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de Saxe Zerden L, Ware OD, Lombardi BN, Lombardi BM. Harm reduction workforce, behavioral health, and service delivery in the USA: a cross-sectional study. Harm Reduct J 2024; 21:36. [PMID: 38336662 PMCID: PMC10858514 DOI: 10.1186/s12954-024-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? METHODS Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. RESULTS Data from 41 states and Washington, D.C. were collected (N = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. CONCLUSIONS The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.
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Affiliation(s)
- Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
| | - Brooke N Lombardi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brianna M Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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2
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Garrison YL, Luo Y, Sahker E. Integration of substance use disorder treatment in traditional mental health facilities: Timeseries and cross-sectional evaluations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104312. [PMID: 38176176 DOI: 10.1016/j.drugpo.2023.104312] [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] [Received: 09/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Despite efforts to increase substance use disorder (SUD) treatment provision in the United States (US), the extent to which traditional mental health (MH) facilities offer SUD treatment remains unclear. In the present study, we analyzed the trend in SUD treatment integration among traditional MH facilities in the US from 2014 to 2020 and identified facility-level factors associated with SUD treatment provision. METHODS Data were extracted from the National Mental Health Services Survey (N-MHSS). A timeseries logit trend analysis for the multi-year dataset (2014-2020) was conducted to assess a yearly change in odds of SUD treatment provision. With the 2020 survey data, analyses were conducted to identify the differences between facilities offering SUD treatment and facilities not offering such treatment. Finally, exploratory multivariable logistic regression was conducted to estimate odds of SUD treatment provision by facility variables. RESULTS US MH facility SUD treatment provision went from 51.7 % (2014) to 57.9 % (2020). A mean sample of 12,312 US MH facilities over seven years, demonstrated a significant but small yearly increase in SUD treatment provision (OR = 1.04, 95 % CI = 1.03, 1.04). Important facility characteristics related to SUD treatment provision for facilities without a core SUD focus were MH diagnostics offered (OR = 2.03), dual-diagnosis program offered (OR = 3.65), state drug/alcohol license maintained (OR = 6.66), and VA setting (OR = 7.94). CONCLUSIONS Despite incremental progress in integrating SUD treatment services into US MH facilities, the SUD treatment gap remains large. Training and service development incentives for identified characteristics could help further reduce the treatment gap.
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Affiliation(s)
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Andrews CM, Hinds OM, Lozano-Rojas F, Besmann WL, Abraham AJ, Grogan CM, Silverman AF. State Funding For Substance Use Disorder Treatment Declined In The Wake Of Medicaid Expansion. Health Aff (Millwood) 2023; 42:981-990. [PMID: 37406236 DOI: 10.1377/hlthaff.2022.01568] [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: 07/07/2023]
Abstract
The US continues to grapple with an escalating epidemic of opioid-related overdose and mortality. State funds, which are the second-largest source of public funding for substance use disorder (SUD) treatment and prevention, play a critically important role in responding to this crisis. Despite their importance, little is known about how these funds are allocated and how they have changed over time, particularly within the context of Medicaid expansion. In this study we assessed trends in state funds during the period 2010-19, using difference-in-differences regression and event history models. Our findings reveal dramatic variation in state funding across states, from a low of $0.61 per capita in Arizona to a high of $51.11 per capita in Wyoming in 2019. Moreover, state funding declined during the period after Medicaid expansion by an average of $9.95 million in expansion states (relative to nonexpansion states), especially in states that expanded eligibility under Republican-controlled legislatures, where it declined by an average of $15.94 million. Medicaid substitution strategies, which, in effect, shift some of the financial burden for financing SUD treatment from the state to the federal level, may erode resources for broader system-level efforts that are urgently needed in the midst of the opioid epidemic.
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Affiliation(s)
- Christina M Andrews
- Christina M. Andrews , University of South Carolina, Columbia, South Carolina
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4
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Adeniran E, Quinn M, Wallace R, Walden RR, Labisi T, Olaniyan A, Brooks B, Pack R. A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100152. [PMID: 37069961 PMCID: PMC10105485 DOI: 10.1016/j.dadr.2023.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
Background Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. Methods A systematic search was conducted with the following databases: "PubMed including MEDLINE", "CINAHL", "Web of Science", "ABI/Inform", and "PsycINFO." We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Results Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). Conclusions This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.
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Affiliation(s)
- Esther Adeniran
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
- Corresponding author at: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Richard Wallace
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Rachel R. Walden
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Titilola Labisi
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Afolakemi Olaniyan
- Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Billy Brooks
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Robert Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
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Dickson-Gomez J, Weeks M, Green D, Boutouis S, Galletly C, Christenson E. Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100051. [PMID: 36845978 PMCID: PMC9948907 DOI: 10.1016/j.dadr.2022.100051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022]
Abstract
Introduction People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use disorder. Few studies to date have conducted qualitative research with substance use disorder (SUD) treatment providers regarding Medicaid and other insurance coverage of SUD treatment following passage of the ACA and parity laws. The present paper fills this gap by reporting data from in-depth interviews with treatment providers from three states, Connecticut, Kentucky, and Wisconsin, that differ in implementation of the ACA. Methods Study teams in each state conducted in-depth, semi-structured interviews with key informants who provided SUD treatment, including providers of behavioral health residential or outpatient programs, office-based buprenorphine providers and opioid treatment programs [OTP, i.e. methadone clinics] (n = 24 in Connecticut, n = 63 in Kentucky and n = 63 in Wisconsin). Key informants were asked for their perceptions on how Medicaid and private insurance facilitates or limits access to drug treatment. All interviews were transcribed verbatim and analyzed for key themes using MAXQDA software using a collaborative approach. Results Results from this study suggest that the promise of the ACA and parity laws to increase access to SUD treatment has only partially been realized. There is wide variation among the three states' Medicaid programs and among private insurance in the types of SUD treatment that is covered. Neither Kentucky's nor Connecticut's Medicaid covered methadone. Wisconsin Medicaid did not cover residential or intensive outpatient treatment. Thus, none of the states studied here provided all levels of care that the ASAM recommends for treating SUD. Further, there were several quantitative limits placed on SUD treatment such as number of urine drug screens or visits allowed. Providers complained that many treatments required prior authorizations, including MOUD like buprenorphine. Conclusions More reform is needed to make SUD treatment accessible to all who need it. Such reforms should consider defining standards for opioid use disorder treatment with reference to evidence-based practices, not be attempting parity with an arbitrarily defined medical standard.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Margaret Weeks
- Institute for Community Research, Hartford, CT, United States
| | - Danielle Green
- Institute for Community Research, Hartford, CT, United States
| | - Sophie Boutouis
- Department of Psychology, University of Texas, Dallas, United States
| | - Carol Galletly
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erika Christenson
- Center of Excellence in Women's Health, Boston Medical Center, BUSM, New England
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6
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Saloner B, Li W, Bandara SN, McGinty EE, Barry CL. Trends In The Use Of Treatment For Substance Use Disorders, 2010-19. Health Aff (Millwood) 2022; 41:696-702. [PMID: 35500189 PMCID: PMC10161241 DOI: 10.1377/hlthaff.2021.01767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rapidly rising drug overdose rates in the United States during the past decade underscore the need to increase access to treatment among people with substance use disorders (SUDs). We analyzed trends in the use of treatment services among people with SUDs during the period 2010-19, using data from the National Survey on Drug Use and Health. Compared with 2013, outpatient visits for general health in the prior year increased 3.6 percentage points by the 2017-19 period. Use of any SUD treatment in the prior year remained unchanged, but treatment use among people involved in the criminal legal system increased by about 6.2 percentage points by the end of the study period. Among those receiving SUD treatment, there was a 14.9-percentage-point increase in having treatment paid for by Medicaid between 2010-13 and 2017-19. Although access to general medical care and insurance coverage have improved for people with SUD, our study findings underscore the importance of renewed efforts to increase the use of SUD treatment.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner , Johns Hopkins University, Baltimore, Maryland
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7
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Abraham AJ, Lawler EC, Harris SJ, Bagwell Adams G, Bradford WD. Spillover of Medicaid Expansion to Prescribing of Opioid Use Disorder Medications in Medicare Part D. Psychiatr Serv 2022; 73:418-424. [PMID: 34407628 DOI: 10.1176/appi.ps.202000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined whether there were positive spillovers in opioid use disorder medication prescribing to Medicare Part D beneficiaries in Medicaid expansion states. Although prior studies have shown several positive benefits of Medicaid expansion for Americans with opioid use disorder, research has not examined potential spillovers to Medicare beneficiaries who have been hit hard by the opioid crisis. METHODS Prescribing data were taken from the Medicare Part D Prescription Public Use File (2010-2017). A difference-in-differences linear regression framework was used to identify spillovers in prescribing of buprenorphine and injectable naltrexone to Medicare Part D beneficiaries in Medicaid expansion states. Three sets of dependent variables measured medication prescribing at the county-year level (N=24,850). All models included county and year fixed effects, with standard errors clustered at the state level to address within-state serial correlation. RESULTS Medicaid expansion was associated with an increase in the probability of a county having an injectable naltrexone provider (p<0.01). After expansion, the number of buprenorphine providers in expansion states increased by 5.6% (p<0.05), and the number of injectable naltrexone providers increased by 3.3% (p<0.01), relative to nonexpansion states. Expansion was associated with a 23.1% (p<0.01) increase in the number of daily doses of injectable naltrexone, relative to nonexpansion states. CONCLUSIONS Medicaid expansion states may be better equipped to address the opioid crisis because of direct benefits to Medicaid beneficiaries and availability of opioid use disorder medications for Medicare Part D beneficiaries. However, additional efforts are likely needed to close the opioid use disorder treatment gap for Medicare beneficiaries.
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Affiliation(s)
- Amanda J Abraham
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Emily C Lawler
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Samantha J Harris
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Grace Bagwell Adams
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - W David Bradford
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
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8
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Auty SG, Griffith KN. Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2022; 232:109340. [PMID: 35131533 PMCID: PMC8809643 DOI: 10.1016/j.drugalcdep.2022.109340] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. METHODS State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. RESULTS The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). CONCLUSIONS The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
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Affiliation(s)
- Samantha G. Auty
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, USA,Correspondence to: 715 Albany Street, Talbot Building, Boston, Massachusetts 02118, USA
| | - Kevin N. Griffith
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, Tennessee 37203, USA,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA
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9
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Knudsen HK, Hartman J, Walsh SL. The effect of Medicaid expansion on state-level utilization of buprenorphine for opioid use disorder in the United States. Drug Alcohol Depend 2022; 232:109336. [PMID: 35123365 PMCID: PMC8885876 DOI: 10.1016/j.drugalcdep.2022.109336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Research on the impact of Medicaid expansion on buprenorphine utilization has largely focused on the Medicaid program. Less is known about its associations with total buprenorphine utilization and non-Medicaid payers. METHODS Monthly prescription data (June 2013-May 2018) for proprietary and generic sublingual as well as buccal buprenorphine products were purchased from IQVIA®. Population-adjusted state-level utilization measures were constructed for Medicaid, commercial insurance, Medicare, cash, and total utilization. A difference-in-differences (DID) approach with population weights estimated the association between Medicaid expansion and buprenorphine utilization, while controlling for treatment capacity. RESULTS Monthly total buprenorphine prescriptions increased by 68% overall and increased 283% for Medicaid, 30% for commercial insurance, and 143% for Medicare. Cash prescriptions decreased by 10%. The DID estimate for Medicaid expansion was not statistically significant for total utilization (-19.780, 95% CI = -45.118, 5.558, p = .123). For Medicaid buprenorphine utilization, there was a significant increase of 27.120 prescriptions per 100,000 total state residents (95% CI = 9.458, 44.782, p = .003) in expansion states versus non-expansion states post-Medicaid expansion. Medicaid expansion had a negative effect on commercial insurance (DID estimate = -37.745, 95% CI = -62.946, -12.544, p = .004), cash utilization (DID estimate = -6.675, 95% CI = -12.627, -0.723, p = .029), and Medicare utilization (DID estimate = -1.855, 95% CI = -3.697, -0.013, p = .048). DISCUSSION The associations between Medicaid expansion and buprenorphine utilization varied across different types of payers, such that the overall impact of Medicaid expansion on buprenorphine utilization was not significant.
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA.,Corresponding author: Hannah K. Knudsen, PhD, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508. Telephone: (859) 323-3947; fax: (859) 257-5232;
| | - Jeanie Hartman
- Substance Use Research Priority Area, University of Kentucky, 845 Angliana Avenue, Room 121, Lexington, KY 40508, USA.
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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11
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Neighbors CJ, Yerneni R, Sun Y, Choi S, Burke C, O’Grady MA, McDonald R, Morgenstern J. Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population. Subst Abuse 2022; 16:11782218221075041. [PMID: 35125871 PMCID: PMC8808013 DOI: 10.1177/11782218221075041] [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: 05/26/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
AIMS We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. METHODS We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. RESULTS CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. CONCLUSION Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.
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Affiliation(s)
- Charles J Neighbors
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Yi Sun
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | - Sugy Choi
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Constance Burke
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | | | - Rebecca McDonald
- Center on Addiction, New York, NY, USA
- King’s College London, London, UK
| | - Jon Morgenstern
- Center on Addiction, New York, NY, USA
- Northwell Health, New Hyde Park, NY, USA
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Das A, Singh P, Bruckner TA. State lockdown policies, mental health symptoms, and using substances. Addict Behav 2022; 124:107084. [PMID: 34507184 PMCID: PMC8358101 DOI: 10.1016/j.addbeh.2021.107084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Objective Previous literature finds an increase in depressive symptoms, substance use, and suicidal ideation following the COVID-19 pandemic in the US – suicides do not appear to increase. We examine whether 1) state lockdown policies in the US precede an increase in mental health symptoms; and 2) the extent to which using substances amplifies or attenuates the relation. Methods We specified, as our exposure variable, the timing of state-level lockdown orders. We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) that measures anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 7,597 adults across 50 states in the US, surveyed biweekly between March 10, 2020 and November 11, 2020. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, household income, and previous mental health diagnosis. Results Regression results indicate an increase in PHQ-4 scores of approximately 1.70 during lockdown, relative to no lockdown (p < 0.05). Relative to no lockdown, an increase in alcohol use corresponds with a 0.08 unit decrease in PHQ-4 scores during lockdown (p < 0.05). Conclusion State lockdown policies precede greater mental health symptoms. Increases in consuming alcohol attenuates the relation between state lockdown policies and mental health symptoms. Results may portend greater addiction following the pandemic warranting further investigation into utilization of substance use treatment.
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McClellan C, Moriya A, Simon K. Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017. J Subst Abuse Treat 2021; 132:108645. [PMID: 34728135 DOI: 10.1016/j.jsat.2021.108645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High out-of-pocket spending has been a barrier to treatment for the estimated 2.0 million Americans suffering from opioid use disorders (OUD). This paper provides national estimates of financial costs faced by the population receiving retail medications for OUD (MOUD). METHODS We used pooled annual data from the 2011-2017 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the civilian noninstitutionalized population in the United States. The sample includes individuals who reported filling a retail prescription for buprenorphine or naltrexone, the two most common medications available from retail pharmacies to treat OUD. The main outcome is out-of-pocket spending of retail MOUD prescriptions per fill and per person. RESULTS Patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage is associated with reduced annual out-of-pocket MOUD expenditures between $316 and $328 per year. CONCLUSIONS Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with OUD.
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Affiliation(s)
- Chandler McClellan
- Agency for Healthcare Research and Quality 5600 Fishers Lane, Rockville, MD 20852, USA
| | - Asako Moriya
- Agency for Healthcare Research and Quality 5600 Fishers Lane, Rockville, MD 20852, USA.
| | - Kosali Simon
- The O'Neill School of Public and Environmental Affairs, Indiana University 1315 East Tenth Street, Bloomington, IN 47405, USA
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14
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Hudgins A, Uzwiak B, Pizzicato L, Viner K. Barriers to effective care: Specialty drug treatment in Philadelphia. J Subst Abuse Treat 2021; 131:108639. [PMID: 34728133 DOI: 10.1016/j.jsat.2021.108639] [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: 01/07/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In Philadelphia, the poorest big city in the United States, an estimated 60,000 people misuse opioids and more than 3500 have died of overdose in the past three years. In 2019, fentanyl was detected in 76% of drug-related deaths and 94% of opioid-involved deaths. While much attention has been directed at the public face of the city's drug problem, more than 75% of drug deaths in 2017 took place in a private residence. METHOD Based on qualitative research to understand the vulnerabilities of this hidden population of drug users, we interviewed kin of 35 people who had died of opioid overdose in 2017 to learn whether their loved one had interacted with any social services or harm-reduction interventions. RESULTS In our demographically and geographically representative sample of decedents, we found that while most had received treatment at least once, many faced barriers to getting treatment when they needed it, including barriers related to stigma, structural racism, gender inequities, bureaucracy, insurance requirements, and cost. CONCLUSION We argue that these barriers place an undue burden on people with substance use disorder and their kin during particularly fraught moments of heightened vulnerability. The failure of state and federal policies, practices, and infrastructure to address these barriers, and the failure to require that evidence-based care be provided during treatment have deleterious effects on people affected by the opioid epidemic in the United States.
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Affiliation(s)
| | - Beth Uzwiak
- Ethnologica, 4732 Stenton Ave., Philadelphia, PA 19144, USA
| | - Lia Pizzicato
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
| | - Kendra Viner
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
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15
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Teplin LA, Potthoff LM, Aaby DA, Welty LJ, Dulcan MK, Abram KM. Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in a 15-Year Longitudinal Study of Youths Involved in the Juvenile Justice System. JAMA Pediatr 2021; 175:e205807. [PMID: 33818599 PMCID: PMC8022269 DOI: 10.1001/jamapediatrics.2020.5807] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Importance Previous studies have found that one-half to three-quarters of youths detained in juvenile justice facilities have 1 or more psychiatric disorders. Little is known about the course of their disorders as they age. Objective To examine the prevalence, comorbidity, and continuity of 13 psychiatric disorders among youths detained in a juvenile justice facility during the 15 years after detention up to a median age of 31 years, with a focus on sex and racial/ethnic differences. Design, Setting, and Participants The Northwestern Juvenile Project is a longitudinal cohort study of health needs and outcomes of 1829 randomly selected youths in a temporary juvenile detention center in Cook County, Illinois. Youths aged 10 to 18 years were interviewed in detention from November 20, 1995, through June 14, 1998. Participants were reinterviewed up to 12 times during the 15-year study period through February 2015, for a total of 16 372 interviews. The sample was stratified by sex, race/ethnicity (Black, Hispanic, and non-Hispanic White), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Data analysis was conducted from February 2014, when data preparation began, to March 2020. Exposures Detention in a juvenile justice facility. Main Outcomes and Measures Psychiatric disorders, assessed by the Diagnostic Interview Schedule for Children, version 2.3 at the baseline interviews. Follow-up interviews were conducted using the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview (beginning at the 6-year follow-up interview). Results The study included 1829 youths sampled at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). Although prevalence and comorbidity of psychiatric disorders decreased as the 1829 participants aged, 52.3% of males and 30.9% of females had at least 1 or more psychiatric disorders 15 years postdetention. Among participants with a disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline (95% CI, 1.79-6.35). Compared with Black participants and Hispanic participants, non-Hispanic White participants had 1.6 times the odds of behavioral disorders (odds ratio, 1.56; 95% CI, 1.27-1.91 and odds ratio, 1.59; 95% CI, 1.23-2.05, respectively) and greater than 1.3 times the odds of substance use disorders (odds ratio, 1.90; 95% CI, 1.55-2.33 and odds ratio, 1.39; 95% CI, 1.11-1.73, respectively) throughout the follow-up period. Behavioral disorders and substance use disorders were the most prevalent 15 years after detention. Conclusions and Relevance This study's findings suggest that persistent psychiatric disorders may complicate the transition from adolescence to adulthood, which is already challenging for youths involved in the juvenile justice system, many of whom are from racial/ethnic minority groups and low-income backgrounds. The pediatric health community should advocate for early identification and treatment of disorders among youths in the justice system.
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Affiliation(s)
- Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren M. Potthoff
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A. Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mina K. Dulcan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Schuler MS, Dick AW, Stein BD. Growing racial/ethnic disparities in buprenorphine distribution in the United States, 2007-2017. Drug Alcohol Depend 2021; 223:108710. [PMID: 33873027 PMCID: PMC8204632 DOI: 10.1016/j.drugalcdep.2021.108710] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether per capita buprenorphine distribution varies by regional racial/ethnic composition, Medicaid expansion status, and time period. METHODS Our unit of analysis -- three-digit ZIP codes ("ZIP3s") -- was classified into quintiles based on percentage of White residents. A weighted linear regression model of buprenorphine distribution -- including White resident quintile, waivered prescriber rate, overdose rate, sociodemographic factors, and year fixed effects -- was estimated using national buprenorphine distribution data from 2007 to 2017. We report predictive margins of the buprenorphine distribution rate by quintile, as well as average marginal effects of waivered prescriber rate on buprenorphine distribution rate for each quintile. Analyses were stratified by Medicaid expansion status and time period (2007-2010, 2011-2014, 2015-2017). RESULTS Buprenorphine distribution increased nationally during 2007-2017, yet growth was disproportionately greater for ZIP3s with higher percentages of White residents. Medicaid expansion states exhibited significant differences in buprenorphine distribution across ZIP3 quintiles during 2007-2010, the magnitude of which increased across time periods. Non-expansion states exhibited significant quintile differences during 2011-2014 and 2015-2017. The average marginal effect of increasing the waivered prescriber rate on the distribution rate was consistently smaller in ZIP3s with lower percentages of White residents, particularly in expansion states. CONCLUSIONS We find ecological evidence consistent with racial/ethnic disparities in buprenorphine distribution. Our finding that increasing the waivered prescriber rate had differential effects by ZIP3 racial/ethnic composition suggest that broad initiatives to increase the number of waivered prescribers are likely insufficient to achieve equitable buprenorphine access. Rather, targeted and tailored policy efforts are warranted.
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17
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Jordan AE, Cleland CM, Wyka K, Schackman BR, Perlman DC, Nash D. Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City. J Infect Dis 2021; 222:S322-S334. [PMID: 32877567 DOI: 10.1093/infdis/jiz659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence. METHODS HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses. RESULTS Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area. CONCLUSIONS HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research, New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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18
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von Gunten CD, Wu LT. Comorbid Substance Use Disorder Profiles and Receipt of Substance Use Disorder Treatment Services: A National Study. J Stud Alcohol Drugs 2021; 82:246-256. [PMID: 33823972 PMCID: PMC8864624 DOI: 10.15288/jsad.2021.82.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/06/2020] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Those with comorbid substance use disorders (SUDs) are a particularly vulnerable group. Information regarding the nature of these comorbidities and how they relate to receipt of substance use treatment could reduce the treatment gap that exists among those with comorbid SUDs. METHOD Public-use data from the 2015-2017 National Surveys on Drug Use and Health was used to analyze past-year SUD comorbidity combinations among 12 substances and the relationship between these combinations with past-year treatment in adults (N = 128,740). RESULTS In all, 7.9% of adults had at least one SUD in the past year (6.7% had one SUD, 0.9% had two SUDs, and 0.3% had three or more). Conditioning on specific SUDs, the prevalence of having additional SUDs ranged from 14.9% (alcohol) to 85.1% (hallucinogens). The four most common SUD combinations all included alcohol use disorder. Alcohol and marijuana use disorder was the most common comorbidity combination and had the lowest receipt of treatment. Compared to those with one SUD, adjusted odds of receiving treatment were almost two times greater for those with two SUDs, and more than four times greater for those with three or more SUDs. Treatment prevalence was lower for those who had higher family income and education, were not employed full time, were married, were younger than age 26 years or older than age 50 years, and were Asian. CONCLUSIONS Even though the treatment gap is reduced among those with multiple SUDs, it remains large. The most common and undertreated comorbid SUD combinations, in conjunction with the most underserved groups, could be targeted to facilitate treatment uptake.
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Affiliation(s)
- Curtis D. von Gunten
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, School of Medicine, Duke University, Durham, North Carolina
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina
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19
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Kapadia SN, Katzman C, Fong C, Eckhardt BJ, Guarino H, Mateu-Gelabert P. Hepatitis C testing and treatment uptake among young people who use opioids in New York City: A cross-sectional study. J Viral Hepat 2021; 28:326-333. [PMID: 33141503 PMCID: PMC8207521 DOI: 10.1111/jvh.13437] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Young people who use drugs have a rising hepatitis C (HCV) incidence in the United States, but they may face barriers to testing and treatment adoption due to stigma. We conducted a cross-sectional study of New York City residents aged 18-29 years who reported non-medical prescription opioid and/or heroin use in the past 30 days. Participants were recruited from the community between 2014-2016 via respondent-driven sampling. Participants completed an in-person structured survey that included questions about HCV testing and treatment and received HCV antibody testing. There were 539 respondents: 353 people who inject drugs (PWID) and 186 non-PWID. For PWID, median age was 25 years, 65% were male and 73% non-Hispanic White. For non-PWID, median age was 23 years, 73% were male and 39% non-Hispanic White. 20% of PWID and 54% of non-PWID had never been tested for HCV (P < .001). Years since first injection (aOR 1.16, CI: 1.02-1.32, P = .02) and history of substance use treatment (aOR 3.17, CI: 1.53-6.61, P = .02) were associated with prior testing among PWID. The seroprevalence of HCV among PWID was 25%, adjusted for sampling weights. Of the 75 who were aware of their HCV-positive status, 53% had received HCV-related medical care, and 28% had initiated treatment. HCV prevalence among young PWID is high, and many have never been tested. Injection experience and treatment engagement is associated with testing. Interventions to increase testing earlier in injection careers, and to improve linkage to HCV treatment, will be critical for young PWID.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Katzman
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Chunki Fong
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Benjamin J Eckhardt
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
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20
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A Cross-Sectional Study on the Affordable Care Act from the Perspective of People Living with HIV: The Interplay between Knowledge, Stigma, Trust, and Attitudes. AIDS Res Treat 2020; 2020:6081721. [PMID: 33376606 PMCID: PMC7744239 DOI: 10.1155/2020/6081721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Many AIDS Drug Assistance Programs (ADAPs) purchased Affordable Care Act (ACA) Qualified Health Plans (QHPs) for low-income people living with HIV (PLWH). To date, little has been published about PLWH's perspective on the ACA. We explored ACA knowledge, HIV stigma, trust in the healthcare system, and ACA attitudes among PLWH with ADAP-funded QHPs in Virginia. Methods Participants were surveyed about demographic characteristics, ACA knowledge, HIV stigma, trust in various healthcare and government entities, and attitudes toward the ACA. Descriptive statistics were used. We assessed for associations (1) between baseline characteristics and correct ACA knowledge, HIV-related stigma, trust, and ACA attitudes and (2) between correct ACA knowledge and the following data: sources of ACA knowledge, HIV stigma, and trust. Results Participants (n = 53) were a vulnerable population based on the assessment of social determinants of health, and 30% had correct ACA knowledge. Almost three-fourths of participants used HIV clinic case managers for ACA information. Participants who used websites for ACA information had correct ACA knowledge more often compared to those that did not (71% vs. 15%; p = 0.001). Those with correct ACA knowledge had lower stigma scores compared to those without correct ACA knowledge (93.8; SD: 15.4 vs. 108; SD: 20.3; p = 0.01). Participants trusted HIV clinicians more than general clinicians and insurance companies. No association was found between having correct ACA knowledge and endorsing having enough information about the ACA to understand how it will impact their HIV care. Conclusions Websites imparted accurate ACA information. HIV clinic case managers were the most used source, and HIV clinicians were a trusted source of information. HIV clinicians and case managers should consider disseminating information about the ACA and its impact on HIV care delivery via internet videos. Lack of internet and stigma are a threat to PLWH gaining actionable healthcare information.
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21
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Thompson HM, Faig W, VanKim NA, Sharma B, Afshar M, Karnik NS. Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service. PLoS One 2020; 15:e0239761. [PMID: 33035229 PMCID: PMC7546454 DOI: 10.1371/journal.pone.0239761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Addiction medicine consultation services (ACS) may improve outcomes of hospitalized patients with substance use disorders (SUD). Our aim was to examine the difference in length of stay and the hazard ratio for a routine hospital discharge between SUD patients receiving and not receiving ACS. METHODS Structured EHR data from 2018 of 1,900 adult patients with a SUD-related diagnostic code at an urban academic health center were examined among 35,541 total encounters. Cox proportional hazards regression models were fit using a cause-specific approach to examine differences in hospital outcome (i.e., routine discharge, leaving against medical advice, in-hospital death, or transfer to another level of care). Models were adjusted for age, sex, race, ethnicity, insurance status, and comorbidities. RESULTS Length of stay was shorter among encounters with a SUD that received a SUIT consultation versus those admissions that did not receive one (5.77 v. 6.54 days, p<0.01). In adjusted analyses, admissions that received a SUIT consultation had a higher hazard of a routine discharge [hazard ratio (95% confidence interval): 1.16 (1.03-1.30)] compared to those not receiving a SUIT consultation. CONCLUSIONS The SUIT consultation service was associated with a reduced length of stay and an increased hazard of a routine discharge. The SUIT model may serve as a benchmark and inform other health systems attempting to improve outcomes in SUD patient cohorts.
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Affiliation(s)
- Hale M. Thompson
- Department of Psychiatry & Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, United States of America
| | - Walter Faig
- Department of Psychiatry & Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, United States of America
| | - Nicole A. VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Brihat Sharma
- Department of Psychiatry & Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, United States of America
| | - Majid Afshar
- Division of Pulmonary and Critical Care, Department of Public Health Sciences, Center for Health Outcomes & Informatics Research, Loyola University, Maywood, IL, United States of America
| | - Niranjan S. Karnik
- Department of Psychiatry & Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, United States of America
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22
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Satre DD, Palzes VA, Young-Wolff KC, Parthasarathy S, Weisner C, Guydish J, Campbell CI. Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. J Subst Abuse Treat 2020; 118:108097. [PMID: 32972648 DOI: 10.1016/j.jsat.2020.108097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy. METHODS We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood. RESULTS Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment. CONCLUSIONS Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Constance Weisner
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, United States of America
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
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Silverstein SM, Daniulaityte R, Miller SC, Martins SS, Carlson RG. On my own terms: Motivations for self-treating opioid-use disorder with non-prescribed buprenorphine. Drug Alcohol Depend 2020; 210:107958. [PMID: 32203863 PMCID: PMC7190448 DOI: 10.1016/j.drugalcdep.2020.107958] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The opioid overdose crisis in the United States has prompted an expansion of treatment services, including pharmacotherapy with buprenorphine. However, many people who use illicit opioids (PWUIO) self-treat their opioid-use disorder (OUD) with non-prescribed buprenorphine (NPB) in lieu of attending formal treatment. The present study aims to qualitatively understand motivations of people who are self-treating their OUD with NPB. METHODS Qualitative study designed to supplement and contextualize quantitative findings from natural history study of buprenorphine diversion, self-treatment, and use of substance use disorder treatment services. Interviews were audio-recorded, transcribed, systematically coded and analyzed via Iterative Categorization. STUDY SETTING The Dayton, Ohio metropolitan area in the midwestern United States; a site previously characterized as high impact in the national opioid overdose crisis. PARTICIPANTS Sixty-five individuals (35 men and 30 women) who met the DSM-5 criteria for OUD (moderate or severe) and had used NPB at least one time in the six months prior to their intake interview. RESULTS Participants described four key motivators for self-treating with NPB: perceived demands of formal treatment, the desire to utilize non-prescribed buprenorphine in combination with a geographic relocation, to self-initiate treatment while preparing for formal services, and to bolster a sense of self-determination and agency in their recovery trajectory. CONCLUSIONS Use of NPB is a recognized self-treatment modality among PWUIO, with some PWUIO transitioning into sustained recovery episodes or enrollment in formal treatment. Understanding the motivations for opting out of treatment is crucial for improving forms of care for people with OUD.
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Affiliation(s)
- Sydney M. Silverstein
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University; 3171 Research Blvd, Kettering, OH, USA
| | - Raminta Daniulaityte
- College of Health Solutions, Arizona State University, 425 N 5(th)Street, Arizona Biomedical Collaborative 121, Phoenix, AZ, 85004, USA.
| | - Shannon C. Miller
- Dayton VA Medical Center/Middletown CBOC; 4337 Union Road, Middletown, OH 45005,Departments of Psychiatry & Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University; 3171 Research Blvd, Kettering, OH, USA
| | - Silvia S. Martins
- Columbia University Mailman School of Public Health, 722 West 168th Street 5th Floor Room 509, New York, NY, USA
| | - Robert G. Carlson
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University; 3171 Research Blvd, Kettering, OH, USA
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Stimpfel AW, Liang E, Goldsamt LA. Early Career Nurse Reports of Work-Related Substance Use. JOURNAL OF NURSING REGULATION 2020. [DOI: 10.1016/s2155-8256(20)30058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pro G, Zaller N. Interaction effects in the association between methadone maintenance therapy and experiences of racial discrimination in U.S. healthcare settings. PLoS One 2020; 15:e0228755. [PMID: 32027723 PMCID: PMC7004348 DOI: 10.1371/journal.pone.0228755] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Disparities in methadone maintenance therapy (MMT) outcomes have received limited attention, but there are important negative outcomes associated with MMT that warrant investigation. Racial discrimination is common in healthcare settings and affects opioid use disorder (OUD) treatment and comorbidities. However, race/ethnicity alone may not fully explain experiences of discrimination. MMT remains highly stigmatized and may compound the effect of race/ethnicity on discrimination in healthcare settings. We sought to quantify differential associations between MMT and experiences of racial discrimination between racial/ethnic groups in a U.S. national sample. METHODS We used the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) to identify a subset of individuals with a lifetime OUD who had ever used MMT (survey n = 766; weighted population n = 5,276,507). We used multivariable logistic regression to model past-year experience of racial discrimination in a healthcare setting. We included an interaction term between race/ethnicity and MMT status to identify the odds of discrimination (MMT vs. no MMT [referent]) within racial/ethnic groups. We used survey procedures with weights to account for the parent study's complex survey design. FINDINGS Twenty-two percent of our sample experienced racial discrimination in a healthcare setting in the past year. Discrimination was more common among those who had ever used MMT (x2 = 10.00, p = 0.001) and racial/ethnic minorities (x2 = 23.15, p<0.001). The interaction effect was much stronger than the main effects of race/ethnicity and MMT status. MMT status (versus no MMT) was positively associated with discrimination among Blacks (aOR = 3.93, 95% CI = 3.87-3.98, p<0.001), Whites (aOR = 2.25, 95% CI = 2.23-2.27, p<0.001), and Latino/Latinas (aOR = 1.59, 95% CI = 1.55-1.62, p<0.001). Among American Indian/Alaska Natives (AI/AN), those who had used MMT had over thirty times the odds of racial discrimination, compared to their non-MMT counterparts (aOR = 32.78, 95% CI = 31.16-34.48, p<0.001). CONCLUSION Race/ethnicity alone did not sufficiently account for racial discrimination in healthcare settings among those with a lifetime OUD. MMT status was strongly associated with racial discrimination among AI/AN. Our strong interaction effect is indicative of an additional barrier to health services utilization among AI/AN, which has important implications for OUD treatment outcomes and comorbidities. Health promotion programs aimed at increased adoption of MMT are promising, but should be considered in the context of racial/ethnic disparities, drug use and MMT stigma, and implicit biases in clinical settings.
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Affiliation(s)
- George Pro
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Nick Zaller
- University of Arkansas for Medical Sciences College of Public Health, Little Rock, Arkansas, United States of America
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Huhn AS, Hobelmann JG, Strickland JC, Oyler GA, Bergeria CL, Umbricht A, Dunn KE. Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States. JAMA Netw Open 2020; 3:e1920843. [PMID: 32031650 PMCID: PMC8188643 DOI: 10.1001/jamanetworkopen.2019.20843] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. OBJECTIVE To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. EXPOSURES Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. MAIN OUTCOMES AND MEASURES Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). RESULTS Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ashley Addiction Treatment, Havre de Grace, Maryland
| | - J Gregory Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ashley Addiction Treatment, Havre de Grace, Maryland
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George A Oyler
- Ashley Addiction Treatment, Havre de Grace, Maryland
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annie Umbricht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Odusola F, Smith JL, Bisaga A, Grbic JT, Fine JB, Granger KE, Hu MC, Levin FR. Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder. J Dent Educ 2020; 84:578-585. [PMID: 32022269 DOI: 10.1002/jdd.12048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 12/28/2022]
Abstract
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first-year dental students (DDS1) attended a 90-minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi-squared test for bivariate comparison. We then applied a Bonferroni correction to the P-values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.
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Affiliation(s)
- Folarin Odusola
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - Jennifer L Smith
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Adam Bisaga
- Columbia University Medical Center, New York, New York, USA
| | - John T Grbic
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - James B Fine
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - Kelly E Granger
- Columbia University College of Dental Medicine, New York, New York, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Frances R Levin
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics 2020; 17:55-69. [PMID: 31907876 PMCID: PMC7007488 DOI: 10.1007/s13311-019-00814-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.
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Affiliation(s)
- Amanda J. Abraham
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Christina M. Andrews
- College of Social Work, University of South Carolina, 1512 Pendleton St., Room 309, Columbia, SC 29208 USA
| | - Samantha J. Harris
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Peter D. Friedmann
- University of Massachusetts Medical School Baystate, 280 Chestnut St., Springfield, MA 01199 USA
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Gonzalez Y, Kozachik SL, Hansen BR, Sanchez M, Finnell DS. Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review. J Am Psychiatr Nurses Assoc 2020; 26:27-42. [PMID: 31509044 DOI: 10.1177/1078390319872536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.
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Affiliation(s)
- Yovan Gonzalez
- Yovan Gonzalez, DNP, FNP-BC, New York City Health and Hospitals/Gouverneur, New York, NY, USA
| | - Sharon L Kozachik
- Sharon L. Kozachik, PhD, RN, FAAN, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan R Hansen
- Bryan R. Hansen, PhD, RN, APRN-CNS, ACNS-BC, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Sanchez
- Michael Sanchez, DNP, ARNP, NP-C, FNP-BC, AAHIVS, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah S Finnell
- Deborah S. Finnell, DNS, RN, CARN-AP, FAAN, Johns Hopkins University, Baltimore, MD, USA
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Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res 2019; 19:884. [PMID: 31767011 PMCID: PMC6876068 DOI: 10.1186/s12913-019-4751-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Addiction health service researchers have focused efforts on opioid use disorder (OUD) and strategies to address the emerging public health threats associated with the epidemics of opioid use and opioid overdose. The increase in OUD is associated with widespread access to prescription opioid analgesics, enhanced purity of heroin, the introduction of potent illicit fentanyl compounds, and a rising tide of opioid overdose fatalities. These deaths have become the face of the opioid epidemic. MAIN TEXT OUD is a chronic disorder that usually requires both medications for opioid use disorder (MOUD) and psychosocial treatment and support. Research has found that MOUD with an opioid receptor agonist (methadone), partial agonist (buprenorphine), or opioid antagonist (extended-release naltrexone) can support recovery. Despite compelling evidence that MOUD are effective, they remain underutilized. More research is needed on these therapies to understand the feasibility of implementation in clinic settings. CONCLUSION This special issue focuses on how health services research has emerged as an important contributor to efforts to control the opioid epidemic in North America and Europe.
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Affiliation(s)
- Kim A Hoffman
- Oregon Health and Science University-Portland State UniversitySchool of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR, 97239-3088, USA.
| | | | - Dennis McCarty
- Oregon Health and Science University-Portland State UniversitySchool of Public Health, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR, 97239-3088, USA
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Kim PC, Yoo JW, Cochran CR, Park SM, Chun S, Lee YJ, Shen JJ. Trends and associated factors of use of opioid, heroin, and cannabis among patients for emergency department visits in Nevada: 2009-2017. Medicine (Baltimore) 2019; 98:e17739. [PMID: 31764772 PMCID: PMC6882558 DOI: 10.1097/md.0000000000017739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada.The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions.The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference - without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference - non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference - non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits.With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances.
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Affiliation(s)
- Pearl C. Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Ji Won Yoo
- Department of Internal Medicine, School of Medicine, University of Nevada, Las Vegas
| | - Chris R. Cochran
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Seong-Min Park
- Department of Criminal Justice, Greenspun College of Urban Affairs, University of Nevada, Las Vegas, NV
| | - Sungyoun Chun
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
| | - Yong-Jae Lee
- Department of Family Medicine, College of Medicine, Yonsei University, Seoul, South Korea
| | - Jay J. Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas
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Predictors of availability of long-acting medication for opioid use disorder. Drug Alcohol Depend 2019; 204:107586. [PMID: 31593871 PMCID: PMC6910228 DOI: 10.1016/j.drugalcdep.2019.107586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The U.S. Food and Drug Administration has approved three long-acting medications for opioid use disorder (MOUD): extended-release naltrexone (XR-NTX) in 2010, a subdermal buprenorphine implant in 2016, and a depot buprenorphine injection in 2017. Long-acting MOUD options may improve adherence while reducing diversion, but their availability compared to daily-dosing MOUD has not been well-characterized. The objective of this analysis was to characterize the availability of long-acting MOUD in substance use disorder treatment settings in the United States. METHODS Using the 2017 National Survey on Substance Abuse Treatment Services (N-SSATS) and state-level opioid overdose mortality, we examined associations between state- and facility-level factors and offering long-acting MOUD, which included XR-NTX and the buprenorphine implant. We constructed multivariable mixed logistic regression models for both types of long-acting MOUD. RESULTS Nationwide, 38% (n = 5141) of substance use treatment facilities provided any kind of MOUD (daily or long-acting). Of these, 62% provided XR-NTX, whereas only 3% offered the buprenorphine implant. Facilities in the East North Central, East South Central, West North Central and Mountain regions had higher odds of offering XR-NTX, as did federally-funded facilities, and facilities in states with the highest opioid overdose mortality rates. CONCLUSIONS In 2017, XR-NTX was available at most of the minority of facilities offering MOUD, but the buprenorphine implant was not. Increasing the availability of MOUD, including long-acting options, is necessary to address unmet need for opioid use disorder treatment.
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Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, Smith LR, Strathdee SA, Wakeman SE, Venkataramani AS. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med 2019; 16:e1002969. [PMID: 31770387 PMCID: PMC6957118 DOI: 10.1371/journal.pmed.1002969] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Mbarara University of Science and Technology, Mbarara,
Uganda
| | - Mathew V. Kiang
- Center for Population Health Sciences, Stanford University School of
Medicine, Stanford, California, United States of America
| | - Michael L. Barnett
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Health Policy and Management, Harvard T. H. Chan School of
Public Health, Boston, Massachusetts, United States of America
- Division of General Internal Medicine and Primary Care, Brigham and
Women’s Hospital, Boston, Massachusetts, United States of
America
| | - Leo Beletsky
- Northeastern University School of Law, Boston, Massachusetts, United
States of America
- Bouvé College of Health Sciences, Northeastern University, Boston,
Massachusetts, United States of America
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Katherine M. Keyes
- Mailman School of Public Health, Columbia University, New York City, New
York, United States of America
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland, United States of
America
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Medicine, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
| | - Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania,
Philadelphia, Pennsylvania, United States of America
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Clinical Workflow and Substance Use Screening, Brief Intervention, and Referral to Treatment Data in the Electronic Health Records: A National Drug Abuse Treatment Clinical Trials Network Study. EGEMS 2019; 7:35. [PMID: 31531381 PMCID: PMC6676918 DOI: 10.5334/egems.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: The use of electronic health records (EHR) data in research to inform recruitment and outcomes is considered a critical element for pragmatic studies. However, there is a lack of research on the availability of substance use disorder (SUD) treatment data in the EHR to inform research. Methods: This study recruited providers who used an EHR for patient care and whose facilities were affiliated with the National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (NIDA CTN). Data about providers’ use of an EHR and other methods to support and document clinical tasks for Substance use screening, Brief Intervention, and Referral to Treatment (SBIRT) were collected. Results: Participants (n = 26) were from facilities across the country (South 46.2%, West 23.1%, Midwest 19.2 percent, Northeast 11.5 percent), representing 26 different health systems/facilities at various settings: primary care (30.8 percent), ambulatory other/specialty (26.9 percent), mixed setting (11.5 percent), hospital outpatient (11.5 percent), emergency department (7.7 percent), inpatient (3.8 percent), and other (7.7 percent). Validated tools were rarely used for substance use screen and SUD assessment. Structured and unstructured EHR fields were commonly used to document SBIRT. The following tasks had high proportions of using unstructured EHR fields: substance use screen, treatment exploration, brief intervention, referral, and follow-up. Conclusion: This study is the first of its kind to investigate the documentation of SBIRT in the EHR outside of unique settings (e.g., Veterans Health Administration). While results are descriptive, they emphasize the importance of developing EHR features to collect structured data for SBIRT to improve health care quality evaluation and SUD research.
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Yip D, Gubner N, Le T, Williams D, Delucchi K, Guydish J. Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment. J Behav Health Serv Res 2019; 47:264-274. [PMID: 31359228 DOI: 10.1007/s11414-019-09669-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined whether living in a Medicaid-expanded state or having health insurance was associated with receipt of smoking cessation services or smoking behaviors among substance use disorder (SUD) treatment clients. In 2015 and 2016, 1702 SUD clients in 14 states were surveyed for health insurance status, smoking cessation services received in their treatment program, and smoking behaviors. Services and behaviors were then compared by state Medicaid expansion and health insurance status independently. Clients in Medicaid-expanded states were more likely to be insured (89.9% vs. 54.4%, p < 0.001) and to have quit smoking during treatment (AOR = 3.77, 95% CI = 2.47, 5.76). Insured clients had higher odds of being screened for smoking status in their treatment program and making quit attempts in the past year. Medicaid expansion supports greater health insurance coverage of individuals in SUD treatment and may enhance smoking cessation.
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Affiliation(s)
- Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA.
| | - Noah Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Denise Williams
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
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Shover CL, Abraham A, D'Aunno T, Friedmann PD, Humphreys K. The relationship of Medicaid expansion to psychiatric comorbidity care within substance use disorder treatment programs. J Subst Abuse Treat 2019; 105:44-50. [PMID: 31443890 DOI: 10.1016/j.jsat.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/31/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Co-occurring mental health disorders are common among substance use disorder (SUD) patients. Medicaid expansion aimed to reduce barriers to SUD and mental health care and thereby improve treatment outcomes. METHODS We estimated change in the proportion of United States SUD treatment sites offering treatment for psychiatric comorbidities following Medicaid expansion as part of implementation of the Affordable Care Act (ACA) in 2014. Using panel data from the 2013-2014, n = 660, and 2016-2017, n = 638, waves of the National Drug Abuse Treatment System Survey (NDATSS), we estimated change in the proportion of sites offering antidepressant medication, other psychiatric medication, behavioral treatment, or any combination thereof for treatment of mental health comorbidities (i.e., beyond services focused on SUD). We modeled the impact of Medicaid expansion as an interaction between year and date of Medicaid expansion. We constructed a mixed-effects linear regression model for each outcome, with the interaction variable as the main exposure, site as a random effect, and site's average duration of treatment, proportion of clients with psychiatric comorbidities, average caseload per treatment prescribing-clinician on staff, type of facility and geographic region as covariates, to estimate a difference-in-differences (D-I-D) equation. RESULTS The adjusted D-I-D analysis indicated that the proportion of SUD treatment sites offering antidepressants for psychiatric treatment increased 10% (95% CI 1%, 18%) in the Medicaid expansion sites compared to non-expansion sites. The D-I-D for other psychiatric medications was also 10% (95% 1%, 19%). No significant changes were observed in behavioral treatment or the combination measure. The strongest association between Medicaid expansion and offering medication for mental health comorbidities was the 34% increase observed for residential treatment settings (95% CI 10%, 59%). CONCLUSION Availability of psychiatric medication treatment in SUD treatment settings increased following Medicaid expansion, particularly in residential SUD facilities. This policy change has facilitated integrated treatment for the substantial share of SUD treatment patients with mental health comorbidities, with the greatest benefit for patients receiving SUD treatment in residential programs.
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Affiliation(s)
- Chelsea L Shover
- Stanford University, Department of Psychiatry, 401 N. Quarry Rd., Stanford, CA 94305, United States of America.
| | - Amanda Abraham
- University of Georgia, School of Public and International Affairs, 280F Baldwin Hall, Athens, GA 30602, United States of America.
| | - Thomas D'Aunno
- New York University, Wagner Graduate School of Public Service, 295 Lafayette St., New York, NY 10012, United States of America.
| | - Peter D Friedmann
- University of Massachusetts Medical School - Baystate, Office of Research, 3601 Main St., Springfield, MA 01107, United States of America.
| | - Keith Humphreys
- Stanford University, Department of Psychiatry, 401 N. Quarry Rd., Stanford, CA 94305, United States of America; Veterans Affairs Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA 94025, United States of America.
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Andrews CM, Grogan CM, Smith BT, Abraham AJ, Pollack HA, Humphreys K, Westlake MA, Friedmann PD. Medicaid Benefits For Addiction Treatment Expanded After Implementation Of The Affordable Care Act. Health Aff (Millwood) 2019; 37:1216-1222. [PMID: 30080460 DOI: 10.1377/hlthaff.2018.0272] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Columbia regarding their addiction treatment benefits and utilization controls in standard and alternative benefit plans in 2014 and 2017, when plans were subject to ACA parity requirements. The number of state plans that provided benefits for residential treatment and opioid use disorder medications increased substantially. States imposing annual service limits on outpatient addiction treatment decreased by over 50 percent. Fewer states required preauthorization for services, with the largest reductions for medications treating opioid use disorder. The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans. This trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.
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Affiliation(s)
- Christina M Andrews
- Christina M. Andrews ( ) is an assistant professor in the College of Social Work, University of South Carolina, in Columbia
| | - Colleen M Grogan
- Colleen M. Grogan is a professor in the School of Social Service Administration, University of Chicago, in Illinois
| | - Bikki Tran Smith
- Bikki Tran Smith is a PhD student in the School of Social Service Administration, University of Chicago
| | - Amanda J Abraham
- Amanda J. Abraham is an assistant professor in the School of Public and International Affairs, University of Georgia, in Athens
| | - Harold A Pollack
- Harold A. Pollack is the Helen Ross Professor in the School of Social Service Administration, University of Chicago
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences in the Department of Psychiatry, Stanford School of Medicine, and a senior research career scientist at the Veterans Affairs Palo Alto Health Care System, both in California
| | - Melissa A Westlake
- Melissa A. Westlake is a PhD student in College of Social Work, University of South Carolina
| | - Peter D Friedmann
- Peter D. Friedmann is chief research officer for academic affairs at Baystate Health, in Springfield, Massachusetts
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38
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Medicaid coverage in substance use disorder treatment after the affordable care act. J Subst Abuse Treat 2019; 102:1-7. [PMID: 31202283 DOI: 10.1016/j.jsat.2019.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/22/2019] [Accepted: 04/08/2019] [Indexed: 11/22/2022]
Abstract
The Affordable Care Act (ACA) prompted sweeping changes to Medicaid, including expanding insurance coverage to an estimated 12 million previously uninsured Americans, and imposing new parity requirements on benefits for behavioral health services, including substance use disorder treatment. Yet, limited evidence suggests that these changes have reduced the number of uninsured in substance use disorder treatment, or increased access to substance use disorder treatment overall. This study links data from a nationally-representative study of outpatient substance use disorder treatment programs and a unique national survey of state Medicaid programs to capture changes in insurance coverage among substance use disorder treatment patients after ACA implementation. Medicaid expansion was associated with a 15.7-point increase in the percentage of patients insured by Medicaid in substance use disorder treatment programs and a 13.7-point decrease in the percentage uninsured. Restrictions in state Medicaid benefits and utilization policies were associated with a decreased percentage of Medicaid patients in treatment. Moreover, Medicaid expansion was not associated with a change in the total number of clients served over the study period. Our findings highlight the important role Medicaid has played in increasing insurance coverage for substance use disorder treatment.
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39
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Zhu H, Wu LT. Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act. Drug Alcohol Depend 2019; 197:115-119. [PMID: 30802735 PMCID: PMC6508559 DOI: 10.1016/j.drugalcdep.2018.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/11/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore whether the Affordable Care Act (ACA) enactment is associated with changes in the proportion of discharge against medical advice (DAMA) among hospitalizations due to substance use disorders (SUDs). METHODS Data were drawn from the 2012-2015 National Inpatient Samples. The sample comprised hospitalizations with a principal diagnosis of SUD (i.e., SUD-involved hospitalization) for patients aged 18-64 years (unweighted N = 287,629). Interrupted time series analyses were conducted to evaluate the effect of the ACA on monthly proportions of DAMA among SUD-involved hospitalizations. RESULTS Overall, approximately 11% of SUD-involved hospitalizations were DAMA. DAMA was most frequently found among hospitalizations for primary opioid use disorder (pre-ACA: 16.4%; post-ACA: 17.2%). Despite the increase in the Medicaid coverage after ACA enactment, there was no significant change in the proportion of DAMA before and after ACA periods across various demographic groups and clinical conditions. Time series analyses also indicated no significant trend effect on the proportion of DAMA during the pre- and post-ACA months. CONCLUSIONS As many as 1 in 10 SUD-involved hospitalizations were considered as DAMA. Concerted efforts are needed to enhance insurance benefits for SUDs and patients' knowledge of SUD treatment benefits in order to increase SUD treatment engagement and completion and to reduce DAMA, especially for substance-using patients with Medicaid or opioid use disorder.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
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40
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Tofighi B, Williams AR, Chemi C, Suhail-Sindhu S, Dickson V, Lee JD. Patient Barriers and Facilitators to Medications for Opioid Use Disorder in Primary Care. Subst Use Misuse 2019; 54:2409-2419. [PMID: 31429351 PMCID: PMC6883164 DOI: 10.1080/10826084.2019.1653324] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: This study explored factors influencing patient access to medications for opioid use disorder (OUD), particularly for individuals eligible but historically suboptimal follow-up with in-house referrals to office-based opioid treatment (OBOT). Objectives: In-depth qualitative interviews among a mostly underserved sample of adults with OUD elicited: 1) knowledge and experiences across the OUD treatment cascade; and 2) more nuanced elements of patient-centered care, including shared decision making with providers, experiences in OBOT versus specialty addiction treatment, transitioning from methadone to buprenorphine or extended-release naltrexone (XR-NTX), and voluntary discontinuation of medications for OUD. Methods: We conducted semi-structured qualitative interviews between January and February of 2018 among adult inpatient detoxification program patients with OUD (n = 23). Preliminary analysis of interviews yielded key themes and ideas that were coded from a grounded theory approach. Results: Willingness to engage with OBOT was influenced by a complex array of practical considerations, including access to patient-centered care in OBOT settings, positive experiences with illicitly obtained buprenorphine, and differential experiences pertaining to OBOT versus specialty addiction treatment. Responses were generally favorable towards OBOT with buprenorphine, yet knowledge regarding extended-release naltrexone was limited. Respondents were often frustrated by clinicians when requesting to transition from methadone to buprenorphine or XR-NTX. Lastly, participants elucidated limited access to OBOT programs in underserved neighborhoods and suburban settings. Conclusion: Limited access to patient-centered care in OBOT with buprenorphine and extended-release naltrexone may exacerbate challenges to retention and/or reengagement with OUD care.
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Affiliation(s)
- Babak Tofighi
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York, NY, USA.,Center for Drug Use and HIV Research, New York, NY, USA
| | | | - Chemi Chemi
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Selena Suhail-Sindhu
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Vicky Dickson
- Center for Drug Use and HIV Research, New York, NY, USA.,Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Joshua D Lee
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Center for Drug Use and HIV Research, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
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41
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Hsu YJ, Marsteller JA, Kachur SG, Fingerhood MI. Integration of Buprenorphine Treatment with Primary Care: Comparative Effectiveness on Retention, Utilization, and Cost. Popul Health Manag 2018; 22:292-299. [PMID: 30543495 DOI: 10.1089/pop.2018.0163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Opioid use disorder (OUD) is a national crisis. Health care must achieve greater success than it has to date in helping opioid users achieve recovery. Integration of comprehensive primary care with treatment for OUD has the potential to increase care access among the substance-using population, improve outcomes, and reduce costs. However, little is known about the effectiveness of such care models. The Comprehensive Care Practice (CCP), a primary care practice located in Maryland, implemented a care model that blends buprenorphine treatment for OUD with attention to primary care needs. This study evaluates the model by comparing patients with OUD treated in CCP and other Maryland facilities in a large state Medicaid program. Compared to the non-CCP patient group (n = 867), the CCP group (n = 131) had a higher 6-month buprenorphine treatment retention rate (79% vs. 61%, adjusted average marginal effect (AME) = 0.17, P < 0.001). CCP patients also had fewer hospital stays in the 12-month follow-up period (0.22 vs. 0.41, AME = -0.17, P = 0.005), and lower total cost (US$10,942 vs. $13,097, AME = -$4554, P < 0.001) and hospital stay cost (US$1448 vs. $4265, AME = -$2609, P = 0.001), but higher buprenorphine pharmacy cost (US$3867 vs. $2781, AME = $987, P < 0.001). Other measures, including emergency department utilization and cost, substance abuse cost, and non-buprenorphine pharmacy cost, were not statistically different between the 2 groups. Results suggested that patients, as well as the health care system, can benefit from an integrated model of buprenorphine treatment and primary care for OUD with better treatment retention, fewer hospital stays, and lower costs.
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Affiliation(s)
- Yea-Jen Hsu
- 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jill A Marsteller
- 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Michael I Fingerhood
- 3Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.,4Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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42
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Campbell CI, Parthasarathy S, Altschuler A, Young-Wolff KC, Satre DD. Characteristics of patients with substance use disorder before and after the Affordable Care Act. Drug Alcohol Depend 2018; 193:124-130. [PMID: 30366189 PMCID: PMC6703160 DOI: 10.1016/j.drugalcdep.2018.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation. METHODS In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures. RESULTS Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans. CONCLUSIONS Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.
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Affiliation(s)
- Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA,Correspondence: Cynthia Campbell, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, Tel: 510 891-3584, Fax: 510 891-3606,
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA
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43
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Campbell ANC, McCarty D, Rieckmann T, McNeely J, Rotrosen J, Wu LT, Bart G. Interpretation and integration of the federal substance use privacy protection rule in integrated health systems: A qualitative analysis. J Subst Abuse Treat 2018; 97:41-46. [PMID: 30577898 DOI: 10.1016/j.jsat.2018.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/28/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Federal regulations (42 CFR Part 2) provide special privacy protections for persons seeking treatment for substance use disorders. Primary care providers, hospitals, and health care organizations have struggled to balance best practices for medical care with adherence to 42 CFR Part 2, but little formal research has examined this issue. The aim of this study was to explore institutional variability in the interpretation and implementation of 42 CFR Part 2 regulations related to health systems data privacy practices, policies, and information technology architecture. METHODS This was a cross-sectional qualitative study using purposive sampling to conduct interviews with privacy/legal officers (n = 17) and information technology specialists (n = 10) from 15 integrated healthcare organizations affiliated with three research nodes of the National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN). Trained staff completed a short survey and digitally recorded semi-structured qualitative interview with each participant. Interviews were transcribed and coded within Atlas.ti. Framework analysis was used to identify and organize key themes across selected codes. RESULTS Participants voiced concern over balancing patient safety with 42 CFR Part 2 privacy protections. Although similar standards of protection regarding release of information outside of the health system was described, numerous workarounds were used to manage intra-institutional communication and care coordination. To align 42 CFR Part 2 restrictions with electronic health records, health systems used sensitive note designation, "break the glass" technology, limited role-based access for providers, and ad hoc solutions (e.g., provider messaging). CONCLUSIONS In contemporary integrated care systems, substance-related EHR records (e.g., patient visit history, medication logs) are often accessible internally without specific consent for sharing despite the intent of 42 CFR Part 2. Recent amendments to 42 CFR Part 2 have not addressed information sharing needs within integrated care settings.
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Affiliation(s)
- Aimee N C Campbell
- New York State Psychiatric Institute and Columbia University Medical Center, Department of Psychiatry, 1051 Riverside Drive, Unit 120, Room 3719, New York, NY 10032, United States of America.
| | - Dennis McCarty
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Traci Rieckmann
- Greenfield Health and OHSU School of Medicine, 9450 SW Barnes Road, Suite 100, Portland, OR 97225, United States of America.
| | - Jennifer McNeely
- New York University School of Medicine, Department of Population Health, 550 1st Avenue, 6th Floor, New York 20016, United States of America.
| | - John Rotrosen
- New York University School of Medicine, One Park Avenue, 8th floor, New York, NY 10016, United States of America.
| | - Li-Tzy Wu
- Duke University Medical Center, PO Box 3903, Durham, NC 27710, United States of America.
| | - Gavin Bart
- Hennepin Healthcare, 701 Park Avenue, G5, Minneapolis, MN 55415, United States of America.
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Liu X, Shen J, Kim P, Park SM, Chun S, Pan JJ, Azab M, Choi H, Yeom H, Lee YJ, Yoo JW. Hepatitis C Infection Screening and Management in Opioid Use Epidemics in the United States. Am J Med 2018; 131:1276-1278. [PMID: 30392636 DOI: 10.1016/j.amjmed.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Xibei Liu
- Department of Medicine University of Arizona College of Medicine Tucson
| | - Jay Shen
- School of Community Health Sciences
| | | | - Seong-Min Park
- Department of Criminal Justice Greenspun College of Urban Affairs University of Nevada Las Vegas
| | - Sungyoun Chun
- Department of Criminal Justice Greenspun College of Urban Affairs University of Nevada Las Vegas
| | - Jen-Jung Pan
- Division of Gastroenterology and Hepatology University of Arizona College of Medicine Tucson
| | | | - Haneul Choi
- Honors College University of Nevada Las Vegas
| | | | - Yong-Jae Lee
- Department of Family Medicine Yonsei University College of Medicine Seoul, Korea
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45
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McCarty D, Gu Y, Renfro S, Baker R, Lind BK, McConnell KJ. Access to treatment for alcohol use disorders following Oregon's health care reforms and Medicaid expansion. J Subst Abuse Treat 2018; 94:24-28. [PMID: 30243413 DOI: 10.1016/j.jsat.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/03/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
The study examines impacts of delivery system reforms and Medicaid expansion on treatment for alcohol use disorders within the Oregon Health Plan (Medicaid). Diagnoses, services and pharmacy claims related to alcohol use disorders were extracted from Medicaid encounter data. Logistic regression and interrupted time series analyses assessed the percent with alcohol use disorder entering care and the percent receiving pharmacotherapy before (January 2010-June 2012) and after (January 2013-June 2015) the initiation of Oregon's Coordinated Care Organization (CCO) model (July 2012-December 2012). Analyses also examined changes in access following Medicaid expansion (January 2014). Treatment entry rates increased from 35% in 2010 to 41% in 2015 following the introduction of CCOs and Medicaid expansion. The number of Medicaid enrollees with a diagnosed alcohol use disorder increased about 150% from 10,360 (2013) to 25,454 (2014) following Medicaid expansion. Individuals with an alcohol use disorder who were prescribed a medication to support recovery increased from 2.3% (2010) to 3.8% (2015). In Oregon, Medicaid expansion and health care reforms enhanced access and improved treatment initiation for alcohol use disorders.
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Affiliation(s)
- Dennis McCarty
- OHSU - PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America; Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America.
| | - Yifan Gu
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America
| | - Stephanie Renfro
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America
| | - Robin Baker
- OHSU - PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Bonnie K Lind
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - K John McConnell
- OHSU - PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America; Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States of America
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Abstract
Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public and prescriber education, use of prescription drug monitoring programs, and safe medication disposal options. Overdose education and naloxone distribution promote access to rescue medication and reduce opioid overdose fatalities. Opioid use disorder prevention and treatment must embrace evidence-based care and integrate with physical and mental health care.
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Affiliation(s)
- Dennis McCarty
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kelsey C Priest
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - P Todd Korthuis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon 97239, USA; , ,
- Addiction Medicine Section, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
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47
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BrintzenhofeSzoc K, Gilbert C. Social workers have an obligation to all patients regarding confidentiality … however, for some patients, the obligation is greater. SOCIAL WORK IN HEALTH CARE 2017; 56:779-793. [PMID: 28699843 DOI: 10.1080/00981389.2017.1343216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Social workers are held to many ethical obligations regarding patients including maintaining patient confidentiality and staying up to date on confidentiality laws, statutes, and regulations. As the landscape of health care continues to change, including the increased use of technology to maintain patient records, highlights this need. The changes in the regulations on confidentiality of those who are receiving substance use treatment, 42 CFR Part 2, are presented. The other regulations and laws covered include HIPAA, HITECH, and the ACA. This includes the changes that have taken place, how to be compliant, and which to follow when.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Caitlyn Gilbert
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
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Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A, Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health 2017. [PMID: 28640680 DOI: 10.2105/ajph.2017.303825] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To determine the prevalence and patterns of polysubstance use among US reproductive-aged women who use opioids for nonmedical purposes. METHODS We used the National Survey of Drug Use and Health (2005-2014) data on female respondents aged 18 to 44 years reporting nonmedical opioid use in the past 30 days (unweighted n = 4498). We categorized patterns of polysubstance use in the past 30 days, including cigarettes, binge drinking, and other legal and illicit substances and reported prevalence adjusted for age, race/ethnicity, and educational attainment. RESULTS Of all women with nonmedical opioid use, 11% reported only opioid use. Polysubstance use was highest in non-Hispanic White women and women with lower educational attainment. The most frequently used other substances among women using opioids nonmedically were cigarettes (56.2% smoked > 5 cigarettes per day), binge drinking (49.7%), and marijuana (32.4%). Polysubstance use was similarly prevalent among pregnant women with nonmedical opioid use. CONCLUSIONS Polysubstance use is highly prevalent among US reproductive-aged women reporting nonmedical opioid use. Public Health Implications. Interventions are needed that address concurrent use of multiple substances.
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Affiliation(s)
- Marian Jarlenski
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Colleen L Barry
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Sarah Gollust
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Amy J Graves
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Alene Kennedy-Hendricks
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Katy Kozhimannil
- Marian Jarlenski is with the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Colleen L. Barry and Alene Kennedy-Hendricks are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah Gollust, Amy J. Graves, and Katy Kozhimannil are with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
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Stopka TJ, Hutcheson M, Donahue A. Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative. Harm Reduct J 2017; 14:26. [PMID: 28521814 PMCID: PMC5437530 DOI: 10.1186/s12954-017-0151-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts. METHODS Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach. RESULTS We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. CONCLUSIONS While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.
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Affiliation(s)
- Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Marguerite Hutcheson
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Ashley Donahue
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
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