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Patel EU, Grieb SM, Winiker AK, Ching J, Schluth CG, Mehta SH, Kirk GD, Genberg BL. Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland. Harm Reduct J 2024; 21:91. [PMID: 38720307 PMCID: PMC11077846 DOI: 10.1186/s12954-024-01008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Substance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs. METHODS People with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants' experiences with substance use disorder treatment-related services. RESULTS The median age of participants was 54 years (range = 24-73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors). CONCLUSIONS Structural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Suzanne M Grieb
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Ching
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Catherine G Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Brener L, Caruana T, Cama E, Gilford C, Crawford S, Capell-Hattam T, von Hippel C. Stigma by association among alcohol and other drug and harm reduction workers: Implications for workplace outcomes. Drug Alcohol Rev 2024. [PMID: 38693827 DOI: 10.1111/dar.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION The negative attitudes people hold towards those who use alcohol or other drugs (AOD) can also affect the people who work with this community, leading to lowered productivity and wellbeing. The impact of this stigma by association in the AOD and harm reduction sector is particularly significant because workers may have lived experience of AOD use and identify strongly with their client group. This study aimed to examine how stigma by association among health workers in the AOD/harm reduction sector relates to workplace outcomes. A secondary aim was to explore how lived experience influences experiences of stigma by association. METHODS The research used a cross-sectional survey design and data collection occurred in 2023. Australian AOD/harm reduction workers (n = 228) completed an online survey assessing stigma by association as well as various workplace outcomes measures. RESULTS Participants who reported experiencing more stigma by association experienced poorer workplace wellbeing, higher burnout and greater intentions to leave the AOD/harm reduction field. Experiences of stigma by association were unrelated to job satisfaction. Additional analyses revealed that participants with lived experience reported higher levels of job satisfaction and lowered intentions to leave the sector, but findings of stigma by association and its impacts on workplace outcomes did not differ from those without lived experience. DISCUSSION AND CONCLUSIONS Identifying staff experiences of stigma by association and developing support and advocacy mechanisms to address this is likely to be key to reducing these experiences and ultimately to increasing positive workplace outcomes for AOD and harm reduction staff.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Kennedy-Hendricks A, Song M, McCourt AD, Sharfstein JM, Eisenberg MD, Saloner B. Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment. Health Aff (Millwood) 2024; 43:732-739. [PMID: 38709972 DOI: 10.1377/hlthaff.2023.01306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.
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Jennings LK, Lander L, Lawdahl T, McClure EA, Moreland A, McCauley JL, Haynes L, Matheson T, Jones R, Robey TE, Kawasaki S, Moschella P, Raheemullah A, Miller S, Gregovich G, Waltman D, Brady KT, Barth KS. Characterization of peer support services for substance use disorders in 11 US emergency departments in 2020: findings from a NIDA clinical trials network site selection process. Addict Sci Clin Pract 2024; 19:26. [PMID: 38589934 PMCID: PMC11003047 DOI: 10.1186/s13722-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Emergency departments (ED) are incorporating Peer Support Specialists (PSSs) to help with patient care for substance use disorders (SUDs). Despite rapid growth in this area, little is published regarding workflow, expectations of the peer role, and core components of the PSS intervention. This study describes these elements in a national sample of ED-based peer support intervention programs. METHODS A survey was conducted to assess PSS site characteristics as part of site selection process for a National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) evaluating PSS effectiveness, Surveys were distributed to clinical sites affiliated with the 16 CTN nodes. Surveys were completed by a representative(s) of the site and collected data on the PSS role in the ED including details regarding funding and certification, services rendered, role in medications for opioid use disorder (MOUD) and naloxone distribution, and factors impacting implementation and maintenance of ED PSS programs. Quantitative data was summarized with descriptive statistics. Free-text fields were analyzed using qualitative content analysis. RESULTS A total of 11 surveys were completed, collected from 9 different states. ED PSS funding was from grants (55%), hospital funds (46%), peer recovery organizations (27%) or other (18%). Funding was anticipated to continue for a mean of 16 months (range 12 to 36 months). The majority of programs provided "general recovery support (81%) Screening, Brief Intervention, and Referral to Treatment (SBIRT) services (55%), and assisted with naloxone distribution to ED patients (64%). A minority assisted with ED-initiated buprenorphine (EDIB) programs (27%). Most (91%) provided services to patients after they were discharged from the ED. Barriers to implementation included lack of outpatient referral sources, barriers to initiating MOUD, stigma at the clinician and system level, and lack of ongoing PSS availability due to short-term grant funding. CONCLUSIONS The majority of ED-based PSSs were funded through time-limited grants, and short-term grant funding was identified as a barrier for ED PSS programs. There was consistency among sites in the involvement of PSSs in facilitation of transitions of SUD care, coordination of follow-up after ED discharge, and PSS involvement in naloxone distribution.
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Affiliation(s)
- Lindsey K Jennings
- Department of Emergency Medicine, Medical University of South Carolina, 169 Ashley Avenue, MSC 300, Charleston, SC, 29425, USA.
| | - Laura Lander
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Tricia Lawdahl
- Faces and Voices of Recovery (FAVOR) Upstate, Greenville, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy Matheson
- Center On Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Thomas E Robey
- Providence Regional Medical Center Everett, Washington State University, Everett, WA, USA
| | - Sarah Kawasaki
- Departments of Psychiatry and Internal Medicine, Penn State Health, Hershey, PA, USA
| | - Phillip Moschella
- Department of Emergency Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Amer Raheemullah
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzette Miller
- Mercy Health - St. Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | - Gina Gregovich
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Deborah Waltman
- Deaconess Hospital, MultiCare Health System, Spokane, WA, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Lardier DT, Gilmore-Powell K, Morton CM, Peterson NA, Borys S. Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241235765. [PMID: 38469829 DOI: 10.1177/29767342241235765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.
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Affiliation(s)
- David T Lardier
- Department of Psychiatry and Behavioral Sciences, Division of Community Behavioral Health, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Kristen Gilmore-Powell
- Center for Prevention Science and the Northeast and Caribbean Prevention Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Cory M Morton
- Center for Prevention Science and the Northeast and Caribbean Prevention Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - N Andrew Peterson
- Center for Prevention Science and the Northeast and Caribbean Prevention Technology Transfer Center, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Suzanne Borys
- Office of Planning, Research, Evaluation and Prevention, New Jersey Division of Mental Health and Addiction Services, Hamilton, NJ, USA
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Kang AW, Bailey A, Napoleon S, Martin R. Contextualizing medications for opioid use disorder and peer support service provision in the probation system with implementation science. BMC Public Health 2024; 24:658. [PMID: 38429688 PMCID: PMC10905868 DOI: 10.1186/s12889-024-18133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) is an evidence-based approach that reduces opioid-related mortality, particularly among criminal legal-involved persons who are at increased risk of adverse outcomes related to OUD. Implementing evidence-based approaches in the context of probation settings requires an in-depth understanding of specific contexts to improve intervention efficacy and effectiveness. Here, we use the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to understand implementation contexts for MOUD provision in the probation setting. METHODS In-depth individual interviews were conducted with key programmatic stakeholders (treatment providers and probation staff involved in service provision for people on probation). The study examined stakeholder perspectives regarding MOUD and Peer Support Service (PSS) implementation among people who are involved in community supervision. Deductive and inductive thematic analysis was conducted, and subsequently the codes, subcodes, and themes were mapped onto the EPIS framework to better understand implementation contexts. RESULTS We deduced key inner, outer, and bridging contexts that shape treatment service provision for individuals with OUD who are on probation. Inner contexts include a strong organizational climate that supports MOUD implementation and enthusiasm for peer support services. Outer contexts include difficulty navigating insurance among providers, treatment costs, and systemic stigma towards MOUD. Bridging contexts include a lack of collaboration/communication between relevant agencies (e.g., probation and courts). CONCLUSIONS Findings indicate the implementation is complex and requires a coordinated effort between correctional systems, probation agencies, and community-based treatment providers.
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Affiliation(s)
- Augustine W Kang
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S. Main St, Box G-121-5, Providence, RI, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Amelia Bailey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S. Main St, Box G-121-5, Providence, RI, USA
| | - Siena Napoleon
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S. Main St, Box G-121-5, Providence, RI, USA
| | - Rosemarie Martin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 S. Main St, Box G-121-5, Providence, RI, USA
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Moffitt T, Fallin-Bennett A, Fanucchi L, Walsh SL, Cook C, Oller D, Ross A, Gallivan M, Lauckner J, Byard J, Wheeler-Crum P, Lofwall MR. The development of a recovery coaching training curriculum to facilitate linkage to and increase retention on medications for opioid use disorder. Front Public Health 2024; 12:1334850. [PMID: 38425462 PMCID: PMC10903364 DOI: 10.3389/fpubh.2024.1334850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility. Methods–pedagogy and training development The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers to entering or continuing MOUD, destigmatize and educate on MOUD and harm reduction (e.g., safe injection practices), increase recovery capital, and provide opioid overdose education with naloxone distribution (OEND). An extensive hybrid (in-person and online, both synchronous and asynchronous), inclusive learning-focused curriculum to support the programs (e.g., motivational interviewing sessions, role plays, MOUD competency assessment, etc.,) was created to ensure RCs developed the necessary skills and could demonstrate competency before deployment in the field. The curriculum, pedagogy, learning environment, and numbers of RCs trained and community venues receiving a trained RC are reported, along with interviews from three RCs about the training program experience. Results The curriculum provides approximately 150 h of training to RCs. From December 2020 to February 2023, 93 RCs and 16 supervisors completed the training program; two were unable to pass a final competency check. RCs were deployed at 45 agencies in eight Kentucky HCS counties. Most agencies (72%) sustained RC services after the study period ended through other funding sources. RCs interviewed reported that the training helped them better explain and dispel myths around MOUD. Conclusion Our novel training and MOUD programs met a current unmet need for the RC workforce and for community agencies. We were able to train and deploy RCs successfully in these new programs aimed at saving lives through improving MOUD linkage and retention. This paper addresses a need to enhance the training requirements around MOUD for peer support specialists.
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Affiliation(s)
- Trevor Moffitt
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, KY, United States
- Voices of Hope, Lexington, KY, United States
| | - Laura Fanucchi
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Sharon L. Walsh
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Christopher Cook
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Devin Oller
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Anna Ross
- Voices of Hope, Lexington, KY, United States
| | - Molly Gallivan
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - John Lauckner
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Jeremy Byard
- Arthur Street Hotel, Louisville, KY, United States
| | | | - Michelle R. Lofwall
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
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Nordeck CD, Sharma A, Terplan M, Dusek K, Gilliams E, Gryczynski J. Opioid Use Disorder Treatment Linkage at Strategic Touchpoints Using Buprenorphine (OUTLAST-B): Rationale, Design, and Evolution of a Randomized Controlled Trial. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2023; 8:e230010. [PMID: 38456042 PMCID: PMC10919199 DOI: 10.20900/jpbs.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Despite the effectiveness and growing availability of treatment for opioid use disorder (OUD) with buprenorphine, many people with OUD do not access treatment services. This article describes the rationale, methodological design, evolution, and progress of an ongoing clinical trial of treatment linkage strategies for people with untreated OUD. Methods The study, titled Opioid Use Disorder Treatment Linkage at Strategic Touchpoints using Buprenorphine (OUTLAST-B), uses "strategic touchpoints", initially sexual health clinics and subsequently broadened to other service venues and participant social networks, for recruitment and screening. Adults with untreated OUD (target N = 360) are randomized to one of the three arms: Usual Care (UC, enhanced with overdose education and naloxone distribution), Patient Navigation (PN), or Patient Navigation with an immediate short-term bridge prescription for buprenorphine (PN + BUP). In the PN and PN + BUP arms, the Patient Navigator works with participants for 2 months to facilitate treatment entry and early retention, resolve barriers (e.g., ID cards, transportation), and provide motivational support. Results The primary outcome is OUD treatment entry within 30 days of enrollment. Participants are assessed at baseline and followed at 3- and 6-months post-enrollment on measures of healthcare utilization, substance use, and general functioning. Challenges and recruitment adaptations pursuant to the COVID-19 pandemic are discussed. Conclusions This study could provide insights on how to reach people with untreated OUD and link them to care through non-traditional routes. Trial Registration The study is registered at ClinicalTrials.gov (NCT04991974).
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Affiliation(s)
| | - Anjalee Sharma
- Friends Research Institute, Baltimore, MD 21201, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | | | - Kristi Dusek
- Friends Research Institute, Baltimore, MD 21201, USA
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Bhondoekhan F, Li Y, Gaither R, Daly MM, Hallowell BD, Chambers LC, Beaudoin FL, Marshall BD. The impact of polysubstance use patterns on engagement of substance use disorder treatment among emergency department patients at high risk of opioid overdose. Addict Behav Rep 2023; 18:100512. [PMID: 37636893 PMCID: PMC10450842 DOI: 10.1016/j.abrep.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their association with SUD treatment engagement among emergency department (ED) patients at risk of opioid overdose. Methods This was a sub-analysis of a randomized controlled trial comparing two behavioral interventions for individuals at two EDs in Rhode Island from 2018 to 2021. Past six-month substance use frequency for eight substances plus injection drug use was self-reported at trial enrollment, and SUD treatment engagement within 90 days after enrollment was obtained using administrative data linkages. Latent class analysis identified substance use patterns and multivariable log-binomial models estimated the association with SUD treatment engagement. Results Among 607 participants, there were four substance use patterns: 1) low reported use (n = 295), 2) frequent injection and heroin use (n = 131), 3) high frequency broad polysubstance use (n = 62), and 4) low frequency broad polysubstance use (n = 119). Compared to participants with the low reported use pattern, those with the frequent injection and heroin pattern had a greater likelihood of SUD treatment engagement (adjusted risk ratio = 1.28; 95% confidence interval = 1.02-1.61). Conclusions Distinct and meaningful polysubstance use patterns showed differential SUD treatment engagement after ED discharge. Nuanced relationships between substance use patterns and treatment highlight the necessity for tailored harm reduction, treatment, and recovery services.
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Affiliation(s)
- Fiona Bhondoekhan
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Yu Li
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Rachel Gaither
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Mackenzie M. Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, 14 Harrington Rd, Cranston, RI 02920, USA
| | | | - Laura C. Chambers
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Francesca L. Beaudoin
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
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Chen Y, Yuan Y, Reed BG. Experiences of peer work in drug use service settings: A systematic review of qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104182. [PMID: 37683570 DOI: 10.1016/j.drugpo.2023.104182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND People with lived or living experiences of drug use and services have been increasingly incorporated into nonpeer-led mainstream organizational settings as a unique workforce. Despite the much discussed effectiveness of peer services in achieving measurable outcomes, limited attention has been given to the experiential aspects of peer work from the perspectives of peers, clients, or others involved. This systematic review synthesized qualitative evidence examining the experiences of peer work in nonpeer-led drug use service settings. It focused on the benefits of incorporating peers as a unique workforce, the challenges they face, and the organizational factors that influence their practices. METHODS A search of 15 databases identified 3,940 unique citations, 33 of which met inclusion criteria. Thematic analysis was utilized to synthesize their findings. RESULTS Foregrounding the uniqueness of peers' shared experience, studies have shown that incorporating peers into nonpeer-led settings can provide benefits at the client, organizational, and societal levels while promoting peers' personal and professional growth. The unique shared experience of peers can also present multidimensional challenges, such as triggering, boundary negotiation, and feelings of being trapped by their peer identity. To fully integrate peers into the system, organizations need to work with them to reconstruct organizational mission, culture, and structures in a way that recognizes and genuine commits to peers' unique values. CONCLUSION This review highlights the significance of understanding peer uniqueness for organizations to create nourishing conditions for peer services and calls for future research exploring context- and setting-specific peer roles and organizational enablers and barriers.
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Affiliation(s)
- Yun Chen
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States.
| | - Yeqing Yuan
- School of Social Work, College of Health, University of Alaska Anchorage, UAA Professional Studies Building, 2533 Providence Dr, Suite 234, Anchorage, AK 99508, United States
| | - Beth Glover Reed
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States
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Incze MA, Sehgal SL, Hansen A, Garcia L, Stolebarger L. Evaluation of a Primary Care-Based Multidisciplinary Transition Clinic for Patients Newly Initiated on Buprenorphine in the Emergency Department. Subst Abus 2023; 44:220-225. [PMID: 37675904 DOI: 10.1177/08897077231188592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Care transitions represent vulnerable events for patients newly initiating medications for opioid use disorder (MOUD). Multidisciplinary primary care-based transition clinics may improve care linkage and retention in MOUD treatment. Additionally, these interventions may help primary care clinicians (PCPs) overcome barriers to adopting MOUD into practice. In this evaluation, we assessed the impact of a primary care-based transition clinic for patients newly initiating buprenorphine for opioid use disorder (OUD) in the emergency department. METHODS We conducted a retrospective program evaluation within a single academic health system involving adults who newly initiated buprenorphine for OUD through an emergency department-based program and were referred to follow up in either a dedicated multidisciplinary primary care-based transition clinic (SPARC) vs referral to usual primary care (UPC). We performed descriptive analyses comparing patient demographics, referral volume, linkage to care, treatment retention, and markers of high-quality care between the 2 groups. A log-rank test was used to determine the difference in probabilities of retention between SPARC and UPC over 6 months. RESULTS Over 12 months, the number of referrals to SPARC was greater than to UPC (N = 64 vs N = 26). About 58% of patients referred to SPARC attended an initial visit vs 38% referred to UPC. Treatment retention was consistently greater in SPARC than UPC (1 m: 90% vs 60%; 3 m: 76% vs 40%; 6 m: 60% vs 30%). Markers of care quality including naloxone provision (100% vs 80%) and infectious screening (81% vs 40%) were greater in SPARC clinic. SPARC was associated with a statistically significant increased probability of retention in treatment as compared to UPC (P < .01). CONCLUSIONS In this observational evaluation, a primary care-based multidisciplinary transition clinic for patients initiating buprenorphine MOUD was associated with expanded access to longitudinal OUD treatment and superior linkage to care, retention in care, and quality of care compared to referral to usual primary care. Further research using a more rigorous research design is required to further evaluate these findings.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sonia L Sehgal
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Annika Hansen
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Luke Garcia
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Laura Stolebarger
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
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12
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Gormley MA, Nagy TR, Moschella P, Lu Z, Rodriguez J, Roth P. HIV Pre-Exposure Prophylaxis in the Emergency Department: A Systematic Review. Ann Emerg Med 2023; 81:468-481. [PMID: 36117011 DOI: 10.1016/j.annemergmed.2022.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/28/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE Many emergency departments (EDs) have identified the importance of HIV prevention and have implemented steps to screen and offer preexposure prophylaxis (PrEP). The objective of this study was to systematically review existing literature that identifies PrEP eligibility in the ED and summarize outcomes along the PrEP cascade of care (awareness, interest, linkage to treatment, initiation, and retention) for patients in ED. METHODS Four databases captured all PrEP-related studies in EDs from January 1, 2013 to January 27, 2022. Data were extracted on study characteristics and outcomes, and study quality was assessed using a modified quality assessment tool by the Effective Public Health Practice Project. RESULTS Of the 218 articles, 16 were subjected to full-text review, and 7 met inclusion criteria. Although most studies identified patients who were PrEP eligible using criteria adapted from the 2017 Centers for Disease Control and Prevention PrEP guidelines, the number and time frame for each criterion varied. Six studies reported outcomes on the PrEP cascade of care, showing a relatively high prevalence of awareness and interest but a very low prevalence of linkage and uptake. No studies documented retention in PrEP treatment. CONCLUSION Although up to a third of patients in ED assessed in the current study were PrEP eligible, less than half of PrEP-eligible participants had prior knowledge of PrEP, and very few who expressed interest in the ED were ultimately linked to PrEP treatment or initiated PrEP. Future research is necessary to identify strategies to increase PrEP education, interest, and linkage to care from the ED.
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Affiliation(s)
- Mirinda Ann Gormley
- Department of Emergency Medicine, Prisma Health Upstate, Greenville, SC; University of South Carolina School of Medicine Greenville, Greenville, SC; Clemson University School of Health Science Research, Greenville, SC.
| | - Tibor R Nagy
- Department of Emergency Medicine, Prisma Health Upstate, Greenville, SC
| | - Phillip Moschella
- Department of Emergency Medicine, Prisma Health Upstate, Greenville, SC; University of South Carolina School of Medicine Greenville, Greenville, SC; Clemson University School of Health Science Research, Greenville, SC
| | - Zhexi Lu
- Penn State University School of Medicine, Hershey, PA
| | - Julia Rodriguez
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Prerana Roth
- University of South Carolina School of Medicine Greenville, Greenville, SC; Clemson University School of Health Science Research, Greenville, SC; Department of Internal Medicine, Prisma Health Upstate, Greenville, SC
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13
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Patel EU, Astemborski J, Feder KA, Rudolph JE, Winiker A, Sosnowski DW, Kirk GD, Mehta SH, Genberg BL. Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use. Drug Alcohol Depend 2023; 244:109802. [PMID: 36774804 PMCID: PMC9908589 DOI: 10.1016/j.drugalcdep.2023.109802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use. METHODS Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively. RESULTS Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]). CONCLUSIONS Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abigail Winiker
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David W Sosnowski
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Pepper D. The Entanglements of Substance Use Disorders and Emergency Departments. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:52-53. [PMID: 37205033 PMCID: PMC10172536 DOI: 10.1176/appi.focus.20220075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David Pepper
- Institute of Living, Hartford Hospital, Hartford, Connecticut
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15
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Placide V, Unruh L, Atkins D, Chisholm L, Scott JB. Factors associated with counselling adherence in opioid treatment programs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6303-e6311. [PMID: 36250340 DOI: 10.1111/hsc.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/12/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Federally certified opioid treatment programs (OTPs) provide psychosocial counselling in addition to medications for opioid use disorder (MOUDs) using a patient-centered approach in providing substance use disorder treatment. This study explored factors associated with patients' adherence to counselling while receiving MOUD at an OTP. A retrospective cohort design using data on adult patients (n = 1151, 61% females, 39% males) admitted to an OTP from July 1, 2014, to June 30, 2016, was employed. The data were for single episodes of care up to 52 weeks. Survival analysis (cox proportional hazards regression) assessed the relationship of personal characteristics, socio-economic status, payment for services, type of substance use, comprehensive care and social support with counselling for up to a year. Results indicated that age, having services paid for by public means, was associated with counselling adherence. Primary heroin use patients had a higher risk of counselling adherence failure than patients who primarily used non-medicinal prescription substances. Treatment agencies may benefit from funding and using evidence-based practices for primary heroin use patients and young adults to better engage and retain these populations in treatment.
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Affiliation(s)
- Vierne Placide
- Health Department, State University of New York College at Cortland, Cortland, New York, USA
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Lynn Unruh
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - Danielle Atkins
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
- Askew School of Public Administration, Florida State University, Tallahassee, Florida, USA
| | - Latarsha Chisholm
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
| | - J Blake Scott
- Department of Writing and Rhetoric, University of Central Florida, Orlando, Florida, USA
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Gastfriend DR, Mee-Lee D. Thirty Years of TheASAMCriteria: A Report Card. Psychiatr Clin North Am 2022; 45:593-609. [PMID: 36055741 DOI: 10.1016/j.psc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The American Society of Addiction Medicine Criteria (ASAM) Criteria has profoundly influenced addiction treatment and reimbursement, with its growing toolkit of ASAM CONTINUUM software, ASAM-CARF Level of Care Certification Program, educational programs, and publications. A retrospective accounting shows that the field has made considerable strides, but has far to go. Providers and payers still need to (1) improve consistency in their use of standardized, multidimensional patient assessment; (2) improve flexibility in providing and reimbursing person-centered, individualized services; (3) improve measurement in treatment planning for determination of progress; and (4) focus on outcomes and value in the care they deliver.
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Affiliation(s)
| | - David Mee-Lee
- DML Training and Consulting, 4228 Boxelder Place, Davis, CA 95618, USA
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Drug court utilization of medications for opioid use disorder in high opioid mortality communities. J Subst Abuse Treat 2022; 141:108850. [DOI: 10.1016/j.jsat.2022.108850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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