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Afshar M, Graham Linck EJ, Spicer AB, Rotrosen J, Salisbury-Afshar EM, Sinha P, Semler MW, Churpek MM. Machine Learning-Driven Analysis of Individualized Treatment Effects Comparing Buprenorphine and Naltrexone in Opioid Use Disorder Relapse Prevention. J Addict Med 2024:01271255-990000000-00313. [PMID: 38776423 DOI: 10.1097/adm.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE A trial comparing extended-release naltrexone and sublingual buprenorphine-naloxone demonstrated higher relapse rates in individuals randomized to extended-release naltrexone. The effectiveness of treatment might vary based on patient characteristics. We hypothesized that causal machine learning would identify individualized treatment effects for each medication. METHODS This is a secondary analysis of a multicenter randomized trial that compared the effectiveness of extended-release naltrexone versus buprenorphine-naloxone for preventing relapse of opioid misuse. Three machine learning models were derived using all trial participants with 50% randomly selected for training (n = 285) and the remaining 50% for validation. Individualized treatment effect was measured by the Qini value and c-for-benefit, with the absence of relapse denoting treatment success. Patients were grouped into quartiles by predicted individualized treatment effect to examine differences in characteristics and the observed treatment effects. RESULTS The best-performing model had a Qini value of 4.45 (95% confidence interval, 1.02-7.83) and a c-for-benefit of 0.63 (95% confidence interval, 0.53-0.68). The quartile most likely to benefit from buprenorphine-naloxone had a 35% absolute benefit from this treatment, and at study entry, they had a high median opioid withdrawal score (P < 0.001), used cocaine on more days over the prior 30 days than other quartiles (P < 0.001), and had highest proportions with alcohol and cocaine use disorder (P ≤ 0.02). Quartile 4 individuals were predicted to be most likely to benefit from extended-release naltrexone, with the greatest proportion having heroin drug preference (P = 0.02) and all experiencing homelessness (P < 0.001). CONCLUSIONS Causal machine learning identified differing individualized treatment effects between medications based on characteristics associated with preventing relapse.
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Affiliation(s)
- Majid Afshar
- From the University of Wisconsin School of Medicine and Public Health, Madison, WI (MA, EJGL, ABS, EMS-A, MMC); New York University Grossman School of Medicine, New York, NY (JR); Washington University School of Medicine, Saint Louis, MO (PS); and Vanderbilt University Medical Center, Nashville, TN (MWS)
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Choi SA, Yan CH, Gastala NM, Touchette DR, Stranges PM. Cost-effectiveness of full and partial opioid agonists for opioid use disorder in outpatient settings: United States healthcare sector perspective. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209237. [PMID: 38061629 DOI: 10.1016/j.josat.2023.209237] [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: 03/16/2023] [Revised: 06/30/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Studies show that medications for opioid use disorder (MOUD) reduce illicit opioid use, emergency healthcare services, opioid-related overdose, and death. However, few studies have investigated the long-term cost-effectiveness of MOUD in office-based opioid treatment (OBOT) and opioid treatment program (OTP) settings. We aimed to estimate the cost, utility, quality-adjusted life years gained (QALYs), and incremental cost-effectiveness ratios (ICERs) of three MOUD compared to each other and counseling without medication from a US healthcare sector perspective. METHODS Our study developed a Markov model to conduct a cost-effectiveness analysis of counseling and three MOUD in the OBOT and OTP settings: sublingual buprenorphine/naloxone (BUPNX), buprenorphine extended-release (XR-BUP) injection, and oral methadone. The model included five health states representing combinations of receiving or off treatment while either using or not actively using illicit opioids, and death. The cycle length was one month; the time-horizon was ten years. The study obtained model inputs from systematic reviews of published literature and public data. A 3 % annual discount rate was applied to cost and utility calculation. The primary outcomes included total costs, life-years (LYs), QALYs, and ICERs. We also conducted a scenario analysis using a hypothetical OBOT outpatient setting with methadone. RESULTS In the base-case OBOT setting, the total costs and QALYs, respectively, were counseling $22,848, 5.60; BUPNX $29,875, 5.82; and XR-BUP $63,936, 5.87. ICERs were $32,345/QALY (BUPNX vs. counseling) and $625,858/QALY (XR-BUP vs BUPNX). In the OTP setting, the total costs of counseling, methadone, BUPNX, and XR-BUP were $20,124, $27,000, $33,500, and $75,272, respectively. QALYs of methadone were 5.86. QALYs of counseling, BUPNX, and XR-BUP remained the same as in the OBOT setting. Incremental ICERs were $26,714/QALY (methadone vs counseling) and $3,337,623/QALY (XR-BUP vs methadone). BUPNX was dominated by methadone. In the scenario analysis, BUPNX was also dominated by methadone. CONCLUSIONS Outpatient MOUD resulted in important gains in quality of life and life expectancy. In both OBOT and OTP settings, XR-BUP was not cost-effective. BUPNX was cost-effective in the OBOT setting, while it was dominated by methadone in the OTP setting. The cost-effectiveness of BUPNX and XR-BUP could be enhanced if the costs of these medications were reduced.
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Affiliation(s)
- Sun A Choi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street MC 871, Chicago, IL 60612, USA.
| | - Connie H Yan
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street MC 871, Chicago, IL 60612, USA.
| | - Nicole M Gastala
- Department of Family Medicine, Mile Square Health Centers, University of Illinois Hospital and Health Science Systems, 1220 S. Wood St., 60608 Chicago, IL, USA.
| | - Daniel R Touchette
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street MC 871, Chicago, IL 60612, USA.
| | - Paul M Stranges
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street Rm C-300, Chicago, IL 60612, USA.
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Shulman M, Provost S, Ohrtman K, Novo P, Meyers-Ohki S, Van Veldhuisen P, Oden N, Otterstatter M, Bailey GL, Liu D, Rotrosen J, Nunes EV, Weiss RD. Discontinuation of medication treatment for opioid use disorder after a successful course: The discontinuation phase of the CTN-0100 (RDD) trial. Contemp Clin Trials 2024; 142:107543. [PMID: 38657730 DOI: 10.1016/j.cct.2024.107543] [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: 01/15/2024] [Revised: 03/26/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION AND BACKGROUND Buprenorphine, and extended-release naltrexone, are effective in decreasing opioid use, morbidity and mortality. The available evidence suggests that these medications should be used for long term treatment; however, patients often ask how long they need to be on medication, and whether it would be safe to discontinue. There are sparse data to guide us. The CTN-0100 trial will address this gap in our knowledge by studying participants who have decided to discontinue buprenorphine and extended-release naltrexone for OUD. RESEARCH DESIGN AND METHODS The trial is a multicenter, randomized, non-blinded study. Participants are stable adult volunteers, on sublingual buprenorphine, extended-release buprenorphine, or extended-release naltrexone, expressing an interest in discontinuing medication. Participants on buprenorphine must be stable for at least 1 year and participants on extended-release naltrexone must be stable for at least 6 months. Participants are engaged in the study for up to 96 weeks, including a flexible taper period, and are then transitioned to follow-up within the trial. All participants are randomly assigned to the study Medical Management (MM) or to MM plus Connections (CHESS health) digital smartphone application aimed at recovery and abstinence (MMD). Sublingual Buprenorphine participants are also randomized (2 × 2 design) to a taper using either sublingual or extended-release buprenorphine. DISCUSSION/CONCLUSION It is hoped that this trial will provide a rich source of data on management of patients discontinuing medication for opioid use disorder (MOUD) to inform future research and practice. The trial will shed light on which strategies are most likely to lead to long-term success (absence of relapse), and what participant characteristics distinguish those who can safely discontinue MOUD from those who remain at risk of relapse should they discontinue. CLINICALTRIALS gov Identifier: NCT04464980.
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Affiliation(s)
- Matisyahu Shulman
- New York State Psychiatric Institute, USA; Columbia University Irving Medical Center, USA.
| | | | | | - Patricia Novo
- New York University Grossman School of Medicine, USA
| | | | | | | | | | - Genie L Bailey
- Warren Alpert School of Medicine of Brown University / Stanley Street Treatment and Resources, Inc., USA
| | - David Liu
- National Institute on Drug Abuse, USA
| | - John Rotrosen
- New York University Grossman School of Medicine, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, USA; Columbia University Irving Medical Center, USA
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Peddireddy SR, Livingston MD, Young AM, Freeman PR, Ibragimov U, Komro KA, Lofwall MR, Oser CB, Staton M, Cooper HLF. Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209262. [PMID: 38103835 PMCID: PMC10947911 DOI: 10.1016/j.josat.2023.209262] [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: 05/23/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Umedjon Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky College of Arts & Sciences, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
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Wai JM, Blevins D, Hunt T, Gilbert L, Campbell ANC, Levin FR, El-Bassel N, Nunes E. An Approach to Enhancing Medication Treatment for Opioid Use Disorder in the HEALing Communities Study. Psychiatr Serv 2024:appips20230159. [PMID: 38347814 DOI: 10.1176/appi.ps.20230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) aims to test the effectiveness of the Communities That HEAL intervention in decreasing opioid overdose deaths in 67 communities across four U.S. states. This intervention enlists a collaborative team of researchers, academic experts, and community coalitions to select and implement interventions from a menu of evidence-based practices, including medications for opioid use disorder (MOUD). The HCS's New York team developed an integrated network systems (INS) approach with a mapping tool to coach coalitions in the selection of strategies to enhance medication treatment. With the INS approach, community coalitions develop a map of service delivery venues in their local county to better engage people with medication treatment wherever this need arises. The map is structured around core services that can provide maintenance MOUD and satellite services, which include all settings where people with opioid use disorder are encountered and can be identified, possibly given medication, and referred to core programs for ongoing MOUD care. This article describes the rationale for the INS mapping tool, with a discussion framed by the consolidated framework for implementation research, and provides a case example of its application.
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Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Derek Blevins
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Tim Hunt
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Louisa Gilbert
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Frances R Levin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Edward Nunes
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
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Hawkins EJ, Malte CA, Hagedorn HJ, Gordon AJ, Williams EC, Trim RS, Blanchard BE, Lott A, Danner AN, Saxon AJ. Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care. J Addict Med 2024:01271255-990000000-00278. [PMID: 38329814 DOI: 10.1097/adm.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. METHODS Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer. RESULTS Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients. CONCLUSIONS Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.
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Affiliation(s)
- Eric J Hawkins
- From the Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA (EJH, CAM, ECW, AL, AND, AJS); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA (EJH, CAM, HJH, AL, AND, AJS); HSR&D Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN (HJH); HSR&D Center of Innovation: Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT (AJG); Department of Health Services, University of Washington, Seattle, WA (ECW); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (EJH, BEB, AJS); Department of Psychiatry, University of Minnesota, Minneapolis, MN (HJH); Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AJG); Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Philadelphia VA Medical Center, Philadelphia, PA (RST)
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Dever JA, Hertz MF, Dunlap LJ, Richardson JS, Wolicki SB, Biggers BB, Edlund MJ, Bohm MK, Turcios D, Jiang X, Zhou H, Evans ME, Guy GP. The Medications for Opioid Use Disorder Study: Methods and Initial Outcomes From an 18-Month Study of Patients in Treatment for Opioid Use Disorder. Public Health Rep 2024:333549231222479. [PMID: 38268479 DOI: 10.1177/00333549231222479] [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: 01/26/2024] Open
Abstract
OBJECTIVE Opioid use disorder (OUD) affects approximately 5.6 million people in the United States annually, yet rates of the use of effective medication for OUD (MOUD) treatment are low. We conducted an observational cohort study from August 2017 through May 2021, the MOUD Study, to better understand treatment engagement and factors that may influence treatment experiences and outcomes. In this article, we describe the study design, data collected, and treatment outcomes. METHODS We recruited adult patients receiving OUD treatment at US outpatient facilities for the MOUD Study. We collected patient-level data at 5 time points (baseline to 18 months) via self-administered questionnaires and health record data. We collected facility-level data via questionnaires administered to facility directors at 2 time points. Across 16 states, 62 OUD treatment facilities participated, and 1974 patients enrolled in the study. We summarized descriptive data on the characteristics of patients and OUD treatment facilities and selected treatment outcomes. RESULTS Approximately half of the 62 facilities were private, nonprofit organizations; 62% focused primarily on substance use treatment; and 20% also offered mental health services. Most participants were receiving methadone (61%) or buprenorphine (32%) and were predominately non-Hispanic White (68%), aged 25-44 years (62%), and female (54%). Compared with patient-reported estimates at baseline, 18-month estimates suggested that rates of abstinence increased (55% to 77%), and rates of opioid-related overdoses (7% to 2%), emergency department visits (9% to 4%), and arrests (15% to 7%) decreased. CONCLUSIONS Our results demonstrated the benefits of treatment retention not only on abstinence from opioid use but also on other quality-of-life metrics, with data collected during an extended period. The MOUD Study produced rich, multilevel data that can lay the foundation for an evidence base to inform OUD treatment and support improvement of care and patient outcomes.
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Affiliation(s)
| | - Marci F Hertz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John S Richardson
- RTI International, Research Triangle Park, NC, USA
- Current affiliation: Stop Soldier Suicide, Durham, NC, USA
| | | | | | | | - Michele K Bohm
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Xinyi Jiang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hong Zhou
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary E Evans
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Gopaldas M, Wenzel K, Campbell ANC, Jalali A, Fishman M, Rotrosen J, Nunes EV, Murphy SM. Impact of Medication-Based Treatment on Health Care Utilization Among Individuals With Opioid Use Disorder. Psychiatr Serv 2023; 74:1227-1233. [PMID: 37337675 PMCID: PMC10730760 DOI: 10.1176/appi.ps.20220549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE This study evaluated the association between medication for opioid use disorder (MOUD) and health care utilization over time among a sample of treatment-seeking individuals with opioid use disorder. In contrast to previous studies, this study used a novel measure of MOUD adherence, more comprehensive utilization data, and analyses that controlled for detailed individual and social determinants of health. METHODS This study was a secondary analysis of a comparative effectiveness trial (N=570) of extended-release naltrexone versus buprenorphine-naloxone. The outcome of interest was usage of nonstudy acute care, inpatient and outpatient addiction services, and other outpatient services across 36 weeks of assessment. Adherence (percentage of days taking MOUD) was defined as low (<20%), medium (≥20% but <80%), or high (≥80%). A two-part model evaluated the probability of utilizing a resource and the quantity (utilization days) of the resource consumed. A time-varying approach was used to examine the effect of adherence in a given month on utilization in the same month, with analyses controlling for a wide range of person-level characteristics. RESULTS Participants with high adherence (vs. low) were significantly less likely to use inpatient addiction (p<0.001) and acute care (p<0.001) services and significantly more likely to engage in outpatient addiction (p=0.045) and other outpatient (p=0.042) services. CONCLUSIONS These findings reinforce the understanding that greater MOUD adherence is associated with reduced usage of high-cost health services and increased usage of outpatient care. The results further suggest the need for enhanced access to MOUD and for interventions that improve adherence.
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Affiliation(s)
- Manesh Gopaldas
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Kevin Wenzel
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Aimee N C Campbell
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Ali Jalali
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Marc Fishman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - John Rotrosen
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Edward V Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Sean M Murphy
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
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9
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Lofwall MR, Young JL, Hansen Z, Wachman EM, Wilder C, Guille C, Charles JE, Leeman L, Gray JR, Winhusen TJ. What to Expect With Pregnant or Postpartum Prescribing of Extended-Release Buprenorphine (CAM2038). JOURNAL OF CLINICAL GYNECOLOGY AND OBSTETRICS 2023; 12:110-116. [PMID: 38435674 PMCID: PMC10906993 DOI: 10.14740/jcgo919] [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] [Indexed: 03/05/2024]
Abstract
Weekly and monthly CAM2038 (Brixadi®) extended-release subcutaneous buprenorphine (XR bup) has been available in Europe and Australia for several years and was approved by the Food and Drug Administration in May 2023. Little is known about the clinical experience of patients and providers using this new medication during prenatal care. Two cases of pregnant persons with opioid use disorder receiving weekly XR bup in an ongoing randomized multi-site outpatient clinical trial are presented along with a brief review of the pharmacology and literature on XR bup formulations. The cases in pregnancy illustrate how treatment with the weekly formulation is initiated including how to make dose adjustments, which may be necessary given the longer half-life; it takes 1 month to achieve steady state. Injection site pain with medication administration was time limited and managed readily. Other injection site reactions experienced included subcutaneous erythema and induration that was delayed in onset and typically mild, resolving with minimal intervention. Delivery management and breastfeeding recommendations while on weekly XR bup were not different compared to sublingual buprenorphine (SL bup). Weekly XR bup is a new treatment for opioid use disorder that may be used in the obstetric population. Obstetric and addiction medicine clinicians should be aware of this new formulation as its use is expected to increase.
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Affiliation(s)
- Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jessica L. Young
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Hansen
- Department of Family Medicine, Division of Addiction Science, Marshall University, Huntington, WV, USA
| | | | - Christine Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jasmin E. Charles
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Jessica R. Gray
- Substance Use Disorder Initiative, Department of Psychiatry, and Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - T. John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Jarrett JB, Bratberg J, Burns AL, Cochran G, DiPaula BA, Dopp AL, Elmes A, Green TC, Hill LG, Homsted F, Hsia SL, Matthews ML, Ghitza UE, Wu LT, Bart G. Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy. Subst Abus 2023; 44:264-276. [PMID: 37902032 PMCID: PMC10870734 DOI: 10.1177/08897077231203849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.
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Affiliation(s)
- Jennie B. Jarrett
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Anne L. Burns
- American Pharmacists Association, Washington, DC, USA (retired)
| | - Gerald Cochran
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bethany A. DiPaula
- Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | | | - Abigail Elmes
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Traci C. Green
- COBER on Opioids and Overdose at Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Lucas G. Hill
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | | | - Stephanie L. Hsia
- Department of Clinical Pharmacy, San Francisco School of Pharmacy, University of California, San Francisco, CA, USA
| | - Michele L. Matthews
- Department of Pharmacy Practice, School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Udi E. Ghitza
- National Institute on Drug Abuse (NIDA), Center for the Clinical Trials Network (CCTN), Bethesda, MD, USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Durham, NC, USA
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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11
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Hornick MG, Stefanski A. Hallucinogenic potential: a review of psychoplastogens for the treatment of opioid use disorder. Front Pharmacol 2023; 14:1221719. [PMID: 37675046 PMCID: PMC10477608 DOI: 10.3389/fphar.2023.1221719] [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: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
The United States is entering its fourth decade of the opioid epidemic with no clear end in sight. At the center of the epidemic is an increase in opioid use disorder (OUD), a complex condition encompassing physical addiction, psychological comorbidities, and socioeconomic and legal travails associated with the misuse and abuse of opioids. Existing behavioral and medication-assisted therapies show limited efficacy as they are hampered by lack of access, strict regimens, and failure to fully address the non-pharmacological aspects of the disease. A growing body of research has indicated the potential of hallucinogens to efficaciously and expeditiously treat addictions, including OUD, by a novel combination of pharmacology, neuroplasticity, and psychological mechanisms. Nonetheless, research into these compounds has been hindered due to legal, social, and safety concerns. This review will examine the preclinical and clinical evidence that psychoplastogens, such as ibogaine, ketamine, and classic psychedelics, may offer a unique, holistic alternative for the treatment of OUD while acknowledging that further research is needed to establish long-term efficacy along with proper safety and ethical guidelines.
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Affiliation(s)
- Mary G. Hornick
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL, United States
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12
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Lunerti V, Shen Q, Li H, Benvenuti F, Soverchia L, Narendran R, Weiss F, Cannella N, Ciccocioppo R. Cebranopadol, a novel long-acting opioid agonist with low abuse liability, to treat opioid use disorder: Preclinical evidence of efficacy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.21.550008. [PMID: 37546836 PMCID: PMC10401954 DOI: 10.1101/2023.07.21.550008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The gold standard pharmacological treatment for opioid use disorder (OUD) consists of maintenance therapy with long-acting opioid agonists such as buprenorphine and methadone. Despite these compounds having demonstrated substantial efficacy, a significant number of patients do not show optimal therapeutic responses. Moreover, the abuse liability of these medications remains a major concern. Cebranopadol, is a new, long-acting pan-opioid agonist that also activates the nociception/orphanin FQ NOP receptor. Here we used rats to explore the therapeutic potential of this agent in OUD. First, in operant intravenous self-administration experiments we compared the potential abuse liability of cebranopadol with the prototypical opioid heroin. Under a fixed ratio 1 (FR1) contingency, rats maintained responding for heroin (1, 7, 20, 60 μg/inf) to a larger extent than cebranopadol (0.03, 0.1, 0.3, 1.0, 6.0 μg/inf). When the contingency was switched to a progressive ratio (PR) reinforcement schedule, heroin maintained responding at high levels at all except the lowest dose. Conversely, in the cebranopadol groups responding decreased drastically and the break point (BP) did not differ from saline controls. Next, we demonstrated that oral administration of cebranopadol (0, 25, 50 μg/kg) significantly attenuated drug self-administration independent of heroin dose (1, 7, 20, 60 μg/inf). Cebranopadol also reduced the break point for heroin (20 μg/inf). Furthermore, in a heroin self-administration training extinction/reinstatement paradigm, pretreatment with cebranopadol significantly attenuated yohimbine stress-induced reinstatement of drug seeking. Together, these data indicate that cebranopadol has limited abuse liability compared to heroin and is highly efficacious in attenuating opioid self-administration and stress-induced reinstatement, suggesting clinical potential of this compound for OUD treatment.
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13
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Lott AM, Danner AN, Malte CA, Williams EC, Gordon AJ, Halvorson MA, Saxon AJ, Hagedorn HJ, Sayre GG, Hawkins EJ. Clinician Perspectives on Delivering Medication Treatment for Opioid Use Disorder during the COVID-19 Pandemic: A Qualitative Evaluation. J Addict Med 2023; 17:e262-e268. [PMID: 37579107 PMCID: PMC10417321 DOI: 10.1097/adm.0000000000001156] [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: 07/14/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic necessitated changes in opioid use disorder care. Little is known about COVID-19's impact on general healthcare clinicians' experiences providing medication treatment for opioid use disorder (MOUD). This qualitative evaluation assessed clinicians' beliefs about and experiences delivering MOUD in general healthcare clinics during COVID-19. METHODS Individual semistructured interviews were conducted May through December 2020 with clinicians participating in a Department of Veterans Affairs initiative to implement MOUD in general healthcare clinics. Participants included 30 clinicians from 21 clinics (9 primary care, 10 pain, and 2 mental health). Interviews were analyzed using thematic analysis. RESULTS The following 4 themes were identified: overall impact of the pandemic on MOUD care and patient well-being, features of MOUD care impacted, MOUD care delivery, and continuance of telehealth for MOUD care. Clinicians reported a rapid shift to telehealth care, resulting in few changes to patient assessments, MOUD initiations, and access to and quality of care. Although technological challenges were noted, clinicians highlighted positive experiences, including treatment destigmatization, more timely visits, and insight into patients' environments. Such changes resulted in more relaxed clinical interactions and improved clinic efficiency. Clinicians reported a preference for in-person and telehealth hybrid care models. CONCLUSIONS After the quick shift to telehealth-based MOUD delivery, general healthcare clinicians reported few impacts on quality of care and highlighted several benefits that may address common barriers to MOUD care. Evaluations of in-person and telehealth hybrid care models, clinical outcomes, equity, and patient perspectives are needed to inform MOUD services moving forward.
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14
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Winograd R, Budesa Z, Banks D, Carpenter R, Wood CA, Duello A, Thater P, Smith C. Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention. Subst Abus 2023; 44:184-195. [PMID: 37702074 PMCID: PMC10591854 DOI: 10.1177/08897077231186213] [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: 09/14/2023]
Abstract
BACKGROUND Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a "Medication First" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients. METHODS This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions. RESULTS White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients. CONCLUSION In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.
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Affiliation(s)
- Rachel Winograd
- University of Missouri – St. Louis, Missouri Institute of Mental Health
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Zach Budesa
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Devin Banks
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Ryan Carpenter
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Claire A. Wood
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Alex Duello
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Paul Thater
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Christine Smith
- Missouri Department of Mental Health, Division of Behavioral Health
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15
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Witkiewitz K, Vowles KE. Everybody Hurts: Intersecting and Colliding Epidemics and the Need for Integrated Behavioral Treatment of Chronic Pain and Substance Use. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2023; 32:228-235. [PMID: 37645017 PMCID: PMC10465109 DOI: 10.1177/09637214231162366] [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: 08/31/2023]
Abstract
Chronic pain and substance use disorders are both common, debilitating, and often persist over the longer term. On their own, each represents a significant health problem, with estimates indicating a substantial proportion of the adult population has chronic pain or a substance use disorder (SUD), and their co-occurrence is increasing. Chronic pain and SUD are also both often invisible, stigmatized disorders and persons with both regularly have difficulty accessing evidence-based treatments, particularly those that offer coordinated and integrated treatment for both conditions. But there is hope. Research is unraveling the mechanisms of chronic pain and substance use, as well as their co-occurrence, integrated behavioral treatment options based on acceptance- and mindfulness-based approaches are increasingly being developed and tested, government agencies are devoting more funds and resources to increase research on chronic pain and SUD, and there have been growing efforts in training, dissemination, and implementation of evidence-based treatments. At the very heart of the matter, though, is to recognize that everybody hurts sometimes, and treatments must empower people to life effectively with these experiences of being human.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance use, And Addictions University of New Mexico
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16
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Degenhardt L, Clark B, Macpherson G, Leppan O, Nielsen S, Zahra E, Larance B, Kimber J, Martino-Burke D, Hickman M, Farrell M. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry 2023; 10:386-402. [PMID: 37167985 DOI: 10.1016/s2215-0366(23)00095-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes. METHODS We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109). FINDINGS We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use). INTERPRETATION Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brodie Clark
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Briony Larance
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jo Kimber
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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17
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Kalamarides DJ, Singh A, Wolfman SL, Dani JA. Sex differences in VTA GABA transmission and plasticity during opioid withdrawal. Sci Rep 2023; 13:8460. [PMID: 37231124 DOI: 10.1038/s41598-023-35673-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
The effectiveness of current treatments for opioid use disorder (OUD) varies by sex. Our understanding of the neurobiological mechanisms mediating negative states during withdrawal is lacking, particularly with regard to sex differences. Based on preclinical research in male subjects, opioid withdrawal is accompanied by increased gamma-aminobutyric acid (GABA) release probability at synapses onto dopamine neurons in the ventral tegmental area (VTA). It is unclear, however, if the physiological consequences of morphine that were originally elucidated in male rodents extend to females. The effects of morphine on the induction of future synaptic plasticity are also unknown. Here, we show that inhibitory synaptic long-term potentiation (LTPGABA) is occluded in the VTA in male mice after repeated morphine injections and 1 day of withdrawal, while morphine-treated female mice maintain the ability to evoke LTPGABA and have basal GABA activity similar to controls. Our observation of this physiological difference between male and female mice connects previous reports of sex differences in areas upstream and downstream of the GABA-dopamine synapse in the VTA during opioid withdrawal. The sex differences highlight the mechanistic distinctions between males and females that can be targeted when designing and implementing treatments for OUD.
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Affiliation(s)
- Daniel J Kalamarides
- Department of Neuroscience, Perelman School of Medicine, Mahoney Institute for Neurosciences, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Aditi Singh
- Department of Neuroscience, Perelman School of Medicine, Mahoney Institute for Neurosciences, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Shannon L Wolfman
- Department of Neuroscience, Perelman School of Medicine, Mahoney Institute for Neurosciences, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA, 19104, USA
| | - John A Dani
- Department of Neuroscience, Perelman School of Medicine, Mahoney Institute for Neurosciences, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA, 19104, USA.
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18
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Rudolph KE, Williams NT, Díaz I, Luo SX, Rotrosen J, Nunes EV. Optimally Choosing Medication Type for Patients With Opioid Use Disorder. Am J Epidemiol 2023; 192:748-756. [PMID: 36549900 PMCID: PMC10423632 DOI: 10.1093/aje/kwac217] [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: 03/07/2022] [Revised: 09/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with opioid use disorder (OUD) tend to get assigned to one of 3 medications based on the treatment program to which the patient presents (e.g., opioid treatment programs tend to treat patients with methadone, while office-based practices tend to prescribe buprenorphine). It is possible that optimally matching patients with treatment type would reduce the risk of return to regular opioid use (RROU). We analyzed data from 3 comparative effectiveness trials from the US National Institute on Drug Abuse Clinical Trials Network (CTN0027, 2006-2010; CTN0030, 2006-2009; and CTN0051 2014-2017), in which patients with OUD (n = 1,459) were assigned to treatment with either injection extended-release naltrexone (XR-NTX), sublingual buprenorphine-naloxone (BUP-NX), or oral methadone. We learned an individualized rule by which to assign medication type such that risk of RROU during 12 weeks of treatment would be minimized, and then estimated the amount by which RROU risk could be reduced if the rule were applied. Applying our estimated treatment rule would reduce risk of RROU compared with treating everyone with methadone (relative risk (RR) = 0.79, 95% confidence interval (CI): 0.60, 0.97) or treating everyone with XR-NTX (RR = 0.71, 95% CI: 0.47, 0.96). Applying the estimated treatment rule would have resulted in a similar risk of RROU to that of with treating everyone with BUP-NX (RR = 0.92, 95% CI: 0.73, 1.11).
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Affiliation(s)
- Kara E Rudolph
- Correspondence to Dr. Kara Rudolph, 722 W. 168th Street, Room 522, New York, NY 10032 (e-mail: )
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19
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Victor G, Ray B, Del Pozo B, Jaffe K, King A, Huynh P. Buprenorphine and opioid analgesics: Dispensation and discontinuity among accidental overdose fatalities in the Indianapolis metropolitan area, 2016-2021. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209053. [PMID: 37105266 DOI: 10.1016/j.josat.2023.209053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/28/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND This study describes overall trends and sociodemographic disparities in buprenorphine and opioid analgesic uptake and prescribing patterns prior to fatal overdose events. METHODS We examined toxicology data from all accidental overdose deaths from 2016 to 2021 (N = 2682) in a large metropolitan area. These data were linked at the individual-level with a prescription drug monitoring program (PDMP). RESULTS Fewer than half of all deaths had any kind of PDMP record (39.9 %, n = 1070). Among those with a buprenorphine prescription, 10.6 % (n = 35) of decedents had a buprenorphine dispensation within 7 days of their death, while the majority (64.7 %, n = 214) were dispensed buprenorphine more than 30 days prior to death. Evidence existed of racial disparities among those with any buprenorphine uptake, whereby Black individuals (7.3 %, n = 24) had significantly fewer any dispensations compared to White individuals (92.7 %, n = 307). Among those with an opioid analgesic prescription, about 12.2 % (n = 90) were dispensed within 7 days of death, with the majority (68.5 %, n = 506) occurring more than 30 days prior to death. Like buprenorphine dispensations, Black individuals were prescribed a significantly smaller proportion of opioid analgesics (21.9 %, n = 162) versus White individuals (77.7 %, n = 574). Buprenorphine was detected in 78.5 % of deaths where fentanyl was present in the toxicology record, significantly greater when compared to opioid analgesics (57.5 %). CONCLUSION Consistent with prior research, our findings suggest prescription opioid analgesics may protect against fatal overdoses. Access to buprenorphine treatment did not keep pace with the rising lethality of the overdose crisis, and in recent years, a smaller percentage of the people at risk of fatal overdose availed themselves of MOUD preceding their death.
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Affiliation(s)
- Grant Victor
- School of Social Work, Rutgers, The State University of New Jersey, 120 Albany St, New Brunswick, NJ 08901, United States of America.
| | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Brandon Del Pozo
- Miriam Hospital/Warren Alpert Medical School of Brown University, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road Bldg. 14, G016, Ann Arbor, MI 48109, United States of America
| | - Andy King
- School of Emergency Medicine, Wayne State University, 4201 St. Antoine, University Health Center - 6G, Detroit, MI 48201, United States of America
| | - Philip Huynh
- Center for Behavioral Health and Justice, Wayne State University, Detroit, MI 48208, United States of America
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20
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Enns B, Krebs E, Whitehurst DGT, Jutras-Aswad D, Le Foll B, Socias ME, Nosyk B. Cost-effectiveness of flexible take-home buprenorphine-naloxone versus methadone for treatment of prescription-type opioid use disorder. Drug Alcohol Depend 2023; 247:109893. [PMID: 37120920 DOI: 10.1016/j.drugalcdep.2023.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Our objective was to examine the cost-effectiveness of flexible take-home buprenorphine-naloxone (BNX) versus methadone alongside the OPTIMA trial in Canada. METHODS The OPTIMA study was a pragmatic, open-label, noninferiority, two-arm randomized controlled trial, to assess the comparative effectiveness of flexible take-home BNX vs. methadone in routine clinical care for individuals with prescription-type opioid use disorder. We evaluated cost-effectiveness using a semi-Markov cohort model. Probabilities of overdose were calibrated, accounting for fentanyl prevalence and other overdose risk factors such as naloxone availability. We considered health sector and societal cost perspectives, including costs (2020 CAD) for treatment, health resource use, criminal activity, and health state-specific preference weights as outcomes to calculate incremental cost-effectiveness ratios. Six-month and lifetime (3% annual discount rate) time-horizons were explored. RESULTS Over a lifetime time horizon, individuals accumulated -0.144 [CI: -0.302, -0.025] incremental quality-adjusted life years (QALYs) in BNX compared with methadone. Incremental costs were -$2047 [CI: -$39,197, $24,250] from a societal perspective, and -$4549 [CI: -$6332, -$3001] from a health sector perspective. Over a six-month time-horizon, individuals accumulated 0.002 [credible interval (CI): -0.011, 0.016] incremental QALYs in BNX compared with methadone. Incremental costs were -$307 [CI: -$10,385, $8466] from a societal perspective and -$1111 [CI: -$1517, -$631] from a health sector perspective. BNX was dominated (costlier, less effective) in 49.7% of simulations when adopting a societal perspective over a lifetime time horizon. CONCLUSIONS Flexible take-home BNX was not cost-effective versus methadone over a lifetime time horizon, resulting from better treatment retention in methadone compared to BNX.
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Affiliation(s)
- Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Emanuel Krebs
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, QuébecH2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, QuébecH3T1J4, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, OntarioM5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 250 College Street, 8th floor, Toronto, OntarioM5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, OntarioM5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada; Acute Care Program, CAMH, 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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21
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Booty M, Harp K, Batty E, Knudsen HK, Staton M, Oser CB. Barriers and facilitators to the use of medication for opioid use disorder within the criminal justice system: Perspectives from clinicians. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209051. [PMID: 37084815 DOI: 10.1016/j.josat.2023.209051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/09/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION This article examines social service clinicians' (SSCs) perspectives of factors within the criminal justice system that impact justice-involved individuals' use of medications for opioid use disorder (MOUD). Opioid use disorder (OUD) rates are high among justice-involved individuals, and overdose risk is heightened upon release from incarceration. This study is innovative, as it specifically focuses on criminal justice contexts that influence the MOUD continuum of care from the perspective of clinicians working within the criminal justice system. Understanding criminal justice-related facilitators and barriers to MOUD treatment will guide tailored policy intervention to increase MOUD use and promote recovery and remission among justice-involved individuals. METHODS The study completed qualitative interviews with 25 SSCs who are employed by a state department of corrections to provide assessment and referrals to substance use treatment to individuals on community supervision. The study used NVivo software to code the major themes found within each transcribed interview; two research assistants participated in consensus coding to ensure consistency in coding across transcripts. This study focused on the secondary codes that fell under the "Criminal Justice System" primary code, as well as codes that indicated barriers and facilitators to MOUD treatment. RESULTS SSCs cited sentencing time credits as structural facilitators of MOUD treatment; clients sought more information about extended-release naltrexone since time off of their sentence was available if initiated. Support for extended-release naltrexone by officers and judges was often mentioned as an attitudinal facilitator of initiation. Poor intra-agency collaboration among department of corrections agents was an institutional barrier to MOUD. Also, probation and parole officers' stigma surrounding other types of MOUD, specifically buprenorphine and methadone, was an attitudinal barrier to MOUD within the criminal justice system. CONCLUSIONS Future research should examine the effect that time credits have on extended-release naltrexone initiation, considering the wide consensus among SSCs that their clients were motivated to initiate this type of MOUD because of the resulting time off their sentences. Stigma among probation and parole officers and lack of communication within the criminal justice system need to be addressed so that more individuals with OUD may be exposed to life-saving treatments.
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Affiliation(s)
- Marisa Booty
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America.
| | - Kathi Harp
- University of Kentucky College of Public Health, Department of Health Management & Policy, 111 Washington Ave, Lexington, KY 40536, United States of America
| | - Evan Batty
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Hannah K Knudsen
- University of Kentucky College of Medicine, Department of Behavioral Science, 109 Medical Behavioral Science Building, Lexington, KY 40536, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Michele Staton
- University of Kentucky College of Medicine, Department of Behavioral Science, 109 Medical Behavioral Science Building, Lexington, KY 40536, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America
| | - Carrie B Oser
- University of Kentucky College of Arts & Sciences, Department of Sociology, 1515 Patterson Office Tower, Lexington, KY 40506, United States of America; University of Kentucky Center on Drug & Alcohol Research, 845 Angliana Ave, Lexington, KY 40508, United States of America; University of Kentucky Center for Health Equity Transformation, Suite 460 Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY 40536, United States of America
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22
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Baxley C, Borsari B, Reavis JV, Manuel JK, Herbst E, Becker W, Pennington D, Batki SL, Seal K. Effects of buprenorphine on opioid craving in comparison to other medications for opioid use disorder: A systematic review of randomized controlled trials. Addict Behav 2023; 139:107589. [PMID: 36565531 DOI: 10.1016/j.addbeh.2022.107589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Craving is a distressing symptom of opioid use disorder (OUD) that can be alleviated with medications for OUD (MOUD). Buprenorphine is an effective MOUD that may suppress craving; however, treatment discontinuation and resumed opioid use is common during the early phases of treatment. More information on the craving response through the high-risk period of initiating buprenorphine may provide meaningful information on how to better target craving, which in turn may enhance outcomes. This systematic review investigated buprenorphine doses and formulations on craving during the induction and maintenance phases of treatment, and for context also compared the craving response to other MOUD (i.e., methadone, extended-release naltrexone [XR-NTX]). METHODS PubMed, PsycInfo, Embase, and Cochrane Central databases were searched for randomized trials of buprenorphine versus placebo, various buprenorphine formulations/doses, or other MOUD that included a measure of opioid craving. RESULTS A total of 10 studies were selected for inclusion. Buprenorphine and buprenorphine/naloxone (BUP/NAL) were each associated with lower craving than placebo over time. Craving was greater among those prescribed lower versus higher buprenorphine doses. In comparison to other MOUD, buprenorphine or BUP/NAL was linked to greater craving than methadone in 3 of the 6 studies. BUP/NAL was associated with greater reported craving than XR-NTX. DISCUSSION Craving is reduced over time with buprenorphine and BUP/NAL, although other MOUD may provide greater reductions in craving. Although there is currently considerable variability in the measurement of craving, it may be a valuable concept to address with individuals receiving MOUD, especially early in treatment.
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Affiliation(s)
- Catherine Baxley
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Jill V Reavis
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States; Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Ellen Herbst
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - William Becker
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, United States; Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - David Pennington
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Steven L Batki
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Karen Seal
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
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23
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Kaufman DE, Kennalley AL, McCall KL, Piper BJ. Examination of methadone involved overdoses during the COVID-19 pandemic. Forensic Sci Int 2023; 344:111579. [PMID: 36739850 PMCID: PMC9886385 DOI: 10.1016/j.forsciint.2023.111579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The US opioid overdose epidemic continues to escalate. The restrictions on methadone availability including take-home dosing were loosened during the COVID-19 pandemic although there have been concerns about the high street value of diverted methadone. This report examined how fatal overdoses involving methadone have changed over the past two-decades including during the pandemic. METHODS The CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER) was used to find the unintentional methadone related overdose death rate from 1999 to 2020. Unintentional methadone deaths were defined using the ICD X40-44 codes with only data for methadone (T40.3). Data from the DEA's Automation of Reports and Consolidated Orders System (ARCOS) on methadone overall use, opioid treatment programs use, and pain management use was gathered for all states for 2020 and corrected for population. RESULTS There have been dynamic changes over the past two-decades in methadone overdoses. Overdoses increased from 1999 (0.9/million) to 2007 (15.9) and declined until 2019 (6.5). Overdoses in 2020 (9.6) were 48.1% higher than in 2019 (t(50) = 3.05, p < .005). The state level correlations between overall methadone use (r(49) = +0.75, p < .001), and opioid treatment program use (r(49) = +0.77, p < .001) with overdoses were positive, strong, and statistically significant. However, methadone use for pain treatment was not associated with methadone overdoses (r(49) = -0.08). CONCLUSIONS Overdoses involving methadone significantly increased by 48.1% in 2020 relative to 2019. Policy changes that were implemented following the COVID-19 pandemic involving methadone take-homes may warrant further study before they are made permanent.
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Affiliation(s)
| | - Amy L Kennalley
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Kenneth L McCall
- University of New England, Portland, ME, USA; Binghamton University, NY, USA
| | - Brian J Piper
- Touro College of Osteopathic Medicine, Middletown, NY, USA; Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA.
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24
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Chambers LC, Hallowell BD, Samuels EA, Daly M, Baird J, Beaudoin FL. An evaluation of the association between specific post-overdose care services in emergency departments and subsequent treatment engagement. J Am Coll Emerg Physicians Open 2023; 4:e12877. [PMID: 36643599 PMCID: PMC9833281 DOI: 10.1002/emp2.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 01/13/2023] Open
Abstract
Objective The objective of this study was to estimate the association between receipt of specific post-overdose care services in the emergency department (ED) and subsequent engagement in treatment for opioid use disorder (OUD) after discharge. Methods This was a retrospective cohort study of Rhode Island residents treated at 1 of 4 EDs for opioid overdose who were not engaged in OUD treatment and were discharged home (May 2016-April 2021). Electronic health record data were used to identify ED services received, and state administrative data were used to define subsequent engagement in OUD treatment within 30 days. Multivariable conditional logistic regression was used to estimate the association between ED services received and subsequent treatment engagement. Results Overall, 1008 people not engaged in OUD treatment were treated at study EDs for opioid overdose and discharged home, of whom 146 (14%) subsequently engaged in OUD treatment within 30 days. Most patients were aged 25 to 44 years (59%) and non-Hispanic White (69%). Receipt of behavioral counseling in the ED (adjusted odds ratio [aOR] = 1.79, 95% confidence interval [CI] = 1.18-2.71) and initiation of buprenorphine treatment in/from the ED (aOR = 5.86, 95% CI = 2.70-12.71) were associated with treatment engagement. Receipt of a take-home naloxone kit or naloxone prescription and referral to treatment at discharge were not associated with treatment engagement. Overall, 49% of patients received behavioral counseling in the ED, and 3% initiated buprenorphine in/from the ED. Conclusion Strategies for increasing provision of behavioral counseling and initiation of buprenorphine in the ED may be useful for improving subsequent engagement in OUD treatment after discharge.
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Affiliation(s)
- Laura C. Chambers
- Substance Use Epidemiology ProgramRhode Island Department of HealthProvidenceRhode IslandUSA,Division of Infectious DiseasesThe Miriam HospitalProvidenceRhode IslandUSA,Department of EpidemiologyBrown UniversityProvidenceRhode IslandUSA
| | - Benjamin D. Hallowell
- Substance Use Epidemiology ProgramRhode Island Department of HealthProvidenceRhode IslandUSA
| | - Elizabeth A. Samuels
- Department of EpidemiologyBrown UniversityProvidenceRhode IslandUSA,Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA,Drug Overdose Prevention ProgramRhode Island Department of HealthProvidenceRhode IslandUSA
| | - Mackenzie Daly
- Research, Data Evaluation, and Compliance UnitRhode Island Department of Behavioral HealthcareDevelopmental Disabilities, and HospitalsProvidenceRhode IslandUSA
| | - Janette Baird
- Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Francesca L. Beaudoin
- Department of EpidemiologyBrown UniversityProvidenceRhode IslandUSA,Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
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25
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Tun S, Vicknasingam B, Singh D, Wai N. Client satisfaction to methadone maintenance treatment program in Myanmar. Subst Abuse Treat Prev Policy 2022; 17:2. [PMID: 34980195 PMCID: PMC8722035 DOI: 10.1186/s13011-021-00429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background To tackle the long-standing opioid misuse problem, Myanmar introduced the methadone maintenance treatment (MMT) program in 2006, starting with 260 clients. Since then, the program has been expanded across different geographical sites in the country. This study was done in 2017 to explore the treatment satisfaction of the clients towards the MMT program. Method A total of 210 clients with a minimum of six-month treatment history enrolled in five MMT program sites across Myanmar were recruited through stratified random sampling. Administering the Verona Service Satisfaction Scale for Methadone-Treatment (VSSS-MT), this study assessed the satisfactory responses under three categories viz., 1) clinic staff professional skills; 2) basic drug intervention; 3) specific intervention (individual rehabilitation and psychotherapy). Results The majority (89%, n = 186) of the respondents were satisfied with the current MMT program. Specifically, 89.5% (n = 187) were satisfied with the clinic staff professional skills category, 91.9% (n = 192) with the basic program intervention and 74.6% (n = 156) with specific interventions. Among the respondents, treatment satisfaction with the MMT program was higher (p < 0.05) in those (i) with a higher quality of life score in physical, psychological, social and environmental categories, ii) who were satisfied with their current marital and leisure status, and those iii) who consumed alcohol. Results from stepwise binary logistic regression showed alcohol consumption and physical health status had a significant association with MMT treatment satisfaction. Conclusion Treatment satisfaction of the clients, in general is high. However, the lower percentage of satisfied clients (74.6%) for the specific interventions category compared with 89.5 and 91.9% respectively for staff and basic drug management categories highlights the need for improvement in this category for overall enhancement of the MMT program.
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26
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Landis RK, Opper I, Saloner B, Gordon AJ, Leslie DL, Sorbero M, Stein BD. Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies. Drug Alcohol Depend 2022; 241:109669. [PMID: 36332589 PMCID: PMC10695272 DOI: 10.1016/j.drugalcdep.2022.109669] [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: 05/12/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. METHODS Using 2006-2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14-64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. RESULTS Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p < 0.01) in the likelihood of episodes with a duration of at least 180 days in the first four years after policy implementation. The policy was not associated with changes in effective dosage or concurrent prescribing of opioid analgesics or benzodiazepines. CONCLUSIONS Buprenorphine prior authorization policies were associated with a sizeable and significant reduction in episodes of at least 180 days duration, underscoring the importance of identifying and removing barriers to effective and appropriate OUD care.
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Affiliation(s)
- Rachel K Landis
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
| | - Isaac Opper
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Douglas L Leslie
- Department of Public Health Sciences and Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA 17033, USA.
| | - Mark Sorbero
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA.
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27
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Harvey PD, Depp CA, Rizzo AA, Strauss GP, Spelber D, Carpenter LL, Kalin NH, Krystal JH, McDonald WM, Nemeroff CB, Rodriguez CI, Widge AS, Torous J. Technology and Mental Health: State of the Art for Assessment and Treatment. Am J Psychiatry 2022; 179:897-914. [PMID: 36200275 DOI: 10.1176/appi.ajp.21121254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Technology is ubiquitous in society and is now being extensively used in mental health applications. Both assessment and treatment strategies are being developed and deployed at a rapid pace. The authors review the current domains of technology utilization, describe standards for quality evaluation, and forecast future developments. This review examines technology-based assessments of cognition, emotion, functional capacity and everyday functioning, virtual reality approaches to assessment and treatment, ecological momentary assessment, passive measurement strategies including geolocation, movement, and physiological parameters, and technology-based cognitive and functional skills training. There are many technology-based approaches that are evidence based and are supported through the results of systematic reviews and meta-analyses. Other strategies are less well supported by high-quality evidence at present, but there are evaluation standards that are well articulated at this time. There are some clear challenges in selection of applications for specific conditions, but in several areas, including cognitive training, randomized clinical trials are available to support these interventions. Some of these technology-based interventions have been approved by the U.S. Food and Drug administration, which has clear standards for which types of applications, and which claims about them, need to be reviewed by the agency and which are exempt.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Colin A Depp
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Albert A Rizzo
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Gregory P Strauss
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - David Spelber
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Linda L Carpenter
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Ned H Kalin
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John H Krystal
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - William M McDonald
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Charles B Nemeroff
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Carolyn I Rodriguez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - Alik S Widge
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
| | - John Torous
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, and Miami VA Medical Center (Harvey); Department of Psychiatry, UC San Diego Medical Center, La Jolla (Depp); USC Institute for Creative Technologies, University of Southern California, Los Angeles (Rizzo); Department of Psychology, University of Georgia, Athens (Strauss); Department of Psychiatry, Dell Medical Center, University of Texas at Austin (Spelber, Nemeroff); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Wisconsin Medical School, Madison (Kalin); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (McDonald); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto (Rodriguez); Department of Psychiatry and Behavioral Sciences and Medical Discovery Team-Addictions, University of Minnesota, Minneapolis (Widge); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous)
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Rudolph KE, Williams NT, Goodwin ATS, Shulman M, Fishman M, Díaz I, Luo S, Rotrosen J, Nunes EV. Buprenorphine & methadone dosing strategies to reduce risk of relapse in the treatment of opioid use disorder. Drug Alcohol Depend 2022; 239:109609. [PMID: 36075154 PMCID: PMC9741946 DOI: 10.1016/j.drugalcdep.2022.109609] [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: 07/07/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although there is consensus that having a "high-enough" dose of buprenorphine (BUP-NX) or methadone is important for reducing relapse to opioid use, there is debate about what this dose is and how it should be attained. We estimated the extent to which different dosing strategies would affect risk of relapse over 12 weeks of treatment, separately for BUP-NX and methadone. METHODS This was a secondary analysis of three comparative effectiveness trials. We examined four dosing strategies: 1) increasing dose in response to participant-specific opioid use, 2) increasing dose weekly until some minimum dose (16 mg BUP, 100 mg methadone) was reached, 3) increasing dose weekly until some minimum and increasing dose in response to opioid use thereafter (referred to as the "hybrid strategy"), and 4) keeping dose constant after the first 2 weeks of treatment. We used a longitudinal sequentially doubly robust estimator to estimate contrasts between dosing strategies on risk of relapse. RESULTS For BUP-NX, increasing dose following the hybrid strategy resulted in the lowest risk of relapse. For methadone, holding dose constant resulted in greatest risk of relapse; the other three strategies performed similarly. For example, the hybrid strategy reduced week 12 relapse risk by 13 % (RR: 0.87, 95 %CI: 0.83-0.95) and by 20 % (RR: 0.80, 95 %CI: 0.71-0.90) for BUP-NX and methadone respectively, as compared to holding dose constant. CONCLUSIONS Doses should be targeted toward minimum thresholds and, in the case of BUP-NX, raised when patients continue to use opioids.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Nicholas T Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alicia T Singham Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matisyahu Shulman
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Maryland Treatment Centers, Baltimore, MD, USA
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Sean Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
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29
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Wang TY, Lu RB, Lee SY, Chang YH, Chen SL, Tsai TY, Tseng HH, Chen PS, Chen KC, Yang YK, Hong JS. Association Between Inflammatory Cytokines, Executive Function, and Substance Use in Patients With Opioid Use Disorder and Amphetamine-Type Stimulants Use Disorder. Int J Neuropsychopharmacol 2022; 26:42-51. [PMID: 36181736 PMCID: PMC9850661 DOI: 10.1093/ijnp/pyac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Long-term opioid and amphetamine-type stimulants (ATS) abuse may affect immunological function and impair executive function. We aimed to determine whether biomarkers of inflammation and executive function were associated with substance use in individuals with opioid use disorder (OUD) and ATS use disorder (ATSUD). The interactions between these biomarkers were also explored. METHODS We assessed plasma cytokines [tumor necrosis factor (TNF)-α, C-reactive protein (CRP), interleukin (IL)-8, IL-6, transforming growth factor (TGF)-β1, brain-derived neurotrophic factor (BDNF), and executive function in terms of the Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) in OUD and ATSUD patients and healthy controls (HC). OUD and ATSUD patients were followed for 12 weeks, and their urine morphine and amphetamine tests, cytokine levels, and executive function were repeatedly measured. RESULTS We enrolled 483 patients and 145 HC. Plasma TNF-α, CRP, IL-8, IL-6, and BDNF levels and most subscale scores on the WCST and CPT significantly differed between OUD and ATSUD patients and HC. Increased TNF-α levels and more perseveration error on the WCST were significantly associated with more urine drug-positive results and less abstinence. Plasma IL-6 and CRP levels were significantly negatively correlated with WCST and CPT performance. CONCLUSION OUD and ATSUD patients had more inflammation and worse executive function than HC. Inflammatory markers and WCST performance were associated with their urinary drug results, and higher inflammation was associated with poor executive function. Studies on regulating the inflammatory process and enhancing executive function in OUD and ATSUD are warranted.
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Affiliation(s)
- Tzu-Yun Wang
- Correspondence: Tzu-Yun Wang, MD, Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan ()
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,YiNing Hospital, Beijing, China
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yun-Hsuan Chang
- Institute of Gerontology,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Genomics and Bioinformatics, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Yu Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jau-Shyong Hong
- Neurobiology Laboratory, NIH/NIEHS, Research Triangle Park, North Carolina, USA
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Kameg B, Fradkin D, Lepore M. An overview of buprenorphine prescribing for the advanced practice psychiatric nurse. Perspect Psychiatr Care 2022; 58:2059-2063. [PMID: 35092616 DOI: 10.1111/ppc.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Rates of at-risk opioid use, opioid use disorder, and opioid overdose remain alarmingly high. There are medications that can be used to treat opioid use disorder, including methadone, buprenorphine, and naltrexone, although access to care remains difficult. This review seeks to provide advanced practice psychiatric nurses (APPNs) with an overview of buprenorphine prescribing, with an emphasis on novel, long-acting delivery systems. CONCLUSIONS APPNs should be familiar with best practices regarding buprenorphine prescribing. Some patients may benefit from long-acting delivery methods, such as subdermal implants, or subcutaneous injections. PRACTICE IMPLICATIONS APPNs can reduce barriers to buprenorphine access and should be familiar with best practices related to buprenorphine prescribing.
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Affiliation(s)
- Brayden Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Dina Fradkin
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Madeleine Lepore
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Nielsen S, Tse WC, Larance B. Opioid agonist treatment for people who are dependent on pharmaceutical opioids. Cochrane Database Syst Rev 2022; 9:CD011117. [PMID: 36063082 PMCID: PMC9443668 DOI: 10.1002/14651858.cd011117.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are ongoing concerns regarding pharmaceutical opioid-related harms, including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin. OBJECTIVES: To assess the effects of maintenance opioid agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence. SEARCH METHODS We updated our searches of the following databases to January 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, four other databases, and two trial registers. We checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with adults and adolescents examining maintenance opioid agonist treatments that made the following two comparisons. 1. Full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment. 2. Full or partial opioid agonist maintenance versus non-opioid agonist treatments (detoxification, opioid antagonist, or psychological treatment without opioid agonist treatment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We identified eight RCTs that met inclusion criteria (709 participants). We found four studies that compared methadone and buprenorphine maintenance treatment, and four studies that compared buprenorphine maintenance to either buprenorphine taper (in addition to psychological treatment) or a non-opioid maintenance treatment comparison. We found low-certainty evidence from three studies of a difference between methadone and buprenorphine in favour of methadone on self-reported opioid use at end of treatment (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.28 to 0.86; 165 participants), and low-certainty evidence from four studies finding a difference in favour of methadone for retention in treatment (RR 1.21, 95% CI 1.02 to 1.43; 379 participants). We found low-certainty evidence from three studies showing no difference between methadone and buprenorphine on substance use measured with urine drug screens at end of treatment (RR 0.81, 95% CI 0.57 to 1.17; 206 participants), and moderate-certainty evidence from one study of no difference in days of self-reported opioid use (mean difference 1.41 days, 95% CI 3.37 lower to 0.55 days higher; 129 participants). There was low-certainty evidence from three studies of no difference between methadone and buprenorphine on adverse events (RR 1.13, 95% CI 0.66 to 1.93; 206 participants). We found low-certainty evidence from four studies favouring maintenance buprenorphine treatment over non-opioid treatments in terms of fewer opioid positive urine drug tests at end of treatment (RR 0.66, 95% CI 0.52 to 0.84; 270 participants), and very low-certainty evidence from four studies finding no difference on self-reported opioid use in the past 30 days at end of treatment (RR 0.63, 95% CI 0.39 to 1.01; 276 participants). There was low-certainty evidence from three studies of no difference in the number of days of unsanctioned opioid use (standardised mean difference (SMD) -0.19, 95% CI -0.47 to 0.09; 205 participants). There was moderate-certainty evidence from four studies favouring buprenorphine maintenance over non-opioid treatments on retention in treatment (RR 3.02, 95% CI 1.73 to 5.27; 333 participants). There was moderate-certainty evidence from three studies of no difference in adverse effects between buprenorphine maintenance and non-opioid treatments (RR 0.50, 95% CI 0.07 to 3.48; 252 participants). The main weaknesses in the quality of the data was the use of open-label study designs, and difference in follow-up rates between treatment arms. AUTHORS' CONCLUSIONS There is very low- to moderate-certainty evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine did not differ on some outcomes, although on the outcomes of retention and self-reported substance use some results favoured methadone. Maintenance treatment with buprenorphine appears more effective than non-opioid treatments. Due to the overall very low- to moderate-certainty evidence and small sample sizes, there is the possibility that the further research may change these findings.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - Wai Chung Tse
- Monash Addiction Research Centre, Monash University, Frankston, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Briony Larance
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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Toloff K, Woodcock EA. Is the Neuroimmune System a Therapeutic Target for Opioid Use Disorder? A Systematic Review. MEDICAL RESEARCH ARCHIVES 2022; 10:2955. [PMID: 37744743 PMCID: PMC10516332 DOI: 10.18103/mra.v10i8.2955] [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] [Indexed: 09/26/2023]
Abstract
Opioid use disorder (OUD) is an epidemic in the United States. In the past 12 months alone, there have been 75,000+ deaths attributed to opioid overdose: more than any other year in American history. Current pharmacotherapies for the treatment of OUD effectively suppress opioid withdrawal symptoms, but long-term relapse rates remain unacceptably high. Novel treatments for OUD are desperately needed to curb this epidemic. One target that has received considerable recent interest is the neuroimmune system. The neuroimmune system is anchored by glial cells, i.e., microglia and astrocytes, but neuroimmune signaling is known to influence neurons, including altering neurotransmission, synapse formation, and ultimately, brain function. Preclinical studies have shown that experimental attenuation of pro-inflammatory neuroimmune signaling modulates opioid addiction processes, including opioid reward, tolerance, and withdrawal symptoms, which suggests potential therapeutic benefit in patients. Whereas the peripheral immune system in OUD patients has been studied for decades and is well-understood, little is known about the neuroimmune system in OUD patients or its viability as a treatment target. Herein, we review the literature describing relationships between opioid administration and the neuroimmune system, the influence of neuroimmune signaling on opioid addiction processes, and the therapeutic potential for targeting the neuroimmune system in OUD subjects using glial modulator medications.
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Affiliation(s)
- Katelyn Toloff
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eric A. Woodcock
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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Fiddian-Green A, Gubrium A, Harrington C, Evans EA. Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159346. [PMID: 35954700 PMCID: PMC9368271 DOI: 10.3390/ijerph19159346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/07/2022]
Abstract
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
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Affiliation(s)
- Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA
- Correspondence:
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
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Taylor JL, Laks J, Christine PJ, Kehoe J, Evans J, Kim TW, Farrell NM, White CS, Weinstein ZM, Walley AY. Bridge clinic implementation of "72-hour rule" methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care. Drug Alcohol Depend 2022; 236:109497. [PMID: 35607834 DOI: 10.1016/j.drugalcdep.2022.109497] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Methadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal for up to 72 h while arranging ongoing care. Our low-barrier bridge clinic implemented a new pathway to treat opioid withdrawal and facilitate OTP linkage utilizing the "72-hour rule." METHODS Patients presenting to a hospital-based bridge clinic were evaluated for OUD, opioid withdrawal, and treatment goals. Eligible patients were offered methadone opioid withdrawal management with rapid OTP referral. OTPs accepted patients as direct admissions. We described bridge clinic patients who received at least one dose of methadone between March-August 2021 and key clinical outcomes including OTP referral completion within 72 h. For the subset of patients referred to our two primary OTP partners, we described OTP linkage (i.e., attended at least one OTP visit within one month) and OTP retention at one month. RESULTS Methadone was administered during 150 episodes of care for 142 unique patients, the majority of whom were male (73%), white (67%), and used fentanyl (85%). In 92% of episodes (138/150), a plan for ongoing care was in place within 72 h. Among 121 referrals to two primary OTP partners, 87% (105/121) linked and 58% (70/121) were retained at one month. CONCLUSIONS Methadone administration for opioid withdrawal with direct OTP admission under the "72-hour rule" is feasible in an outpatient bridge clinic and resulted in high OTP linkage and 1-month retention rates. This model has the potential to improve methadone access.
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Affiliation(s)
- Jessica L Taylor
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Paul J Christine
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Jessica Kehoe
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - James Evans
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Theresa W Kim
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA; Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Cedric S White
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Zoe M Weinstein
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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John WS, Mannelli P, Hoyle RH, Greenblatt L, Wu LT. Association of chronic non-cancer pain status and buprenorphine treatment retention among individuals with opioid use disorder: Results from electronic health record data. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100048. [PMID: 36845986 PMCID: PMC9948869 DOI: 10.1016/j.dadr.2022.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although chronic non-cancer pain (CNCP) is common among individuals with opioid use disorder (OUD), its impact on buprenorphine treatment retention is unclear. The goal of this study was to use electronic health record (EHR) data to examine the association of CNCP status and 6-month buprenorphine retention among patients with OUD. METHODS We analyzed EHR data of patients with OUD who received buprenorphine treatment in an academic healthcare system between 2010 and 2020 (N = 676). We used Kaplan-Meier curves and Cox proportional hazards regression to estimate risk of buprenorphine treatment discontinuation (≥90 days between subsequent prescriptions). We used Poisson regression to estimate the association of CNCP and the number of buprenorphine prescriptions over 6 months. RESULTS Compared to those without CNCP, a higher proportion of patients with CNCP were of older age and had comorbid diagnoses for psychiatric and substance use disorders. There were no differences in the probability of buprenorphine treatment continuation over 6 months by CNCP status (p = 0.15). In the adjusted cox regression model, the presence of CNCP was not associated with time to buprenorphine treatment discontinuation (HR = 0.90, p = 0.28). CNCP status was associated with a higher number of prescriptions over 6 months (IRR = 1.20, p < 0.01). CONCLUSIONS These findings suggest that the presence of CNCP alone cannot be reliably associated with buprenorphine retention in patients with OUD. Nonetheless, providers should be aware of the association between CNCP and greater psychiatric comorbidity among patients with OUD when developing treatment plans. Research on the influence of additional characteristics of CNCP on treatment retention is needed.
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Affiliation(s)
- William S. John
- Department of Psychiatry and Behavioral Sciences, Division of Social and Community Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - Paolo Mannelli
- Department of Pyschiatry and Behavioral Sciences, Division of Adult Psychiatry and Psychology, Duke University Medical Center, Durham, NC, United States
| | - Rick H. Hoyle
- Department of Pyschiatry and Behavioral Sciences, Division of Adult Psychiatry and Psychology, Duke University Medical Center, Durham, NC, United States
| | - Lawrence Greenblatt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Division of Social and Community Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Institue for Brain Sciences, Duke University, Durham, NC, United States
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, United States
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Golan OK, Totaram R, Perry E, Fortson K, Rivera-Atilano R, Entress R, Golan M, Andraka-Christou B, Whitaker D, Pigott T. Systematic review and meta-analysis of changes in quality of life following initiation of buprenorphine for opioid use disorder. Drug Alcohol Depend 2022; 235:109445. [PMID: 35430522 DOI: 10.1016/j.drugalcdep.2022.109445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND People with opioid use disorder (OUD) experience lower quality of life (QoL) than the general population, but buprenorphine treatment for OUD could help improve QoL of individuals with OUD. Thus, we conducted a systematic review and meta-analysis of the impact of buprenorphine on QoL among people with OUD. METHODS Seven databases were searched through August 2020. We included English-language studies with pre- and post- QoL assessments internationally. Standardized mean differences were calculated for five domains of QoL measures using a random effects model for correlated effect sizes with robust variance estimation. Meta-regression was used to assess variation in effect sizes based on QoL domain, treatment, and patient factors. RESULTS Twenty-one peer-reviewed studies from twelve countries were included. Only three studies included a no-treatment control group and five studies assigned groups using randomization. Improvements between baseline and follow-up were observed across all five domains of QoL measures (overall, physical, psychological, social, and environmental). The certainty of evidence was low for all domains of QoL, and very low for environmental QoL. We did not observe differences in the effect of buprenorphine on QoL by QoL domain, duration, dose, participant characteristics, or adjunctive counseling services. CONCLUSIONS Buprenorphine treatment likely improves overall, physical, psychological, and social QoL, and may improve environmental QoL, for individuals with OUD. Findings are limited by study quality, including lack of control groups and incomplete reporting. Future studies with more rigorous methods and comprehensive reporting are needed.
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Affiliation(s)
- Olivia K Golan
- School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Rachel Totaram
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States
| | - Elizabeth Perry
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Kennicia Fortson
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | | | - Rebecca Entress
- School of Public Administration, University of Central Florida, Orlando, FL, United States
| | - Matthew Golan
- School of Law, Emory University, Atlanta, GA, United States
| | - Barbara Andraka-Christou
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States; Department of Internal Medicine, University of Central Florida, Orlando, FL, United States
| | - Daniel Whitaker
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Therese Pigott
- School of Public Health, Georgia State University, Atlanta, GA, United States; College of Education & Human Development, Georgia State University, Atlanta, GA, United States
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Clifton D, Ivey N, Poley S, O'Regan A, Raman SR, Frascino N, Hamilton S, Setji N. Implementation of a comprehensive hospitalist-led initiative to improve care for patients with opioid use disorder. J Hosp Med 2022; 17:427-436. [PMID: 35535562 PMCID: PMC9321616 DOI: 10.1002/jhm.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND As opioid-related hospitalizations rise, hospitals must be prepared to evaluate and treat patients with opioid use disorder (OUD). We implemented a hospitalist-led program, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET) to address gaps in care for hospitalized patients with OUD. OBJECTIVE Implement evidence-based treatment for inpatients with OUD and refer to postdischarge care. DESIGN, SETTING, AND PARTICIPANTS Project COMET launched in July 2019 at Duke University Hospital (DUH), an academic medical center in Durham, NC. INTERVENTION, MAIN OUTCOMES, AND MEASURES We engaged key stakeholders, performed a needs assessment, and secured health system funding. We developed protocols to standardize OUD treatment and employed a social worker to facilitate postdischarge care. Electronic health records were utilized for data analysis. RESULTS COMET evaluated 512 patients for OUD during their index hospitalization from July 1, 2019 through June 30, 2021. Seventy-one percent of patients received medication for OUD (MOUD) during admission. Of those who received buprenorphine during admission, 64% received a discharge prescription. Of those who received methadone during admission, 83% of eligible patients were connected to a methadone clinic. Among all patients at DUH with OUD, MOUD use during hospitalization and at discharge increased in the post-COMET period compared to the pre-COMET period (p < .001 for both). CONCLUSION Our program is one of the first to demonstrate successful implementation of a hospitalist-led, comprehensive approach to caring for hospitalized patients with OUD and can serve as an example to other institutions seeking to implement life-saving, evidence-based treatment in this population.
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Affiliation(s)
- Dana Clifton
- Department of MedicineDivision of General Internal Medicine, Duke University School of MedicineDurhamNorth CarolinaUSA
- Department of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Noel Ivey
- Department of MedicineDivision of General Internal Medicine, Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Stephanie Poley
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Amy O'Regan
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sudha R. Raman
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Nicole Frascino
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Shavone Hamilton
- Clinical Social Work, Duke University HospitalDurhamNorth CarolinaUSA
| | - Noppon Setji
- Department of MedicineDivision of General Internal Medicine, Duke University School of MedicineDurhamNorth CarolinaUSA
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Champagne K, Date P, Forero JP, Arany J, Gritsenko K. Patients on Buprenorphine Formulations Undergoing Surgery. Curr Pain Headache Rep 2022; 26:459-468. [PMID: 35460492 DOI: 10.1007/s11916-022-01046-6] [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] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the pharmacology of buprenorphine, the evolution of buprenorphine dosing recommendations, and the current literature regarding its recommendations for the perioperative period. RECENT FINDINGS There is a consensus that for all surgeries, buprenorphine should be continued throughout the perioperative period. If the surgery is a minimal to mild pain surgery, no dose adjustment is needed. There is no clear consensus regarding moderate to severe pain. With all surgeries, multimodal analgesia should be utilized, with regional anesthesia when possible. Patients taking buprenorphine should continue their buprenorphine perioperatively; whether to decrease or maintain dosing is up for debate. Multimodal analgesia should also be used throughout the perioperative period, and communication between the patient and all provider teams is of the utmost importance to provide adequate analgesia during the perioperative period, as well as to arrange safe analgesia upon discharge.
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Affiliation(s)
- Katelynn Champagne
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Preshita Date
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Juan Pablo Forero
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Joshua Arany
- Townsend Harris High School, 149-11 Melbourne Ave, Flushing, NY, 11367, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
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Wakeman SE. Opioid Use Disorder Diagnosis and Management. NEJM EVIDENCE 2022; 1:EVIDra2200038. [PMID: 38319203 DOI: 10.1056/evidra2200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Opioid Use Disorder Diagnosis and ManagementThe last 20 years have seen a staggering increase in opioid-related morbidity and mortality. Although the consequences of untreated OUDs are significant, OUD is a treatable illness. This article reviews the epidemiology of OUD and its complications, screening, diagnosis, treatment, and harm reduction interventions.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Quality, Patient Experience, and Equity, Mass General Brigham, Boston
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Rudolph KE, Shulman M, Fishman M, Díaz I, Rotrosen J, Nunes EV. Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse. Addiction 2022; 117:637-645. [PMID: 34338389 PMCID: PMC9717480 DOI: 10.1111/add.15654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Dynamic, adaptive pharmacologic treatment for opioid use disorder (OUD) has been previously recommended over static dosing to prevent relapse, and is aligned with personalized medicine. However, there has been no quantitative evidence demonstrating its advantage. Our objective was to estimate the extent to which a hypothetical intervention that increased buprenorphine dose in response to opioid use would affect risk of relapse over 24 weeks of follow-up. DESIGN A secondary analysis of the buprenorphine arm of an open-label randomized controlled 24-week comparative effectiveness trial, 2014-17. SETTING Eight community addiction treatment programs in the United States. PARTICIPANTS English-speaking adults with DSM-5 OUD, recruited during inpatient admission (n = 270). Participants were mainly white (65%) and male (72%). INTERVENTION(S) Participants were treated with daily sublingual buprenorphine-naloxone (BUP-NX), with dose based on clinical indication, determined by the provider. We examined a hypothetical intervention of increasing dose in response to opioid use. MEASUREMENTS Outcome was relapse to regular opioid use during the 24 weeks of outpatient treatment, assessed in a survival framework. We estimated the relapse-free survival curves of participants under a hypothetical (i.e. counterfactual) intervention in which their BUP-NX dosage would be increased following their own subject-specific opioid use during the first 12 weeks of treatment versus a hypothetical intervention in which dose would remain constant. FINDINGS We estimated that increasing BUP-NX dose in response to recent opioid use would lower risk of relapse by 19.17 percentage points [95% confidence interval (CI) = -32.17, -6.18) (additive risk)] and 32% (0.68, 95% CI = 0.49, 0.86) (relative risk). The number-needed-to-treat with this intervention to prevent a single relapse is 6. CONCLUSIONS In people with opioid use disorder, a hypothetical intervention that increases sublingual buprenorphine-naloxone dose in response to opioid use during the first 12 weeks of treatment appears to reduce risk of relapse over 24 weeks, compared with holding the dose constant after week 2.
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Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matisyahu Shulman
- Department of Psychiatry, School of Medicine, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Maryland Treatment Centers, Baltimore, MD, USA
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, School of Medicine, New York University, New York, NY, USA
| | - Edward V. Nunes
- Department of Psychiatry, School of Medicine, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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White KM, Hill LG, Perez JC, Torrez SB, Zagorski CM, Loera LJ. Policies regarding use of medications for opioid use disorder in professional recovery programs: A scoping review. Subst Abuse 2022; 43:749-755. [DOI: 10.1080/08897077.2021.2010161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kelley M. White
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Lucas G. Hill
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Joshua C. Perez
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Sorina B. Torrez
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Claire M. Zagorski
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Lindsey J. Loera
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
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Lee YK, Gold MS, Fuehrlein BS. Looking beyond the opioid receptor: A desperate need for new treatments for opioid use disorder. J Neurol Sci 2022; 432:120094. [PMID: 34933249 DOI: 10.1016/j.jns.2021.120094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
The mainstay of treatment for opioid use disorder (OUD) is opioid agonist therapy (OAT), which modulates opioid receptors to reduce substance craving and use. OAT maintains dependence on opioids but helps reduce overdose and negative sequelae of substance abuse. Despite increasing availability of OAT, its effectiveness is limited by difficulty in initiating and maintaining patients on treatment. With the worsening opioid epidemic in the United States and rising overdose deaths, a more durable and effective treatment for OUD is necessary. This paper reviews novel treatments being investigated for OUD, including neuromodulatory interventions, psychedelic drugs, and other novel approaches. Neuromodulatory interventions can stimulate the addiction neural circuitry involving the dorsolateral prefrontal cortex and deeper mesolimbic structures to curb craving and reduce use, and multiple clinical trials for interventional treatment for OUD are currently conducted. Similarly, psychedelic agents are being investigated for efficacy in OUD specifically. There is a resurgence of interest in psychedelic agents' therapeutic potential, with evidence of improving mood symptoms and decreased substance use even after just one dose. Exact mechanism of their anti-addictive effect is not fully elucidated, but psychedelic agents do not maintain opioid dependence and some may even be helpful in abating symptoms of withdrawal. Other potential approaches for OUD include targeting different parts of the dopamine-dependent addiction pathway, identifying susceptible genes and modulating gene products, as well as utilizing vaccines as immunotherapy to blunt the addictive effects of substances. Much more clinical data are needed to support efficacy and safety of these therapies in OUD, but these proposed novel treatments look beyond the opioid receptor to offer hope for a more durably effective OUD treatment.
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Affiliation(s)
- Yu Kyung Lee
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA.
| | - Mark S Gold
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Brian S Fuehrlein
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT 06511, USA.
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Kessler SH, Schwarz ES, Liss DB. Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder? J Med Toxicol 2022; 18:11-18. [PMID: 34554396 PMCID: PMC8758885 DOI: 10.1007/s13181-021-00858-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/03/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Data are needed to inform whether the choice of medication during hospitalization influences probability of retention in outpatient OUD treatment. METHODS This was a retrospective cohort analysis of patients who received a medical toxicology consult for OUD. Medical records were reviewed to determine if patients received MOUD and were referred to Engaging Patients in Care Coordination (EPICC), a service that connects hospitalized patients with OUD to outpatient care. Patients were stratified by the last form of MOUD they received in the hospital (methadone verses buprenorphine); retention in outpatient treatment was measured at 2 weeks, 30 days, and 12 weeks. The log-rank test was used to determine the difference in probabilities of retention in the methadone and buprenorphine groups. An event was defined as drop-out from outpatient treatment. RESULTS Of 267 total patients with medical toxicology consults for OUD, 155 received MOUD and referral to EPICC. One hundred six patients received buprenorphine and 46 received methadone. Three additional patients were excluded. The rate of retention in outpatient treatment for patients who received buprenorphine was 37%, 26%, and 13% and for patients who received methadone was 43%, 39%, and 35% at 2 weeks, 30 days, and 12 weeks, respectively. Methadone was associated with a statistically significant increased probability of retention in outpatient treatment as compared to buprenorphine (P < 0.01). CONCLUSION Despite the limitations of this retrospective study, in hospitalized patients who received MOUD, the probability of retention in outpatient treatment was higher in patients receiving methadone compared to buprenorphine.
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Affiliation(s)
- Skyler H Kessler
- Washington University in St. Louis School of Medicine, St. Louis, USA
| | - Evan S Schwarz
- Division of Toxicology, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave. Campus, Box 8072, St. Louis, MO, 63110, USA
| | - David B Liss
- Division of Toxicology, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave. Campus, Box 8072, St. Louis, MO, 63110, USA.
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Greiner MG, Shulman M, Scodes J, Choo TH, Pavlicova M, Opara O, Campbell ANC, Novo P, Fishman M, Lee JD, Rotrosen J, Nunes EV. Patient Characteristics Associated with Opioid Abstinence after Participation in a Trial of Buprenorphine versus Injectable Naltrexone. Subst Use Misuse 2022; 57:1732-1742. [PMID: 35975917 PMCID: PMC10044490 DOI: 10.1080/10826084.2022.2112230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background and Objectives: Better understanding of predictors of opioid abstinence among patients with opioid use disorder (OUD) may help to inform interventions and personalize treatment plans. This analysis examined patient characteristics associated with opioid abstinence in the X:BOT (Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment) trial. Methods: This post-hoc analysis examined factors associated with past-month opioid abstinence at the 36-week follow-up visit among participants in the X:BOT study. 428 participants (75% of original sample) attended the visit at 36 weeks. Logistic regression models were used to estimate the probability of opioid abstinence across various baseline sociodemographics, clinical characteristics, and treatment variables. Results: Of the 428 participants, 143 (33%) reported abstinence from non-prescribed opioids at the 36-week follow-up. Participants were more likely to be opioid abstinent if randomized to XR-NTX (compared to BUP-NX), were on XR-NTX at week 36 (compared to those off OUD pharmacotherapy), successfully inducted onto either study medication, had longer time on study medication, reported a greater number of abstinent weeks, or had longer time to relapse during the 24-week treatment trial. Participants were less likely to be abstinent if Hispanic, had a severe baseline Hamilton Depression Rating (HAM-D) score, or had baseline sedative use. Conclusions: A substantial proportion of participants was available at follow-up (75%), was on OUD pharmacotherapy (53%), and reported past-month opioid abstinence (33%) at 36 weeks. A minority of patients off medication for OUD reported abstinence and additional research is needed exploring patient characteristics that may be associated with successful treatment outcomes.
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Affiliation(s)
- Miranda G Greiner
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Matisyahu Shulman
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer Scodes
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Onumara Opara
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Aimee N C Campbell
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Patricia Novo
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Marc Fishman
- Department of Psychiatry, Johns Hopkins University School of Medicine and Maryland Treatment Centers, Baltimore, Maryland, USA
| | - Joshua D Lee
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - John Rotrosen
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Edward V Nunes
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
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Tun S, Balasingam V, Singh DS. Factors associated with quality of life (QOL) scores among methadone patients in Myanmar. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000469. [PMID: 36962722 PMCID: PMC10021231 DOI: 10.1371/journal.pgph.0000469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
The Drug Dependency Treatment and Research Unit (DDTRU) in Myanmar established opioid substitution with methadone in 2006. Reducing HIV transmission could be affected by eliminating the unsafe needle sharing among injecting drug uses and treatment with opioid substitution. The quality of life (QOL) among the clients retained in the methadone program is important for their personal development and is an indication of the treatment efficacy. This study evaluated factors associated with the QOL of methadone patients to ensure efficient service delivery. It also identified how patients' characteristics had differed QOL scores of respondents. This cross-sectional study was conducted in five cities with stratified random sampling. The study assessed the QOL of methadone patients in Myanmar. The study recruited 210 respondents to answer structured questionnaires for their quality of life: WHOQOL-BREF questionnaires and urine sample collection for methadone and illicit drug use. Survey responses on the QOL were transformed into 100-scale ratings, and higher QOL scores reflect better QOL. The average score of total QOL was 60.82%; precisely 60.09% in the physical domain, 63.11% in the psychological domain, 59.87% in the social relation domain, 60.41% in the environmental domain respectively. Respondents who reported illicit drug use had lower QOL scores. Statistically significant association of the QOL category of the methadone patients was identified with frequent methadone treatment episodes, the infection status of HIV, current treatment on antiretroviral therapy (ART), tuberculosis (TB) treatment history, sexually transmitted infections (STI) history in their lifetime, current work status as peer, Addiction Severity Index (ASI) for drug use, satisfaction with current marital status, satisfaction with current leisure status, history of psychological abuse within 30 days, heroin injection within 30 days, frequency of injection, and reported use of barbiturates (p<0.05). Addressing these factors will improve the treatment service intervention and the quality of life among methadone patients.
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Affiliation(s)
- Sun Tun
- Myanmar Medical Association, Yangon, Myanmar
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
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Hawkins EJ, Malte CA, Gordon AJ, Williams EC, Hagedorn HJ, Drexler K, Blanchard BE, Burden JL, Knoeppel J, Danner AN, Lott A, Liberto JG, Saxon AJ. Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System. JAMA Netw Open 2021; 4:e2137238. [PMID: 34870679 PMCID: PMC8649831 DOI: 10.1001/jamanetworkopen.2021.37238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE With increasing rates of opioid use disorder (OUD) and overdose deaths in the US, increased access to medications for OUD (MOUD) is paramount. Rigorous effectiveness evaluations of large-scale implementation initiatives using quasi-experimental designs are needed to inform expansion efforts. OBJECTIVE To evaluate a US Department of Veterans Affairs (VA) initiative to increase MOUD use in nonaddiction clinics. DESIGN, SETTING, AND PARTICIPANTS This quality improvement initiative used interrupted time series design to compare trends in MOUD receipt. Primary care, pain, and mental health clinics in the VA health care system (n = 35) located at 18 intervention facilities and nonintervention comparison clinics (n = 35) were matched on preimplementation MOUD prescribing trends, clinic size, and facility complexity. The cohort of patients with OUD who received care in intervention or comparison clinics in the year after September 1, 2018, were evaluated. The preimplementation period extended from September 1, 2017, through August 31, 2018, and the postimplementation period from September 1, 2018, through August 31, 2019. EXPOSURES The multifaceted implementation intervention included education, external facilitation, and quarterly reports. MAIN OUTCOMES AND MEASURES The main outcomes were the proportion of patients receiving MOUD and the number of patients per clinician prescribing MOUD. Segmented logistic regression evaluated monthly proportions of MOUD receipt 1 year before and after initiative launch, adjusting for demographic and clinical covariates. Poisson regression models examined yearly changes in clinician prescribing over the same time frame. RESULTS Overall, 7488 patients were seen in intervention clinics (mean [SD] age, 53.3 [14.2] years; 6858 [91.6%] male; 1476 [19.7%] Black, 417 [5.6%] Hispanic; 5162 [68.9%] White; 239 [3.2%] other race [including American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiple races]; and 194 [2.6%] unknown) and 7558 in comparison clinics (mean [SD] age, 53.4 [14.0] years; 6943 [91.9%] male; 1463 [19.4%] Black; 405 [5.4%] Hispanic; 5196 [68.9%] White; 244 [3.2%] other race; 250 [3.3%] unknown). During the preimplementation year, the proportion of patients receiving MOUD in intervention clinics increased monthly by 5.0% (adjusted odds ratio [AOR], 1.05; 95% CI, 1.03-1.07). Accounting for this preimplementation trend, the proportion of patients receiving MOUD increased monthly by an additional 2.3% (AOR, 1.02; 95% CI, 1.00-1.04) during the implementation year. Comparison clinics increased by 2.6% monthly before implementation (AOR, 1.03; 95% CI, 1.01-1.04), with no changes detected after implementation. Although preimplementation-year trends in monthly MOUD receipt were similar in intervention and comparison clinics, greater increases were seen in intervention clinics after implementation (AOR, 1.04; 95% CI, 1.01-1.08). Patients treated with MOUD per clinician in intervention clinics saw greater increases from before to after implementation compared with comparison clinics (incidence rate ratio, 1.50; 95% CI, 1.28-1.77). CONCLUSIONS AND RELEVANCE A multifaceted implementation initiative in nonaddiction clinics was associated with increased MOUD prescribing. Findings suggest that engagement of clinicians in general clinical settings may increase MOUD access.
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Affiliation(s)
- Eric J. Hawkins
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Carol A. Malte
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Health Services Research & Development, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Emily C. Williams
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Hildi J. Hagedorn
- Center for Care Delivery & Outcomes Research, Health Services Research & Development, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Psychiatry, University of Minnesota, Minneapolis
| | - Karen Drexler
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jennifer L. Burden
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
| | - Jennifer Knoeppel
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
| | - Anissa N. Danner
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Aline Lott
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Joseph G. Liberto
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Andrew J. Saxon
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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Greiner MG, Shulman M, Choo TH, Scodes J, Pavlicova M, Campbell ANC, Novo P, Fishman M, Lee JD, Rotrosen J, Nunes EV. Naturalistic follow-up after a trial of medications for opioid use disorder: Medication status, opioid use, and relapse. J Subst Abuse Treat 2021; 131:108447. [PMID: 34098301 PMCID: PMC8556394 DOI: 10.1016/j.jsat.2021.108447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
AIM This report examined naturalistic opioid use outcomes and utilization of medications for opioid use disorder (MOUD) 36 weeks post-randomization in the National Drug Abuse Treatment Clinical Trials Network (CTN) Extended-Release Naltrexone (XR-NTX) versus Buprenorphine-Naloxone (BUP-NX) for Opioid Treatment trial (CTN-0051, X:BOT). DESIGN X:BOT was a multisite, randomized, 24-week comparative effectiveness trial of BUP-NX (N = 287) and XR-NTX (N = 283). Study medications were discontinued following treatment completion, relapse, or dropout. Participants were encouraged to continue MOUD. This report examined opioid use outcomes in 428 (75%) of the 570 participants who attended the 36-week follow-up visit. SETTING AND PARTICIPANTS Adults with opioid use disorder recruited from 8 community treatment programs across the United States. MEASUREMENTS Outcomes included medication status (on/off MOUD), type of MOUD (BUP-NX, XR-NTX, or methadone), abstinence from non-prescribed opioids, opioid use days, relapse, and other substance use 30 days prior to the 36-week visit. Relapse was defined as opioid use for 4 consecutive weeks or 7 consecutive days in the past month. Baseline and clinical variables included opioid use severity, intravenous drug use, study medication assignment, and induction status. FINDINGS Of the 428 participants who completed the 36-week visit, 225 (53%) of participants were receiving MOUD and 203 (47%) were not. Compared to those off medication, participants on medication had fewer opioid use days (4.4 days (SD 9.0) versus 9.8 days (SD 12.1)), fewer met relapse criteria (37 (16.4%) versus 79 (38.9%)), and reported less stimulant use (34 (15.2%) versus 56 (27.7%)) and sedative use (14 (6.3%) versus 31 (15.3%)). There was no difference in abstinence rates between those on or off MOUD. A greater proportion of participants on XR-NTX (47 (53.4%) of 88 participants) were abstinent from non-prescribed opioids compared to those on buprenorphine (28 (23.3%) of 120 participants). CONCLUSIONS Naturalistic outcomes data showed that despite potential barriers to continuing treatment in the community, about half of individuals were on opioid use disorder pharmacotherapy at follow-up and those on medication generally had better outcomes. Future research should explore barriers and facilitators to treatment retention in community settings; and developing interventions tailored to improve treatment engagement and adherence.
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Affiliation(s)
- Miranda G Greiner
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Matisyahu Shulman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Tse-Hwei Choo
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Jennifer Scodes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Martina Pavlicova
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, United States of America.
| | - Aimee N C Campbell
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Patricia Novo
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Marc Fishman
- Johns Hopkins University School of Medicine and Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - John Rotrosen
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Edward V Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
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Rudolph KE, Díaz I, Luo SX, Rotrosen J, Nunes EV. Optimizing opioid use disorder treatment with naltrexone or buprenorphine. Drug Alcohol Depend 2021; 228:109031. [PMID: 34534863 PMCID: PMC8595679 DOI: 10.1016/j.drugalcdep.2021.109031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Relapse rates during opioid use disorder (OUD) treatment remain unacceptably high. It is possible that optimally matching patients with medication type would reduce risk of relapse. Our objective was to learn a rule by which to assign type of medication for OUD to reduce risk of relapse, and to estimate the extent to which risk of relapse would be reduced if such a rule were used. METHODS This was a secondary analysis of an open-label randomized controlled, 24-week comparative effectiveness trial of injection extended-release naltrexone (XR-NTX), delivered approximately every 28 days, or daily sublingual buprenorphine-naloxone (BUP-NX) for treating OUD, 2014-2017 (N = 570). Outcome was a binary indicator of relapse to regular opioid use during the 24 weeks of outpatient treatment. RESULTS We found that applying an estimated individualized treatment rule-i.e., a rule that assigns patients with OUD to either XR-NTX or BUP-NX based on their individual characteristics in such a way that risk of relapse is minimized-would reduce risk of relapse by 24 weeks by 12% compared to randomly assigned treatment. CONCLUSIONS The number-needed-to-treat with the estimated treatment rule to prevent a single relapse is 14. A simpler, alternative estimated rule in which homeless participants would be treated with XR-NTX and stably housed participants would be treated with BUP-NX performed similarly. These results provide an estimate of the amount by which a relatively simple change in clinical practice could be expected to improve prevention of OUD relapse.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Iván Díaz
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Sean X Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, United States
| | - John Rotrosen
- Department of Psychiatry, School of Medicine, New York University, New York, NY, United States
| | - Edward V Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, NY, United States
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Chenworth M, Perrone J, Love JS, Graves R, Hogg-Bremer W, Sarker A. Methadone and suboxone ® mentions on twitter: thematic and sentiment analysis. Clin Toxicol (Phila) 2021; 59:982-991. [PMID: 33821724 PMCID: PMC9177078 DOI: 10.1080/15563650.2021.1893742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND According to the latest medical evidence, Methadone and buprenorphine-naloxone (Suboxone®) are effective treatments for opioid use disorder (OUD). While the evidence basis for the use of these medications is favorable, less is known about the perceptions of the general public about them. OBJECTIVE This study aimed to use Twitter to assess the public perceptions about methadone and buprenorphine-naloxone, and to compare their discussion contents based on themes/topics, subthemes, and sentiment. METHODS We conducted a descriptive analysis of a small and automatic analysis of a large volume of microposts ("tweets") that mentioned "methadone" or "suboxone". In the manual analysis, we categorized the tweets into themes and subthemes, as well as by sentiment and personal experience, and compared the information posted about these two medications. We performed automatic topic modeling and sentiment analysis over large volumes of posts and compared the outputs to those from the manual analyses. RESULTS We manually analyzed 900 tweets, most of which related to access (15.3% for methadone; 14.3% for buprenorphine-naloxone), stigma (17.0%; 15.5%), and OUD treatment (12.8%; 15.6%). Only a small proportion of tweets (16.4% for Suboxone® and 9.3% for methadone) expressed positive sentiments about the medications, with few tweets describing personal experiences. Tweets mentioning both medications primarily discussed MOUD broadly, rather than comparing the two medications directly. Automatic topic modeling revealed topics from the larger dataset that corresponded closely to the manually identified themes, but sentiment analysis did not reveal any notable differences in chatter regarding the two medications. CONCLUSIONS Twitter content about methadone and Suboxone® is similar, with the same major themes and similar sub-themes. Despite the proven effectiveness of these medications, there was little dialogue related to their benefits or efficacy in the treatment of OUD. Perceptions of these medications may contribute to their underutilization in combatting OUDs.
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Affiliation(s)
- Megan Chenworth
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer S. Love
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Rachel Graves
- Department of Emergency Medicine, Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Whitney Hogg-Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
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50
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Psychiatric comorbidity and treatment outcomes in patients with opioid use disorder: Results from a multisite trial of buprenorphine-naloxone and methadone. Drug Alcohol Depend 2021; 228:108996. [PMID: 34555691 PMCID: PMC8674982 DOI: 10.1016/j.drugalcdep.2021.108996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals treated for opioid use disorder (OUD) have high rates of psychiatric disorders potentially diminishing treatment outcomes. We examined long-term treatment experiences and outcomes by type of psychiatric disorder among participants who participated in the Starting Treatment with Agonist Replacement Therapies (START) study and its follow-up study. METHODS We categorized the 593 participants who completed the Mini-International Neuropsychiatric Interview (MINI) during the START follow-up study into four mutually exclusive groups to indicate current psychiatric diagnosis: 1) bipolar disorder (BPD; n = 51), 2) major depressive disorder (MDD; n = 85), 3) anxiety disorder (AXD; n = 121), and 4) no comorbid mental disorder (NMD; n = 336). We compared participants' baseline characteristics and treatment outcomes. RESULTS Groups with mental disorders had worse substance use outcomes and poorer psychosocial functioning than the NMD group. Participants with BPD had significantly more self-reported days using opioids (Mean: 8.6 for BPD vs. 3.4 days for NMD, p < 0.01) and heroin (Mean: 6.4 for BPD vs. 2.0 for MDD, 3.1 days for NMD, p < 0.05) in the 30 days prior to the final interview. Compared to patients without mental disorders, patients with MDD spent more time engaged with OUD pharmacotherapy during the ∼16-month period between MINI and final interview (mean: 71.6 % vs. 50.6 %; p < 0.001). CONCLUSIONS Our results show that treatment outcomes in individuals with OUD vary by psychiatric comorbidity groups, which supports the need for mental health assessment and treatment for psychiatric conditions in the context of pharmacotherapy for patients with OUD.
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