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Weybright E, Phibbs S, Watters C, Myers A, Peavy M, Martin A. The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities. Eval Health Prof 2024; 47:192-203. [PMID: 38790114 DOI: 10.1177/01632787241237515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The opioid epidemic in the United States continues to disproportionately affect those in rural, compared to urban, areas due to a variety of treatment and recovery barriers. One mechanism to increase capacity of rural-serving providers is through delivery of training and technical assistance (TTA) for evidence-based programs by leveraging the Cooperative Extension System. Guided by the Interactive Systems Framework, the current study evaluates TTA delivered by the Northwest Rural Opioid Technical Assistance Collabroative to opioid prevention, treatment, and recovery providers on short- (satisfaction, anticipated benefit), medium-, (behavioral intention to change current practice), and long-term goals (changes toward adoption of evidence-based practices). We also evaluated differences in short- and medium-term goals by intensity of TTA event and rurality of provider. Surveys of 351 providers who received TTA indicated high levels of satisfaction with TTA events attended, expressed strong agreement that they would benefit from the event, intended to make a professional practice change, and preparation toward implementing changes. Compared to urban-based providers, rural providers reported higher intention to use TTA information to change current practice. We conclude with a review of remaining gaps in the research to practice pipeline and recommendations for moving forward.
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Affiliation(s)
- Elizabeth Weybright
- Department of Human Development, Washington State University, Pullman, WA, USA
- Extension Youth and Families Unit, Washington State University, Pullman, WA, USA
| | - Sandi Phibbs
- Oregon State University Center for Health Innovation, Oregon State University, Corvallis, OR, USA
| | - Cassandra Watters
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Allison Myers
- Extension Family and Community Health, Oregon State University, Corvallis, OR, USA
| | - Michelle Peavy
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University Spokane, Spokane, WA, USA
| | - Abbey Martin
- Oregon State University Center for Health Innovation, Oregon State University, Corvallis, OR, USA
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Englander H, Thakrar AP, Bagley SM, Rolley T, Dong K, Hyshka E. Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl: A Review. JAMA Intern Med 2024; 184:691-701. [PMID: 38683591 DOI: 10.1001/jamainternmed.2023.7282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Importance The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. Observations Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl's high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl's unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians' understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. Conclusions and Relevance The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in General Internal Medicine and the Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland
| | - Ashish P Thakrar
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarah M Bagley
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024. [PMID: 38646735 DOI: 10.1111/dar.13832] [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: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [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: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
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Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
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Mathias H, Jackson LA, Buxton JA, Dubé A, Kiepek N, Martin F, Martin P. What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada. Subst Abuse Treat Prev Policy 2024; 19:20. [PMID: 38520017 PMCID: PMC10960477 DOI: 10.1186/s13011-024-00602-0] [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: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. METHODS One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. RESULTS Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. CONCLUSIONS Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 87 AvenueEdmonton, T6G 1C9, Edmonton, Alberta, Canada.
| | - Lois A Jackson
- School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, B3H 4R2, Halifax, NS, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, V6T 1Z8, Vancouver, BC, Canada
| | - Anik Dubé
- Faculty of Health Sciences and Community Services, School of Nursing, Université de Moncton, 18, avenue Antonine-Maillet, E1A 3E9, Moncton, New Brunswick, Canada
| | - Niki Kiepek
- School of Occupational Therapy, Dalhousie University, Forrest Building, Room 215, 5869 University Avenue, B3H 4R2, Halifax, NS, Canada
| | - Fiona Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Marion McCain Arts and Social Sciences Building, Room 1128, 6135 University Avenue, B3H 4R2, Halifax, NS, Canada
| | - Paula Martin
- Direction 180, 2151 Gottingen Street, B3K 3B5, Halifax, NS, Canada
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Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024. [PMID: 38456488 DOI: 10.1111/1475-6773.14299] [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: 03/09/2024] Open
Abstract
OBJECTIVE To examine rural-urban disparities in substance use disorder treatment access and continuation. DATA SOURCES AND STUDY SETTING We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. STUDY DESIGN This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. DATA COLLECTION We included individuals 18-64 years old with continuous employer-sponsored insurance. PRINCIPAL FINDINGS Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. CONCLUSIONS These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.
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Affiliation(s)
- Eli Raver
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Sheldon M Retchin
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yiting Li
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Andrew D Carlo
- Meadows Mental Health Policy Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wendy Y Xu
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Poulsen MN, Roe SA, Asdell PB, Rahm AK, Berrettini W. Clinical stakeholders' perceptions of patient engagement in outpatient medication treatment for opioid use disorder: A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209250. [PMID: 38072381 PMCID: PMC10947908 DOI: 10.1016/j.josat.2023.209250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 11/30/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) reduce risk of opioid overdose and promote recovery from opioid use disorder, but poor retention in MOUD limits these positive effects. This study explored patient engagement in MOUD from the perspective of clinical stakeholders within an outpatient addiction medicine program to identify program factors influencing patient engagement with treatment. METHODS We conducted a qualitative case study of a multi-clinic outpatient addiction medicine program embedded within an integrated health system that serves a geographically diverse area of Pennsylvania. Collectively, the program's clinics provide MOUD (primarily buprenorphine) to ~2000 patients annually. From January to March 2021, we conducted semi-structured telephone/video interviews with three stakeholder groups involved in delivering MOUD: administrators (n = 4), providers (n = 7), and addiction care coordinators (n = 5). Data analysis utilized the framework method. RESULTS We identified five themes related to patient engagement. First, participants described health system integration as enhancing quality and offering opportunities for addressing patients' comprehensive health care needs. However, lack of knowledge about addiction and stigma among health system providers was felt to limit patient benefits from this integration, including access to MOUD. Second, participants viewed patient engagement as central to the program's policies, practices, and clinical environment. Adoption of a harm reduction approach and maintenance of a non-stigmatizing clinic environment were described as essential facilitators of engagement. Third, while clinics followed uniform operations, physician leads expressed differing philosophical approaches to treatment, which participants associated with variations in clinical practice and patient engagement. Fourth, participants identified key services that bolstered engagement in MOUD, including psychosocial services, psychiatric care, and telemedicine. Finally, staff well-being emerged as a key consideration for patient engagement. CONCLUSIONS Understanding perceptions of those who administer and deliver care is critical for identifying barriers and facilitators to patient engagement in MOUD. Findings suggest potential opportunities for addiction treatment programs to improve patient engagement and ultimately MOUD retention, including integration with other healthcare services to meet comprehensive healthcare needs; adoption of a harm reduction approach; creation of non-stigmatizing clinical environments; investment in psychosocial services, psychiatric care, and telemedicine; and prioritization of staff wellness.
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Affiliation(s)
- Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA.
| | - Sophie A Roe
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA.
| | - Patrick B Asdell
- Department of Family Medicine, Summa Health, Barberton, OH 44203, USA.
| | | | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Böttcher L, Chou T, D’Orsogna MR. Forecasting drug-overdose mortality by age in the United States at the national and county levels. PNAS NEXUS 2024; 3:pgae050. [PMID: 38725534 PMCID: PMC11079616 DOI: 10.1093/pnasnexus/pgae050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 05/12/2024]
Abstract
The drug-overdose crisis in the United States continues to intensify. Fatalities have increased 5-fold since 1999 reaching a record high of 108,000 deaths in 2021. The epidemic has unfolded through distinct waves of different drug types, uniquely impacting various age, gender, race, and ethnic groups in specific geographical areas. One major challenge in designing interventions and efficiently delivering treatment is forecasting age-specific overdose patterns at the local level. To address this need, we develop a forecasting method that assimilates observational data obtained from the CDC WONDER database with an age-structured model of addiction and overdose mortality. We apply our method nationwide and to three select areas: Los Angeles County, Cook County, and the five boroughs of New York City, providing forecasts of drug-overdose mortality and estimates of relevant epidemiological quantities, such as mortality and age-specific addiction rates.
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Affiliation(s)
- Lucas Böttcher
- Department of Computational Science and Philosophy, Frankfurt School of Finance and Management, 60322 Frankfurt am Main, Germany
| | - Tom Chou
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
| | - Maria R D’Orsogna
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1766, USA
- Department of Mathematics, California State University at Northridge, Los Angeles, CA 91330-8313, USA
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Santos J, Acevedo-Morales A, Jones L, Bautista T, Camplain C, Keene CN, Baldwin J. Client perspectives on primary care integration in a rural-serving behavioral health center. JOURNAL OF INTEGRATED CARE 2024; 32:31-44. [PMID: 38516678 PMCID: PMC10954248 DOI: 10.1108/jica-08-2023-0061] [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] [Indexed: 03/23/2024]
Abstract
Purpose Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona. Design/methodology/approach Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview. Findings The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes. Originality/value This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Lillian Jones
- Department of Clinical Psychology, Northern Arizona University, Flagstaff, AZ
| | | | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, PA
| | | | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
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10
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Liu P, Korthuis PT, Buchheit BM. Novel Therapeutic and Program-Based Approaches to Opioid Use Disorders. Annu Rev Med 2024; 75:83-97. [PMID: 37827194 DOI: 10.1146/annurev-med-050522-033924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Opioid use disorder continues to drive overdose deaths in many countries, including the United States. Illicit fentanyl and its analogues have emerged as key contributors to the complications and mortality associated with opioid use disorder. Medications for opioid use disorder treatment, such as methadone and buprenorphine, are safe and substantially reduce opioid use, infectious complications, and mortality risk, but remain underutilized. Polysubstance use and emerging substances such as xylazine and designer benzodiazepines create additional treatment challenges. Recent clinical and policy innovations in treatment delivery, including telemedicine, bridge clinics, and expanded models for accessing methadone have the potential to increase access to life-saving care for people living with opioid use disorder.
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Affiliation(s)
- Patricia Liu
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
| | - P Todd Korthuis
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Bradley M Buchheit
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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11
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Hser YI, Zhu Y, Baldwin LM, Mooney LG, Saxon AJ. Medication treatment for opioid use disorder among rural primary care patients. J Rural Health 2024; 40:195-199. [PMID: 37495899 PMCID: PMC10811271 DOI: 10.1111/jrh.12785] [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: 04/20/2023] [Revised: 06/18/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To investigate the prevalence of opioid use disorder (OUD) and medication treatment for OUD (MOUD) receipt in rural primary care settings and identify characteristics associated with MOUD among patients with OUD. METHODS Secondary analyses based on electronic health records of all adult patients who visited 1 of the 6 rural primary care clinic sites from October 2019 to January 2021. Mixed effects logistic regression was conducted to assess MOUD receipt (Y/N) in relation to patient characteristics (eg, demographics, other substance use disorders [SUDs], mental health disorders, and chronic pain) and the number of MOUD prescribers per clinic. FINDINGS The prevalence of OUD varied from 0.7% to 8.2% (Mean [SD] = 3.3% [95% CI: 0.4, 6.1]) among 36,762 primary care patients across 6 clinic sites. Among 1,164 patients with OUD, on average 50.1% received MOUD (95% CI: 28.0, 72.3). Patients in clinics with more than 3 MOUD prescribers had more than 3 times the odds of receiving MOUD (OR = 3.42; 95% CI, 1.22-9.62) as those in clinics with fewer than 3 prescribers. MOUD was positively associated with younger age (18-30 [OR = 6.97; 95% CI, 3.37-14.42], 31-64 [OR = 5.03; 95% CI, 2.64-9.57], relative to those 65 and older), having other co-occurring SUDs (OR = 3.77; 95% CI, 2.57-5.52), being male (OR = 1.50; 95% CI, 1.12-2.01), and negatively associated with having chronic pain disorders (OR = 0.69; 95% CI, 0.50-0.94). CONCLUSIONS The prevalence of OUD and MOUD are high but vary considerably across rural primary care clinics; primary care MOUD prescribers play a key role on MOUD access in rural settings.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Larissa G. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Franz B, Dhanani LY, Hall OT, Brook DL, Simon JE, Miller WC. Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US. Harm Reduct J 2023; 20:180. [PMID: 38129903 PMCID: PMC10740221 DOI: 10.1186/s12954-023-00918-3] [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: 06/15/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). METHODS We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one's training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. RESULTS Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. CONCLUSION Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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13
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Brown AR, Walters JE, Harmer B, Cates L, Jones AE. Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209153. [PMID: 37673286 DOI: 10.1016/j.josat.2023.209153] [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: 11/30/2022] [Revised: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION The United States has experienced substantial increases in opioid use for more than two decades. This growth has impacted rural areas where overdoses have risen drastically during this time period and more often involve prescription opioids than in urban areas. Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings due to lack of access, inadequate prescribing, and stigma. METHODS The study collected data using a cross-sectional online survey of nonprescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the United States. The study used multiple recruitment methods to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics including rurality of practice location, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. The study compared treatment preferences for OUD and attitudes toward MOUDs based on rurality of practice location. We tested a mediation model to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation. RESULTS Most of the 636 NPCs surveyed favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment. Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as effective or acceptable compared to those in urban settings. Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly and indirectly influenced attitudes toward MOUDs through an effect on treatment orientation. CONCLUSIONS NPCs play important roles in the implementation of MOUDs, and while efforts to increase their knowledge of and exposure to MOUDs have contributed broadly to more favorable attitudes toward MOUDs among NPCs, this study's findings indicate that additional efforts are still needed, particularly among NPCs who work in rural settings. Findings also indicate that, among rural clinicians, increasing knowledge of and exposure to harm reduction principles may be a necessary prerequisite to engaging them in the implementation of specific harm reduction strategies such as MOUDs.
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Affiliation(s)
- Aaron R Brown
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA.
| | - Jayme E Walters
- Utah State University, Department of Social Work, 0730 Old Main Hill, Logan, UT 84322-0730, USA
| | - Beth Harmer
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Lara Cates
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Aubrey E Jones
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA
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15
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Golan OK, Sheng F, Dick AW, Sorbero M, Whitaker DJ, Andraka-Christou B, Pigott T, Gordon AJ, Stein BD. Differences in medicaid expansion effects on buprenorphine treatment utilization by county rurality and income: A pharmacy data claims analysis from 2009-2018. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100193. [PMID: 37876376 PMCID: PMC10590758 DOI: 10.1016/j.dadr.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Background Although use of buprenorphine for treating opioid use disorder increased over the past decade, buprenorphine utilization remains limited in lower-income and rural areas. We examine how the Affordable Care Act Medicaid expansion influenced buprenorphine initiation rates by county income and evaluate how associations differ by county rural-urban status. Methods This study used nationwide 2009-2018 IQVIA retail pharmacy data and a comparative interrupted time series framework-a hybrid framework combining regression discontinuity and difference-in-difference approaches. We used piecewise linear estimation to quantify changes in buprenorphine initiation rates before and after Medicaid expansion. Results The sample included observations from 376,704 county-months. We identified 5,227,340 new buprenorphine treatment episodes, with an average of 9.2 new buprenorphine episodes per month per 100,000 county residents. Among urban counties, those with the lowest median incomes experienced significantly larger increases in buprenorphine initiation rates associated with Medicaid expansion than counties with higher median incomes (5-year rates difference est=3525.3, se=1695.3, p = 0.04). However, among rural counties, there was no significant association between buprenorphine initiation rates and county median income after Medicaid expansion (5-year rates difference est=979.0, se=915.8, p = 0.29). Conclusions Medicaid expansion was associated with a reduction in income-related buprenorphine disparities in urban counties, but not in rural counties. To achieve more equitable buprenorphine access, future policies should target low-income rural areas.
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Affiliation(s)
- Olivia K. Golan
- NORC at the University of Chicago, Chicago, IL, United States
- School of Public Health, Georgia State University, Atlanta, Georgia
| | | | | | | | | | - Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, United States
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, United States
| | - Therese Pigott
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Staton M, Tillson M, Levi MM, Dickson M, Webster M, Leukefeld C. Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review. Subst Abuse Rehabil 2023; 14:131-145. [PMID: 38026785 PMCID: PMC10655602 DOI: 10.2147/sar.s409944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Megan Dickson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Matt Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
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17
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Kesich Z, Ibragimov U, Komro K, Lane K, Livingston M, Young A, Cooper HLF. "I'm not going to lay back and watch somebody die": a qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment and overdose education/naloxone distribution intervention. Harm Reduct J 2023; 20:166. [PMID: 37946233 PMCID: PMC10636969 DOI: 10.1186/s12954-023-00900-z] [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: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Overdoses have surged in rural areas in the U.S. and globally for years, but harm reduction interventions have lagged. Overdose education and naloxone distribution (OEND) programs reduce overdose mortality, but little is known about people who use drugs' (PWUD) experience with these interventions in rural areas. Here, we analyze qualitative data with rural PWUD to learn about participants' experiences with an OEND intervention, and about how participants' perceptions of their rural risk environments influenced the interventions' effects. METHODS Twenty-nine one-on-one, semi-structured qualitative interviews were conducted with rural PWUD engaged in the CARE2HOPE OEND intervention in Appalachian Kentucky. Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim. Thematic analysis was conducted, guided by the Rural Risk Environment Framework. RESULTS Participants' naloxone experiences were shaped by all domains of their rural risk environments. The OEND intervention transformed participants' roles locally, so they became an essential component of the local rural healthcare environment. The intervention provided access to naloxone and information, thereby increasing PWUDs' confidence in naloxone administration. Through the intervention, over half of participants gained knowledge on naloxone (access points, administration technique) and on the criminal-legal environment as it pertained to naloxone. Most participants opted to accept and carry naloxone, citing factors related to the social environment (responsibility to their community) and physical/healthcare environments (overdose prevalence, suboptimal emergency response systems). Over half of participants described recent experiences administering intervention-provided naloxone. These experiences were shaped by features of the local rural social environment (anticipated negative reaction from recipients, prior naloxone conversations). CONCLUSIONS By providing naloxone paired with non-stigmatizing health and policy information, the OEND intervention offered support that allowed participants to become a part of the healthcare environment. Findings highlight need for more OEND interventions; outreach to rural PWUD on local policy that impacts them; tailored strategies to help rural PWUD engage in productive dialogue with peers about naloxone and navigate interpersonal conflict associated with overdose reversal; and opportunities for rural PWUD to formally participate in emergency response systems as peer overdose responders. Trial registration The ClinicalTrials.gov ID for the CARE2HOPE intervention is NCT04134767. The registration date was October 19th, 2019.
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Affiliation(s)
- Zora Kesich
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Kelli Komro
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Kenneth Lane
- College of Public Health, University of Kentucky, Lexington, KY, 40536, USA
| | - Melvin Livingston
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - April Young
- College of Public Health, University of Kentucky, Lexington, KY, 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Tatara E, Lin Q, Ozik J, Kolak M, Collier N, Halpern D, Anselin L, Dahari H, Boodram B, Schneider J. Spatial inequities in access to medications for treatment of opioid use disorder highlight scarcity of methadone providers under counterfactual scenarios. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289915. [PMID: 37292847 PMCID: PMC10246029 DOI: 10.1101/2023.05.12.23289915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Access to treatment and medication for opioid use disorder (MOUD) is essential in reducing opioid use and associated behavioral risks, such as syringe sharing among persons who inject drugs (PWID). Syringe sharing among PWID carries high risk of transmission of serious infections such as hepatitis C and HIV. MOUD resources, such as methadone provider clinics, however, are often unavailable to PWID due to barriers like long travel distance to the nearest methadone provider and the required frequency of clinic visits. The goal of this study is to examine the uncertainty in the effects of travel distance in initiating and continuing methadone treatment and how these interact with different spatial distributions of methadone providers to impact co-injection (syringe sharing) risks. A baseline scenario of spatial access was established using the existing locations of methadone providers in a geographical area of metropolitan Chicago, Illinois, USA. Next, different counterfactual scenarios redistributed the locations of methadone providers in this geographic area according to the densities of both the general adult population and according to the PWID population per zip code. We define different reasonable methadone access assumptions as the combinations of short, medium, and long travel distance preferences combined with three urban/suburban travel distance preference. Our modeling results show that when there is a low travel distance preference for accessing methadone providers, distributing providers near areas that have the greatest need (defined by density of PWID) is best at reducing syringe sharing behaviors. However, this strategy also decreases access across suburban locales, posing even greater difficulty in regions with fewer transit options and providers. As such, without an adequate number of providers to give equitable coverage across the region, spatial distribution cannot be optimized to provide equitable access to all PWID. Our study has important implications for increasing interest in methadone as a resurgent treatment for MOUD in the United States and for guiding policy toward improving access to MOUD among PWID.
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Affiliation(s)
- Eric Tatara
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Qinyun Lin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Nicholson Collier
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, USA
| | - Dylan Halpern
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - John Schneider
- University of Chicago Medicine, Department of Infectious Disease, Chicago, IL, USA
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Bridges NC, Taber R, Foulds AL, Bear TM, Cloutier RM, McDonough BL, Gordon AJ, Cochran GT, Donohue JM, Adair D, DiDomenico E, Pringle JL, Gellad WF, Kelley D, Cole ES. Medications for opioid use disorder in rural primary care practices: Patient and provider experiences. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209133. [PMID: 37543217 DOI: 10.1016/j.josat.2023.209133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION The opioid epidemic has exacted a significant toll in rural areas, yet adoption of medications for opioid use disorder (MOUD) lags. The Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project facilitated adoption of MOUD in rural primary care clinics. The purpose of this study was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide MOUD in rural Pennsylvania. METHODS In total, the study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. Qualitative analysis incorporated both deductive and inductive approaches. The study team coded interviews and performed thematic analysis. Using a modified social-ecological framework, themes from the qualitative interviews are organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. RESULTS Patients and providers agreed on many barriers (e.g., lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health, as they highlighted their lives outside of the therapeutic encounter in the clinic. Providers focused on their professional roles, responsibilities, and operations within the primary care setting. CONCLUSIONS Providers may want to discuss barriers to treatment related to social determinants of health with patients, and pursue partnerships with organizations that seek to address those barriers. The findings from these interviews point to potential opportunities to enhance patient experience, increase access to and optimize processes for MOUD in rural areas, and reduce stigma against people with opioid use disorder (OUD) in the wider community.
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Affiliation(s)
- Nora C Bridges
- Department of Family Medicine, University of Pittsburgh; Schenley Place, Suite 520, 4420 Bayard Street, Pittsburgh, PA 15260, USA.
| | - Rachel Taber
- Department of Family Medicine, University of Pittsburgh; Schenley Place, Suite 520, 4420 Bayard Street, Pittsburgh, PA 15260, USA
| | - Abigail L Foulds
- Division of General Internal Medicine, University of Pittsburgh, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Todd M Bear
- Department of Family Medicine, University of Pittsburgh; Schenley Place, Suite 520, 4420 Bayard Street, Pittsburgh, PA 15260, USA
| | - Renee M Cloutier
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Medicine, 3501 Terrace St., Pittsburgh, PA 15261, USA
| | - Brianna L McDonough
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Medicine, 3501 Terrace St., Pittsburgh, PA 15261, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA
| | - Gerald T Cochran
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA
| | - Julie M Donohue
- University of Pittsburgh School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Dale Adair
- Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg, PA 17105, USA
| | - Ellen DiDomenico
- Pennsylvania Department of Human Services, 625 Forster St., Harrisburg, PA, 17120, USA
| | - Janice L Pringle
- Program Evaluation and Research Unit (PERU), University of Pittsburgh School of Medicine, 3501 Terrace St., Pittsburgh, PA 15261, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, 3550 Terrace St., Pittsburgh, PA, 15213, USA
| | - David Kelley
- Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg, PA 17105, USA
| | - Evan S Cole
- University of Pittsburgh School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
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Hong C, Hoskin J, Berteau LK, Schamel JT, Wu ESC, King AR, Randall LA, Holloway IW, Frew PM. Violence Victimization, Homelessness, and Severe Mental Illness Among People Who Use Opioids in Three U.S. Cities. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11165-11185. [PMID: 37462229 PMCID: PMC10466992 DOI: 10.1177/08862605231179720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
This study examined the associations between violence victimization, homelessness, and severe mental illness (SMI) among people who use opioids (PWUOs) in three U.S. cities. We analyzed data from a cross-sectional survey conducted from May 2019 to February 2020 across three study sites: Los Angeles, CA; Las Vegas, NV; and Atlanta, GA. We used multivariable regressions to examine how multiple victimizations and housing situation are associated with SMI. Based on K-6 scale, nearly half (44.2%) were screened positive for SMI. Meanwhile, 69.7% of the participants reported experiencing some kind of violence in their lifetime, and more than half (51.9%) reported experiencing recent violence (in the past 6 months). The most common form of lifetime violence was emotional (59.5%), followed by physical and intimate partner violence (IPV) (56.1 and 34.9%, respectively), and 34.9% of all participants reported experiencing multiple forms of victimization in the past 6 months. Participants who reported homelessness were more likely to report having experienced recent violence victimization (p < .001). In multivariable models, experiencing recent victimization was significantly associated with SMI (adjusted odds ratio (AOR) = 1.85, 95% confidence interval [CI] [1.46, 2.38]), as was homelessness (AOR = 1.57, 95% CI [1.15, 2.14]), after adjusting for study covariates. Among those with moderate and SMI (n = 927), only 22% were currently receiving mental health services, and those who reported having experienced any forms of violence in the past 6 months were more likely to utilize mental health services than those who had not experienced any recent violence victimization (25 vs. 17.9%, p < .05). To improve mental health and wellness among this high priority population, mental health facilities and syringe service programs may consider screening for experiences of violence and using trauma-informed mental health approaches. Harm reduction interventions must be responsive to the diverse individual and structural-level needs of PWUOs, especially those experiencing homelessness and housing insecurity. Holistic strategies and services are needed to meet the social and structural needs of this population.
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Affiliation(s)
- Chenglin Hong
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jordan Hoskin
- State of California Department of Rehabilitation, Los Angeles, USA
| | | | - Jay T Schamel
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | - Adrian R King
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
| | - Laura A Randall
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
| | - Ian W Holloway
- UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Paula M Frew
- University of Nevada - School of Public Health/Population Health & Health Equity Initiative, Las Vegas, NV, USA
- Merck & Co., Inc., Kenilworth, NJ, USA
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Wu LT, Mannelli P, John WS, Anderson A, Schwartz RP. Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff. Subst Abuse Treat Prev Policy 2023; 18:55. [PMID: 37697326 PMCID: PMC10496162 DOI: 10.1186/s13011-023-00563-w] [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: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The US federal regulations allow pharmacy administration and dispensing of methadone for opioid use disorder (PADMOUD) to increase the capability of opioid treatment programs (OTPs) in providing methadone maintenance treatment (MMT) for opioid use disorder (OUD) as part of a medication unit. However, there is a lack of research data from both pharmacy and OTP staff to inform the implementation of PADMOUD. METHODS Staff of a pharmacy (n = 8) and an OTP (n = 9) that participated in the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were recruited to participate in this qualitative interview study to explore implementation-related factors for PADMOUD. Each interview was recorded and transcribed verbatim. NVivo was used to help identify themes of qualitative interview data. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide the coding and interpretation of data. RESULTS Six pharmacy staff and eight OTP staff (n = 14) completed the interview. Results based on PARIHS domains were summarized, including evidence, context, and facilitation domains. Participants perceived benefits of PADMOUD for patients, pharmacies, OTPs, and payers. PADMOUD was considered to increase access for stable patients, provide additional patient service opportunities and revenues for pharmacies/pharmacists, enhance the capability of OTPs to treat more new patients, and reduce patients' cost when receiving medication at a pharmacy relative to an OTP. Both pharmacy and OTP staff were perceived to be supportive of the implementation of PADMOUD. Pharmacy staff/pharmacists were perceived to need proper training on addiction and methadone as well as a protocol of PADMOUD to conduct PADMOUD. Facilitators include having thought leaders to guide the operation, a certification program to ensure proper training of pharmacy staff/pharmacist, having updated pharmacy service software or technology to streamline the workflow of delivering PADMOUD and inventory management, and reimbursement for pharmacists. CONCLUSION This study presents the first findings on perspectives of PADMOUD from both staff of a community pharmacy and an OTP in the US. Finding on barriers and facilitators are useful data to guide the development of strategies to implement PADMOUD to help address the US opioid crisis.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Bansal P, Saini B, Bansal PD, Bansal A, Dhillon JS, Kaur V, Singh G, Saini S. Presenting Pattern and Psychiatric Comorbidities in Rural versus Urban Substance Dependent Patients: A Hospital-Based Cross-Sectional Study. Indian J Community Med 2023; 48:666-675. [PMID: 37970168 PMCID: PMC10637592 DOI: 10.4103/ijcm.ijcm_618_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/27/2023] [Indexed: 11/17/2023] Open
Abstract
Background "Locality" is a significant factor in substance initiation, maintenance, and relapse. The pattern of substance dependence among rural and urban populations varies across studies and is scarcely studied, warranting further research. To compare presenting patterns (sociodemographic and drug-related variables), reasons for substance use, and psychiatric comorbidities (prevalence, type, and severity) between rural and urban substance-dependent groups. Materials and Methods This study was a cross-sectional analytical study in a government de-addiction center, including rural and urban patient groups aged 18-65. International Classification of Diseases, Tenth Revision (ICD-10) criteria, and severity of dependence scale were used for diagnosing substance dependence. After detoxification, psychiatric comorbidity was assessed using brief psychiatric rating scale, Young's mania rating scale, and patient health questionnaire - somatic, anxiety, and depression symptoms scale. Post-analysis was performed to assess socioeconomic variables and access to de-addiction services. Results The final sample was 500 (250 rural and 250 urban). The post-analysis sample size was 386 (211 rural and 175 urban). The mean age was 38.2 ± 12.4 years, mostly males (n = 495, 99%). Substance frequency was opioids (92%)> benzodiazepines (24.8%) > alcohol (22%) > cannabis (1.6%) for rural and opioids (91.2%) > alcohol (29.6%) > benzodiazepines (14.8%) > cannabis (2%) for urban patients. More than half of patients had comorbid nicotine dependence. Rural patients were more benzodiazepine dependent (P = 0.007), and urban were more opioid + alcohol dependent (P = 0.001). Rural patients had higher age (P = 0.012), less education (P < 0.001), positive family history of substance (P = 0.028), daily wagers, and farmers (P < 0.001) than urban patients who were younger, students (P = 0.002), businessmen and government employed (P < 0.001). Urban patients expended more on drugs (P < 0.001), had higher treatment attempts (P = 0.008), and had better availability and accessibility of de-addiction services (P < 0.001). More rural users initiated substances to "enhance performance," whereas urban ones initiated for "stress relief/novelty" (P < 0.001). For treatment seeking, "External pressure" was a more common reason in urban patients (P < 0.001), who also had more psychiatric comorbidities (P = 0.026). Conclusion Significant pattern differences exist between rural and urban substance dependents, warranting emphasis on locality-specific factors for appropriate intervention.
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Affiliation(s)
- Priyanka Bansal
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Bhavneesh Saini
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Pir D. Bansal
- DDAC, District Hospital, Bathinda, Punjab, India
- Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | | | | | - Vanipreet Kaur
- Department of Psychiatry, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Sumit Saini
- Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, India
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Bailey A, Senthilkumar R, Evans EA. Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail. J Addict Med 2023; 17:568-573. [PMID: 37788611 PMCID: PMC10593985 DOI: 10.1097/adm.0000000000001180] [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] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Little is known about the correlates of use of medications to treat opioid use disorder (MOUD, ie, buprenorphine, methadone, naltrexone) offered in jails. We evaluated the implementation and outcomes of a MOUD program offered by 2 of the first jails nationwide to provide access to such care. METHODS We examined use of MOUD among adults with opioid use disorder (n = 347) incarcerated by 2 rural jails in Massachusetts (2018-2021). We examined MOUD transitions from intake to during incarceration. Using logistic regression, we examined factors associated with in-jail use of MOUD. RESULTS At jail entry, 48.7% of individuals with opioid use disorder were being treated with MOUD. During incarceration, 65.1% received MOUD, attributable to a 9.2% increase in use of methadone (from 15.9% to 25.1%) and a 10.1% increase in use of buprenorphine (from 28.5% to 38.6%). During incarceration, 32.3% of individuals were continued on the same MOUD from the community, 25.4% were started, 8.9% stopped, and 7.5% switched type. A total of 25.9% entered jail not on any MOUD and were not started on it. Use of MOUD during incarceration was positively associated with having received MOUD in the community (odds ratio, 12.2; 95% confidence interval, 5.8-25.5) and incarceration at site 1 compared with site 2 (OR, 24.6; 95% CI, 10.9-54.4). CONCLUSIONS Expanded access to MOUD in jails can engage an at-risk population with treatment. Understanding factors related to this population's use of MOUD may aid efforts to optimize care during incarceration and after community re-entry.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Rithika Senthilkumar
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
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Conway A, Krawczyk N, McGaffey F, Doyle S, Baaklini V, Marshall AD, Treloar C, Davis CS, Colledge-Frisby S, Grebely J, Cerdá M. Typology of laws restricting access to methadone treatment in the United States: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104141. [PMID: 37540917 DOI: 10.1016/j.drugpo.2023.104141] [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: 02/10/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership. METHODS A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated. RESULTS States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22). CONCLUSIONS States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.
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Affiliation(s)
- Anna Conway
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Sheri Doyle
- The Pew Charitable Trusts, Philadelphia, United States
| | | | - Alison D Marshall
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Corey S Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Los Angeles, United States
| | - Samantha Colledge-Frisby
- National Drug Research Institute, Curtin University, Melbourne, Australia; National Drug and Alcohol Research Centre, Burnet Institute, Melbourne, Australia
| | | | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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25
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Magee T, Peters C, Jacobsen SM, Nees D, Dunford B, Ford AI, Vassar M. Inequities in the treatment of opioid use disorder: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209082. [PMID: 37271346 DOI: 10.1016/j.josat.2023.209082] [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: 08/11/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients. METHODS We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample. RESULTS A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings. CONCLUSIONS Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.
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Affiliation(s)
- Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Caleb Peters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Samuel M Jacobsen
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bryan Dunford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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Hser YI, Mooney LJ, Baldwin LM, Ober A, Marsch LA, Sherman S, Matthews A, Clingan S, Fei Z, Zhu Y, Dopp A, Curtis ME, Osterhage KP, Hichborn EG, Lin C, Black M, Calhoun S, Holtzer CC, Nesin N, Bouchard D, Ledgerwood M, Gehring MA, Liu Y, Ha NA, Murphy SM, Hanano M, Saxon AJ. Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study. J Rural Health 2023; 39:780-788. [PMID: 37074350 PMCID: PMC10718290 DOI: 10.1111/jrh.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.
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Affiliation(s)
- 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
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Seth Sherman
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Abigail Matthews
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Sarah Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Zhe Fei
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, California, USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Katie P. Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Emily G. Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | | | - Noah Nesin
- Penobscot Community Health Care, Bangor, Maine, USA
| | | | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | | | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Neul Ah Ha
- Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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27
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Wu LT, John WS, Mannelli P, Morse ED, Anderson A, Schwartz RP. Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S. Addict Sci Clin Pract 2023; 18:45. [PMID: 37533071 PMCID: PMC10398989 DOI: 10.1186/s13722-023-00399-6] [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: 11/07/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients' perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis. METHODS Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes. RESULTS Seventeen participants completed the interview. Patients' perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists' training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD. CONCLUSION This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients' views and needs.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | | | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Albright DL, Suntai Z, McDaniel JT, Johnson K, Henson H, Robertson E, McIntosh S. Opioid Use Disorder Among the Economically Disadvantaged in the Rural South. J Addict Med 2023; 17:418-423. [PMID: 37579099 DOI: 10.1097/adm.0000000000001142] [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: 02/04/2023]
Abstract
OBJECTIVE This study aimed to identify county-level hotspots and associated risk factors for opioid use disorder (OUD) in the state of Alabama. METHODS Using 2015 to 2019 Alabama Medicaid administrative claims data, Medicaid recipients with OUD were identified. We performed local indicators of spatial association analysis to identify hotspots of OUD rates. Using logistic regression, we examined county-level social determinants of health associated with county OUD hotspots. RESULTS There was a +14.13% percentage change from 2015 to 2019. The county level local indicators of spatial association analysis found that 5 counties in the northwestern part of Alabama remained "hotspots" throughout the entire study period. Results of the logistic regression model showed that location within the Appalachian region was an independent predictor of high OUD rates ( b = 2.58; adjusted odds ratio, 13.27, P = 0.04). CONCLUSIONS The high rates of OUD may reflect the economic distress and lack of access to resources germane to the Appalachian region in Alabama.
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Affiliation(s)
- David L Albright
- From the School of Social Work, University of Alabama, Tuscaloosa, AL (DLA, KJ, ER, SM); Diana R. Garland School of Social Work, Baylor University, Waco, TX (ZS); School of Human Sciences, Southern Illinois University, Carbondale, IL (JTM); and STEM Education Research Center, Southern Illinois University, Carbondale, IL (HH)
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McFadden LM. Changes in buprenorphine visits in frontier and remote locations: Effects of the SARS-CoV-2 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100155. [PMID: 37065774 PMCID: PMC10052936 DOI: 10.1016/j.dadr.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
Background The pandemic has changed many aspects of healthcare, including the treatment of people with opioid use disorder with buprenorphine. Prior to the pandemic, rural health disparities existed in the accessibility of this treatment. Rural and frontier areas of the United States, particularly the Great Plains, had few or no providers of this evidence-based treatment. This study aimed to investigate how access to buprenorphine changed in the Great Plains during the pandemic. Methods This retrospective observational study compared the number of weekly patient appointments resulting in a buprenorphine prescription for 55 weeks before the start of the SARS-CoV-2 pandemic and 55 weeks after. Electronic health records of the largest rural health provider in the Great Plains were queried. Patients were categorized as coming from a frontier location or a non-frontier location based on the home address provided at the visit. The USDA defines frontier as communities that are small and distant from urban centers. Time series analysis was utilized to understand changes in weekly visits during this period. Results A significant increase in weekly buprenorphine visits occurred after the pandemic's start. Further, females and people from frontier locations had significantly higher numbers of buprenorphine visits. Conclusions In an area of the country with low pre-existing access to buprenorphine treatment for opioid use disorder, increases in buprenorphine visits were found after the pandemic began. This was particularly true of females who reside in frontier areas. Pandemic-related changes may have reduced barriers to this critical treatment, especially among rural populations.
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Affiliation(s)
- Lisa M. McFadden
- University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069, USA
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Chhatwal J, Mueller PP, Chen Q, Kulkarni N, Adee M, Zarkin G, LaRochelle MR, Knudsen AB, Barbosa C. Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States. JAMA Netw Open 2023; 6:e2314925. [PMID: 37294571 PMCID: PMC10257094 DOI: 10.1001/jamanetworkopen.2023.14925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/08/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs). Objective To estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo. Design, Setting, and Participants This decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic. Exposure Increasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years. Main Outcomes and Measures Projected reduction in number of OODs under different combinations and durations of sustainment of interventions. Results Compared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained. Conclusions and Relevance In this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.
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Affiliation(s)
- Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Peter P. Mueller
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park
| | - Neeti Kulkarni
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Madeline Adee
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Gary Zarkin
- RTI International, Research Triangle Park, North Carolina
| | - Marc R. LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Amy B. Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Shrestha S, Lindstrom M, Harris D, Rock P, Srinivasan S, Pustz J, Bayly R, Stopka TJ. Spatial access to buprenorphine-waivered prescribers in the HEALing communities study: Enhanced 2-step floating catchment area analyses in Massachusetts, Ohio, and Kentucky. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209077. [PMID: 37211155 DOI: 10.1016/j.josat.2023.209077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The opioid overdose epidemic continues to impact a large swath of the population in the US. Medications for opioid use disorders (MOUD) are an effective resource to combat the epidemic; however, there is limited research on MOUD treatment access that accounts for both supply of and demand for services. We aimed to examine access to buprenorphine prescribers in the HEALing Communities Study (HCS) Wave 2 communities in Massachusetts, Ohio, and Kentucky during 2021, and the association between buprenorphine access and opioid-related incidents, specifically fatal overdoses and opioid-related responses by emergency medical services (EMS). METHODS We calculated Enhanced 2-Step Floating Catchment Area (E2SFCA) accessibility indices for each state, as well as Wave 2 communities in each state, based on the location of providers (buprenorphine-waivered clinicians from the US Drug Enforcement Agency Active Registrants database), population-weighted centroids at the census block group level, and catchment areas defined by the state or community's average commute time. In advance of intervention initiation, we quantified the opioid-related risk environment of communities. We assessed gaps in services by using bivariate Local Moran's I analysis, incorporating accessibility indices and opioid-related incident data. RESULTS Massachusetts Wave 2 HCS communities had the highest rates of buprenorphine prescribers per 1000 patients (median: 165.8) compared to Kentucky (38.8) and Ohio (40.1). While urban centers in all three states had higher E2SFCA index scores compared to rural communities, we observed that suburban communities often had limited access. Through bivariate Local Moran's I analysis, we identified numerous locations with low buprenorphine access surrounded by high opioid-related incidents, particularly in communities that surrounded Boston, Massachusetts; Columbus, Ohio; and Louisville, Kentucky. CONCLUSION Rural communities demonstrated a great need for additional access to buprenorphine prescribers. However, policymakers should also direct attention toward suburban communities that have experienced significant increases in opioid-related incidents.
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Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Megan Lindstrom
- Department of Geography, Ohio State University, 154 North Oval Mall, Columbus, OH 43210, United States of America
| | - Daniel Harris
- Department of Pharmacy Practice and Science, College of Pharmacy, Lee T. Todd Building, University of Kentucky, Lexington, KY 40506, United States of America; Institute of Pharmaceutical Outcomes and Policy, College of Pharmacy, Lee T. Todd Building, University of Kentucky, Lexington, KY 40506, United States of America
| | - Peter Rock
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, KY 40506, United States of America
| | - Sumeeta Srinivasan
- Department of Urban and Environmental Policy and Planning, Tufts University Graduate School of Arts and Sciences, 97 Talbot Ave., Medford, MA, United States of America
| | - Jennifer Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Ric Bayly
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America; Clinical and Translational Sciences Institute, Tufts University School of Medicine, 35 Kneeland St., Boston, MA 02111, United States of America; Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, United States of America; Department Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Ave, Medford, MA, United States of America.
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Bremer W, Plaisance K, Walker D, Bonn M, Love JS, Perrone J, Sarker A. Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature. Front Public Health 2023; 11:1141093. [PMID: 37151596 PMCID: PMC10158842 DOI: 10.3389/fpubh.2023.1141093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers. Methods In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described. Results On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%). Conclusion The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.
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Affiliation(s)
- Whitney Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, School of Medicine, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Karma Plaisance
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Drew Walker
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Jennifer S. Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
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Implementation of Telemedicine Delivery of Medications for Opioid Use Disorder in Pennsylvania Treatment Programs During COVID-19. J Addict Med 2023; 17:e110-e118. [PMID: 36129690 PMCID: PMC10022523 DOI: 10.1097/adm.0000000000001079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Temporary policy changes during the coronavirus disease 2019 pandemic facilitated rapid expansion of medication for opioid use disorder via telemedicine (tele-MOUD). Evidence for tele-MOUD best practices and its impact on treatment engagement and retention remains limited. This quality improvement initiative compared tele-MOUD implementation among Pennsylvania medication for opioid use disorder (MOUD) programs, evaluated sociodemographic characteristics of patients using tele-MOUD, and described trends in tele-MOUD use and patient engagement and retention. METHODS Five health systems with MOUD programs completed questionnaires regarding their tele-MOUD models and provided aggregated sociodemographic data for MOUD patients with in-person and telemedicine visits in 2020. Three programs provided aggregated monthly appointment data (scheduled, completed, no-show, tele-MOUD visits) over the period in which tele-MOUD scaled up. RESULTS Differences in tele-MOUD protocols related to provision of tele-MOUD inductions, patient eligibility for tele-MOUD, and operationalization of remote drug testing. Across programs, 88% of prescribers conducted tele-MOUD appointments, and 50% of patients used tele-MOUD in 2020. We observed sociodemographic differences, with a greater proportion of female, White, and non-Hispanic patients using tele-MOUD. Across programs with appointment data, overall patient enrollment increased, and new patient enrollment remained relatively constant. Engagement trends suggested a temporary decline in no-show appointments that aligned with the escalation of tele-MOUD in one program. CONCLUSIONS Tele-MOUD protocol differences indicate a need for research to inform evidence-based guidance. Findings suggest that patients largely remained engaged and retained in MOUD as tele-MOUD was implemented but reveal inequities in tele-MOUD use, highlighting the need for efforts to overcome technology access barriers and avoid exacerbating disparities in MOUD access.
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Victor G, Hedden BJ, Lister J, Lee G, Huynh P, Ray B. Community overdose surveillance: Fentanyl involvement in overdose deaths in rural Michigan. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100150. [PMID: 37069960 PMCID: PMC10105480 DOI: 10.1016/j.dadr.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Purpose Examine fatal overdose toxicology trends to contribute toward understanding the outreach and treatment needs of people who use drugs in rural areas. Methods We describe toxicology results from overdose deaths that occurred between January 1, 2018, and December 31, 2020, in 11 rural counties in Michigan, a state with relatively high rates of overdose mortality. One-way ANOVA with Tukey's HSD posthoc tests were used to test statistically significant differences in the frequency of substances detected between years. Findings Decedents (N = 107) were male (72.9%), White (96.3%), non-military (96.3%), unemployed (71.0%), married (73.9%), and had a mean age of 47 years old. The number of observed overdose deaths increased considerably from 2019 to 2020, with an increase of 72.4%. Fentanyl was the most common substance detected and had a 94% increase during the three-year period to present in 70% of all the deaths in these counties in 2020. Among the deaths we examined where cocaine was detected, 69% also contained fentanyl, and in deaths where methamphetamine was detected, 77% also contained fentanyl. Conclusion Findings could inform rural health and outreach initiatives aimed at reducing overdose risks by providing education on the risks of stimulant and opioid couse but also the widespread saturation of illicit drugs that contain fentanyl. Lowthreshold harm reduction interventions are discussed amid limited prevention and treatment resources in rural communities.
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Cook RR, Foot C, Arah OA, Humphreys K, Rudolph KE, Luo SX, Tsui JI, Levander XA, Korthuis PT. Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addict Sci Clin Pract 2023; 18:11. [PMID: 36788634 PMCID: PMC9930351 DOI: 10.1186/s13722-023-00364-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent "real-world" populations who would benefit from treatment. METHODS We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. RESULTS Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30-49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49-0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48-1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51-1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35-1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08-0.69, p = 0.008). CONCLUSIONS Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.
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Affiliation(s)
- R R Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA.
| | - C Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - O A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Division of Physical Sciences, Department of Statistics, UCLA College, Los Angeles, CA, USA
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - K E Rudolph
- Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA
| | - S X Luo
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, USA
| | - J I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - X A Levander
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - P T Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
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Carl A, Pasman E, Broman MJ, Lister JJ, Agius E, Resko SM. Experiences of Healthcare and Substance Use Treatment Provider-based Stigma Among Patients Receiving Methadone. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100138. [PMID: 36994374 PMCID: PMC10040326 DOI: 10.1016/j.dadr.2023.100138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Background Medications for Opioid Use Disorder (MOUD) are efficacious, however only one-third of individuals with an opioid use disorder (OUD) enter into treatment. Low rates of MOUD utilization are partially due to stigma. This study examines provider-based stigma toward MOUD and identifies factors associated with experiencing stigma related to MOUD from substance use treatment and healthcare providers among people receiving methadone. Methods Clients receiving MOUD at an opioid treatment program (N = 247) were recruited to complete a cross-sectional computer-based survey assessing socio-demographics, substance use, depression and anxiety symptoms, self-stigma, and recovery supports/barriers. Logistic regression was used to examine factors associated with hearing negative comments about MOUD from substance use treatment and healthcare providers. Results 27.9% and 56.7% of respondents reported they sometimes/often hear negative comments about MOUD from substance use treatment and healthcare providers, respectively. Logistic regression results indicate that individuals who experience more negative consequences resulting from their OUD (OR=1.09, p=.019) had greater odds of hearing negative comments from substance use treatment providers. Age (OR=0.966, p=.017) and treatment stigma (OR=1.42, p=.030) were associated with greater odds of hearing negative comments from healthcare providers. Conclusions Stigma can be a deterrent to seeking substance use treatment, healthcare, and recovery support. Understanding factors associated with experiencing stigma from substance use treatment providers and healthcare providers is important as these individuals may act as advocates for those with OUD. This study highlights individual factors associated with hearing negative comments about methadone and other MOUD and point to areas for targeted education.
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Affiliation(s)
- Alexis Carl
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Emily Pasman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Michael J. Broman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Jamey J. Lister
- School of Social Work, Rutgers University – New Brunswick, 120 Albany Street, Tower One, New Brunswick, NJ 08901, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Stella M. Resko
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
- Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI 48202, USA
- Corresponding author.
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Bommersbach T, Justen M, Bunting AM, Funaro MC, Winstanley EL, Joudrey PJ. Multidimensional assessment of access to medications for opioid use disorder across urban and rural communities: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103931. [PMID: 36563489 DOI: 10.1016/j.drugpo.2022.103931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The majority of patients with opioid use disorder do not receive medications for opioid use disorder (MOUD), especially in rural areas. The patient-centered access to healthcare framework posits access as a multidimensional phenomenon impacted by five healthcare system and five patient ability dimensions. Interventions to improve local MOUD treatment outcomes require an understanding of how these dimensions differ across urban and rural communities. This scoping review sought to systematically appraise the literature on MOUD access across urban and rural communities (i.e., rurality) in the US using the patient-centered access framework. METHODS We performed a scoping review of 1) electronic databases, 2) grey literature, and 3) correspondence with content experts (March 2021). We included articles specifying the study sample by rurality and examining at least one dimension of access to MOUD. The analysis and qualitative synthesis of study results examined study characteristics and categorized key findings by access dimensions. RESULTS The search produced 3963 unique articles, of which 147 met inclusion criteria. Among included studies, 96% (142/147) examined healthcare system dimensions of access while less than 20% (25/147) examined any of the five dimensions of patient ability. Additionally, 49% (72/147) of studies compared access dimensions by rurality. Across studies, increasing rurality was associated with fewer available MOUD services, but little was known about geographic variation in other critical dimensions of access. CONCLUSIONS The vast majority of studies examined healthcare system dimensions of MOUD access and few studies made comparisons by rurality or prioritized the patient's perspective, limiting our understanding of how access differs by rurality in the US. As COVID-19 spurs novel changes in MOUD delivery, this inadequate multidimensional understanding of MOUD access may impede the tailoring of interventions to local needs. There is an urgent need for mixed-methods and community-engaged research prioritizing the patient's perspective of MOUD access by rurality. REGISTRATION Open Science Framework (https://osf.io/wk6b9/).
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Affiliation(s)
| | | | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA; Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Paul J Joudrey
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
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Healthcare Provider Reports on Social Determinants of Health in Opioid Treatment. PSYCH 2023. [DOI: 10.3390/psych5010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Opioid overdose and death from overdose continue to present a pressing problem in the United States. It is well-established that a range of social and economic factors, often referred to as social determinants of health (SDOH), are associated with increased opioid overdose and death. Few studies have examined healthcare provider reports on social and economic barriers to opioid treatment. Healthcare providers (N = 161) participating in opioid Project ECHO (Extension for Community Healthcare Outcomes) programs were surveyed on the portion of their patients experiencing 15 different SDOH. Results indicated that multiple determinants were experienced by the majority of their patients, with poverty as the most commonly experienced social determinant (72%). Regression analyses indicated that physicians generally reported a lower portion of patients experiencing SDOH compared with social workers, nurse practitioners, and other healthcare providers. Results suggest that SDOH are widely experienced by patients seeking opioid treatment and that professional backgrounds may be related to reports of SDOH at the point of care. Multi-disciplinary teams involving social workers, nurse practitioners, and other healthcare providers may improve the identification of social and economic barriers to opioid treatment.
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Fatima D, Tsai WH, Corrigan J, Ogah I, Ip-Buting A, Sharpe H, Laratta CR, Peller P, Pendharkar SR. Exploring patient-borne costs and wait times for obstructive sleep apnea (OSA) care among rural and urban adults. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2022.2156936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Duaa Fatima
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H. Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Corrigan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imhokhai Ogah
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Ada Ip-Buting
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather Sharpe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl R. Laratta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R. Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lister JJ, Joudrey PJ. Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption. J Rural Health 2023; 39:18-20. [PMID: 35691930 PMCID: PMC10084067 DOI: 10.1111/jrh.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jamey J Lister
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Paul J Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Brown V, Bowie M, Bales D, Scheyett A, Thomas R, Cook G. Cooperative Extension offices as mental health hubs: A social ecological case study in rural Georgia, United States. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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King B, Holmes LM, Rishworth A, Patel R. Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic. Health Place 2023; 79:102938. [PMID: 36549235 PMCID: PMC9765327 DOI: 10.1016/j.healthplace.2022.102938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
The convergence of the opioid epidemic and the COVID-19 pandemic has created new health challenges throughout the United States. Since the onset of the pandemic, media attention and scholarly research have drawn attention to the intersections of addiction and COVID-19. However, there remain few empirical studies that examine the direct impacts of the COVID-19 pandemic for opioid overdose patterns. Even fewer have integrated quantitative and qualitative methods to detail the place-specific dynamics shaping opioid overdose and addiction treatment during the COVID-19 pandemic. This article measures and maps change in the age-adjusted rate of opioid-related overdose incidents at the county level from 2018 to 2020. These analyses are combined with interviews conducted since December 2020 with public health providers in the state of Pennsylvania to identify the key factors influencing opioid misuse and transformations in addiction treatment practices.
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Affiliation(s)
- Brian King
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
| | - Louisa M. Holmes
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States
| | | | - Ruchi Patel
- Department of Geography, The Pennsylvania State University, University Park, PA, 16802, United States.
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Miller EE, Ball J, Emery M, Robbins CB, Daniel J, Ahmed P, Hunt A. Promoting harm reduction in rural South Dakota using an interdisciplinary consortium. J Am Pharm Assoc (2003) 2023; 63:366-373. [PMID: 36207271 DOI: 10.1016/j.japh.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Deaths from drug-related overdoses are increasing. Rural areas continue to have fewer accessible resources than urban areas. The START-SD (Stigma, Treatment, Avoidance, and Recover in Time - South Dakota) project is funded by the Health Resources and Services Administration and aims to address needs surrounding substance use disorder (SUD) in South Dakota. Pharmacists can play a key role in these efforts. OBJECTIVE Describe harm reduction and prevention activities implemented through START-SD to reduce the impact of SUD in South Dakota. PRACTICE DESCRIPTION The interdisciplinary team at South Dakota State University, including pharmacists and student pharmacist researchers, partnered with collaborating organizations to provide improved access to prevention, treatment, and recovery services for those impacted by SUD. PRACTICE INNOVATION Given the rural and conservative nature of the state, the START-SD team used an innovative framework to implement harm reduction and prevention programs that other states could adopt. EVALUATION METHODS Because the START-SD project uses evidence-based programs, evaluation focuses on the number of programs implemented and the number of people subsequently served. Data are collected and reported biannually by the team. RESULTS The core team established and expanded an interdisciplinary consortium and advisory board. A variety of harm reduction and prevention strategies were implemented: establishing and developing partnerships with key organizations, working to increase access to harm reduction programs, facilitating educational activities and trainings, and working to reduce stigma related to SUD and harm reduction. DISCUSSION Reducing the impact of SUD requires a broad, multifaceted approach, as well as overcoming many environmental barriers. Pharmacists and pharmacy staff are uniquely positioned to positively affect harm reduction for patients. CONCLUSION More work to decrease the impact of SUD is needed, particularly in rural areas. Pharmacists can play a key role in projects to increase the reach and impact of prevention, treatment, and recovery efforts.
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Bardwell G, Mansoor M, Van Zwietering A, Cleveland E, Snell D, Kerr T. The "goldfish bowl": a qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting. Harm Reduct J 2022; 19:136. [PMID: 36476225 PMCID: PMC9730691 DOI: 10.1186/s12954-022-00725-2] [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: 09/08/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing body of research has focused on contextual factors that shape health and well-being of people who use drugs (PWUD). However, most of this research focuses on large cities and less is known about the effects of social and structural contexts on drug use and associated risks in rural Canadian settings. Therefore, we undertook this study to examine rural-specific contextual factors that affect the day-to-day experiences of PWUD. METHODS Twenty-seven qualitative semi-structured interviews were conducted with PWUD in a rural and coastal setting in British Columbia, Canada. Participants had to be ≥ 19 years old, used illegal opioids and/or stimulants regularly, and lived in the qathet region. Interview transcripts were coded based on themes identified by the research team. RESULTS Participants described progressive shifts in politics and culture in the qathet region while also identifying resource scarcity, homelessness, and changes in the drug supply, where illicit drug contents have become highly toxic and unpredictable. Participants discussed the qualities of a small community where everyone knows each other and there is a lack of privacy and confidentiality around drug use, which resulted in experiences of stigma, discrimination, and surveillance. Participants also reported rural-specific policing issues and experiences of surveillance on ferries when traveling to larger cities to purchase drugs. This led to significantly higher drug prices for PWUD due to the time dedication and criminalized risks associated with drug possession and trafficking. CONCLUSIONS Our findings illustrate the unique experiences faced by PWUD in a rural and coastal setting. The "goldfish bowl" effect in this rural community created heightened social and structural surveillance of PWUD, which led to a variety of negative consequences. There is a clear need for interventions to address the larger contextual drivers affecting people who use drugs in rural settings, including decriminalization and peer-led anti-stigma strategies, in order to improve the lives of PWUD.
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Affiliation(s)
- Geoff Bardwell
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Manal Mansoor
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Ashley Van Zwietering
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Ellery Cleveland
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Dan Snell
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Substance Users Society Teaching Advocacy Instead of Neglect (SUSTAIN), 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Thomas Kerr
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Poulsen MN, Asdell PB, Berrettini W, McBryan K, Rahm AK. Application of the COM-B model to patient barriers and facilitators of retention in medication treatment for opioid use disorder in rural Northeastern United States: A qualitative study. SSM. MENTAL HEALTH 2022; 2:100151. [PMID: 36776723 PMCID: PMC9912293 DOI: 10.1016/j.ssmmh.2022.100151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Medications for opioid use disorder (MOUD) reduce illicit opioid use and overdose mortality, but effectiveness remains limited by poor treatment retention. Understanding multilevel barriers and facilitators to retention from the patient perspective can guide intervention strategies to improve retention. Methods We conducted semi-structured telephone interviews to elicit perspectives of individuals with opioid use disorder (OUD) currently (n = 19) and formerly (n = 16) receiving treatment from a multi-clinic outpatient MOUD program in Pennsylvania in July 2020 to January 2021. The Capability, Opportunity, Motivation, Behavior model provided a theoretical framework for analysis. Results Based on interview themes, physical, rather than psychological, capability was more salient to MOUD engagement, and pertained to individual-level factors such as side effects, withdrawal, and the degree to which MOUD addressed participants' need for pain management. Co-existing mental health conditions also challenged participants' physical ability to attend appointments. The opportunity domain contained both physical and social aspects. Physical opportunity for MOUD engagement centered on community-level factors related to MOUD access (e.g., distance, transportation) and clinical-level factors including program policies. Themes related to social opportunity included interpersonal influences-such as therapeutic and social support-and stigma associated with OUD and MOUD. Motivation emerged as the dominant domain for patients. Reflective motivation factors included individual-level factors such as participants' recognition of their addiction and "readiness" to quit illicit opioid use, attitudes toward MOUD, future treatment expectations, motivation to engage in MOUD, and perceived consequences of disengagement. Automatic motivation factors included the degree to which MOUD created a sense of normalcy for participants and the use of illicit drugs to numb emotions. Conclusions Factors at the individual, interpersonal, clinical, community, and societal levels influenced patients' capability, opportunity, and motivation to engage in MOUD. Understanding such factors can inform implementation strategies to improve retention.
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Affiliation(s)
- Melissa N. Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA,Corresponding author. 100 North Academy Avenue Geisinger, Danville, PA, 17822, USA. (M.N. Poulsen)
| | - Patrick B. Asdell
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA
| | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kortney McBryan
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, 17822, USA
| | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, 17822, USA
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Fujita AW, Loughry N, Moore DE, Carter AE, Hussen SA, Cooper H, Colasanti JA, Sheth AN. Prevalence, Distribution, and Characteristics Associated with Possession of Buprenorphine Waivers Among Infectious Diseases Physicians in the United States. Clin Infect Dis 2022; 76:1197-1204. [PMID: 36419250 DOI: 10.1093/cid/ciac909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use, thus ID physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown. METHODS This cross-sectional study merged data from several publicly available datasets from November 1, 2021 to January 15, 2022. Our primary outcome was proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine geographic distribution of waivered ID physicians. RESULTS We identified 6372 ID physicians in the US, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR 0.79, 95% CI 0.68-0.91). ID physicians practicing in counties with higher proportion of uninsured residents had lower odds of having a waiver (OR 0.75, 95% CI 0.62-0.90). Among counties with at least one ID physician (n = 729), only 11.2% had at least one waivered ID physician. CONCLUSIONS We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.
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Affiliation(s)
- Ayako Wendy Fujita
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Nora Loughry
- Division of General Internal Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - DeLante E Moore
- Department of Biostatistics, Rollins School of Public Health, Emory University Department of Medicine, Atlanta, GA, USA
| | - Andrea E Carter
- Division of General Internal Medicine, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA
| | - Sophia A Hussen
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral, Social, and Health Education Services, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
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David AR, Sian CR, Gebel CM, Linas BP, Samet JH, Sprague Martinez LS, Muroff J, Bernstein JA, Assoumou SA. Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study. J Subst Abuse Treat 2022; 142:108870. [PMID: 36084559 PMCID: PMC10084712 DOI: 10.1016/j.jsat.2022.108870] [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: 11/23/2021] [Revised: 07/19/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions. METHODS We conducted semi-structured interviews (N = 24) at a detox center (2018-2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes. RESULTS Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions. CONCLUSIONS Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for. individualized preferences and needs.
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Affiliation(s)
- Allison R David
- Department of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, United States of America.
| | - Carlos R Sian
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America.
| | - Christina M Gebel
- Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America; Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America; Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA 02118, United States of America.
| | - Jeffrey H Samet
- Department of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, United States of America; Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America.
| | - Linda S Sprague Martinez
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Jordana Muroff
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Judith A Bernstein
- Boston University School of Public Health, 801 Massachusetts Ave., Crosstown Center, Boston, MA 02118, United States of America.
| | - Sabrina A Assoumou
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA 02118, United States of America.
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Ellis JD, Pasman E, Brown S, Lister JJ, Agius E, Resko SM. An examination of correlates of simultaneous opioid and benzodiazepine use among patients in medication treatment for opioid use disorder in a small midwestern community. J Addict Dis 2022; 40:542-551. [PMID: 35285423 PMCID: PMC9969715 DOI: 10.1080/10550887.2022.2042152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Concurrent and/or simultaneous use of opioids and benzodiazepines has been associated with increased risk of accident and injury, as well as with co-occurring psychopathology. Objectives: The purpose of the present study was to explore potential correlates of simultaneous opioid and benzodiazepine use in a small community, including perceived risk, positive screens for psychiatric symptoms, and opioid-related consequences. Methods: A sample of 267 participants were recruited from a medication treatment provider that serves a small Midwestern community. Multinomial logistic regression was used to explore demographic and mental health correlates associated with self-reports of past-year simultaneous use. Zero-inflated Poisson regression was used to explore past-year consequences associated with reported simultaneous benzodiazepine and opioid use. Results: Intentional simultaneous use of opioids and benzodiazepines was associated with greater anxiety and depression symptoms, greater likelihood of a positive PTSD screen, and low self-perceived risk of simultaneous use. Individuals reporting opioid/benzodiazepine simultaneous use were also more likely to report opioid-related consequences. Conclusions: Results highlight the importance of assessing and treating simultaneous opioid/benzodiazepine co-use, as well as relevant comorbidities.
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Affiliation(s)
- Jennifer D. Ellis
- Johns Hopkins University School of Medicine, Baltimore, MD
- Wayne State University School of Social Work, Detroit, MI
| | - Emily Pasman
- Wayne State University School of Social Work, Detroit, MI
| | - Suzanne Brown
- Wayne State University School of Social Work, Detroit, MI
| | - Jamey J. Lister
- Wayne State University School of Social Work, Detroit, MI
- Rutgers School of Social Work, New Brunswick, NJ
| | | | - Stella M. Resko
- Wayne State University School of Social Work, Detroit, MI
- Wayne State University Merrill Palmer Skillman Institute, Detroit, MI
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Walters JE, Jones AE, Brown AR, Wallis D. Impacts of the COVID-19 Pandemic on a Rural Opioid Support Services Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11164. [PMID: 36141436 PMCID: PMC9517684 DOI: 10.3390/ijerph191811164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
During 2020, Kentucky saw the third highest increase in overdose deaths in the U.S. Employment issues, inadequate housing, transportation problems, and childcare needs present barriers to accessing treatment in rural areas. These barriers and others (e.g., technology) arose during the pandemic negatively affecting individuals in recovery and service providers as they adjusted services to provide primarily telehealth and remote services. This study examines the impact of COVID-19 in its early stages on an opioid use disorder (OUD) support services program in a nonprofit located in rural eastern Kentucky, part of the central Appalachia region. A qualitative design was applied, employing semi-structured interviews in early fall 2020. Participants were associated with one OUD support services program, including service recipients, program coordinators, and business vendors. Guided by the Social Determinants of Health framework, two-cycle coding-descriptive coding and pattern coding-was utilized. Codes were sorted into three patterns: changes to daily life; financial impacts; and service access and provision. Overall, early stages of COVID-19 brought increased stress for individuals in recovery, as they were taking on more responsibility and navigating a changing environment. Coordinators were under pressure to provide services in a safe, timely manner. Vendors vocalized their struggles and successes related to finances. These findings can help organizations make realistic adjustments and policymakers set reasonable expectations and consider additional financial support.
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Affiliation(s)
- Jayme E. Walters
- Department of Social Work, Utah State University, 0730 Old Main Hill, Logan, UT 84322, USA
| | - Aubrey E. Jones
- College of Social Work, University of Kentucky, 619 Patterson Office Tower, Lexington, KY 40506, USA
| | - Aaron R. Brown
- College of Social Work, University of Kentucky, 619 Patterson Office Tower, Lexington, KY 40506, USA
| | - Dorothy Wallis
- Department of Social Work, Utah State University, 0730 Old Main Hill, Logan, UT 84322, USA
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Abstract
The incidence of opioid use disorder (OUD) and overdose deaths is rising yearly within the United States. Many cases are associated with illicitly manufactured fentanyl use. In addition to offering patients medications for OUD (methadone, buprenorphine, and naltrexone), the approach to this epidemic should involve increasing provider awareness and education about substance use disorders, expanding urine toxicology screens to test for fentanyl, and using low-threshold treatment approaches.
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