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Bortz C, Armistead I, Bonaguidi A, Coyle DT. Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years. J Subst Use Addict Treat 2024; 161:209342. [PMID: 38513975 DOI: 10.1016/j.josat.2024.209342] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents-safety events occurring in OTPs that are reportable to regulatory entities-across all Colorado OTPs during the COVID-19 pandemic. METHODS This study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15-December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15-December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. RESULTS OTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). CONCLUSIONS There was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.
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Affiliation(s)
- Cole Bortz
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Isaac Armistead
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
| | - Angela Bonaguidi
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - D Tyler Coyle
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA.
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Agley J, Gassman R, Reho K, Roberts J, Heil SKR, Golzarri-Arroyo L, Eddens K. Organizational Network Analysis of SAMHSA's Technology Transfer Center (TTC) Network. J Behav Health Serv Res 2024; 51:123-131. [PMID: 37872261 PMCID: PMC10733212 DOI: 10.1007/s11414-023-09867-y] [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] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Technology transfer centers (TTCs) facilitate the movement of evidence-based practices in behavioral healthcare from theory to practice. One of the largest such networks is the Substance Abuse and Mental Health Services Administration's (SAMHSA) TTC Network. This brief report shares findings from an organizational network analysis (ONA) of the network conducted as part of an external evaluation. For non-supervisory TTCs (n = 36) across three focus areas (addiction, prevention, and mental health), the authors computed network density, harmonic closeness, and non-null dyadic reciprocity for five types of interactions (e.g., "collaborated in workgroups"), then, for each interaction type, used Welch's T-test to compare mean harmonic closeness of standalone TTC grantees versus multiple-TTC grantees. ONA identified potentially isolated regional TTCs as well as mismatches between some centers' desired scope and their network centrality and enabled investigation of broader questions around behavioral health support systems. The approach appears useful for evaluating TTCs and similar support networks.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA.
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Susan K R Heil
- American Institutes for Research (AIR), Arlington, VA, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
| | - Kate Eddens
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Nwanaji-Enwerem JC, Rivera Blanco LE, Kiernan EA, Morgan BW, Gittinger MH, Steck AR. Revisiting emergency department use of buprenorphine as a primary analgesic in nonopioid use disorder patients post-X-waiver. Acad Emerg Med 2023; 30:1272-1274. [PMID: 37119058 DOI: 10.1111/acem.14749] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Jamaji C Nwanaji-Enwerem
- Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Emily A Kiernan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brent W Morgan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Melissa H Gittinger
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alaina R Steck
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Ramdin C, Azer A, Ghafoor N, Attaalla K, Ghbrial M, Nelson L. Prevalence and services for the treatment of chronic pain at residential substance treatment centers. J Addict Dis 2023:1-6. [PMID: 37665562 DOI: 10.1080/10550887.2023.2251856] [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: 09/05/2023]
Abstract
Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA's treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amanda Azer
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Naila Ghafoor
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kyrillos Attaalla
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mina Ghbrial
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Pena E, Ahmed S. TIME TO REVISIT UNEVEN POLICY IN THE UNITED STATES FOR MEDICATION FOR OPIOID USE DISORDER DURING COVID-19. Addiction 2020; 115:1978-1979. [PMID: 32447795 PMCID: PMC7283694 DOI: 10.1111/add.15143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Eduardo Pena
- Drug Dependence Treatment Center, VA Boston Healthcare SystemJamaicaPlainMAUSA
| | - Saeed Ahmed
- Boston Medical Center/VA Boston Healthcare SystemBostonMAUSA
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Payne HE, Steele M, Bingham JL, Sloan CD. Identifying and Reducing Disparities in Mental Health Outcomes Among American Indians and Alaskan Natives Using Public Health, Mental Healthcare and Legal Perspectives. Adm Policy Ment Health 2018; 45:5-14. [PMID: 28144762 DOI: 10.1007/s10488-016-0777-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/09/2023]
Abstract
The purpose of this paper was to investigate disparities in mental healthcare delivery in American Indian/Alaska Native populations from three perspectives: public health, legal policy and mental healthcare and provide evidence-based recommendations toward reducing those disparities. Data on mental health funding to tribes were obtained from the Substance Abuse and Mental Health Services Administration. As a result of analysis of these data, vital statistics and current literature, we propose three recommendations to reduce mental health disparities. First, where possible, increase mental health funding opportunities for federally-recognized tribes. Second, model funding practices on principles of tribal self-determination. Finally, support diverse interventions that are culturally-based and culturally-appropriate.
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Affiliation(s)
- Hannah E Payne
- Department of Health Science, Brigham Young University, 2048 Life Sciences Building, Provo, UT, 84602, USA
| | - Michalyn Steele
- J. Reuben Clark Law School, Brigham Young University, Provo, UT, USA
| | - Jennie L Bingham
- Counseling and Psychological Services, Brigham Young University, Provo, UT, USA
| | - Chantel D Sloan
- Department of Health Science, Brigham Young University, 2048 Life Sciences Building, Provo, UT, 84602, USA.
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Abstract
AIMS To generate a short version of a newly developed inventory that adopted the conceptual framework of the Substance Abuse and Mental Health Services Administration (SAMHSA) consensus statement on recovery. METHODS Through Rasch analysis, this paper presents how this recovery inventory (SAMHSA-RIC), with its original 111 items, can be reduced to a much shorter version with only 41 items. RESULTS Although internal consistency is slightly lowered because of item reduction, the short version maintains satisfactory and significant correlations with quality of life measures. Overall, the canonical correlation between the scale and WHOQOL-BREF was virtually the same, with only a 0.2% decrease. CONCLUSIONS SAMHSA-RIC (short version) has strong potential to become a general tool for evaluating rehabilitative services for persons with persistent and severe mental illness. A validation study of the short version with clinical samples is warranted.
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Stoops WW, Bennett JA, Lile JA, Sevak RJ, Rush CR. Influence of aripiprazole pretreatment on the reinforcing effects of methamphetamine in humans. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:111-7. [PMID: 23994622 DOI: 10.1016/j.pnpbp.2013.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022]
Abstract
Methamphetamine use disorders remain a significant public health concern. Methamphetamine produces its behavioral effects by facilitating release of monoamines like dopamine (DA) and serotonin (5-HT). Results from animal studies show that acute pretreatment with DA and 5-HT antagonists attenuates the effects of methamphetamine, but this area remains largely unexplored in humans. This study sought to assess whether aripiprazole, a partial agonist at D2/5-HT1A receptors and an antagonist at 5-HT2A receptors, would attenuate the reinforcing and subject-rated effects of oral methamphetamine. Seven subjects with histories of recreational stimulant use completed a placebo-controlled, crossover, double-blind protocol in which they first sampled doses of oral methamphetamine (0, 4, 8 or 16 mg) following acute pretreatment with aripiprazole (0 and 15 mg). During each Sampling Session, subjects also completed a battery of subject-rated, cardiovascular, and other performance measures. In subsequent Self-Administration Sessions, subjects were provided the opportunity to earn the previously sampled methamphetamine dose on a progressive-ratio procedure. Methamphetamine functioned as a reinforcer, and produced prototypical stimulant-like subject-rated and cardiovascular effects (e.g., increased ratings of Stimulated; elevated blood pressure). Aripiprazole reduced methamphetamine self-administration and attenuated some of the positive subject-rated effects of methamphetamine (e.g., ratings of Like Drug). These results indicate that acute aripiprazole pretreatment attenuates the abuse-related effects of methamphetamine.
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