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Roche AI, Young A, Sabaque C, Kelpin SS, Sinicrope P, Pham C, Marsch LA, Campbell ANC, Venner K, Baker-DeKrey L, Wyatt T, WhiteHawk S, Nord T, Resnicow K, Young C, Brown A, Bart G, Patten C. Wiidookaage'win: Beta-test of a Facebook group intervention for native women to support opioid use recovery. J Subst Use Addict Treat 2024:209396. [PMID: 38759734 DOI: 10.1016/j.josat.2024.209396] [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: 11/02/2023] [Revised: 02/16/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The ongoing opioid misuse epidemic has had a marked impact on American Indian/Alaska Native (AI/AN) communities. Culture- and gender-specific barriers to medically assisted recovery from opioid use disorder (OUD) have been identified, exacerbating its impact for AI/AN women. Wiidookaage'win is a community-based participatory research study that aims to develop a culturally tailored, moderated, private Facebook group intervention to support Minnesotan AI/AN women in medically assisted recovery from OUD. The current study assessed the preliminary feasibility and acceptability of the intervention in a beta-test to inform refinements before conducting a pilot randomized controlled trial (RCT). METHODS The intervention was beta-tested for 30 days. Moderators were trained prior to delivering the intervention. Study assessments were conducted at baseline and post-intervention. The post-intervention assessments included substance use (self-report and urine drug screen), treatment acceptability, mental health, and spirituality outcomes. We examined intervention engagement patterns using Facebook metrics and qualitatively explored common topics that emerged in participant posts and comments. RESULTS Ten AI/AN women taking medication for OUD (MOUD) were accrued (age range 25-62 years). Participants had been in opioid recovery a mean of 15.2 months (SD = 16.1; range = 3-60). The study participation rate (accrued/eligible) was 91 %. Nine participants completed the post-intervention survey assessment and eight completed a UDS. Acceptability was high based on the mean treatment satisfaction score (M = 4.8, SD = 0.2 out of a possible 5.0), Facebook group engagement, and positive qualitative feedback. All participants retained at post-intervention continued their MOUD treatment, and none had returned to opioid use. CONCLUSIONS The beta-test indicated that the Facebook platform and study procedures generally worked as intended and that the intervention was largely acceptable to study participants. The results of this study phase provided valuable insights to inform refinements prior to conducting a pilot RCT to further assess the feasibility, acceptability, and potential efficacy of the intervention.
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Affiliation(s)
- Anne I Roche
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Antonia Young
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Corinna Sabaque
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sydney S Kelpin
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Pamela Sinicrope
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Cuong Pham
- Division of General Internal Medicine, University of Minnesota, 401 East River Parkway, Minneapolis, MN, 55455, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA.
| | - Aimee N C Campbell
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Kamilla Venner
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, 2650 Yale Boulevard Southeast, Albuquerque, NM 87106, USA.
| | - Laiel Baker-DeKrey
- Counseling and Recovery Services, Indian Health Board of Minneapolis, Inc., 1315 East 24(th) Street, Minneapolis, MN 55404, USA.
| | - Thomas Wyatt
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN 55404, USA.
| | - Sharyl WhiteHawk
- American Indian Family Center, 579 Wells Street, St. Paul, MN, USA.
| | - Teresa Nord
- ICWA Law Center, American Indian Prison Project, 1730 Clifton Place Suite 104, Minneapolis, MN 55403, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Colleen Young
- Division of Health Education & Content Services, Mayo Clinic Connect, 200 First Street Southwest, Rochester, MN 55905, United States.
| | - Ashley Brown
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Gavin Bart
- Hennepin Healthcare, 730 South Eighth Street, Minneapolis, MN 55415, USA.
| | - Christi Patten
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Zhu JM, Charlesworth CJ, Stein BD, Drake C, Polsky D, Korthuis PT, McConnell KJ. Composition of buprenorphine prescribing networks in Medicaid and association with quality of care. J Subst Use Addict Treat 2024; 163:209363. [PMID: 38641055 DOI: 10.1016/j.josat.2024.209363] [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: 08/30/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Despite Medicaid's outsized role in delivering and financing medications for opioid use disorder (MOUD), little is known about the extent to which buprenorphine prescriber networks vary across Medicaid health plans, and whether network characteristics affect quality of treatment received. In this observational cross-sectional study, we used 2018-2019 Medicaid claims in Oregon to assess network variation in the numbers and types of buprenorphine prescribers, as well as the association of prescriber and network characteristics with quality of care. METHODS We describe prescribers (MD/DOs and advanced practice providers) of OUD-approved buprenorphine formulations to patients with an OUD diagnosis, across networks. For each patient who initiated buprenorphine treatment during 2018, we assigned a "usual prescriber" and assessed four measures of quality in the 180d following initiation: 1) continuous receipt of buprenorphine; 2) receipt of any behavioral health counseling services; 3) receipt of any urine drug screen; and 4) receipt of any prescription for a benzodiazepine. We used multivariable linear regressions to examine the association of prescriber and network characteristics with quality of buprenorphine care following initiation. RESULTS We identified 645 providers who prescribed buprenorphine to 20,739 eligible Medicaid enrollees with an OUD diagnosis. The composition of buprenorphine prescriber networks varied in terms of licensing type, specialty, and panel size, with the majority of prescribers providing buprenorphine to small panels of patients. In the 180 days following initiation, a third of patients were maintained on buprenorphine; 69.9 % received behavioral health counseling; 88.4 % had a urine drug screen; and 11.3 % received a benzodiazepine prescription. In regression analyses, while no single network characteristic was associated with higher quality across all examined measures, each one unit increase in prescriber-to-enrollee ratio was associated with a 1.18 p.p. increase in the probability of continuous buprenorphine maintenance during the 180 days following initiation (95 % confidence interval = [0.21, 2.15], p = 0.017). CONCLUSIONS Medicaid plans may be able to leverage their networks to provide higher quality care. Our findings, which should be interpreted as descriptive only, suggest that higher prescriber-to-enrollee ratio is associated with increased buprenorphine maintenance. Future research should focus on isolating the causal relationships between MOUD prescribing network design and patient outcomes.
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Affiliation(s)
- Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
| | | | | | - Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - P Todd Korthuis
- Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
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Bali B, Tuan WJ, Scott A, Bollampally P, Groff D, Leong SL, King VL, Bone C. Assessing men with opioid use disorder for testosterone deficiency after the development of symptoms. J Addict Dis 2024:1-7. [PMID: 38619057 DOI: 10.1080/10550887.2024.2327751] [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: 04/16/2024]
Abstract
OBJECTIVE Individuals with opioid use disorder (OUD) have reduced life expectancy and inferior outcomes when treated for depression, diabetes, and fractures. Their elevated risk of testosterone deficiency may contribute to all of these relationships, however few individuals prescribed opioids are evaluated with testosterone assays. The purpose of this study is to determine whether patients with opioid use disorder are evaluated for testosterone deficiency after development of a symptom that may merit investigation, such as erectile dysfunction (ED). METHOD We conducted a retrospective longitudinal cohort study that utilized data from a national database called TriNetX. Patients were eligible for inclusion if they were 20 to 90 years of age, male, and diagnosed with erectile dysfunction. We utilized descriptive statistics and logistic regression to address study aims. RESULTS Testosterone testing was uncommon for all patients with ED. Among 20,658 patients, it was assessed in 11.2% with OUD and 15.1% without OUD. Among those screened, 40% individuals with OUD and ED had testosterone deficiency. Odds of screening those with OUD were lower than matched controls (RR 0.74). CONCLUSIONS Individuals with OUD are at increased risk of testosterone deficiency than the general population, but nearly 90% are not evaluated for this condition even after development symptoms. That 40% of individuals assessed were classified as testosterone deficient suggests endocrine disorders may be contributing to increased fracture risk, chronic pain, and severe depression commonly encountered in patients with OUD. Addressing this care gap may reduce morbidity and mortality associated with opioid use disorder.
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Affiliation(s)
- Bhavna Bali
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Wen Jan Tuan
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alyssa Scott
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | | | - Destin Groff
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Shou Ling Leong
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Van L King
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Curtis Bone
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Bradford W, Akselrod H, Bassler J, Gagnon KW, Burkholder G, Carpenter JE, Steck A, Catalanotti J, Kuo I, McGonigle K, Mai W, Notis M, Brokus C, Kattakuzhy S, Rosenthal E, Eaton EF. Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment. Addict Sci Clin Pract 2024; 19:22. [PMID: 38528590 DOI: 10.1186/s13722-024-00451-z] [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: 06/28/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Hospitalization is a "reachable moment" for people who inject drugs (PWID), but preventive care including HIV testing, prevention and treatment is rarely offered within inpatient settings. METHODS We conducted a multisite, retrospective cohort study of patients with opioid use disorder with infectious complications of injection drug use hospitalized between 1/1/2018-12/31/2018. We evaluated HIV care continuum outcomes using descriptive statistics and hypothesis tests for intergroup differences. RESULTS 322 patients were included. Of 300 patients without known HIV, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 (59%) had a viral load collected during admission of whom all were viremic and 10 (45%) were successfully linked to care post-discharge. Rates of readmission, Medicaid or uninsured status, and unstable housing were high in both groups. DISCUSSION We observed poor provision of HIV testing, PrEP and other HIV services for hospitalized PWID across multiple U.S. medical centers. Future initiatives should focus on providing this group with comprehensive HIV testing and treatment services through a status neutral approach.
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Affiliation(s)
- William Bradford
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
| | - Hana Akselrod
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - John Bassler
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Kelly W Gagnon
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | | | - Alaina Steck
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Jillian Catalanotti
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, USA
| | - Keanan McGonigle
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - William Mai
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Melissa Notis
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA
| | - Christopher Brokus
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Sarah Kattakuzhy
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Elana Rosenthal
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Ellen F Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
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Shelton T, Nama S, Hall O, Williams M. Case report: Successful induction of buprenorphine in medically complex patients concurrently on opioids: a case series at a tertiary care center. Front Pharmacol 2024; 15:1335345. [PMID: 38523636 PMCID: PMC10960361 DOI: 10.3389/fphar.2024.1335345] [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: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024] Open
Abstract
Effective pain management is essential for optimal surgical outcomes; however, it can be challenging in patients with a history of opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a valuable treatment option for patients with OUD. Initiating buprenorphine treatment in patients concurrently taking opioids can be complex due to potential adverse outcomes like precipitated withdrawal. Evolving guidelines suggest there are benefits to continuing buprenorphine for surgical patients throughout the perioperative period, however situations do arise when buprenorphine has been discontinued. Typically, in this scenario patients would be restarted on buprenorphine after they have fully recovered from post-surgical pain and no longer require opioids for pain control. Unfortunately, holding MOUD may expose the patient to risks such as opioid induced respiratory depression or addiction relapse. In this case series, we discuss a novel method to restart buprenorphine in small incremental doses, known as micro-dosing, while the patient is still taking opioids for pain. We will present two complex clinical cases when this method was used successfully at a tertiary care hospital system.
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Affiliation(s)
- Thomas Shelton
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Sharanya Nama
- Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Orman Hall
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margaret Williams
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Qeadan F, Tingey B, Mensah NA. The risk of opioid use disorder among women undergoing obstetric-related procedures: Results from the Cerner Real-World Database. Drug Alcohol Depend Rep 2024; 10:100210. [PMID: 38186564 PMCID: PMC10767310 DOI: 10.1016/j.dadr.2023.100210] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
Introduction While the relationship between various obstetric procedures and the onset of opioid use disorder (OUD) remains ambiguous, this study aims to elucidate the immediate and prolonged risks of OUD in women who have undergone procedures such as vaginal and cesarean deliveries, induced abortions, and treatments related to miscarriages and ectopic pregnancies. Methods Retrospective data (n = 632,872) from the Cerner Real-World Data™ for pregnant females (age 15-44) between January 2010 and March 2020 were used. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to compare odds of OUD for each obstetric outcome to normal vaginal delivery using multivariable logistic regression. New opioid prescriptions and persistent opioid prescriptions were secondary outcomes for which modified Poisson regression models were used. Results Compared to patients with a vaginal delivery, those with an ectopic pregnancy, a cesarean delivery, miscarriage, and an induced abortion had 84%, 46%, 119%, and 131% significantly higher odds of OUD (aOR [95% CI]: 1.84 [1.36, 2.48], 1.46 [1.29, 1.65], 2.19 [1.94, 2.47], and 2.31 [1.80, 2.96]) respectively. Among opioid naïve patients, all other obstetric procedure groups (besides miscarriage) had significantly higher risk of being prescribed new opioids than those with a vaginal delivery. Among those newly prescribed opioids, patients from all other obstetric procedure groups demonstrated a significantly higher risk of persistent opioid prescription compared to those who had a vaginal delivery. Conclusion The association between specific obstetric outcomes, notably miscarriage and induced abortions, and opioid use patterns should inform safer and more effective pain management in a maternal population.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
| | - Nana Akofua Mensah
- Kaiser Permanente Department of Research and Evaluation, 2160 N 1st Ave, Pasadena, CA, USA
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Goss T, Esguerra J, Newman C, Patrick J, Templeton K. Inclusion of Sex and Gender Differences in U.S. State Action Plans for Opioid Use and Opioid Use Disorder. J Womens Health (Larchmt) 2024; 33:275-282. [PMID: 38064491 DOI: 10.1089/jwh.2023.0232] [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: 03/13/2024] Open
Abstract
Background: States have developed action plans to address the "opioid crisis" over the past several years. While sex- and gender-based differences have been identified in complications of opioid use, risks of addiction to opioids, barriers to treatment of opioid use disorder, and associated stigma, it is unknown if or to what extent opioid plans consider or account for these differences. The objectives of this study were to analyze U.S. state opioid action plans and their inclusion of sex- and gender-specific concerns. Methods: A content analysis of 49 state plans was conducted in June 2020, assessing their inclusion of 14 variables covering provider education, pregnancy-related, and sex- or gender-based differences in opioid addiction and treatment. Results: Neonatal opioid withdrawal syndrome was the most common variable, noted in 57% of plans. Only 14% included pregnancy-related stigma, and 4% identified gender-specific stigma. Contraceptives and family-planning were included in 12% and 10% of plans, respectively. Two states included more than half of the variables and five plans made no mention of sex or gender differences. Conclusions: Few state plans contained sex- or gender-specific information, and those that did focused almost exclusively on childbearing, excluding other unique considerations of opioid-using-women of all ages. The results of this study could improve the care of women using opioids by informing the strategies of state agencies and impacting legislative efforts for prevention initiatives, substance use disorder treatment, and law enforcement programs.
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Affiliation(s)
- Taylor Goss
- Pennsylvania State University College of Medicine, State College, Pennsylvania, USA
| | - Jody Esguerra
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Connie Newman
- Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Jessica Patrick
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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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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Almudaifer AI, Feldman SS, O'Leary T, Covington WL, Hairston J, Deitch Z, Crisan E, Riggs K, Walters L, Osborne JD. Annotation of Opioid Use Disorder Entity Modifiers in Clinical Text. Stud Health Technol Inform 2024; 310:1458-1459. [PMID: 38269695 DOI: 10.3233/shti231243] [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: 01/26/2024]
Abstract
Natural Language Processing can be used to identify opioid use disorder in patients from clinical text1. We annotate a corpus of clinical text for mentions of concepts associated with unhealthy use of opiates including concept modifiers such as negation, subject, uncertainty, relation to document time and illicit use.
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Affiliation(s)
| | - Sue S Feldman
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Tobias O'Leary
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Whitney L Covington
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - JaMor Hairston
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Zachary Deitch
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Estera Crisan
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kevin Riggs
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lauren Walters
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - John D Osborne
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Maxwell JF, Li L, Feldman SS. Substance Use Telemedicine Retention and Outcomes. Stud Health Technol Inform 2024; 310:1560-1561. [PMID: 38269745 DOI: 10.3233/shti231293] [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: 01/26/2024]
Abstract
Evidence-based SUD treatments are available, yet utilization remains low demonstrating the need to utilize alternative treatment delivery methods. We assess the effectiveness of an SUD treatment program delivered via telemedicine and in-person mode over 12 months. 40% of the intervention group remained engaged and 46% remained opioid free.
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Affiliation(s)
- Justine F Maxwell
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Li Li
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Sue S Feldman
- University of Alabama at Birmingham, Birmingham, Alabama, United States
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Osterhage KP, Hser YI, Mooney LJ, Sherman S, Saxon AJ, Ledgerwood M, Holtzer CC, Gehring MA, Clingan SE, Curtis ME, Baldwin LM. Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities. Addiction 2024; 119:160-168. [PMID: 37715369 PMCID: PMC10846664 DOI: 10.1111/add.16338] [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: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND AND AIMS International Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD-10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics' OUD patient registries and clinician/staff EHR entries. DESIGN Cross-sectional observational study. SETTING Four rural primary care clinics in Washington and Idaho, USA. PARTICIPANTS 307 patients. MEASUREMENTS This study used three data sources from each clinic: (1) a limited dataset extracted from the EHR, (2) a clinic-based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD-10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid-induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain. FINDINGS F11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently. CONCLUSIONS Lack of uniform application of ICD diagnosis codes make it challenging to use diagnosis code data from EHR to identify a research population of persons with opioid use disorder.
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Affiliation(s)
- Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | - Caleb C Holtzer
- Providence Northeast Washington Medical Group, Colville, Washington, USA
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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12
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Borris JB, Dowd-Green C, Bowman LA, Nesbit SA, Fingerhood M, Stewart RW. Evaluation of opioid use disorder treatment outcomes in patients receiving split daily versus once daily dosing of buprenorphine-naloxone. J Subst Use Addict Treat 2024; 156:209209. [PMID: 37939905 DOI: 10.1016/j.josat.2023.209209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION In clinical practice, sublingual (SL) buprenorphine-naloxone is prescribed as once daily or split daily dosing for the management of opioid use disorder (OUD). Evidence is lacking that assesses how split daily buprenorphine-naloxone affects OUD outcomes. This study aims to evaluate how the dosing frequency of SL buprenorphine-naloxone impacts therapy effectiveness when treating patients with OUD. METHODS This retrospective analysis included adult outpatients prescribed treatment with SL buprenorphine-naloxone for OUD between July 1, 2016, and March 1, 2020. The study excluded patients with sickle cell disease, recent methadone treatment, or pregnancy. We characterized study groups by dosing frequency, either once daily or split dosing. The study compared retention in treatment, medication adherence, adherence to treatment program, and hospital encounters between groups. RESULTS The study screened eight-hundred and seven patients, and included 250 patients newly prescribed SL buprenorphine-naloxone. Fifty-seven patients (22.8 %) were prescribed once daily dosing and 193 patients (77.2 %) were prescribed split daily dosing. The study found no significant differences noted in 12-month rates of treatment retention (52.6 % vs. 45.6 %, p = .35). These outcomes remained similar when assessed at three and six months. Within a year of buprenorphine-naloxone initiation, the study found no differences in the percentage of patients with hospitalizations (26.3 % vs. 38.3 %, p = .10), median number of hospitalizations (2 vs. 2), or proportion of days covered by a prescription ≥80 % (93.3 % vs. 92.0 %, p = .82). CONCLUSIONS In this study, patients receiving once daily buprenorphine-naloxone had similar treatment outcomes to patients receiving split dosing. Further controlled studies are necessary to evaluate which patients are more likely to benefit from split dosing.
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Affiliation(s)
- Joshua B Borris
- Johns Hopkins Bayview Medical Center, Department of Pharmacy, 4940 Eastern Ave, Baltimore, MD 21224, United States of America.
| | - Caitlin Dowd-Green
- The Johns Hopkins Hospital, Department of Pharmacy, 600 N Wolfe St, Baltimore, MD 21287, United States of America.
| | - Lindsay A Bowman
- The Johns Hopkins Hospital, Department of Pharmacy, 600 N Wolfe St, Baltimore, MD 21287, United States of America.
| | - Suzanne A Nesbit
- The Johns Hopkins Hospital, Department of Pharmacy, 600 N Wolfe St, Baltimore, MD 21287, United States of America.
| | - Michael Fingerhood
- Johns Hopkins University School of Medicine, Department of Medicine, 5200 Eastern Ave, Baltimore, MD 21224, United States of America.
| | - Rosalyn W Stewart
- Johns Hopkins University School of Medicine, Department of Medicine, 5200 Eastern Ave, Baltimore, MD 21224, United States of America.
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13
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Scherzer C, Jiménez Muñoz P, Ramsey S, Carey KB, Ranney ML, Clark S, Rich J, Langdon KJ. Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder. J Addict Dis 2024; 42:24-32. [PMID: 36325942 PMCID: PMC10154429 DOI: 10.1080/10550887.2022.2126273] [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: 11/06/2022]
Abstract
Background: Nearly two million adults in the US currently live with an Opioid Use Disorder (OUD) diagnosis. Recent efforts have encouraged and facilitated widespread adoption of empirically supported medications for opioid use disorder (MOUD), yet MOUD and OUD behavioral health interventions remain dramatically underutilized. Fear of discrimination and judgment, compounded by systemic and regulatory barriers, hinder individuals' access to specialty treatment.Objectives: The goal of the current study was to (1) reveal how perspectives toward OUD treatment may differ across medication types, program settings, and drug use history; (2) address systemic and regulatory components that potentially foster and propagate positive or negative attributions to OUD; and (3) understand how experiences reduce patients' willingness to pursue and/or maintain long term treatment.Methods: Twenty-four adults engaged in buprenorphine treatment at two outpatient addiction treatment centers participated in in-depth, qualitative interviews between 2019 and 2020 in Providence, Rhode Island.Results: Thematic analysis revealed negative attributions toward OUD across all participants. Three key themes developed from the coding and analysis: (1) differential perceptions of therapeutic medications (2) negative perceptions of treatment programs and (3) perceptions of drugs and people who use drugs.Conclusions: Stigmatizing language remains a major public health issue that needs to be addressed to facilitate treatment for individuals for OUD and other drug use disorders. Incorporating strategies targeting labeling across medication types, program settings, and drug use may improve treatment outcomes by reducing the inaccurate beliefs surrounding OUD and connecting patients to evidence-based support.
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Affiliation(s)
- Caroline Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, United States
- Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, United States
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- School of Public Health, Brown University, Providence, RI, United States
| | - Seth Clark
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Josiah Rich
- Department of Medicine and Epidemiology, Brown University, Providence, RI, United States
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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14
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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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15
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Celik M, Cosentino D, Fuehrlein B. Sleep-wake disorders in veterans with opioid use disorder: Prevalence and comorbidities. Sleep Health 2023; 9:889-892. [PMID: 37438174 DOI: 10.1016/j.sleh.2023.05.012] [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] [Received: 01/12/2023] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To determine the prevalence of sleep-wake disorders among veterans with opioid use disorder (OUD) and the demographic characteristics, medical comorbidities, and outpatient medications in this group. METHODS US veterans seeking care in the VA Connecticut Healthcare System between January 1, 2000, and December 31, 2021 with a diagnosis of OUD (N = 5937) were analyzed retrospectively for sleep-wake disorders (N = 1447). That group was analyzed for demographic characteristics, comorbidities, and medications. RESULTS Of those with OUD, 24.4% had a diagnosis of any sleep-wake disorder. The most common was obstructive sleep apnea (73.7%). Major depressive disorder (68.6%) and hypertension (67.1%) were the most common comorbid conditions. Commonly prescribed medications included antidepressants (91%) and benzodiazepines (62%). CONCLUSIONS Veterans with OUD frequently suffer from sleep-wake disorders. Comorbid medical and psychiatric conditions and the detrimental effects of specific medication classes should be considered in this patient population to create more effective prevention and treatment strategies.
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Affiliation(s)
- Muhammet Celik
- Mental Health Service Line, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Danielle Cosentino
- Medical Informatics, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian Fuehrlein
- Mental Health Service Line, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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16
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Nock NL, Hernandez E, Robinson D, Hoffer L, Wachholtz A. Barriers, perceived benefits and preferences to exercise in adults with an opioid use disorder in the U.S. Prev Med Rep 2023; 36:102393. [PMID: 37753380 PMCID: PMC10518576 DOI: 10.1016/j.pmedr.2023.102393] [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] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/07/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Over 10 million Americans misuse opioids and more than 5 million have been diagnosed with an opioid use disorder (OUD). In 2021, over 100,000 Americans died of a drug overdose and more than 75% of these deaths involved an opioid. Exercise has been shown to increase abstinence and decrease anxiety and depression in people with a substance use disorder. However, only a few small trials have focused on persons with OUD who often experience additional challenges including chronic pain, mental health disorders and cardio-metabolic abnormalities. Methods We aimed to describe the barriers, perceived benefits and preferences to exercise in adults with OUD in residential treatment in the U.S. as part of a larger study. We conducted 33 individually administered, semi-structured interviews and transcribed audiotapes verbatim, conducted coding and thematic analysis using NVivo v12 software (QSR International Inc.). Results Our sample had nearly equal representation of males and females and, was predominantly Caucasian (88%) with a mean of age of 34.5 (s.d. 7.5) years old. Participants stated that exercise helps to reduce drug cravings, anxiety, depression and pain and improve mood, physical health and build "normalcy". Barriers included lack of time, access to resources, fear of poor health and triggering pain. Participants preferred moderate intensity exercise 3 times/week and 30-60 min sessions. Conclusions Our findings indicate that adults with OUD believe exercise is a valuable tool to use in their recovery but they encounter several barriers. Many barriers, however, could be overcome with structured programs offered by residential treatment centers.
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Affiliation(s)
- Nora L. Nock
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
| | | | - Dallas Robinson
- Department of Psychology, University of Colorado at Denver, Denver, CO, USA
| | - Lee Hoffer
- Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Wachholtz
- Department of Psychology, University of Colorado at Denver, Denver, CO, USA
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Mason M, Post LA, Aggarwal R. Health care and harm reduction provider perspectives on treating older adults who use non-medical opioids: a qualitative study set in Chicago. BMC Health Serv Res 2023; 23:876. [PMID: 37598163 PMCID: PMC10439613 DOI: 10.1186/s12913-023-09843-4] [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: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Opioid overdose death rates are increasing for adults aged 55 and older, with especially high rates in large urban areas. In parallel, admissions to treatment programs for older adults using illicit substances are increasing as well. Despite these trends, there is a lack of information about older adults who use non-medical opioids (NMO) and even less knowledge about their health and service encounters. Conducted in Chicago, Illinois, this qualitative study explores the perspectives of health care and harm reduction service providers who work with older adults using non-medical opioids. METHODS The study used snowball sampling to locate participants with expertise in working with older adults who use non-medical opioids. In total, we conducted 26 semi-structured interviews from September 2021-August 2022. We explored questions regarding participants' perceptions of older adult opioid use patterns, comorbidities, and involvement in harm reduction outreach and opioid use disorder treatment. RESULTS Many of the providers we interviewed consider older adults who use NMO as a distinct population that employ unique use behaviors with the intent to protect them from opioid overdose. However, these same unique behaviors may potentiate their risk for overdose in today's climate. Providers report initial encounters that are not care seeking for opioid use and primarily oriented around health conditions. Older adults who use non-medical opioids are seen as complex patients due to the need to diagnostically untangle symptoms of substance use from co-morbidities and conditions associated with aging. Treatment for this population is also viewed as complicated due to the interactions between aging, comorbidities, and substance use. Providers also noted that older adults who use NMO have use behaviors that make them less visible to outreach and treatment service providers, potentially putting them at increased risk for overdose and health conditions associated with opioid use. CONCLUSIONS Findings from this study are intended to inform future research on care provision for older adults who use non-medical opioids and may be especially applicable to large urban reas with histories of opioid use dating back to earlier drug epidemics of the 1970s, 1980s, and 1990s.
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Affiliation(s)
- Maryann Mason
- Feinberg School of Medicine, Northwestern University, Chicago, 60611, USA.
- Buehler Center for Health Policy and Economics, Northwestern University, 420 E. Superior St., Rubloff Building 9th floor, Room 939, Chicago, IL, 60611, USA.
| | - Lori Ann Post
- Department of Emergency Medicine, The Buehler Center for Health Policy & Economics, Institute for Global Health, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, 9-915 Rubloff Building, 420 E. Superior St, Chicago, Il, 60611, USA
| | - Rahul Aggarwal
- Weinberg School of Arts and Sciences, Northwestern University, 1918 Sheridan Rd, Evanston, IL, 60208, USA
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18
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Campbell CI, Chen CH, Adams SR, Asyyed A, Athale NR, Does MB, Hassanpour S, Hichborn E, Jackson-Morris M, Jacobson NC, Jones HK, Kotz D, Lambert-Harris CA, Li Z, McLeman B, Mishra V, Stanger C, Subramaniam G, Wu W, Zegers C, Marsch LA. Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder. J Med Internet Res 2023; 25:e45556. [PMID: 37310787 DOI: 10.2196/45556] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. OBJECTIVE The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. METHODS The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (≥8 hours per day) and watch wear (≥18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. RESULTS The participants' average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. CONCLUSIONS To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3389/fpsyt.2022.871916.
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Affiliation(s)
- Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States
| | - Ching-Hua Chen
- Center for Computational Health, IBM Research, Yorktown Heights, NY, United States
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Asma Asyyed
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Oakland, CA, United States
| | - Ninad R Athale
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Vallejo, CA, United States
| | - Monique B Does
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Saeed Hassanpour
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Heather K Jones
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - David Kotz
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Chantal A Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Zhiguo Li
- Center for Computational Health, IBM Research, Yorktown Heights, NY, United States
- Profit Intelligence, Amazon.com, Seattle, WA, United States
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Varun Mishra
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Weiyi Wu
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Christopher Zegers
- Addiction Medicine and Recovery Services, The Permanente Medical Group Northern California, Sacramento, CA, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Kitzman JM, Bowman LC, Lin YC. Acupuncture in Addiction Medicine: Its History, Evidence, and Possibilities. Med Acupunct 2023; 35:111-116. [PMID: 37361008 PMCID: PMC10282830 DOI: 10.1089/acu.2023.0021] [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: 06/28/2023] Open
Abstract
Substance-use disorders (SUDs) and drug addiction are not only national, but also global health concerns that have worsened during and after the COVID-19 pandemic. Acupuncture augments the endogenous opioid system and, therefore, has a theoretical basis as a treatment for opioid use disorders (OUDs). The basic science of acupuncture, its clinical research in addiction medicine, and decades of success of the National Acupuncture Detoxification Association protocol offer positive findings supporting this protocol's utility for treating SUDs. Considering the mounting opioid/substance-use concerns and deficiencies in SUD treatment availability in the United States, acupuncture can be a safe, feasible treatment option and adjunct in addiction medicine. Furthermore, large governmental agencies are lending support to acupuncture for treating acute and chronic pain, which, in turn, could translate to prevention of SUDs and addictions. This article is a narrative review of the background, the basic science and clinical research, and future direction of acupuncture in addiction medicine.
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Affiliation(s)
- Jamie M. Kitzman
- Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Laura C. Bowman
- Metro Acupuncture, CHRIS180, Atlanta, GA and Behavioral Health Group, Jackson and Bremen, GA, USA
- Substance Use Services, CHRIS180, Atlanta, GA and Behavioral Health Group, Jackson and Bremen, GA, USA
| | - Yuan-Chi Lin
- Medical Acupuncture Service, Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Banks TJ, Nguyen TD, Uhlmann JK, Nair SS, Scherrer JF. Predicting opioid use disorder before and after the opioid prescribing peak in the United States: A machine learning tool using electronic healthcare records. Health Informatics J 2023; 29:14604582231168826. [PMID: 37042333 PMCID: PMC10158959 DOI: 10.1177/14604582231168826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Existing predictive models of opioid use disorder (OUD) may change as the rate of opioid prescribing decreases. Using Veterans Administration's EHR data, we developed machine-learning predictive models of new OUD diagnoses and ranked the importance of patient features based on their ability to predict a new OUD diagnosis in 2000-2012 and 2013-2021. Using patient characteristics, the three separate machine learning techniques were comparable in predicting OUD, achieving an accuracy of >80%. Using the random forest classifier, opioid prescription features such as early refills and length of prescription consistently ranked among the top five factors that predict new OUD. Younger age was positively associated with new OUD, and older age inversely associated with new OUD. Age stratification revealed prior substance abuse and alcohol dependency as more impactful in predicting OUD for younger patients. There was no significant difference in the set of factors associated with new OUD in 2000-2012 compared to 2013-2021. Characteristics of opioid prescriptions are the most impactful variables that predict new OUD both before and after the peak in opioid prescribing rates. Predictive models should be tailored to age groups. Further research is warranted to determine if machine learning models perform better when tailored to other patient subgroups.
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Affiliation(s)
- Tyler J Banks
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Tung D Nguyen
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Jeffery K Uhlmann
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Satish S Nair
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Jeffrey F Scherrer
- Saint Louis University School of Medicine, Medicine, Saint Louis, MO, USA
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21
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Kushniruk A, Balapal N, Ankem A, Shyamsundar S, Balaji A, Kannikal J, Bruno M, He S, Chong P. Primary Perspectives in Meme Utilization as a Digital Driver for Medical Community Engagement and Education Mobilization: Pre-Post Study. JMIR Hum Factors 2023; 10:e40244. [PMID: 36705964 PMCID: PMC9919443 DOI: 10.2196/40244] [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: 06/15/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Memes have gone "viral," gaining increasing prominence as an effective communications strategy based on their unique ability to engage, educate, and mobilize target audiences in a call to action through a cost-efficient and culturally relevant approach. Within the medical community in particular, visual media has evolved as a means to influence clinical knowledge transfer. To this end, the GetWaivered (GW) project has leveraged memes as part of a behavioral economics toolkit to address one of the most critical public health emergencies of our time-the 20-year opioid epidemic. As part of a multidimensional digital awareness campaign to increase Drug Enforcement Administration (DEA)-X waiver course registration, GW investigated the results of meme usage in terms of impressions, website traffic, and ultimately user acquisition, as determined by web-based training enrollment and attendance outcomes. OBJECTIVE The objective of this study was to determine the efficacy of implementing humor-based promotional content versus the traditional educational model, and how the translation of the increase in engagement would increase the participant count and website traffic for GW's remote DEA-X waiver training. METHODS The approach to this study was based on 2 time frames (pre- and postcampaign). During April-July 2021, we developed a campaign via advertisements on Facebook, Twitter, Instagram, and the GW website to expand outreach. These memes targeted medical professionals with the ability to prescribe buprenorphine. The time frame of this campaign measured engagement metrics and compared values to preceding months (January-March 2021) for our GetWaivered website and social media pages, which translated to registrants for our remote DEA-X waiver training. RESULTS By the end of July 2021, a total of 9598 individuals had visited the GW website. There was an average of 79.3 visitors per day, with the lowest number of daily visitors being 0 and the highest being 575. CONCLUSIONS The use of memes may provide a medium for social media engagement (likes, comments, and shares) while influencing viewers to pursue a proposed action, such as e-training registration.
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Affiliation(s)
| | - Neha Balapal
- CUNY School of Medicine, New York, NY, United States
| | - Amala Ankem
- Lab of Computer Science, Massachusetts General Hospital, Boston, MA, United States
| | | | - Adarsh Balaji
- American University of the Caribbean School of Medicine, Cupecoy, Netherlands
| | - Jasmine Kannikal
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marlie Bruno
- Northeastern University, Boston, MA, United States
| | - Shuhan He
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States.,Center for Innovation in Digital HealthCare, Massachusetts General Hospital, Boston, MA, United States
| | - Paul Chong
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
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22
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Luderer H, Enman N, Gerwien R, Braun S, McStocker S, Xiong X, Koebele C, Cannon C, Glass J, Maricich Y. A Prescription Digital Therapeutic to Support Unsupervised Buprenorphine Initiation for Patients With Opioid Use Disorder: Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2023; 12:e43122. [PMID: 36662568 PMCID: PMC9898828 DOI: 10.2196/43122] [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: 09/30/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Home-based (unsupervised) buprenorphine initiation is considered safe and effective, yet many patients report barriers to successful treatment initiation. Prescription digital therapeutics (PDTs) are software-based disease treatments regulated by the US Food and Drug Administration (FDA). The reSET-O PDT was authorized by the FDA in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder (OUD). A prototype PDT (PEAR-002b) designed for use with reSET-O was developed to assist in unsupervised buprenorphine initiation. OBJECTIVE The primary objective of this pilot study is to evaluate the acceptability of PEAR-002b in individuals with OUD who use it to support buprenorphine initiation, their unsupervised buprenorphine initiation success rate, and their medication adherence. METHODS Ten adults with OUD will be recruited for acceptability and feasibility testing. Outcomes will be assessed using week-1 visit attendance, participant interviews and satisfaction surveys, and urine drug screening (UDS). Three tools will be used in the study: PEAR-002b, reSET-O, and EmbracePlus. PEAR-002b includes a new set of features designed for use with reSET-O. The mechanism of action for the combined PEAR-002b and reSET-O treatment is a program of medication dosing support during week 1 of the initiation phase, cognitive behavioral therapy, and contingency management. During the medication initiation phase, participants are guided through a process to support proper medication use. PEAR-002b advises them when to take their buprenorphine based on provider inputs (eg, starting dose), self-reported substance use, and self-reported withdrawal symptoms. This study also administers the EmbracePlus device, a medical-grade smartwatch, to pilot methods for collecting physiologic data (eg, heart rate and skin conductance) and evaluate the device's potential for use along with PDTs that are designed to improve OUD treatment initiation. Home buprenorphine initiation success will be summarized as the proportion of participants attending the post-buprenorphine initiation visit (week 1) and the proportion of participants who experience buprenorphine initiation-related adverse events (eg, precipitated withdrawal). Acceptability of PEAR-002b will be evaluated based on individual participants' ratings of ease of use, satisfaction, perceived helpfulness, and likelihood of recommending PEAR-002b. Medication adherence will be evaluated by participant self-report data and confirmed by UDS. UDS data will be summarized as the mean of individual participants' proportion of total urine samples testing positive for buprenorphine or norbuprenorphine over the 4-week study. RESULTS This project was funded in September 2019. As of September 2022, participant enrollment is ongoing. CONCLUSIONS This is the first study to our knowledge to develop a PDT that assists with unsupervised buprenorphine initiation with the intent to better support patients and prescribers during this early phase of treatment. This pilot study will assess the acceptability and utility of a digital therapeutic to assist individuals with OUD with unsupervised buprenorphine initiation. TRIAL REGISTRATION ClinicalTrials.gov NCT05412966; https://clinicaltrials.gov/ct2/show/NCT05412966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/43122.
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Affiliation(s)
| | - Nicole Enman
- Pear Therapeutics (US), Inc, Boston, MA, United States
| | | | - Stephen Braun
- Pear Therapeutics (US), Inc, Boston, MA, United States
| | | | - Xiaorui Xiong
- Pear Therapeutics (US), Inc, Boston, MA, United States
| | | | | | - Joseph Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Yuri Maricich
- Pear Therapeutics (US), Inc, Boston, MA, United States
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23
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Lutgen C, Callen E, Robertson E, Clay T, Filippi MK. Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions. Subst Abus 2023; 44:51-61. [PMID: 37226899 DOI: 10.1177/08897077231174675] [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: 05/26/2023]
Abstract
INTRODUCTION Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions. METHODS The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups. RESULTS All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion (P = .047), but other participants had greater increases in confidence in the majority of topic areas. Physicians also had greater increases in knowledge than other participants in dosing and monitoring for safety (P = .033) and dosing and monitoring for diversion (P = .024), whereas other participants had greater increases in knowledge in most remaining topics. Participants agreed that sessions provided practical knowledge, except for relevancy of the case study portion of the session to current practice (P = .023) and the session improved participant ability to care for patients (P = .044). CONCLUSION Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.
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Affiliation(s)
- Cory Lutgen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elisabeth Callen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elise Robertson
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Tarin Clay
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Melissa K Filippi
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
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24
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Oreper S, Bond A, Bazinski M, Tierney M, Fang M, Sankaran S, Rambachan A. A Focused Screening and Clinical Intervention with Streamlined Outpatient Linkage for Hospitalized Patients with Opioid Use Disorder Experiencing Homelessness. Subst Abuse 2023; 17:11782218231166382. [PMID: 37051016 PMCID: PMC10084569 DOI: 10.1177/11782218231166382] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023]
Abstract
Background Patients experiencing homelessness have higher rates of substance use and related mortality, often driven by opioid overdose. Conversely, opioid use disorder (OUD) is a leading risk factor for homelessness. Our goal was to test the efficacy of an electronic health record (EHR) screen in identifying this vulnerable population during hospitalization and to assess the feasibility of a bundled intervention in improving opioid safety. Methods We assessed patients' housing status, substance use, previous MOUD treatment, barriers to MOUD treatment and readiness to take MOUD in and out of the hospital. For each post discharge follow up call, patients were asked about their MOUD status, barriers accessing treatment, current substance use, and housing status. We also assessed team members perceptions and experiences of the study. Results We enrolled 32 patients with housing insecurity and OUD. The mean age was 44, the majority self-identified as male (78%), and mostly as White (56%) or Black (38%). At each follow up within the 6-months post-discharge, reach rates were low: 40% of enrollees answered at least 1 call and the highest reach rate (31% of patients) occurred at week 4. At the third and sixth-month follow ups, >50% of subjects still taking MOUD were also using opioids. Conclusion Our clinician augmented EHR screen accurately identified inpatients experiencing OUD and PEH. This intervention showed high rates of attrition among enrolled patients, even after providing cellphones. The majority of patients who were reached remained adherent to MOUD though they reported significant barriers.
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Affiliation(s)
- Sandra Oreper
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Allison Bond
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Marilyn Bazinski
- Center for Nursing Excellence and Innovation, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew Tierney
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sujatha Sankaran
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Aksharananda Rambachan
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Aksharananda Rambachan, Division of Hospital Medicine, University of California San Francisco, 521 Parnassus Ave, San Francisco, CA 94143, USA.
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25
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Antoine D, Venigalla G, Truitt B, Roy S. Linking the gut microbiome to microglial activation in opioid use disorder. Front Neurosci 2022; 16:1050661. [PMID: 36590299 PMCID: PMC9800800 DOI: 10.3389/fnins.2022.1050661] [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: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Substance use disorder (SUD) is a physical and psychological disorder globally prevalent today that has resulted in over 107,000 drug overdose deaths in 2021 in the United States alone. This manuscript reviews the potential relationship between opioid use disorder (OUD), a prevalent subset of SUD, and the microglia, the resident macrophages of the central nervous system (CNS), as they have been found to become significantly more activated during opioid exposure. The inflammatory response mediated by the microglia could contribute to the pathophysiology of SUDs, in particular OUD. Further understanding of the microglia and how they respond to not only signals in the CNS but also signals from other areas of the body, such as the gut microbiome, could explain how the microglia are involved in drug use. Several studies have shown extensive communication between the gut microbiome and the microglia, which may be an important factor in the initiation and development of OUD. Particularly, strategies seeking to manipulate and restore the gut microbiome have been shown to reduce microglial activation and attenuate inflammation. In this review, we discuss the evidence for a link between the microglia and OUD and how the gut microbiome might influence microglial activation to drive the disorder and its associated behaviors. Understanding this connection between microglia and the gut microbiome in the context of drug use may present additional therapeutic targets to treat the different stages of drug use.
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Affiliation(s)
- Danielle Antoine
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States,Department of Neuroscience, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Greeshma Venigalla
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bridget Truitt
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States,Department of Neuroscience, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Sabita Roy
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States,*Correspondence: Sabita Roy,
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26
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Williams AR. Commentary on Burns et al: M OUD saves lives, especially after 60 days, and the longer the better. Addiction 2022; 117:3089-3090. [PMID: 36100579 PMCID: PMC9633431 DOI: 10.1111/add.16043] [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: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
Scaling interventions and treatment services to reduce mortality stemming from OUD is critical for turning back the opioid epidemic, yet empiric data are lacking regarding how risk changes over the course of care. Burns et al show substantial reductions in hazards of overdose accrue after 60 continuous days on medication.
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Affiliation(s)
- Arthur Robin Williams
- Columbia University College of Physicians and Surgeons - Psychiatry, New York, NY, USA
- Ophelia Health, Inc., New York, NY, USA
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27
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Kusic D, Heil J, Zajic S, Brangan A, Dairo O, Smith G, Morales-Scheihing D, Buono RJ, Ferraro TN, Haroz R, Salzman M, Baston K, Bodofsky E, Sabia M, Resch A, Scheinfeldt LB. Patient Perceptions and Potential Utility of Pharmacogenetic Testing in Chronic Pain Management and Opioid Use Disorder in the Camden Opioid Research Initiative. Pharmaceutics 2022; 14:pharmaceutics14091863. [PMID: 36145611 PMCID: PMC9505214 DOI: 10.3390/pharmaceutics14091863] [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] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pharmacogenetics (PGx) has the potential to improve opioid medication management. Here, we present patient perception data, pharmacogenetic data and medication management trends in patients with chronic pain (arm 1) and opioid use disorder (arm 2) treated at Cooper University Health Care in Camden City, NJ. Our results demonstrate that the majority of patients in both arms of the study (55% and 65%, respectively) are open to pharmacogenetic testing, and most (66% and 69%, respectively) believe that genetic testing has the potential to improve their medical care. Our results further support the potential for CYP2D6 PGx testing to inform chronic pain medication management for poor metabolizers (PMs) and ultrarapid metabolizers (UMs). Future efforts to implement PGx testing in chronic pain management, however, must address patient concerns about genetic test result access and genetic discrimination.
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Affiliation(s)
- Dara Kusic
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
| | - Jessica Heil
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Cooper University Health Care, Camden, NJ 08103, USA
| | - Stefan Zajic
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- GSK, Collegeville, PA 19426, USA
| | - Andrew Brangan
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Geisinger, Danville, PA 17822, USA
| | - Oluseun Dairo
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Gretchen Smith
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
| | | | - Russell J. Buono
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | | | - Rachel Haroz
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Matthew Salzman
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Kaitlan Baston
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Elliot Bodofsky
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Michael Sabia
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Alissa Resch
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
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28
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Affiliation(s)
- Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, PA, USA.,Division of Addiction Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Robert A Kleinman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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29
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Herndon CM, Riley AM, Gattas NM, Tiemeier AM. Pharmacist Opioid Dispensing Confidence in an Evolving Practice Landscape. J Pain Palliat Care Pharmacother 2022; 36:187-193. [PMID: 35975957 DOI: 10.1080/15360288.2022.2102704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Pharmacists are increasingly called upon to make dispensing decisions when presented with prescriptions for opioids. Risk mitigation strategies have been implemented to assist pharmacists in making these decisions, but they have also increased the complexity of decision-making. The primary objective of this study was to describe change in pharmacist comfort levels with opioid prescription dispensing over the previous year. This was a cross-sectional, multi-state, 16-item survey disseminated to the general membership of 2 state-level professional pharmacy organizations in November 2018. Of 274 pharmacists who opened the questionnaire, 195 (n = 195) completed at least 80% of the survey and were included. Three-fourths (74.6%) of the respondents noted community/retail as their practice site. When asked about change in comfort with dispensing opioids, 19.6% reported an increase in comfort level, 42.5% reported a decrease in comfort level, and 38.0% reported no change. When asked about information that may increase comfort in dispensing opioids, respondents noted diagnosis, morphine milligram equivalent, prior treatments, past medical history, drug monitoring program verification, and previous treatment trials with opioids. Comfort with dispensing opioids decreased over a 12-month period among pharmacists surveyed. Improved communication between prescriber and pharmacist, as well as enhanced access to patient health information, is critical to reduce barriers to care for patients.
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30
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Lynch JJ, Hughes AA, Burnett SJ, Payne ER, Clemency BM. Population characteristics and follow-up rates of a novel emergency buprenorphine initiation and referral program. Am J Emerg Med 2022; 61:222-223. [PMID: 35915000 DOI: 10.1016/j.ajem.2022.07.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- Joshua J Lynch
- Department of Emergency Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA; Department of Family Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA
| | - Ariana A Hughes
- Department of Emergency Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA
| | - Susan J Burnett
- Department of Emergency Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA
| | - Emily R Payne
- AIDS Institute, New York State Department of Health; Empire State Plaza, Corning Tower, Albany, NY 12237, USA
| | - Brian M Clemency
- Department of Emergency Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA; Department of Family Medicine, University at Buffalo, The State University of New York; 77 Goodell St., Buffalo, NY 14203, USA.
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31
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Freda PJ, Kranzler HR, Moore JH. Novel digital approaches to the assessment of problematic opioid use. BioData Min 2022; 15:14. [PMID: 35840990 PMCID: PMC9284824 DOI: 10.1186/s13040-022-00301-1] [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] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
The opioid epidemic continues to contribute to loss of life through overdose and significant social and economic burdens. Many individuals who develop problematic opioid use (POU) do so after being exposed to prescribed opioid analgesics. Therefore, it is important to accurately identify and classify risk factors for POU. In this review, we discuss the etiology of POU and highlight novel approaches to identifying its risk factors. These approaches include the application of polygenic risk scores (PRS) and diverse machine learning (ML) algorithms used in tandem with data from electronic health records (EHR), clinical notes, patient demographics, and digital footprints. The implementation and synergy of these types of data and approaches can greatly assist in reducing the incidence of POU and opioid-related mortality by increasing the knowledge base of patient-related risk factors, which can help to improve prescribing practices for opioid analgesics.
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Affiliation(s)
- Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA.
| | - Henry R Kranzler
- University of Pennsylvania, Center for Studies of Addiction, 3535 Market St., Suite 500 and Crescenz VAMC, 3800 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Jason H Moore
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, 700 N. San Vicente Blvd., Pacific Design Center Suite G540, West Hollywood, CA, 90069, USA
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32
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Jalodia R, Abu YF, Oppenheimer MR, Herlihy B, Meng J, Chupikova I, Tao J, Ghosh N, Dutta RK, Kolli U, Yan Y, Valdes E, Sharma M, Sharma U, Moidunny S, Roy S. Opioid Use, Gut Dysbiosis, Inflammation, and the Nervous System. J Neuroimmune Pharmacol 2022; 17:76-93. [PMID: 34993905 DOI: 10.1007/s11481-021-10046-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
Opioid use disorder (OUD) is defined as the chronic use or misuse of prescribed or illicitly obtained opioids and is characterized by clinically significant impairment. The etiology of OUD is multifactorial as it is influenced by genetics, environmental factors, stress response and behavior. Given the profound role of the gut microbiome in health and disease states, in recent years there has been a growing interest to explore interactions between the gut microbiome and the central nervous system as a causal link and potential therapeutic source for OUD. This review describes the role of the gut microbiome and opioid-induced immunopathological disturbances at the gut epithelial surface, which collectively contribute to OUD and perpetuate the vicious cycle of addiction and relapse.
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Yu MJ, Hawk K. Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey. AEM Educ Train 2022; 6:e10779. [PMID: 35784380 PMCID: PMC9242423 DOI: 10.1002/aet2.10779] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objective was to describe emergency medicine (EM) resident attitudes, preferences, and experiences around the knowledge and skills around the evidence-based treatment of opioid use disorder (OUD) in the emergency department (ED). METHODS We created an online survey that was distributed by the Emergency Medicine Residents' Association research committee listserv to approximately 6600 resident physicians at all levels of EM residency training. Data were collected between June 2020 and October 2020. This 12-question voluntary, anonymous survey included questions exploring EM resident preferences and experiences around the education and exposure to the evidence-based management of patients with OUD in the ED setting. Descriptive statistics were used. RESULTS A total of 288 of 6600 invited EM residents (response rate 4.4%) from 127 different EM residency programs across 38 states in the United States, District of Columbia, and Puerto Rico completed the survey. Most respondents (165/288; 57.3%) reported that it was "very important" for emergency physicians to have training to initiate buprenorphine treatment for patients with OUD. Just under half (140/288; 48.6%) reported they have or will receive X-waiver training during residency and 46.9% (135/288) reported experience prescribing buprenorphine in the ED. The estimated proportions of EM faculty at responding residents' primary teaching hospital with an X-waiver was "most or all" (48/285; 16.8%), "about half" (23/285; 8.1%), "a handful" (79/285; 27.7%), "one or two" (33/285; 11.6%), "none" (19/285; 6.7%), or "not sure" (83/285; 29.1%). CONCLUSION Survey results suggest that resident emergency physicians perceive the evidence-based management of OUD to be relevant to EM residency training and are interested in receiving training on initiating medications for OUD treatment in the ED. Opportunities to improve resident education and clinical use of buprenorphine during ED residency training were identified.
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Affiliation(s)
- Megan J. Yu
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Kathryn Hawk
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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Ghanem N, Dromgoole D, Hussein A, Jermyn RT. Review of medication-assisted treatment for opioid use disorder. J Osteopath Med 2022; 122:367-374. [PMID: 35285220 DOI: 10.1515/jom-2021-0163] [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: 10/14/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. OBJECTIVES This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. METHODS The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. RESULTS Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. CONCLUSIONS The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.
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Affiliation(s)
- Nessreen Ghanem
- Neuromusculoskeletal Institute at Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Devin Dromgoole
- Neuromusculoskeletal Institute at Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Ahmad Hussein
- Neuromusculoskeletal Institute at Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Richard T Jermyn
- Neuromusculoskeletal Institute at Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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Schoenfeld EM, Soares W, Schaeffer EM, Gitlin J, Burke K, Westafer L. "This is part of emergency medicine now": A qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine. Acad Emerg Med 2022; 29:28-40. [PMID: 34374466 PMCID: PMC8842516 DOI: 10.1111/acem.14369] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. We explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians. METHODS We conducted semistructured interviews with a purposeful sample of ED clinicians. An interview guide was developed using the Consolidated Framework for Implementation Research and Theoretical Domains Framework implementation science frameworks. Interviews were recorded, transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized. RESULTS We interviewed 25 ED clinicians from 11 states in the United States. Participants were diverse with regard to years in practice and practice setting. While outer setting barriers such as the logistic costs of getting a DEA-X waiver and lack of clear follow-up for patients were noted by many participants, individual-level determinants driven by emotion (stigma), beliefs about consequences and roles, and knowledge predominated. Participants' responses suggested that implementation strategies should address stigma, local culture, knowledge gaps, and logistic challenges, but that a particular order to addressing barriers may be necessary. CONCLUSIONS While some participants were hesitant to adopt a "new" role in treating patients with medications for OUD, many already had and gave concrete strategies regarding how to encourage others to embrace their attitude of "this is part of emergency medicine now."
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Affiliation(s)
- Elizabeth M. Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School – Baystate, Springfield, MA
| | - William Soares
- Department of Emergency Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School – Baystate, Springfield, MA
| | - Emily M. Schaeffer
- Department of Emergency Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA
| | - Jacob Gitlin
- University of Massachusetts Medical School, Worcester, MA
| | - Kimberly Burke
- University of Massachusetts Medical School, Worcester, MA
| | - Lauren Westafer
- Department of Emergency Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School – Baystate, Springfield, MA
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Brezing CA, Brixner DI. The Rise of Prescription Digital Therapeutics in Behavioral Health. Adv Ther 2022; 39:5301-5306. [PMID: 36242730 PMCID: PMC9569000 DOI: 10.1007/s12325-022-02320-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/07/2022] [Indexed: 01/30/2023]
Abstract
Medicine is evolving to incorporate digital technologies of all kinds-technologies that may improve patient health, reduce clinician workload, lower costs, reduce health disparities, and expand access to needed treatments. Prescription digital therapeutics (PDTs) are an emerging technology with particular potential. These are software-based treatments delivered on mobile devices that address the behavioral dimensions of many diseases and conditions. Unlike health and wellness apps, PDTs are rigorously evaluated for safety and effectiveness and are authorized by the US Food and Drug Administration (FDA). Nine PDTs are currently authorized to treat conditions such as substance use disorders, attention-deficit disorder, and chronic insomnia. The findings reported in two recent research papers published by Advances in Therapy related to use of PDTs for substance use disorder and opioid use disorder provide real-world evidence of clinical and cost effectiveness, strengthening the evidence base for these technologies and suggesting a role for these technologies in the efforts to help patients recover from these often-chronic and deadly conditions.
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Affiliation(s)
- Christina A. Brezing
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, New York, NY USA
| | - Diana I. Brixner
- grid.223827.e0000 0001 2193 0096University of Utah College of Pharmacy, Salt Lake City, UT USA
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Dai Q, Pu SS, Yang X, Li C, He Y, Liu X, Wang G. Whole Transcriptome Sequencing of Peripheral Blood Shows That Immunity/GnRH/PI3K-Akt Pathways Are Associated With Opioid Use Disorder. Front Psychiatry 2022; 13:893303. [PMID: 35800019 PMCID: PMC9253397 DOI: 10.3389/fpsyt.2022.893303] [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: 03/10/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD), which is most commonly exhibited as addiction, is a persistent chronic disease that places a burden on families and society. Various peripheral traits have been linked to OUD in the past, but research on this topic is insufficient. METHODS Seven male patients with OUD and 7 male healthy controls with matched demographic and clinical data were enrolled in this study. Peripheral blood RNA was used to construct an rRNA-removed library and a small RNA library. The peripheral transcriptomic differences between the two groups were investigated using RNA-seq. Differentially expressed messenger RNAs (mRNAs), long non-coding RNAs (lncRNAs), circular RNAs (circRNAs) and microRNAs (miRNAs) were identified by bioinformatics methods, and functional enrichment analysis with differentially expressed RNAs was performed to investigate the potential biological mechanisms of OUD. RESULTS A total of 229 mRNAs (115 upregulated, 114 downregulated), 416 lncRNAs (191 upregulated, 225 downregulated), 17 circRNAs (16 upregulated, 1 downregulated) and 74 miRNAs (42 upregulated, 32 downregulated) were differentially expressed between the OUD group and the healthy control group. Functional enrichment analysis with differentially expressed mRNAs showed that immunity, GnRH secretion, and PI3K-Akt signaling pathways were associated with OUD. Immunity-, JAK-STAT-, and insulin-related pathways were enriched in functional enrichment analysis of target genes predicted by differentially expressed miRNAs. CONCLUSION We identified hundreds of differentially expressed genes that were enriched in immunity, GnRH secretion and PI3K-Akt signaling pathways. Some genes with significant changes might be used as potential biomarkers for progression and treatment of OUD.
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Affiliation(s)
- Qi Dai
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China
| | - Shan-Shan Pu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Addiction, Wuhan Mental Health Center, Wuhan, China
| | - Xue Yang
- Department of Addiction, Wuhan Mental Health Center, Wuhan, China
| | - Chang Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Yafei He
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Xiaobo Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Gang Wang
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China.,Department of Addiction, Wuhan Mental Health Center, Wuhan, China
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Lai B, Croghan I, Ebbert JO. Buprenorphine Waiver Attitudes Among Primary Care Providers. J Prim Care Community Health 2022; 13:21501319221112272. [PMID: 35822763 PMCID: PMC9284198 DOI: 10.1177/21501319221112272] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite efforts to improve access to Medications for Opioid Use Disorder (MOUD), such as buprenorphine, the number of opioid overdoses in the United States continues to rise. In April 2021, the Department of Health and Human Services removed the mandatory training requirement to obtain a buprenorphine waiver; the goal was to encourage more providers to prescribe buprenorphine, thus improving access. Little is known about the attitudes on buprenorphine prescribing after this policy change. OBJECTIVE The primary objective was to assess attitudes among primary care providers toward the removal of the buprenorphine waiver training requirement. A secondary objective was to identify other barriers to prescribing buprenorphine. METHODS We conducted a survey between September 15 and October 13, 2021 to assess the overall beliefs on the effectiveness of MOUD and attitudes toward the removal of the waiver training, current knowledge of buprenorphine, current practice styles related to screening for and treating OUD, and attitudes toward prescribing buprenorphine in the future. This survey was sent to 890 Mayo Clinic primary care providers in 5 US states. RESULTS One hundred twenty-three respondents (13.8%) completed the survey; 35.8% respondents agreed that the removal of the waiver training was a positive step. These respondents expressed a greater familiarity with the different formulations, pharmacology, and titration of buprenorphine. This group was also more likely to prescribe (or continue to prescribe) buprenorphine in the future. Approximately one-third (34.4%) of respondents reported perceived institutional support in prescribing buprenorphine. This group expressed greater confidence in diagnosing OUD, had greater familiarity with the different formulations, pharmacology, and titration of buprenorphine, and was more likely to prescribe (or continue to prescribe) buprenorphine in the future. Respondents who have been in practice for 11 to 20 years since completion of training were most likely to refer all OUD patients to specialists. CONCLUSIONS Results of our survey suggests that simply removing the mandatory waiver training requirement is insufficient in positively changing attitudes toward buprenorphine prescribing. A key barrier is the perceived lack of institutional support. Future studies investigating effective ways to provide such support may help improve providers' willingness to prescribe buprenorphine.
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Affiliation(s)
- Benjamin Lai
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ivana Croghan
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jon O Ebbert
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Velez F, Huang D, Mody L, Malone DC. Five-year budget impact of a prescription digital therapeutic for patients with opioid use disorder. Expert Rev Pharmacoecon Outcomes Res 2021; 22:599-607. [PMID: 34894988 DOI: 10.1080/14737167.2022.2016396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is associated with high healthcare resource utilization (HCRU) and costs. reSET-O is an FDA-cleared prescription digital therapeutic that delivers neurobehavioral therapy as an adjunct to treatment-as-usual (TAU; buprenorphine, face-to-face counseling, and contingency management). METHODS A budget impact model was developed to evaluate reSET-O as an adjunct to TAU in OUD for a 1 million-member US mixed health plan over a 5-year time horizon. Model inputs included treatment costs and medical costs of hospitalizations, partial hospitalizations, intensive care unit stays, and emergency department visits. RESULTS The base-case results and the alternative scenario analysis showed the addition of reSET-O was projected to result in consistently lower total yearly costs vs TAU and no treatment. The estimated total and per member per month (PMPM) budget impact over 5 years was -$763,026 and -$0.0116, respectively. When the upper range of cost estimates was used, the total and PMPM budget impacts over 5 years were -$2,481,563 and -$0.0378, respectively. Sensitivity analysis showed results were most sensitive to the proportion of patients untreated. CONCLUSION The introduction of reSET-O in addition to TAU for OUD has the potential to reduce healthcare resource utilization and costs from 12 weeks up to 5 years.
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Velez FF, Colman S, Kauffman L, Ruetsch C, Anastassopoulos K, Maricich YA. Comparison of Healthcare Resource Utilization Between Patients Who Engaged or Did Not Engage With a Prescription Digital Therapeutic for Opioid Use Disorder. Clinicoecon Outcomes Res 2021; 13:909-916. [PMID: 34754205 PMCID: PMC8568698 DOI: 10.2147/ceor.s334274] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/15/2021] [Indexed: 01/05/2023] Open
Abstract
Background A prescription digital therapeutic (PDT) (reSET-O®) may expand access to behavioral treatment for patients with opioid use disorder (OUD) treated with buprenorphine, but long-term data on effectiveness are lacking. Objective To compare real-world healthcare resource utilization (HCRU) among patients who engaged with reSET-O and buprenorphine compared to similar patients in recovery treated with buprenorphine who did not fill their reSET-O script or engage with the PDT beyond week one. Methods A retrospective analysis of facility and clinical service claims data was conducted in adults with PDT initiation and between 12 weeks and 9 months of continuous enrollment in a health plan after initiation. Patients who filled their prescription and engaged with the therapeutic were compared to patients who filled the prescription but did not engage beyond week one (NE), and patients who did not fill the prescription (NR) (the latter two groups combined into one group hereafter referred to as “non-engagers”). Comparisons were analyzed using a repeated-measures negative binomial model of encounters/procedures, adjusted for number of days in each period. Associated cost trends assessed using current Medicare reimbursement rates. Results A total of 444 patients redeemed a prescription and engaged with the PDT (mean age 37.5 years, 63.1% female, 84% Medicaid), and 64 patients did not engage with the PDT (mean age 39.5 years, 32.8% female, 73.4% Medicaid). Total cost of hospital facility encounters was $2693 for engaged patients vs $6130 for non-engaged patients. Engaged patients had somewhat higher rates of certain clinician services. Total facility and clinician services costs for engaged vs non-engaged patients were $8733 vs $11,441, for a net cost savings over 9 months of $2708 per patient who engaged with reSET-O. Conclusion Patients who engaged with an OUD-specific PDT had a net cost reduction for inpatient and outpatient services of $2708 per patient over 9 months compared to patients who did not engage with the PDT, despite similar levels of buprenorphine adherence.
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Affiliation(s)
| | - Sam Colman
- Covance Market Access, Gaithersburg, MD, USA
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Meshberg-Cohen S, Ross MacLean R, Schnakenberg Martin AM, Sofuoglu M, Petrakis IL. Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and Posttraumatic stress disorder: A review. Addict Behav 2021; 122:107026. [PMID: 34182307 DOI: 10.1016/j.addbeh.2021.107026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Opioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes. METHODS A search was performed using articles identified through June 30, 2020 in PubMed, PsycINFO, and EMBASE. Included peer-reviewed articles evaluated individuals with OUD and a PTSD diagnosis via standardized assessment and/or medical record diagnoses, and reported relationships between diagnosis and treatment outcomes and/or other psychiatric conditions. RESULTS Out of 412 articles, 17 studies met inclusion criteria for this review (from 13 databases). Articles included had a total of n = 2190 with OUD, with n = 79 non-OUD comparison participants. Studies examining individuals with OUD revealed comorbid PTSD was associated with more severe addiction, higher rates of depression, attempted suicide, and psychosocial problems. CONCLUSIONS Among individuals with OUD, presence of PTSD is associated with multiple mental health problems. The impact of PTSD on drug use is inconclusive. Although only 5 studies examined psychosocial PTSD treatment, all found PTSD-focused treatment to be effective for those with comorbid OUD. Overall, results suggest the need to better identify PTSD among those with OUD, and to develop and evaluate interventions that are brief, integrative, and easy to implement in clinical settings.
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Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA.
| | - R Ross MacLean
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ashley M Schnakenberg Martin
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
| | - Ismene L Petrakis
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, USA; Yale University School of Medicine, Department of Psychiatry, USA
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Menard S, Jhawar A. Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report. Ment Health Clin 2021; 11:369-372. [PMID: 34824962 PMCID: PMC8582770 DOI: 10.9740/mhc.2021.11.369] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Buprenorphine is a partial mu-opioid receptor agonist approved for the treatment of opioid dependence. The risk of withdrawal symptoms and wait time required to safely initiate buprenorphine provides challenges to both patients and providers. Microdose induction is proposed as a possible solution to ease the transition to buprenorphine; however, little data has been published to date on patients stabilized on methadone doses greater than 100 mg. CASE REPORT A 29-year-old patient stabilized on methadone 105 mg was successfully transitioned to sublingual buprenorphine-naloxone using a 7-day microdose protocol on an inpatient psychiatric service. During the transition, the patient reported only minimal symptoms. CONCLUSION This report adds to the growing literature supporting the use of a microdose induction to initiate buprenorphine-naloxone. Additionally, this approach may be significant for patients stabilized on high doses of methadone who may not be able to tolerate a traditional buprenorphine induction.
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Affiliation(s)
- Shannon Menard
- Clinical Pharmacy Specialist, Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Clinical Pharmacy Specialist, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
| | - Archana Jhawar
- Clinical Pharmacy Specialist, Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Clinical Pharmacy Specialist, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
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Mallow PJ, Belk KW. Cost-utility analysis of single nucleotide polymorphism panel-based machine learning algorithm to predict risk of opioid use disorder. J Comp Eff Res 2021; 10:1349-1361. [PMID: 34672212 DOI: 10.2217/cer-2021-0115] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To conduct a cost-utility analysis of a novel genetic diagnostic test (OUDTEST) for risk of developing opioid use disorder for elective orthopedic surgery patients. Materials & Methods: A simulation model assessed cost-effectiveness and quality-adjusted life-years (QALYs) for OUDTEST from private insurer and self-insured employer perspectives over a 5-year time horizon for a hypothetical patient population. Results: OUDTEST was found to cost less and increase QALYs, over a 5-year period for private insurance (savings US$2510; QALYs 0.02) and self-insured employers (-US$2682; QALYs 0.02). OUDTEST was a dominant strategy in 71.1% (private insurance) and 72.7% (self-insured employer) of model iterations. Sensitivity analyses revealed robust results except for physician compliance. Conclusion: OUDTEST was expected to be a cost-effective solution for personalizing postsurgical pain management in orthopedic patients.
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Affiliation(s)
- Peter J Mallow
- Department of Health Services Administration, Xavier University, 3800 Victory Parkway, Cincinnati, OH 45207, USA
| | - Kathy W Belk
- Health Clarity Solutions, LLC, Mooresville, NC 28115, USA
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Velez FF, Colman S, Kauffman L, Anastassopoulos K, Murphy S, Maricich Y. Real-world changes in US health system hospital-based services following treatment with a prescription digital therapeutic for opioid use disorder. Hosp Pract (1995) 2021; 49:341-347. [PMID: 34275401 DOI: 10.1080/21548331.2021.1956256] [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] [Indexed: 10/20/2022]
Abstract
Outcomes associated with buprenorphine therapy for the treatment of opioid use disorder (OUD) are suboptimal. reSET-O is an FDA-authorized prescription digital therapeutic (PDT) delivering neurobehavioral therapy via mobile devices to patients with OUD treated with buprenorphine. This analysis evaluated the net impact of reSET-O on medical costs among actively-engaged reSET-O patients using real-world observations. This real-world retrospective analysis of health care claims between October 2018 and October 2019 evaluated health care resource utilization up to 6 months before and 6 months after the initiation of a reSET-O prescription after accounting for the subset of patients not continuing on therapy after week 1 (non-engaged patients). Repeated-measures negative binomial models compared incidences of hospital-based encounters/procedures adjusted for days in each period as well as associated costs. The number needed to treat (NNT) to avoid an inpatient visit was calculated. Of the 351 patients who were prescribed reSET-O, 321 met the criteria of active engagement. Treatment with reSET-O was associated with a substantial reduction in medical costs of -$765,450 (-$2,385/patient, $235/patient greater than a previous analysis in which non-engaged patients were included) in the 6-month period after initiation. The gross reSET-O prescription cost of $584,415 ($1,665/patient) was substantially offset by $49,950 ($142.31/patient) in refunds to payers. The medical cost reduction in engaged patients offset the cost of the therapeutic resulting in an overall cost reduction of -$230,985 in this cohort (net savings of -$720 per patient). The number needed to treat to avoid an inpatient visit was 4.8. Engagement and continued treatment with reSET-O in patients with OUD treated with buprenorphine is associated with substantial real-world reductions in medical costs in the 6-month period following the initiation of the reSET-O prescription.
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Affiliation(s)
- Fulton F Velez
- Pear Therapeutics Inc, Health Economics and Real-World Evidence, Boston, MA, USA
| | | | | | | | - Sean Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, USA
| | - Yuri Maricich
- Pear Therapeutics Inc, Health Economics and Real-World Evidence, Boston, MA, USA
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Berger O, Rector K, Meredith J, Sebaaly J. Evaluation of drug-drug interactions in hospitalized patients on medications for OUD. Ment Health Clin 2021; 11:231-237. [PMID: 34316418 PMCID: PMC8287868 DOI: 10.9740/mhc.2021.07.231] [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] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Medications used to treat OUD have common metabolic pathways and pharmacodynamic properties that can lead to drug-drug interactions (DDIs) that may go unnoticed in the inpatient setting. The purpose of this study was to identify the frequency of DDIs between medications prescribed for OUD and commonly used inpatient medications. Methods This was a retrospective review of orders for buprenorphine, buprenorphine-naloxone, and methadone to identify potential DDIs. Adult inpatients with an order for one of these medications for OUD were included. Medication regimens were evaluated throughout the inpatient stay and on day of discharge for DDIs. DDIs were classified by severity and type of interaction (increased risk of QT prolongation, additive CNS effects/respiratory depression, and opioid withdrawal). The primary endpoint was the number of potential DDIs. Other endpoints included number of each classification/severity of DDI, duration of therapy of interacting medications, and modifications made to OUD medications because of DDIs. Results A total of 102 patients were included, with 215 inpatient interactions and 83 interactions at discharge identified. While inpatient, 85% of patients were on an interacting medication, and 46% of patients were on an interacting medication at discharge. The most common classification of DDI was additive CNS effects/respiratory depression (68.8% inpatient, 50.6% discharge), followed by QT prolongation (24.2% inpatient, 45.8% discharge). The majority of DDIs were classified as requiring close monitoring rather than contraindicated. Discussion There are opportunities to optimize the prescribing practices surrounding OUD medications in both the inpatient setting and at discharge to ensure patient safety.
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Affiliation(s)
- Olivia Berger
- Pain Management and Palliative Care PGY-2 Pharmacy Resident, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Katherine Rector
- Clinical Team Leader, Internal Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - Jacqueline Meredith
- Clinical Pharmacy Specialist, Infectious Diseases, Clinical Team Leader, Antimicrobial Stewardship (Central Division), Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - Jamielynn Sebaaly
- Pain Management and Palliative Care PGY-2 Pharmacy Resident, The Johns Hopkins Hospital, Baltimore, Maryland.,Clinical Team Leader, Internal Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina.,Clinical Pharmacy Specialist, Infectious Diseases, Clinical Team Leader, Antimicrobial Stewardship (Central Division), Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
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Estave PM, Jacobs ML, Rukstalis M, Goforth J, Stone SN, Choi JA, Barrett J, Douglas HE, Oliver JB, Keating MK, Freischlag JA, O'Brien MC, McEwen S, Strowd RE. Opioid stewardship training during the transition to residency to prepare medical students to recognize and treat opioid use disorder. Subst Abus 2021; 42:1040-1048. [PMID: 34236292 DOI: 10.1080/08897077.2021.1915918] [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: 10/20/2022]
Abstract
Background: With a drastic shortage of addiction medicine specialists-and an ever-growing number of patients with opioid use disorder (OUD)-there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/post- knowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9-17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15-10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and (6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.
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Affiliation(s)
| | | | - Margaret Rukstalis
- University of South Carolina School of Medicine and VAMC, Columbia, SC, USA
| | - Jon Goforth
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Shane N Stone
- Department of Physician Medicine and Rehabilitation, McGaw Medical Center, Northwestern University, Chicago, IL, USA
| | | | | | - Heather E Douglas
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jennifer B Oliver
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Michelle K Keating
- Department of Family Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Julie A Freischlag
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Mary Claire O'Brien
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sara McEwen
- Governor's Institute on Substance Abuse, Raleigh, NC, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
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Donaldson K, Cardamone D, Genovese M, Garbely J, Demers L. Clinical Performance of a Gene-Based Machine Learning Classifier in Assessing Risk of Developing OUD in Subjects Taking Oral Opioids: A Prospective Observational Study. Ann Clin Lab Sci 2021; 51:451-460. [PMID: 34452883] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To reduce the incidence of Opioid Use Disorder (OUD), multiple guidelines recommend assessing the risk of OUD prior to prescribing oral opioids. Although subjective risk assessments are available to help classify subjects at risk for OUD, we are aware of no clinically validated objective risk assessment tools. An objective risk assessment based on genetics may help inform shared decision-making prior to prescribing short-duration oral opioids. METHODS A multicenter, observational cohort of adults exposed to prescription oral opioids for 4-30 days was conducted to determine the performance of an OUD classifier derived from machine learning (ML). From this cohort, the demographics of the U.S. adult opioid-prescribed population were used to create a blinded, random, representative group of subjects (n=385) for analysis to accurately estimate the performance characteristics in the intended use population. Genotyping was performed via a qualitative SNP microarray on DNA extracted from buccal samples. RESULTS In the study subjects, the classifier demonstrated 82.5% sensitivity (95% confidence intervals: 76.1%-87.8%) and 79.9% specificity (73.7-85.2%), with no statistically significant differences in clinical performance observed based on gender, age, length of follow-up from opioid exposure, race, or ethnicity. CONCLUSION This study demonstrates an ML classifier may provide additional objective information regarding a patient's risk of developing OUD. This information may enable subjects and healthcare providers to make more informed decisions when considering the use of oral opioids.
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Hohmeier KC, Cernasev A, Sensmeier M, Hall E, Webb K, Barenie R, Cochran G. U.S. student pharmacist perceptions of the pharmacist's role in methadone for opioid use disorder: A qualitative study. SAGE Open Med 2021; 9:20503121211022994. [PMID: 34158941 PMCID: PMC8182209 DOI: 10.1177/20503121211022994] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Of the over 20 million Americans reporting an opioid use disorder, only around 3 million report receiving treatment of any kind. The gold standard for opioid use disorder treatment is medication in combination with psychosocial support, but despite robust evidence supporting treatment, barriers are substantial and include limited insurance coverage, patient beliefs, ease of access, regulatory hurdles, and stigma. Although trained as medication experts, U.S. pharmacists are not routinely involved in opioid use disorder treatment and may represent an underutilized care team member. OBJECTIVE To explore U.S. pharmacy students' perspectives on pharmacists as providers of methadone-based medications for opioid use disorder treatment. METHODS A qualitative design with focus groups of student pharmacists in a U.S. college of pharmacy in the Southeastern United States. RESULTS Over 2 months in 2020, three focus groups were conducted with 15 students in each group participating, and including second-, third-, and fourth-year student pharmacists. Three overarching themes emerged from the data: (1) student pharmacists desire exposure to therapeutic knowledge and lived experiences related to opioid use disorder and methadone treatment, (2) students perceive stigmatizing views held by practicing pharmacists toward opioid use disorder and methadone treatment, (3) pharmacists should play a role in methadone treatment. CONCLUSION Student pharmacists desire an active and larger role in the care of patients managing opioid use disorder. Findings indicate these students perceive less stigma toward opioid use disorder than currently practicing pharmacists. Pharmacy curricula should emphasize stories of lived experiences of patients with opioid use disorder, therapeutic knowledge and guidelines related to medications for opioid use disorder, and the regulatory environment surrounding opioid use disorder treatment.
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Affiliation(s)
- Kenneth C Hohmeier
- Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, The University of Tennessee Health
Science Center, Nashville, TN, USA
| | - Alina Cernasev
- Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, The University of Tennessee Health
Science Center, Nashville, TN, USA
| | - Megan Sensmeier
- Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, The University of Tennessee Health
Science Center, Nashville, TN, USA
| | - Elizabeth Hall
- Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, The University of Tennessee Health
Science Center, Nashville, TN, USA
| | | | - Rachel Barenie
- Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, The University of Tennessee Health
Science Center, Nashville, TN, USA
| | - Gerald Cochran
- School of Medicine, University of Utah,
Salt Lake City, UT, USA
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49
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Rosenthal ES, Silk R, Mathur P, Gross C, Eyasu R, Nussdorf L, Hill K, Brokus C, D'Amore A, Sidique N, Bijole P, Jones M, Kier R, McCullough D, Sternberg D, Stafford K, Sun J, Masur H, Kottilil S, Kattakuzhy S. Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs. Clin Infect Dis 2021; 71:1715-1722. [PMID: 32009165 DOI: 10.1093/cid/ciaa105] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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: 10/22/2019] [Accepted: 01/31/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use-related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. METHODS In this prospective, open-label, observational trial at a harm reduction organization's drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. RESULTS Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04). CONCLUSIONS The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. CLINICAL TRIALS REGISTRATION NCT03221309.
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Affiliation(s)
- Elana S Rosenthal
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Rachel Silk
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Poonam Mathur
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Chloe Gross
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Rahwa Eyasu
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Laura Nussdorf
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristi Hill
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Brokus
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron D'Amore
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Nadeera Sidique
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Phyllis Bijole
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | - Miriam Jones
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | - Randy Kier
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | | | | | - Kristen Stafford
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry Masur
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Shyamasundaran Kottilil
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Sarah Kattakuzhy
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
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50
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Freda PJ, Moore JH, Kranzler HR. The phenomics and genetics of addictive and affective comorbidity in opioid use disorder. Drug Alcohol Depend 2021; 221:108602. [PMID: 33652377 PMCID: PMC8059867 DOI: 10.1016/j.drugalcdep.2021.108602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/14/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.
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Affiliation(s)
- Philip J. Freda
- University of Pennsylvania, Biostatistics, Epidemiology, & Informatics, The Perelman School of Medicine, University of Pennsylvania A201 R…, Philadelphia, Pennsylvania 19104, United States
| | - Jason H. Moore
- Edward Rose Professor of Informatics, Director, Institute for Biomedical Informatics, Director, Division of Informatics, Department of Biostatistics, Epidemiology, & Informatics, Senior Associate Dean for Informatics, The Perelman School of Medicine, University of Pennsylvania, Contact Information: D202 Richards Building, 3700 Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-6116
| | - Henry R. Kranzler
- Benjamin Rush Professor in Psychiatry, Department of Psychiatry, University of Pennsylvania, Treatment Research Center, 3535 Market Street, Suite 500, Philadelphia, PA 19104-6178
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