) had recent positive drug test results; 2) had documented alprazolam use; 3) were younger; 4) had shorter treatment durations; 5) were female. The majority of deaths were among long-term patients over 50 and were not caused by drug poisoning. These results support keeping patients in treatment despite ongoing drug use, and linking them to appropriate primary care.
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Affiliation(s)
- Elenore P Bhatraju
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.,Evergreen Treatment Services, Seattle, WA, USA
| | - Caitlin Fuller
- Department of Clinical Psychology, Alliant International University, San Diego, CA, USA
| | - Paul Grekin
- Evergreen Treatment Services, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Hatch-Maillette MA, Peavy KM, Tsui JI, Banta-Green CJ, Woolworth S, Grekin P. Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: Provider perspectives. J Subst Abuse Treat 2020; 124:108223. [PMID: 33342667 DOI: 10.1016/j.jsat.2020.108223] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/15/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
COVID-19 necessitated rapid changes in methadone take-home policies in opioid treatment programs (OTPs); these changes markedly contrast with existing, long-standing federal mandates on OTP rules about take-home methadone. OTP providers describe how these changes have affected clinical decision-making, equity in patient care, and workflow. We also discuss implications for medical ethics and patient autonomy. We provide suggestions for future research that will examine the impact of COVID-19 on OTP treatment and its patients, as well as the effect of making methadone take-home polices patient centered, all of which may foreshadow larger changes in the ways OTPs deliver their services.
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Affiliation(s)
- Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, United States of America; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States of America.
| | - K Michelle Peavy
- Evergreen Treatment Services, 1700 Airport Way S., Seattle, WA 98134, United States of America
| | - Judith I Tsui
- Evergreen Treatment Services, 1700 Airport Way S., Seattle, WA 98134, United States of America; Division of Internal Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America
| | - Caleb J Banta-Green
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, United States of America; Department of Health Services, University of Washington School of Public Health, Seattle, WA 98195, United States of America
| | - Stephen Woolworth
- Evergreen Treatment Services, 1700 Airport Way S., Seattle, WA 98134, United States of America
| | - Paul Grekin
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Evergreen Treatment Services, 1700 Airport Way S., Seattle, WA 98134, United States of America
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Peavy KM, Darnton J, Grekin P, Russo M, Green CJB, Merrill JO, Fotinos C, Woolworth S, Soth S, Tsui JI. Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program. AIDS Behav 2020; 24:2469-2472. [PMID: 32347404 PMCID: PMC7186943 DOI: 10.1007/s10461-020-02887-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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