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Gallardo KR, Wilkerson JM, Stewart HLN, Zoschke IN, Fredriksen Isaacs C, McCurdy SA. "Being here is saving my life": Resident experiences of living in recovery residences for people taking medication for an opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209242. [PMID: 38061632 DOI: 10.1016/j.josat.2023.209242] [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: 04/07/2023] [Revised: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are an effective treatment for addressing opioid use disorder. Despite MOUD's demonstrated effectiveness, MOUD-related stigma is prevalent throughout many recovery communities and subsequently limits persons taking MOUD access to recovery supports, including recovery housing. While recovery residences that serve people taking MOUD could be a critical recovery support, they are limited in number and understudied. METHODS We conducted in-depth interviews with 47 residents in medication-assisted recovery (MAR) living in 11 Texas-based recovery residences serving people taking MOUD to characterize residents' experiences and understand the impact that these homes had on their recovery. RESULTS We found that many participants could not previously access recovery housing and other recovery supports due to MOUD-related stigma, thus recovery homes that supported people in MAR were considered a groundbreaking opportunity. Recovery residences provided participants with a space in which they did not feel judged for taking MOUD, which facilitated participants' connections with their fellow housemates. Subsequently, participants no longer had to hide their MAR pathway and could be transparent about taking MOUD among their recovery residence community. Last, recovery homes provided a supportive environment in which participants' internalized MOUD-related stigma could evolve into acceptance of their MAR pathway. CONCLUSIONS Recovery residences that serve people in MAR provide a supportive, safe, nonjudgmental recovery environment in which residents develop relationships with other peers taking MOUD, share openly about their MAR, and are empowered to embrace their recovery pathway. These findings highlight the need for more recovery residences that are supportive of people taking MOUD as part of their recovery.
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Affiliation(s)
- Kathryn R Gallardo
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America.
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Hannah L N Stewart
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - I Niles Zoschke
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Cameron Fredriksen Isaacs
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Sheryl A McCurdy
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
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Morford KL, Tetrault JM, Zhou B, Li F, Gleeson B, Edelman EJ, Stein MD, Barry DT, Madden L. The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study. Drug Alcohol Depend 2022; 241:109707. [PMID: 36423462 PMCID: PMC9777057 DOI: 10.1016/j.drugalcdep.2022.109707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Open-access opioid treatment programs (OTP) offer same-day access to methadone without an appointment and aim to minimize treatment barriers that often reduce admission and/or retention. We explored whether patients with benzodiazepine exposure at treatment entry would have similar 12-month retention compared to those without benzodiazepine exposure. METHODS We conducted a retrospective cohort study of 2968 patients consecutively initiated on methadone between January 2015 and February 2017 at an open-access OTP. The sample was stratified into benzodiazepine-exposed and nonexposed groups based on intake urine toxicology. Group comparison of 12-month retention was conducted. Kaplan Meier analysis compared time to methadone treatment discontinuation between groups with a log-rank test. Multivariable Cox regression was performed to compare retention by baseline benzodiazepine exposure with adjustment for confounders. RESULTS Overall, 31% of patients with benzodiazepine exposure (n = 171) and 31% without exposure (n = 2423) were retained at 12 months (p = 0.95). Median treatment duration was 182 days (95% CI, 152-239) and 175 days (95% CI, 156-196) for patients with and without benzodiazepine exposure, respectively. Kaplan-Meier analysis showed no significant difference in treatment duration between groups (log-rank test p = 0.73). Cox regression found no difference in treatment retention between groups (adjusted Hazard Ratio= 1.03, 95% CI, 0.91-1.16). CONCLUSIONS In this cohort of patients receiving methadone at an open-access OTP, benzodiazepine exposure at intake was not observed to impact 12-month treatment retention or duration. These findings support U.S. Food and Drug Administration (FDA) recommendations to not withhold medications for opioid use disorder from patients taking benzodiazepines.
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Affiliation(s)
- Kenneth L. Morford
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
| | - Jeanette M. Tetrault
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
| | - Bin Zhou
- Yale Center for Analytic Sciences, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520, United States
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520, United States
| | - Brynna Gleeson
- Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604, United States
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118. United States
| | - Declan T. Barry
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States
| | - Lynn Madden
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
- APT Foundation, 1 Long Wharf Drive, New Haven, CT 06511, United States
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Friesen EL, Kurdyak P. The impact of psychiatric comorbidity on treatment discontinuation among individuals receiving medications for opioid use disorder. Drug Alcohol Depend 2020; 216:108244. [PMID: 32861134 DOI: 10.1016/j.drugalcdep.2020.108244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psychiatric illness complicates the clinical course of opioid use disorder (OUD) including treatment using medication for OUD (MOUD). The purpose of this study was to assess the relationship between psychiatric comorbidity and MOUD discontinuation, stratified by whether the client dropped out of treatment or whether MOUD was terminated by the addiction facility. METHODS The study population consisted of individuals with OUD receiving MOUD. Data was derived from the 2015-2017 Treatment Episodes Dataset - Discharges (TEDS-D), which includes discharge records from addiction treatment centers across the United States. The association between psychiatric comorbidity and MOUD discontinuation (including client dropout and facility termination) was assessed using multivariable logistic regression models that included clinically relevant covariates (age, sex, race, education, employment status, living arrangement, prior addiction treatment, intravenous opioid use, primary opioid used at admission, polysubstance use, previous arrests, length of stay, and referral source). RESULTS Psychiatric comorbidity decreased the odds of client dropout (adjusted odds ratio (aOR): 0.88, 95 % confidence interval (CI): 0.86 - 0.89) but increased the odds of MOUD being terminated by the treatment facility (aOR: 1.59, 95 % CI: 1.56-1.63). The association between psychiatric comorbidity and MOUD discontinuation varied considerably between states. CONCLUSIONS Individuals with psychiatric illness are slightly less likely to drop out of MOUD treatment but are more likely to have their treatment prematurely terminated by the treatment facility. This emphasizes the importance of considering psychiatric illness when providing OUD treatment and suggests that measures to improve MOUD retention for individuals with psychiatric illness are required.
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Affiliation(s)
- Erik Loewen Friesen
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction & Mental Health, Toronto, Canada.
| | - Paul Kurdyak
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada; Centre for Addiction & Mental Health, Toronto, Canada; ICES, Toronto, Canada.
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