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Pepin MD, Joseph JK, Chapman BP, McAuliffe C, O’Donnell LK, Marano RL, Carreiro SP, Garcia EJ, Silk H, Babu KM. A mobile addiction service for community-based overdose prevention. Front Public Health 2023; 11:1154813. [PMID: 37538275 PMCID: PMC10394629 DOI: 10.3389/fpubh.2023.1154813] [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: 01/31/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Mainstays of opioid overdose prevention include medications for opioid use disorder (e.g., methadone or buprenorphine) and naloxone distribution. Inadequate access to buprenorphine limits its uptake, especially in communities of color, and people with opioid use disorders encounter multiple barriers to obtaining necessary medications including insurance, transportation, and consistent availability of telephones. UMass Memorial Medical Center and our community partners sought to alleviate these barriers to treatment through the deployment of a mobile addiction service, called the Road to Care. Using this approach, multidisciplinary and interprofessional providers deliver holistic addiction care by centering our patients' needs with respect to scheduling, location, and convenience. This program also extends access to buprenorphine and naloxone among people experiencing homelessness. Additional systemic and individualized barriers encountered are identified, as well as potential solutions for future mobile addiction service utilization. Over a two-year period, we have cared for 1,121 individuals who have accessed our mobile addiction service in over 4,567 encounters. We prescribed buprenorphine/naloxone (Suboxone®) to 330 individuals (29.4% of all patients). We have distributed nearly 250 naloxone kits directly on-site or and more than 300 kits via prescriptions to local pharmacies. To date, 74 naloxone rescue attempts have been reported back to us. We have demonstrated that a community-based mobile addiction service, anchored within a major medical center, can provide high-volume and high-quality overdose prevention services that facilitate engagement with additional treatment. Our experience is described as a case study below.
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Affiliation(s)
- Michael D. Pepin
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Jillian K. Joseph
- UMass Memorial Health, Worcester, MA, United States
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, United States
| | - Brittany P. Chapman
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Christina McAuliffe
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | | | - Ryan L. Marano
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Stephanie P. Carreiro
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Erik J. Garcia
- UMass Memorial Health, Worcester, MA, United States
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, United States
| | - Hugh Silk
- UMass Memorial Health, Worcester, MA, United States
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, United States
| | - Kavita M. Babu
- UMass Memorial Health, Worcester, MA, United States
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
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Nelson DS, Marano RL, Joo Y, Tian SY, Patel B, Kaplan DH, Shlomchik MJ, Stevenson K, Bronson RT, Rollins BJ. BRAF V600E and Pten deletion in mice produces a histiocytic disorder with features of Langerhans cell histiocytosis. PLoS One 2019; 14:e0222400. [PMID: 31527903 PMCID: PMC6748438 DOI: 10.1371/journal.pone.0222400] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is characterized by the accumulation of Langerin (CD207)-expressing histiocytes. Mutational activation of mitogen-activated protein kinase pathway genes, in particular BRAF, drives most cases. To test whether activated BRAF is sufficient for the development of LCH, we engineered mice to express BRAF V600E under the control of the human Langerin promoter. These mice have shortened survivals, smaller lymphoid organs, absent Leydig cells, and fewer epidermal LCs than controls, but do not accumulate histiocytes. To test whether the absence of histiocyte proliferation could be due to oncogene-induced senescence, we engineered homozygous Pten loss in the same cells that expressed BRAF V600E. Like mice with intact Pten, these mice have shortened survivals, smaller thymi, and absent Leydig cells. However, loss of Pten also leads to the accumulation of CD207+ histiocytes in spleen, thymus, and some lymph nodes. While many CD207+ histiocytes in the thymus are CD8-, reminiscent of LCH cells, the CD207+ histiocytes in the spleen and lymph nodes are CD8+. These mice also accumulate large numbers of CD207- cells in the lamina propria (LP) of the small intestine. Both the lymphoid and LP phenotypes are likely due to human Langerin promoter-driven BRAF V600E expression in resident CD8+ dendritic cells in the former and LP dendritic cells in the latter and confirm that Pten loss is required to overcome inhibitory pathways induced by BRAF V600E expression. The complex phenotype of these mice is a consequence of the multiple murine cell types in which the human Langerin promoter is active.
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Affiliation(s)
- David S. Nelson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Ryan L. Marano
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Yechaan Joo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Sara Y. Tian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Bhumi Patel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
| | - Daniel H. Kaplan
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Mark J. Shlomchik
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Roderick T. Bronson
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, United States of America
| | - Barrett J. Rollins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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