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Zhang P, Tossone K, Ashmead R, Bickert T, Bailey E, Doogan NJ, Mack A, Schmidt S, Bonny AE. Examining differences in retention on medication for opioid use disorder: An analysis of Ohio Medicaid data. J Subst Abuse Treat 2022; 136:108686. [PMID: 34953637 DOI: 10.1016/j.jsat.2021.108686] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 10/07/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Medications for opioid use disorder (MOUDs), including methadone, buprenorphine and naltrexone, are associated with lower death rates and improved quality of life for people in recovery from opioid use disorder (OUD). Less is known about each MOUD modality's association with treatment retention and the contribution of behavioral health therapy (BHT). The objectives of the current study were to estimate the association between MOUD type and treatment retention and determine whether BHT was associated with length of time retained. METHODS We investigated the time from initiation to discontinuation from MOUD by medication type and exposure to BHT using statewide Medicaid Claims data (N = 81,752). We estimated covariate adjusted hazard ratios (AHR) using a Cox proportional hazards model. RESULTS Compared to methadone, buprenorphine was associated with a higher risk of discontinuation at the time of initiation (AHR = 2.41, 95% CI = 2.28-2.55), however that difference decreased over one year of maintained retention (AHR = 1.44, 95% CI = 1.37-1.50). Compared to methadone and buprenorphine, naltrexone was associated with a higher risk of discontinuation at the time of initiation (naltrexone vs. methadone AHR = 2.49, 95% CI = 2.30-2.65; naltrexone vs. buprenorphine AHR 1.03, 95% CI = 1.00-1.07), and that relative risk increased over the course of one year of retention (naltrexone vs. methadone AHR = 3.85, 95% CI = 3.63-4.09; naltrexone vs. buprenorphine AHR = 2.67, 95% CI = 2.54-2.81). In general, independent of MOUD type, exposure to BHT during MOUD treatment was associated with a lower risk of discontinuation (AHR = 0.94, 95% CI = 0.92-0.96). However, BHT during the treatment episode was not associated with retention in the adolescent/young adult and pregnant women subpopulations. DISCUSSION From the standpoint of early success, methadone was associated with the lowest risk of treatment discontinuation. While buprenorphine and naltrexone were associated with similar risks at the beginning of treatment, the relative discontinuation risk for buprenorphine was less than half that of naltrexone at one year of retention. In general, BHT with MOUD was associated with a lower risk of treatment discontinuation.
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Affiliation(s)
- Pengyue Zhang
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, United States of America
| | - Krystel Tossone
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Robert Ashmead
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America
| | - Tina Bickert
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America.
| | - Emelie Bailey
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America
| | - Nathan J Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America
| | - Aimee Mack
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America
| | | | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, United States of America; Department of Pediatrics, College of Medicine, The Ohio State University, United States of America
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:e2021052368. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Hochheimer M, Unick GJ. Systematic review and meta-analysis of retention in treatment using medications for opioid use disorder by medication, race/ethnicity, and gender in the United States. Addict Behav 2022; 124:107113. [PMID: 34543869 DOI: 10.1016/j.addbeh.2021.107113] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is mounting evidence that opioid use disorder is experienced differently by people of different genders and race/ethnicity groups. Similarly, in the US access to specific medications for opioid use is limited by gender and race/ethnicity. This study aims to evaluate if gender or race/ethnicity is associated with different rates of treatment retention in the US, for each of three medications used to treat opioid use disorder. METHODS A systematic search was conducted using PubMed, CINHAL, and PsychINFO, databases. All studies that provided a ratio of those retained in treatment at a specified time in terms of gender and/or race/ethnicity and medication were included. Variables were created to assess the effects of time in treatment, recruited sample, required attendance at concurrent psychosocial treatment, and adherence to strict rules of conduct for continuation in treatment on retention. Meta-analytical and meta-regression methods were used to compare studies on the ratio of those who completed a specific time in treatment by race/ethnicity group and by gender. RESULTS Nineteen articles that provided the outcome variable of interest were found (11 buprenorphine, six methadone, and two naltrexone). Meta-analyses found that treatment retention was similar for all gender and racial/ethnic groups for all three medications. Meta-regression found that those of the African American group who were recruited into buprenorphine treatment were retained significantly longer than African Americans in buprenorphine treatment who were studied retrospectively. Also, both genders had significantly lower retention in methadone treatment when there was the additional requirement of psychosocial therapy.
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Choi S, Stein MD, Raifman J, Rosenbloom D, Clark JA. Estimating the impact on initiating medications for opioid use disorder of state policies expanding Medicaid and prohibiting substance use during pregnancy. Drug Alcohol Depend 2021; 229:109162. [PMID: 34768053 PMCID: PMC8671210 DOI: 10.1016/j.drugalcdep.2021.109162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medicaid expansion increased access to addiction treatment services for pregnant women. However, states' imposition of civil or criminal child abuse sanctions for drug use during pregnancy could inhibit access to treatment. We estimated the effects of Medicaid expansion on pregnant women's medications for opioid use disorder (MOUD) use, and its interaction with statutes that prohibit substance use during pregnancy. METHODS Using the Treatment Episode Dataset for Discharge (2010-2018), we identified the initial treatment episode of pregnant women with opioid use disorder (OUD). We described changes in MOUD use and estimated adjusted difference-in-differences and event study models to evaluate differences in changes in MOUD between states that prohibit substance use during pregnancy and states that do not. FINDINGS Among a total of 16,070 treatment episodes for pregnant women with OUD from 2010 to 2018, most (74%) were in states that expanded Medicaid. By one year post-expansion, the proportion of episodes receiving MOUD in states not prohibit substance use during pregnancy increased by 8.7% points (95% CI: 2.7, 14.7) from the pre-expansion period compared to a 5.6% point increase in states prohibiting substance use during pregnancy (95% CI: -3.3, 14.8). In adjusted event study analysis, the expansion was associated with an increase in MOUD use by 15.3% by year 2 in states not prohibiting versus 1.5% percentage points in states prohibiting substance use during pregnancy, respectively. CONCLUSIONS State policies prohibiting substance use during pregnancy may limit the salutary effects of Medicaid expansion for pregnant women who could benefit from MOUD treatment.
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Affiliation(s)
- Sugy Choi
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA.
| | - Michael D. Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - David Rosenbloom
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Jack A Clark
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts 02118, USA
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Joshi C, Skeer MR, Chui K, Neupane G, Koirala R, Stopka TJ. Women-centered drug treatment models for pregnant women with opioid use disorder: A scoping review. Drug Alcohol Depend 2021; 226:108855. [PMID: 34198134 DOI: 10.1016/j.drugalcdep.2021.108855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While there is a high unmet need for drug treatment services tailored to the needs of pregnant women, fewer than half of the opioid use disorder (OUD) treatment programs in the U.S. offer such services. We conducted a scoping review of the literature to identify women-centered drug treatment models that address access, coordination, and quality of care, and their facilitators and barriers. METHODS We searched PubMed, EMBASE, PsycInfo, Sociology Database, Web of Science, CINAHL, EBSCO Open Dissertations, Health Services Research Projects in Progress, and relevant agency websites from 1990 to 2020. We included studies that evaluated multicomponent models of care that provided medication for OUD (MOUD) to pregnant women in the U.S. RESULTS Of the 1,578 unduplicated articles screened, 26 articles met the inclusion criteria, which reported on 19 different studies and included 3,193 women. We identified seven different models of care and found that: (1) access was improved by co-locating various services for drug treatment and care, (2) coordination was enhanced by inter-professional collaboration, (3) quality was improved by treating pregnant patients in groups, and (4) stigmatization and criminalization of substance use during pregnancy was a significant barrier to care. CONCLUSIONS There is an urgent need to bolster patient-provider relationships that are built on trust, are free of stigma, and that empower patients to make their own decisions. Improved policies and regulations to reduce stigma around the use of opioids and MOUD are needed, so that pregnant women with OUD can access high quality care.
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Affiliation(s)
- Chandni Joshi
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Margie R Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Kenneth Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Gagan Neupane
- Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, United States.
| | | | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Seguí HA, Melin K, Quiñones DS, Duconge J. A review of the pharmacogenomics of buprenorphine for the treatment of opioid use disorder. JOURNAL OF TRANSLATIONAL GENETICS AND GENOMICS 2020; 4:263-277. [PMID: 33274315 PMCID: PMC7709797 DOI: 10.20517/jtgg.2020.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As the opioid epidemic continues to grow across the United States, the number of patients requiring treatment for opioid use disorder continues to climb. Although medication-assisted treatment presents a highly effective tool that can help address this epidemic, its use has been limited. Nonetheless, with easier dosing protocols (compared to the more complex dosing required of methadone due to its long and variable half-life) and fewer prescribing limitations (may be prescribed outside the setting of federally approved clinics), the increase in buprenorphine use in the United States has been dramatic in recent years. Despite buprenorphine's demonstrated efficacy, patient-specific factors can alter the response to the medications, which may lead to treatment failure in some patients. Clinical characteristics (sex, concurrent medications, and mental health comorbidities) as well as social determinants of health (housing status, involvement with the criminal justice system, and socioeconomic status) may impact treatment outcomes. Furthermore, a growing body of data suggests that genetic variations can alter pharmacological effects and influence therapeutic response. This review will cover the available pharmacogenomic data for the use of buprenorphine in the management of opioid use disorders. Pharmacogenomic determinants that affect opioid receptors, the dopaminergic system, metabolism of buprenorphine, and adverse events are discussed. Although much of the existing data comes from observational studies, clinical research is ongoing. Nevertheless, the development of pharmacogenomic-guided strategies has the potential to reduce opioid misuse, improve clinical outcomes, and save healthcare resources.
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Affiliation(s)
| | - Kyle Melin
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Darlene Santiago Quiñones
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Jorge Duconge
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
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Singh R, Rothstein R, Ricci K, Visintainer P, Shenberger J, Attwood E, Friedmann P. Partnering with parents to improve outcomes for substance exposed newborns-a pilot program. J Perinatol 2020; 40:1041-1049. [PMID: 32203180 DOI: 10.1038/s41372-020-0662-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Assess impact of parental involvement in care provision for term substance exposed newborns (SENs). STUDY DESIGN Prospective observational cohort study included mothers with opioid use disorder and their SENs over 4 year study period. Maternal-Infant dyads enrolled in EMPOWER and rooming-in (RI) programs were included and received care 24/7 in a private room until newborn's discharge. Outcomes were compared for dyads participating in EMPOWER/RI with historical controls. RESULTS Ninety of 156 historical SENs were RI eligible, while 49 of 108 SENs born during RI period had mothers enrolled in EMPOWER. EMPOWER/RI SENs had lower rates for and duration of pharmacotherapy, shorter neonatal intensive care unit (NICU) and hospital lengths of stay. EMPOWER/RI increased initiation and continuation of breastfeeding at discharge. CONCLUSIONS Parental participation was associated with a decrease in initiation and duration of pharmacotherapy, NICU admission, length of stay and hospital charges while increasing breastfeeding initiation and continuation at discharge.
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Affiliation(s)
- Rachana Singh
- Baystate Medical Center, Springfield, MA, USA. .,University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Rachel Rothstein
- Baystate Medical Center, Springfield, MA, USA.,Penn State College of Medicine, Hershey, PA, USA
| | - Karen Ricci
- Baystate Medical Center, Springfield, MA, USA
| | - Paul Visintainer
- University of Massachusetts Medical School-Baystate, Springfield, MA, USA.,Office of Research, UMMS-Baystate, Springfield, MA, USA
| | - Jeffrey Shenberger
- Baystate Medical Center, Springfield, MA, USA.,Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eilean Attwood
- Baystate Medical Center, Springfield, MA, USA.,University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Peter Friedmann
- Baystate Medical Center, Springfield, MA, USA.,Office of Research, UMMS-Baystate, Springfield, MA, USA
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Crane D, Marcotte M, Applegate M, Massatti R, Hurst M, Menegay M, Mauk R, Williams S. A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants. J Subst Abuse Treat 2019; 102:53-59. [PMID: 31202289 DOI: 10.1016/j.jsat.2019.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
A collaborative led by state health and human service agencies, academic leaders, and stakeholders tested interventions to expand use of medication assisted treatment (MAT) through a maternal medical home (MMH) model that coordinated behavioral health and prenatal care with social supports for pregnant women with opioid use disorder (OUD) enrolled in Medicaid. The program was anchored in four clinical organizations with distinct models of care: community behavioral health, residential behavioral health, hospital-based obstetrical practice, and co-located obstetrical and behavioral health. A modified version of the Institute for Healthcare Improvement Breakthrough Series Model for Improvement was implemented using monthly performance data feedback to conduct small tests of change and improve care. Administrative data from the state's Medicaid, vital statistics, and child welfare systems were linked to evaluate the impact of MOMS on 252 mother-infant dyads compared to a sample of 846 Medicaid beneficiaries with OUD in the third trimester of pregnancy. MOMS participation was associated with increased likelihood of MAT in trimesters one, two and three (AOR = 2.30, 4.40, 2.75, respectively), behavioral health counseling during trimesters two and three (AOR = 3.75 and 2.07, respectively), retention in MAT during postpartum months one through three and four through six (AOR = 2.86, 2.40, respectively), and marginally lower out-of-home placement of infants born to mothers with OUD (AOR = 0.66). Within the MOMS program, greater participation in behavioral health treatment and MAT (χ2(3) ≥ 12.09) was observed in the co-located behavioral health/obstetrical care practice site compared to behavioral health-led and obstetrical provider-led sites.
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Affiliation(s)
- Dushka Crane
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Michael Marcotte
- Tri-State Maternal-Fetal Medicine Associates, United States of America.
| | - Mary Applegate
- FACP - NASHP, Ohio Department of Medicaid, United States of America.
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, United States of America.
| | - Mark Hurst
- Ohio Department of Mental Health and Addiction Services, United States of America.
| | - Michelle Menegay
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Rachel Mauk
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Susan Williams
- Ohio Department of Job and Family Services, United States of America.
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Lee E, Cooper RJ. Codeine Addiction and Internet Forum Use and Support: Qualitative Netnographic Study. JMIR Ment Health 2019; 6:e12354. [PMID: 31021328 PMCID: PMC6658256 DOI: 10.2196/12354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/31/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of codeine as an analgesic is well-recognized, but there are increasing concerns that for some individuals continued use may lead to misuse, dependence, and fatalities. Research suggests that those affected may represent a hard-to-reach group who do not engage with formal treatment services. OBJECTIVE This study sought to explore the experiences of people with self-reported addiction to codeine and, specifically, how a social media forum is used to communicate with others about this issue. METHODS Using a qualitative netnographic methodology, the social media forum Mumsnet was used, with permission, and searches were undertaken in 2016 of any posts that related to codeine and addiction. A total of 95 relevant posts were identified; a purposive sample of 25 posts was selected to undertake subsequent six-stage thematic analysis and development of emerging themes. These 25 posts were posted between 2003 and 2016 and comprised 757 individual posts. RESULTS Individuals created posts to actively request help in relation to usually their own, but occasionally their partner's or relative's, problems relating to codeine use and self-reported "addiction." Varying levels of detail were provided in narratives of problematic codeine use. There were both positive and negative descriptions of side effects emerging, problems experiencing withdrawal, and failed attempts to discontinue codeine use. Mainly positive and supportive responses to posts were identified from those with either self-reported health profession experience or lay respondents, who often drew on their own experiences of similar problems. Treatment advice emerged in two main ways, either as signposting to formal health services or to informal approaches and often anecdotal advice about how to taper or use cold turkey techniques. Some posts were more critical of the original poster, and arguments and challenges to advice were not uncommon. Shame and stigma were often associated with users' posts and, while there was a desire to receive support and treatment advice in this forum, users often wanted to keep their codeine use hidden in other aspects of their lives. Distinctly different views emerged as to whether responsibility lay with prescribers or patients. Some users expressed anger toward doctors and their prescribing practices. CONCLUSIONS This study provides a unique insight into how a public internet forum is used by individuals to confirm and seek support about problematic codeine use and of the ways others respond. The pseudonymous use of internet forums for such information and variation in treatment options suggested by often lay respondents suggest that increased formal support and awareness about codeine addiction are needed. There may be opportunities for providing further support directly on such online forums. Improvements in prescribing codeine and in the over-the-counter supply of codeine are required to prevent problematic use from occurring.
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Affiliation(s)
- Eleanor Lee
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Richard J Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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