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Freibott CE, Jalali A, Murphy SM, Walley AY, Linas BP, Jeng PJ, Bratberg J, Marshall BDL, Zang X, Green TC, Morgan JR. The association between naloxone claims and proportion of independent vs. chain pharmacies: A longitudinal analysis of naloxone claims in the US. J Am Pharm Assoc (2003) 2024:102093. [PMID: 38604474 DOI: 10.1016/j.japh.2024.102093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Expanding access to naloxone through pharmacies is an important policy goal. Our objective was to characterize national county-level naloxone dispensing of chain versus independent pharmacies. METHODS The primary exposure in our longitudinal analysis was the proportion of chain pharmacies in a county, identified through the US Department of Homeland Security 2010 Infrastructure Foundation-Level Data. We defined counties as having "higher proportion" of chain pharmacies if at least 50% of pharmacies were large national chains. The primary outcome was quarter-year (2016Q1-2019Q2) rate of pharmacy naloxone claims per 100,000 persons from Symphony Health at the county-level. We compared the naloxone dispensing rate between county types using two-sample t-tests. We estimated the association between county-level chain pharmacy proportion and rate of naloxone claims using a linear model with year-quarter fixed effects. RESULTS Nearly one third of counties (n=946) were higher proportion. Higher proportion counties had a significantly higher rate of naloxone claims across the study period, in 4 of 6 urban-rural classifications, and in counties with and without naloxone access laws. The linear model confirmed that higher proportion counties had a significantly higher rate of naloxone claims, adjusting for urban/rural designation, income, population characteristics, opioid mortality rate, co-prescribing laws and naloxone access laws. CONCLUSION In this national study, we found an association between naloxone dispensing rates and the county-level proportion of chain (versus independent) pharmacies. Incentivizing naloxone dispensing through educational, regulatory, or legal efforts may improve naloxone availability and dispensing rates - particularly in counties with proportionately high numbers of independent pharmacies.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Benjamin P Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Jeffrey Bratberg
- The University of Rhode Island, College of Pharmacy, Kingston, RI, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; COBRE on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Xiao Zang
- University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN, USA
| | - Traci C Green
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; COBRE on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA; Brandeis University Heller School for Social Policy and Management; Rhode Island Hospital, RI, USA
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
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Montoya ID, Watson C, Aldridge A, Ryan D, Murphy SM, Amuchi B, McCollister KE, Schackman BR, Bush JL, Speer D, Harlow K, Orme S, Zarkin GA, Castry M, Seiber EE, Barocas JA, Linas BP, Starbird LE. Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study. Addict Sci Clin Pract 2024; 19:23. [PMID: 38566249 PMCID: PMC10988809 DOI: 10.1186/s13722-024-00454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. METHODS This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. RESULTS State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. CONCLUSION We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
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Affiliation(s)
- Iván D Montoya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brenda Amuchi
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Joshua L Bush
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Drew Speer
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kristin Harlow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stephen Orme
- RTI International, Research Triangle Park, NC, USA
| | | | - Mathieu Castry
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric E Seiber
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joshua A Barocas
- Sections of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin P Linas
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Laura E Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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Konstantinides NA, Murphy SM, Whelan BM, Harmon KG, Poddar SK, Hernández TD, Rowe RK. Nominal Differences in Acute Symptom Presentation and Recovery Duration of Sport-Related Concussion Between Male and Female Collegiate Athletes in the PAC-12. Sports Med Open 2024; 10:31. [PMID: 38564117 PMCID: PMC10987417 DOI: 10.1186/s40798-024-00699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Sport-related concussion (SRC) is a heterogenous injury that often presents with varied symptoms and impairment. Recently, research has focused on identifying subtypes, or clinical profiles of concussion to be used in assessing and treating athletes with SRC. The purpose of this study was to investigate sex differences in clinical profiles, recovery duration, and initial symptom severity after SRC in a cohort of collegiate athletes in the Pacific-12 Conference (Pac-12). METHODS This prospective cohort study examined post-SRC symptoms, recovery, and return-to-play times using data from the Pac-12 CARE Affiliated Program and Pac-12 Health Analytics Program. Clinical profiles reported by student-athletes were defined by the number (> 50%) of specific symptoms frequently reported for each profile. Generalized linear mixed models were used to examine associations among sex, clinical profiles, time-to-recovery, and return-to-play times. RESULTS 479 concussion incidents met inclusion criteria. The probabilities of initial presentation of each clinical profile, initial injury severity scores, and recovery times within a profile did not differ between sexes (p = 0.33-0.98). However, both males and females had > 0.75 probabilities of exhibiting cognitive and ocular profiles. Initial injury severity score was a strong nonlinear predictor of initial number of clinical profiles (p < 0.0001), which did not differ between sexes. The number of clinical profiles was also a nonlinear predictor of time-to-recovery (p = 0.03) and return-to-play times (p < 0.0001). CONCLUSIONS Initial symptom severity was strongly predictive of the number of acute clinical profiles experienced post-SRC. As the number of clinical profiles increased, time-to-recovery and time to return-to-play also increased. Factors other than sex may be better associated with acute symptom presentation post-concussion as no sex differences were found in reported clinical profiles or recovery. Understanding the number and type of clinical profiles experienced post-SRC may help inform concussion diagnostics and management.
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Affiliation(s)
- Niki A Konstantinides
- Department of Integrative Physiology, University of Colorado Boulder, UCB 354, Boulder, CO, 80309, USA.
| | - Sean M Murphy
- Cumberland Biological and Ecological Researchers, Longmont, CO, USA
| | | | | | - Sourav K Poddar
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Theresa D Hernández
- Psychology and Neuroscience (CU Boulder), Physical Medicine and Rehabilitation (CU Anschutz School of Medicine), Aurora, CO, USA
| | - Rachel K Rowe
- Department of Integrative Physiology, University of Colorado Boulder, UCB 354, Boulder, CO, 80309, USA
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Lu TT, Parent SC, Chaytor N, Amiri S, Palmer K, McPherson S, Jett J, Ries R, McDonell MG, Murphy SM. Budget Impact Tool for Implementing Contingency Management for Co-occurring Alcohol Use Disorders and Serious Mental Illness. Psychiatr Serv 2024; 75:326-332. [PMID: 37855102 PMCID: PMC10984796 DOI: 10.1176/appi.ps.20220547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Contingency management (CM) is a behavioral intervention in which tangible incentives are provided to patients when they achieve a desired behavior (e.g., reducing or abstaining from alcohol use). The authors sought to describe the resource requirements and associated costs of various CM versions (usual, high magnitude, and shaping) tailored to a high-risk population with co-occurring serious mental illness and severe alcohol use disorder. METHODS A microcosting analysis was conducted to identify the resource requirements of the different CM versions. This approach included semistructured interviews with site investigators, who also staffed the intervention. The resource costing method-multiplying the number of units of each resource utilized by its respective unit cost-was used to value the resources from a provider's perspective. All cost estimates were calculated in 2021 U.S. dollars. RESULTS The cost of setting up a CM program was $6,038 per site. Assuming full capacity and 56% of urine samples meeting the requirement for receipt of the CM incentive, the average cost of 16 weeks of usual and shaping CM treatments was $1,119-$1,136 and of high-magnitude CM was $1,848-$1,865 per participant. CONCLUSIONS A customizable tool was created to estimate the costs associated with various levels of treatment success and CM design features. After the trial, the tool will be updated and used to finalize per-participant cost for incorporation into a comprehensive economic evaluation. This costing tool will help a growing number of treatment providers who are interested in implementing CM with budgeting for and sustaining CM in their practices.
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Affiliation(s)
- Thanh T Lu
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina
| | - Sara C Parent
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Naomi Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle
| | - Katharine Palmer
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Julianne Jett
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City
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McCollister KE, Gordon AJ, Acevedo A, Voshtina D, Li JM, Tse B, Murphy SM. The 2023 Addiction Health Services Research Conference: Back in Person and Taking a Bite of the Big Apple. Subst Use Addctn J 2024; 45:163-167. [PMID: 38288727 DOI: 10.1177/29767342231225577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The Addiction Health Services Research (AHSR) Conference has been held since 2002. This Conference brings together researchers, graduate students, policymakers, and treatment providers to focus improving the organization, distribution, and financing of healthcare resources for prevention/care of SUD. The AHSR 2023 Conference took place in New York City, October 18-20th, and was hosted by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH; cherishresearch.org). Attended by more than 300 participants, the Conference comprised several themes relating to the latest research on addiction health services delivery, financing, and impact. The agenda also included pre-conference workshops, distinguished plenary speakers, a multitude of networking opportunities, and career support for early-stage and minority investigators. AHSR 2023 featured 3 plenary sessions, 120 oral presentations, and 143 poster presentations from academics throughout the world. Overall, AHSR 2023 provided numerous opportunities to advance the field of addiction health services research. The state-of-the-art techniques and insights gained by attending scholars will position them to be change-agents in the addiction field going forward.
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Affiliation(s)
- Kathryn E McCollister
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Dorela Voshtina
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bonnie Tse
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Sean M Murphy
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Cherian T, Lim S, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Rosner Z, MacDonald R, Lee JD. Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration. Drug Alcohol Depend 2024; 259:111274. [PMID: 38643529 DOI: 10.1016/j.drugalcdep.2024.111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Non-fatal overdose is a leading predictor of subsequent fatal overdose. For individuals who are incarcerated, the risk of experiencing an overdose is highest when transitioning from a correctional setting to the community. We assessed if enrollment in jail-based medications for opioid use disorder (MOUD) is associated with lower risk of non-fatal opioid overdoses after jail release among individuals with opioid use disorder (OUD). METHODS This was a retrospective, observational cohort study of adults with OUD who were incarcerated in New York City jails and received MOUD or did not receive any MOUD (out-of-treatment) within the last three days before release to the community in 2011-2017. The outcome was the first non-fatal opioid overdose emergency department (ED) visit within 1 year of jail release during 2011-2017. Covariates included demographic, clinical, incarceration-related, and other characteristics. We performed multivariable cause-specific Cox proportional hazards regression analysis to compare the risk of non-fatal opioid overdose ED visits within 1 year after jail release between groups. RESULTS MOUD group included 8660 individuals with 17,119 incarcerations; out-of-treatment group included 10,163 individuals with 14,263 incarcerations. Controlling for covariates and accounting for competing risks, in-jail MOUD was associated with lower non-fatal opioid overdose risk within 14 days after jail release (adjusted HR=0.49, 95% confidence interval=0.33-0.74). We found no significant differences 15-28, 29-56, or 57-365 days post-release. CONCLUSION MOUD group had lower risk of non-fatal opioid overdose immediately after jail release. Wider implementation of MOUD in US jails could potentially reduce post-release overdoses, ED utilization, and associated healthcare costs.
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Affiliation(s)
- Teena Cherian
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA.
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Monica Katyal
- New York City Health + Hospitals/Correctional Health Service, 55 Water Street, New York, NY 10041, USA
| | - Keith S Goldfeld
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
| | - Ryan McDonald
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Maria Khan
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
| | - Noa Krawczyk
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Sean M Murphy
- Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Ali Jalali
- Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Philip J Jeng
- Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Zachary Rosner
- New York City Health + Hospitals/Correctional Health Service, 55 Water Street, New York, NY 10041, USA
| | - Ross MacDonald
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
| | - Joshua D Lee
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10010, USA
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Peck RN, Issarow B, Kisigo GA, Kabakama S, Okello E, Rutachunzibwa T, Willkens M, Deogratias D, Hashim R, Grosskurth H, Fitzgerald DW, Ayieko P, Lee MH, Murphy SM, Metsch LR, Kapiga S. Linkage Case Management and Posthospitalization Outcomes in People With HIV: The Daraja Randomized Clinical Trial. JAMA 2024; 331:1025-1034. [PMID: 38446792 PMCID: PMC10918579 DOI: 10.1001/jama.2024.2177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Importance Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. Objective To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Design, Setting, and Participants Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. Intervention The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. Main Outcomes and Measures The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. Results The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P = .96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P < .001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P < .001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P = .005), ART adherence (81.1% vs 67.6%; P = .002), and HIV viral load suppression (78.6% vs 67.1%; P = .01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Conclusions and Relevance Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. Trial Registration ClinicalTrials.gov Identifier: NCT03858998.
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Affiliation(s)
- Robert N. Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Benson Issarow
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Godfrey A. Kisigo
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Elialilia Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Thomas Rutachunzibwa
- Ministry of Health, Community Development, Gender, Elderly, and Children, Mwanza, Tanzania
| | - Megan Willkens
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Derick Deogratias
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel W. Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Philip Ayieko
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Sean M. Murphy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lim S, Cherian T, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Rosner Z, MacDonald R, Lee JD. Jail-based medication for opioid use disorder and patterns of reincarceration and acute care use after release: A sequence analysis. J Subst Use Addict Treat 2024; 158:209254. [PMID: 38072387 PMCID: PMC10947890 DOI: 10.1016/j.josat.2023.209254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Treatment with methadone and buprenorphine medications for opioid use disorder (MOUD) during incarceration may lead to better community re-entry, but evidence on these relationships have been mixed. We aimed to identify community re-entry patterns and examine the association between in-jail MOUD and a pattern of successful reentry defined by rare occurrence of reincarceration and preventable healthcare utilization. METHODS Data came from a retrospective, observational cohort study of 6066 adults with opioid use disorder who were incarcerated in New York City jails and released to the community during 2011-14. An outcome was community re-entry patterns identified by sequence analysis of 3-year post-release reincarceration, emergency department visits, and hospitalizations. An exposure was receipt of in-jail MOUD versus out-of-treatment (42 % vs. 58 %) for the last 3 days before discharge. The study accounted for differences in baseline demographic, clinical, behavioral, housing, and criminal legal characteristics between in-jail MOUD and out-of-treatment groups via propensity score matching. RESULTS This study identified five re-entry patterns: stability (64 %), hospitalization (23 %), delayed reincarceration (7 %), immediate reincarceration (4 %), and continuous incarceration (2 %). After addressing confounding, 64 % and 57 % followed the stability pattern among MOUD and out-of-treatment groups who were released from jail in 2011, respectively. In 2012-14, the prevalence of following the stability pattern increased year-by-year while a consistently higher prevalence was observed among those with in-jail MOUD. CONCLUSIONS Sequence analysis helped define post-release stability based on health and criminal legal system involvement. Receipt of in-jail MOUD was associated with a marker of successful community re-entry.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America.
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Monica Katyal
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Keith S Goldfeld
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ryan McDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Maria Khan
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, New York, NY, United States of America
| | - Ali Jalali
- Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, New York, NY, United States of America
| | - Zachary Rosner
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Ross MacDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, United States of America
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9
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Williams AR, Rowe C, Minarik L, Gray Z, Murphy SM, Pincus HA. Use of in-network insurance benefits is critical for improving retention in telehealth-based buprenorphine treatment. Health Aff Sch 2024; 2:qxae009. [PMID: 38450044 PMCID: PMC10914333 DOI: 10.1093/haschl/qxae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
An empiric evidence base is lacking regarding the relationship between insurance status, payment source, and outcomes among patients with opioid use disorder (OUD) on telehealth platforms. Such information gaps may lead to unintended impacts of policy changes. Following the phase-out of the COVID-19 Public Health Emergency, states were allowed to redetermine Medicaid eligibility and disenroll individuals. Yet, financial barriers remain a common and significant hurdle for patients with OUD and are associated with worse outcomes. We studied 3842 patients entering care in 2022 at Ophelia Health, one of the nation's largest OUD telehealth companies, to assess associations between insurance status and 6-month retention. In multivariable analyses, in-network patients who could use insurance benefits were more likely to be retained compared with cash-pay patients (adjusted risk ratio [aRR]: 1.50; 95% CI: 1.40-1.62; P < .001). Among a subsample of 882 patients for whom more detailed insurance data were available (due to phased-in electronic health record updates), in-network patients were also more likely to be retained at 6 months compared with insured, yet out-of-network patients (aRR: 1.86; 95% CI: 1.54-2.23; P < .001). Findings show that insurance status, and specifically the use of in-network benefits, is associated with superior retention and suggest that Medicaid disenrollment and insurance plan hesitation to engage with telehealth providers may undermine the nation's response to the opioid crisis.
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Affiliation(s)
- Arthur Robin Williams
- Ophelia Health, Inc, New York, NY 10003, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | | | - Lexie Minarik
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Zack Gray
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Sean M Murphy
- Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Harold A Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
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10
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Behrends CN, Leff JA, Lowry W, Li JM, Onuoha EN, Fardone E, Bayoumi AM, McCollister KE, Murphy SM, Schackman BR. Economic Evaluations of Establishing Opioid Overdose Prevention Centers in 12 North American cities: A Systematic Review. Value Health 2024:S1098-3015(24)00073-1. [PMID: 38401795 DOI: 10.1016/j.jval.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Overdose prevention centers (OPCs) provide a safe place where people can consume preobtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions. METHODS We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs. RESULTS We included 16 final studies that were evaluated with the Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists. Eight studies reported cost-effectiveness results (eg, cost per overdose avoided or cost per quality-adjusted life-year), with 6 also including cost-benefit; 5 reported only cost-benefit results, and 3 cost offsets. Health outcomes primarily included overdose mortality outcomes or HIV/hepatitis C virus infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC. CONCLUSIONS OPCs were found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and use a greater diversity of modeling designs.
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Affiliation(s)
- Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Jared A Leff
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Weston Lowry
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erica N Onuoha
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erminia Fardone
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed M Bayoumi
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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11
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Green TR, Nguyen T, Dunker V, Ashton D, Ortiz JB, Murphy SM, Rowe RK. Blood-Brain Barrier Dysfunction Predicts Microglial Activation After Traumatic Brain Injury in Juvenile Rats. Neurotrauma Rep 2024; 5:95-116. [PMID: 38404523 PMCID: PMC10890961 DOI: 10.1089/neur.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Traumatic brain injury (TBI) disrupts the blood-brain barrier (BBB), which may exacerbate neuroinflammation post-injury. Few translational studies have examined BBB dysfunction and subsequent neuroinflammation post-TBI in juveniles. We hypothesized that BBB dysfunction positively predicts microglial activation and that vulnerability to BBB dysfunction and associated neuroinflammation are dependent on age at injury. Post-natal day (PND)17 and PND35 rats (n = 56) received midline fluid percussion injury or sham surgery, and immunoglobulin-G (IgG) stain was quantified as a marker of extravasated blood in the brain and BBB dysfunction. We investigated BBB dysfunction and the microglial response in the hippocampus, hypothalamus, and motor cortex relative to age at injury and days post-injury (DPI; 1, 7, and 25). We measured the morphologies of ionized calcium-binding adaptor molecule 1-labeled microglia using cell body area and perimeter, microglial branch number and length, end-points/microglial cell, and number of microglia. Data were analyzed using generalized hierarchical models. In PND17 rats, TBI increased levels of IgG compared to shams. Independent of age at injury, IgG in TBI rats was higher at 1 and 7 DPI, but resolved by 25 DPI. TBI activated microglia (more cells and fewer end-points) in PND35 rats compared to respective shams. Independent of age at injury, TBI induced morphological changes indicative of microglial activation, which resolved by 25 DPI. TBI rats had fewer cells and end-points per cell at 1 and 7 DPI than 25 DPI. Independent of TBI, PND17 rats had larger, more activated microglia than PND35 rats; PND17 TBI rats had larger cell body areas and perimeters than PND35 TBI rats. Importantly, we found support in both ages that IgG quantification predicted microglial activation after TBI. The number of microglia increased with increasing IgG, whereas branch length decreased with increasing IgG, which together indicate microglial activation. Our results suggest that stabilization of the BBB after pediatric TBI may be an important therapeutic strategy to limit neuroinflammation and promote recovery.
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Affiliation(s)
- Tabitha R.F. Green
- Department of Integrative Physiology, University of Colorado Boulder, Colorado, USA
| | - Tina Nguyen
- Department of Integrative Physiology, University of Colorado Boulder, Colorado, USA
| | - Veronika Dunker
- Department of Integrative Physiology, University of Colorado Boulder, Colorado, USA
| | - Danielle Ashton
- Department of Integrative Physiology, University of Colorado Boulder, Colorado, USA
| | - J. Bryce Ortiz
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Arizona, USA
| | - Sean M. Murphy
- Cumberland Biological and Ecological Researchers, Longmont, Colorado, USA
| | - Rachel K. Rowe
- Department of Integrative Physiology, University of Colorado Boulder, Colorado, USA
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12
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Ortiz JB, Tellez S, Rampal G, Mannino GS, Couillard N, Mendez M, Green TRF, Murphy SM, Rowe RK. Diffuse traumatic brain injury substantially alters plasma growth hormone in the juvenile rat. J Endocrinol 2024; 260:e230157. [PMID: 37855319 PMCID: PMC10692649 DOI: 10.1530/joe-23-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Traumatic brain injury (TBI) can damage the hypothalamus and cause improper activation of the growth hormone (GH) axis, leading to growth hormone deficiency (GHD). GHD is one of the most prevalent endocrinopathies following TBI in adults; however, the extent to which GHD affects juveniles remains understudied. We used postnatal day 17 rats (n = 83), which model the late infantile/toddler period, and assessed body weights, GH levels, and number of hypothalamic somatostatin neurons at acute (1, 7 days post injury (DPI)) and chronic (18, 25, 43 DPI) time points. We hypothesized that diffuse TBI would alter circulating GH levels because of damage to the hypothalamus, specifically somatostatin neurons. Data were analyzed with generalized linear and mixed effects models with fixed effects interactions between the injury and time. Despite similar growth rates over time with age, TBI rats weighed less than shams at 18 DPI (postnatal day 35; P = 0.03, standardized effect size [d] = 1.24), which is around the onset of puberty. Compared to shams, GH levels were lower in the TBI group during the acute period (P = 0.196; d = 12.3) but higher in the TBI group during the chronic period (P = 0.10; d = 52.1). Although not statistically significant, TBI-induced differences in GH had large standardized effect sizes, indicating biological significance. The mean number of hypothalamic somatostatin neurons (an inhibitor of GH) positively predicted GH levels in the hypothalamus but did not predict GH levels in the somatosensory cortex. Understanding TBI-induced alterations in the GH axis may identify therapeutic targets to improve the quality of life of pediatric survivors of TBI.
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Affiliation(s)
- J Bryce Ortiz
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Sebastian Tellez
- Arizona State University, School of Life Sciences, Tempe, Arizona, USA
| | - Giri Rampal
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Grant S Mannino
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Nicole Couillard
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Matias Mendez
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Tabitha R F Green
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Sean M Murphy
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Rachel K Rowe
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
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13
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Vekaria V, Patra BG, Xi W, Murphy SM, Avery J, Olfson M, Pathak J. Association of opioid or other substance use disorders with health care use among patients with suicidal symptoms. J Subst Use Addict Treat 2024; 156:209177. [PMID: 37820869 PMCID: PMC10841388 DOI: 10.1016/j.josat.2023.209177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/23/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Prior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits. METHODS Using electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups. RESULTS Among patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59-0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter. CONCLUSIONS This study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.
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Affiliation(s)
- Veer Vekaria
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Braja G Patra
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Wenna Xi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Jonathan Avery
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, NY, United States of America
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America; Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America.
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14
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Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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15
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Gopaldas M, Wenzel K, Campbell ANC, Jalali A, Fishman M, Rotrosen J, Nunes EV, Murphy SM. Impact of Medication-Based Treatment on Health Care Utilization Among Individuals With Opioid Use Disorder. Psychiatr Serv 2023; 74:1227-1233. [PMID: 37337675 PMCID: PMC10730760 DOI: 10.1176/appi.ps.20220549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE This study evaluated the association between medication for opioid use disorder (MOUD) and health care utilization over time among a sample of treatment-seeking individuals with opioid use disorder. In contrast to previous studies, this study used a novel measure of MOUD adherence, more comprehensive utilization data, and analyses that controlled for detailed individual and social determinants of health. METHODS This study was a secondary analysis of a comparative effectiveness trial (N=570) of extended-release naltrexone versus buprenorphine-naloxone. The outcome of interest was usage of nonstudy acute care, inpatient and outpatient addiction services, and other outpatient services across 36 weeks of assessment. Adherence (percentage of days taking MOUD) was defined as low (<20%), medium (≥20% but <80%), or high (≥80%). A two-part model evaluated the probability of utilizing a resource and the quantity (utilization days) of the resource consumed. A time-varying approach was used to examine the effect of adherence in a given month on utilization in the same month, with analyses controlling for a wide range of person-level characteristics. RESULTS Participants with high adherence (vs. low) were significantly less likely to use inpatient addiction (p<0.001) and acute care (p<0.001) services and significantly more likely to engage in outpatient addiction (p=0.045) and other outpatient (p=0.042) services. CONCLUSIONS These findings reinforce the understanding that greater MOUD adherence is associated with reduced usage of high-cost health services and increased usage of outpatient care. The results further suggest the need for enhanced access to MOUD and for interventions that improve adherence.
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Affiliation(s)
- Manesh Gopaldas
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Kevin Wenzel
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Aimee N C Campbell
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Ali Jalali
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Marc Fishman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - John Rotrosen
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Edward V Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
| | - Sean M Murphy
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York City (Gopaldas, Campbell, Nunes); Maryland Treatment Centers, Baltimore (Wenzel, Fishman); Department of Population Health Sciences, Weill Cornell Medical College, New York City (Jalali, Murphy); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Fishman); Department of Psychiatry, New York University Grossman School of Medicine, New York City (Rotrosen)
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Wartko PD, Bobb JF, Boudreau DM, Matthews AG, McCormack J, Lee AK, Qiu H, Yu O, Hyun N, Idu AE, Campbell CI, Saxon AJ, Liu DS, Altschuler A, Samet JH, Labelle CT, Zare-Mehrjerdi M, Stotts AL, Braciszewski JM, Murphy MT, Dryden D, Arnsten JH, Cunningham CO, Horigian VE, Szapocznik J, Glass JE, Caldeiro RM, Phillips RC, Shea M, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Lapham GT, Addis M, Bradley KA, Ghiroli MM, Hamilton LK, Hu Y, LaHue JS, Loree AM, Murphy SM, Northrup TF, Shmueli-Blumberg D, Silva AJ, Weinstein ZM, Wong MT, Burganowski RP. Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1343-1354. [PMID: 37902748 PMCID: PMC10616772 DOI: 10.1001/jamainternmed.2023.5701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments. Objective To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization. Design, Setting, and Participants The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after. Intervention The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine. Main Outcomes and Measures The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up. Results During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70). Conclusions and Relevance The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD. Trial Registration ClinicalTrials.gov Identifier: NCT03407638.
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Affiliation(s)
- Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Genentech Inc, South San Francisco, California
| | | | | | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Kaiser Permanente Washington, Renton
| | - Hongxiang Qiu
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, North Bethesda, Maryland
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jeffrey H Samet
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Colleen T Labelle
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Mohammad Zare-Mehrjerdi
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Angela L Stotts
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Douglas Dryden
- MultiCare Health System, Tacoma, Washington
- Now with Mosaic Medical, Bend, Oregon
| | - Julia H Arnsten
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Bronx, New York
- Now with New York State Office of Addiction Services and Supports, New York
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Ryan M Caldeiro
- Mental Health and Wellness Department, Kaiser Permanente Washington, Renton
| | | | - Mary Shea
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- University of Minnesota Medical School, Minneapolis
| | | | - Jennifer McNeely
- Department of Population Health, Grossman School of Medicine, New York University, New York
| | - Jane M Liebschutz
- Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Joseph O Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California
| | - Megan M Ghiroli
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Yong Hu
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Thomas F Northrup
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | | | | | - Zoe M Weinstein
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
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Singla DR, de Oliveira C, Murphy SM, Patel V, Charlebois J, Davis WN, Dennis CL, Kim JJ, Kurdyak P, Lawson A, Meltzer-Brody S, Mulsant BH, Schoueri-Mychasiw N, Silver RK, Tschritter D, Vigod SN, Byford S. Protocol for an economic evaluation of scalable strategies to improve mental health among perinatal women: non-specialist care delivered via telemedicine vs. specialist care delivered in-person. BMC Psychiatry 2023; 23:817. [PMID: 37940930 PMCID: PMC10634150 DOI: 10.1186/s12888-023-05318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial. METHODS The economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants' depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances. DISCUSSION Results of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.
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Affiliation(s)
- Daisy R Singla
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, USA
| | | | | | - Cindy-Lee Dennis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - J Jo Kim
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Andrea Lawson
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, USA
| | - Benoit H Mulsant
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Richard K Silver
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Dana Tschritter
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Harm Reduct J 2023; 20:152. [PMID: 37853481 PMCID: PMC10585909 DOI: 10.1186/s12954-023-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). METHODS We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White, and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. RESULTS Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate, and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. CONCLUSIONS This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA
| | - Andrew J Trinidad
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Ashly E Jordan
- Department of Health & Mental Hygiene, Bureau of Alcohol & Drug Use Prevention, Care, & Treatment, 42-09 28Th St, Queens, New York, NY, 11101, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
- Center of Biomedical Research Excellence On Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI, 02906, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
| | - Xiao Zang
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI, 02912, USA.
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, New York, NY, 10065, USA
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Chatterjee A, Yan S, Lambert A, Morgan JR, Green TC, Jeng PJ, Jalali A, Xuan Z, Krieger M, Marshall BDL, Walley AY, Murphy SM. Comparison of a national commercial pharmacy naloxone data source to state and city pharmacy naloxone data sources-Rhode Island, Massachusetts, and New York City, 2013-2019. Health Serv Res 2023; 58:1141-1150. [PMID: 37408299 PMCID: PMC10480090 DOI: 10.1111/1475-6773.14200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Accurate naloxone distribution data are critical for planning and prevention purposes, yet sources of naloxone dispensing data vary by location, and completeness of local datasets is unknown. We sought to compare available datasets in Massachusetts, Rhode Island, and New York City (NYC) to a commercially available pharmacy national claims dataset (Symphony Health Solutions). DATA SOURCES AND STUDY SETTING We utilized retail pharmacy naloxone dispensing data from NYC (2018-2019), Rhode Island (2013-2019), and Massachusetts (2014-2018), and pharmaceutical claims data from Symphony Health Solutions (2013-2019). STUDY DESIGN We conducted a descriptive, retrospective, and secondary analysis comparing naloxone dispensing events (NDEs) captured via Symphony to NDEs captured by local datasets from the three jurisdictions between 2013 and 2019, when data were available from both sources, using descriptive statistics, regressions, and heat maps. DATA COLLECTION/EXTRACTION METHODS We defined an NDE as a dispensing event documented by the pharmacy and assumed that each dispensing event represented one naloxone kit (i.e., two doses). We extracted NDEs from local datasets and the Symphony claims dataset. The unit of analysis was the ZIP Code annual quarter. PRINCIPAL FINDINGS NDEs captured by Symphony exceeded those in local datasets for each time period and location, except in RI following legislation requiring NDEs to be reported to the PDMP. In regression analysis, absolute differences in NDEs between datasets increased substantially over time, except in RI before the PDMP. Heat maps of NDEs by ZIP code quarter showed important variations reflecting where pharmacies may not be reporting NDEs to Symphony or local datasets. CONCLUSIONS Policymakers must be able to monitor the quantity and location of NDEs in order to combat the opioid crisis. In regions where NDEs are not required to be reported to PDMPs, proprietary pharmaceutical claims datasets may be useful alternatives, with a need for local expertise to assess dataset-specific variability.
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Affiliation(s)
- Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Shapei Yan
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Audrey Lambert
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Jake R. Morgan
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Traci C. Green
- The Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Philip J. Jeng
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
| | - Ali Jalali
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
| | - Ziming Xuan
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Maxwell Krieger
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Brandon D. L. Marshall
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal MedicineBoston Medical Center/Boston University School of MedicineBostonMassachusettsUSA
| | - Sean M. Murphy
- Department of Population Health SciencesWeill Cornell Medical CollegeNew York CityNew YorkUSA
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20
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Hser YI, Mooney LJ, Baldwin LM, Ober A, Marsch LA, Sherman S, Matthews A, Clingan S, Fei Z, Zhu Y, Dopp A, Curtis ME, Osterhage KP, Hichborn EG, Lin C, Black M, Calhoun S, Holtzer CC, Nesin N, Bouchard D, Ledgerwood M, Gehring MA, Liu Y, Ha NA, Murphy SM, Hanano M, Saxon AJ. Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study. J Rural Health 2023; 39:780-788. [PMID: 37074350 PMCID: PMC10718290 DOI: 10.1111/jrh.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Seth Sherman
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Abigail Matthews
- Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA
| | - Sarah Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Zhe Fei
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, California, USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Katie P. Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Emily G. Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | | | - Noah Nesin
- Penobscot Community Health Care, Bangor, Maine, USA
| | | | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | | | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Neul Ah Ha
- Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Andrew J. Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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21
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Pham H, Lin C, Zhu Y, Clingan SE, Lin LA, Mooney LJ, Murphy SM, Campbell CI, Liu Y, Hser YI. Telemedicine-delivered treatment for substance use disorder: A scoping review. J Telemed Telecare 2023:1357633X231190945. [PMID: 37537907 DOI: 10.1177/1357633x231190945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The COVID pandemic prompted a significant increase in the utilization of telemedicine (TM) for substance use disorder (SUD) treatment. As we transition towards a "new normal" policy, it is crucial to comprehensively understand the evidence of TM in SUD treatment. This scoping review aims to summarize existing evidence regarding TM's acceptability, quality, effectiveness, access/utilization, and cost in the context of SUD treatment in order to identify knowledge gaps and inform policy decisions regarding TM for SUDs. METHOD We searched studies published in 2012-2022 from PubMed, Cochrane Library, Embase, Web of Science, and other sources. Findings were synthesized using thematic analysis. RESULTS A total of 856 relevant articles were screened, with a final total of 42 articles included in the review. TM in SUD treatment was perceived to be generally beneficial and acceptable. TM was as effective as in-person SUD care in terms of substance use reduction and treatment retention; however, most studies lacked rigorous designs and follow-up durations were brief (≤3 months). Telephone-based TM platforms (vs video) were positively associated with older age, lower education, and no prior overdose. Providers generally consider TM to be affordable for patients, but no relevant studies were available from patient perspectives. CONCLUSIONS TM in SUD treatment is generally perceived to be beneficial and acceptable and as effective as in-person care, although more rigorously designed studies on effectiveness are still lacking. Access and utilization of TM may vary by platform. TM service quality and costs are the least studied and warrant further investigations.
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Affiliation(s)
- Huyen Pham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Lewei Allison Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| | - Cynthia I Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, USA
| | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
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22
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Kropp FB, Smid MC, Lofwall MR, Wachman EM, Martin PR, Murphy SM, Wilder CM, Winhusen TJ. Collaborative care programs for pregnant and postpartum individuals with opioid use disorder: Organizational characteristics of sites participating in the NIDA CTN0080 MOMs study. Journal of Substance Use and Addiction Treatment 2023; 149:209030. [PMID: 37023858 DOI: 10.1016/j.josat.2023.209030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Pregnant individuals with substance use disorders face complex issues that may serve as barriers to treatment entry and retention. Several professional organizations have established recommendations on comprehensive, collaborative approaches to treatment to meet the needs of this population, but information on real-world application is lacking. Sites participating in the NIDA CTN0080 "Medication treatment for Opioid use disorder in expectant Mothers (MOMs)"-a randomized clinical trial of extended release compared to sublingual buprenorphine among pregnant and postpartum individuals (PPI)-were selected, in part, because they have a collaborative approach to treating PPI with opioid use disorder (OUD). However, organizational differences among sites and how they implement expert recommendations for collaborative care could impact study outcomes. METHODS Prior to study launch at each of the 13 MOMs sites, investigators used the Pregnancy and Addiction Services Assessment (PAASA) to collect information about organizational factors. Input from a team of addiction, perinatal, and economic evaluation experts guided the development of the PAASA. Investigators programmed the PAASA into a web-based data system and summarized the resultant site data using descriptive statistics. RESULTS Study sites represented four US census regions. Most sites were specialty obstetrics & gynecology (OB/GYN) programs providing OUD services (n = 9, 69.2 %), were affiliated with an academic institution (n = 11, 84.6 %), and prescribed buprenorphine in an ambulatory/outpatient setting (n = 11, 84.6 %); all sites offered access to naloxone. Sites reported that their population was primarily White, utilized public insurance, and faced numerous psychosocial barriers to treatment. Although all sites offered many services recommended by expert consensus groups, they varied in how they coordinated these services. CONCLUSIONS By providing the organizational characteristics of sites participating in the MOMs study, this report assists in filling the current gap in knowledge regarding similar programs providing services to PPI with OUD. Collaborative care programs such as those participating in MOMs are uniquely positioned to participate in research to determine the most effective models of care and to determine how research can be integrated into those clinical care settings.
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Affiliation(s)
- Frankie B Kropp
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA.
| | - Marcela C Smid
- University of Utah, 50 N. Medical Drive, Salt Lake City, UT 84132, USA.
| | - Michelle R Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Elisha M Wachman
- Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA.
| | - Peter R Martin
- Vanderbilt Psychiatric Hospital, Vanderbilt University Medical Center, 1601 23rd Avenue South, Suite 3035, Nashville, TN 372124, USA.
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Christine M Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - T John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
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23
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Cadet T, Jalali A, Jeng PJ, Poole S, Woody G, Murphy SM. Determinants of health-related quality of life among individuals with opioid use disorder, recently released from incarceration. Addict Sci Clin Pract 2023; 18:34. [PMID: 37231479 DOI: 10.1186/s13722-023-00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND\OBJECTIVES: Concomitant with low rates of pharmacotherapy for incarcerated individuals with OUD, there is a high rate of opioid overdose following re-entry into the community. Our research objective was to develop a better understanding of the factors that influence health-related quality-of-life (HRQoL) among this population during the high-risk transition period from incarceration to community. Few studies have assessed health-related quality-of-life (HRQoL) among individuals with OUD who are involved with the criminal-legal system, let alone over the period directly surrounding release from incarceration. METHODS Secondary longitudinal analysis of data from a clinical trial where participants were randomized 1:1 to pre-release extended-release naltrexone (XR-NTX) + referral to community XR-NTX, vs. referral only. We conducted individual, multivariable regressions of EQ-5D domains (mobility, pain/discomfort, anxiety/depression; usual activities and self-care were excluded due to insufficient variation in scores), and the overall preference/utility score. HRQoL data were subset to timepoints immediately before release (baseline) and 12 weeks post-release; treatment groups were collapsed across condition. Multiple imputation by chained equations was conducted to handle missing 3-month data in the dependent variables and covariates, ad hoc. RESULTS Greater severity in the psychiatric composite score was associated with substantially lower HRQoL, across all measures, following release from incarceration. Greater severity in the medical composite score was associated with lower pain/discomfort-related HRQoL. CONCLUSIONS Our findings highlight the importance of ensuring individuals with OUD are linked not only to MOUD, but also treatment for their comorbid conditions upon release from incarceration.
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Affiliation(s)
- Techna Cadet
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA.
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
| | - Sabrina Poole
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Woody
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61St Street, Suite 301, New York, NY, 10065, USA
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Nolen S, Trinidad AJ, Jordan AE, Green TC, Jalali A, Murphy SM, Zang X, Marshall BDL, Schackman BR. Racial/Ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City. Res Sq 2023:rs.3.rs-2934002. [PMID: 37292718 PMCID: PMC10246282 DOI: 10.21203/rs.3.rs-2934002/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC). Methods We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other covariates to 42 NYC neighborhoods. We used a multilevel negative binomial regression model to assess the relationship between neighborhood-specific naloxone receipt rates and race/ethnicity. Race/ethnicity was stratified into four mutually exclusive groups: Latino, non-Latino Black, non-Latino White and non-Latino Other. We also conducted racial/ethnic-specific geospatial analyses to assess whether there was within-group geographic variation in naloxone receipt rates for each racial/ethnic group. Results Non-Latino Black residents had the highest median quarterly naloxone receipt rate of 41.8 per 100,000 residents, followed by Latino residents (22.0 per 100,000), non-Latino White (13.6 per 100,000) and non-Latino Other residents (13.3 per 100,000). In our multivariable analysis, compared with non-Latino White residents, non-Latino Black residents had a significantly higher receipt rate and non-Latino Other residents had a significantly lower receipt rate. In the geospatial analyses, both Latino and non-Latino Black residents had the most within-group geographic variation in naloxone receipt rates compared to non-Latino White and Other residents. Conclusions This study found significant racial/ethnic differences in naloxone receipt from NYC OOPPs. We observed substantial variation in naloxone receipt for non-Latino Black and Latino residents across neighborhoods, indicating relatively poorer access in some neighborhoods and opportunities for new approaches to address geographic and structural barriers in these locations.
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Affiliation(s)
| | | | | | - Traci C Green
- Warren Alpert School of Medicine of Brown University
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25
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Giordano KR, Saber M, Green TR, Rojas-Valencia LM, Ortiz JB, Murphy SM, Lifshitz J, Rowe RK. Colony-Stimulating Factor-1 Receptor Inhibition Transiently Attenuated the Peripheral Immune Response to Experimental Traumatic Brain Injury. Neurotrauma Rep 2023; 4:284-296. [PMID: 37139183 PMCID: PMC10150725 DOI: 10.1089/neur.2022.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
To investigate microglial mechanisms in central and peripheral inflammation after experimental traumatic brain injury (TBI), we inhibited the colony-stimulating factor-1 receptor (CSF-1R) with PLX5622 (PLX). We hypothesized that microglia depletion would attenuate central inflammation acutely with no effect on peripheral inflammation. After randomization, male mice (n = 105) were fed PLX or control diets (21 days) and then received midline fluid percussion injury or sham injury. Brain and blood were collected at 1, 3, or 7 days post-injury (DPI). Immune cell populations were quantified in the brain and blood by flow cytometry. Cytokines (interleukin [IL]-6, IL-1β, tumor necrosis factor-α, interferon-γ, IL-17A, and IL-10) were quantified in the blood using a multi-plex enzyme-linked immunosorbent assay. Data were analyzed using Bayesian multi-variate, multi-level models. PLX depleted microglia at all time points and reduced neutrophils in the brain at 7 DPI. PLX also depleted CD115+ monocytes, reduced myeloid cells, neutrophils, and Ly6Clow monocytes in blood, and elevated IL-6. TBI induced a central and peripheral immune response. TBI elevated leukocytes, microglia, and macrophages in the brain and elevated peripheral myeloid cells, neutrophils, Ly6Cint monocytes, and IL-1β in the blood. TBI lowered peripheral CD115+ and Ly6Clow monocytes in the blood. TBI PLX mice had fewer leukocytes and microglia in the brain at 1 DPI, with elevated neutrophils at 7 DPI compared to TBI mice on a control diet. TBI PLX mice also had fewer peripheral myeloid cells, CD115+, and Ly6Clow monocytes in the blood at 3 DPI, but elevated Ly6Chigh, Ly6Cint, and CD115+ monocyte populations at 7 DPI, compared to TBI mice on a control diet. TBI PLX mice had elevated proinflammatory cytokines and lower anti-inflammatory cytokines in the blood at 7 DPI compared to TBI mice on a control diet. CSF-1R inhibition reduced the immune response to TBI at 1 and 3 DPI, but elevated peripheral inflammation at 7 DPI.
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Affiliation(s)
- Katherine R. Giordano
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, Arizona, USA
| | - Maha Saber
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Tabitha R.F. Green
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Luisa M. Rojas-Valencia
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, Arizona, USA
| | - J. Bryce Ortiz
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, Arizona, USA
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, Arizona, USA
| | - Rachel K. Rowe
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
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26
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Chatterjee A, Weitz M, Savinkina A, Macmadu A, Madushani RWMA, Potee RA, Ryan D, Murphy SM, Walley AY, Linas BP. Estimated Costs and Outcomes Associated With Use and Nonuse of Medications for Opioid Use Disorder During Incarceration and at Release in Massachusetts. JAMA Netw Open 2023; 6:e237036. [PMID: 37058306 PMCID: PMC10105308 DOI: 10.1001/jamanetworkopen.2023.7036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Importance Most prisons and jails in the US discontinue medications for opioid use disorder (MOUD) upon incarceration and do not initiate MOUD prior to release. Objective To model the association of MOUD access during incarceration and at release with population-level overdose mortality and OUD-related treatment costs in Massachusetts. Design, Setting, and Participants This economic evaluation used simulation modeling and cost-effectiveness with costs and quality-adjusted life-years (QALYs) discounted at 3% to compare MOUD treatment strategies in a corrections cohort and an open cohort representing individuals with OUD in Massachusetts. Data were analyzed between July 1, 2021, and September 30, 2022. Exposures Three strategies were compared: (1) no MOUD provided during incarceration or at release, (2) extended-release (XR) naltrexone offered only at release from incarceration, and (3) all 3 MOUDs (naltrexone, buprenorphine, and methadone) offered at intake. Main Outcomes and Measures Treatment starts and retention, fatal overdoses, life-years and QALYs, costs, and incremental cost-effectiveness ratios (ICERs). Results Among 30 000 simulated incarcerated individuals with OUD, offering no MOUD was associated with 40 927 (95% uncertainty interval [UI], 39 001-42 082) MOUD treatment starts over a 5-year period and 1259 (95% UI, 1130-1323) overdose deaths after 5 years. Over 5 years, offering XR-naltrexone at release led to 10 466 (95% UI, 8515-12 201) additional treatment starts, 40 (95% UI, 16-50) fewer overdose deaths, and 0.08 (95% UI, 0.05-0.11) QALYs gained per person, at an incremental cost of $2723 (95% UI, $141-$5244) per person. In comparison, offering all 3 MOUDs at intake led to 11 923 (95% UI, 10 861-12 911) additional treatment starts, compared with offering no MOUD, 83 (95% UI, 72-91) fewer overdose deaths, and 0.12 (95% UI, 0.10-0.17) QALYs per person gained, at an incremental cost of $852 (95% UI, $14-$1703) per person. Thus, XR-naltrexone only was a dominated strategy (both less effective and more costly) and the ICER of all 3 MOUDs compared with no MOUD was $7252 (95% UI, $140-$10 018) per QALY. Among everyone with OUD in Massachusetts, XR-naltrexone only averted 95 overdose deaths over 5 years (95% UI, 85-169)-a 0.9% decrease in state-level overdose mortality-while the all-MOUD strategy averted 192 overdose deaths (95% UI, 156-200)-a 1.8% decrease. Conclusions and Relevance The findings of this simulation-modeling economic study suggest that offering any MOUD to incarcerated individuals with OUD would prevent overdose deaths and that offering all 3 MOUDs would prevent more deaths and save money compared with an XR-naltrexone-only strategy.
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Affiliation(s)
- Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Michelle Weitz
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Alexandra Savinkina
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - R W M A Madushani
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ruth A Potee
- Franklin County House of Corrections, Greenfield, Massachusetts
| | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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D’Onofrio G, Edelman EJ, Hawk KF, Chawarski MC, Pantalon MV, Owens PH, Martel SH, Rothman R, Saheed M, Schwartz RP, Cowan E, Richardson L, Salsitz E, Lyons MS, Freiermuth C, Wilder C, Whiteside L, Tsui JI, Klein JW, Coupet E, O’Connor PG, Matthews AG, Murphy SM, Huntley K, Fiellin DA. Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. JAMA Netw Open 2023; 6:e235439. [PMID: 37017967 PMCID: PMC10077107 DOI: 10.1001/jamanetworkopen.2023.5439] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/05/2023] [Indexed: 04/06/2023] Open
Abstract
Importance Emergency department (ED)-initiated buprenorphine for the treatment of opioid use disorder (OUD) is underused. Objective To evaluate whether provision of ED-initiated buprenorphine with referral for OUD increased after implementation facilitation (IF), an educational and implementation strategy. Design, Setting, and Participants This multisite hybrid type 3 effectiveness-implementation nonrandomized trial compared grand rounds with IF, with pre-post 12-month baseline and IF evaluation periods, at 4 academic EDs. The study was conducted from April 1, 2017, to November 30, 2020. Participants were ED and community clinicians treating patients with OUD and observational cohorts of ED patients with untreated OUD. Data were analyzed from July 16, 2021, to July 14, 2022. Exposure A 60-minute in-person grand rounds was compared with IF, a multicomponent facilitation strategy that engaged local champions, developed protocols, and provided learning collaboratives and performance feedback. Main Outcomes and Measures The primary outcomes were the rate of patients in the observational cohorts who received ED-initiated buprenorphine with referral for OUD treatment (primary implementation outcome) and the rate of patients engaged in OUD treatment at 30 days after enrollment (effectiveness outcome). Additional implementation outcomes included the numbers of ED clinicians with an X-waiver to prescribe buprenorphine and ED visits with buprenorphine administered or prescribed and naloxone dispensed or prescribed. Results A total of 394 patients were enrolled during the baseline evaluation period and 362 patients were enrolled during the IF evaluation period across all sites, for a total of 756 patients (540 [71.4%] male; mean [SD] age, 39.3 [11.7] years), with 223 Black patients (29.5%) and 394 White patients (52.1%). The cohort included 420 patients (55.6%) who were unemployed, and 431 patients (57.0%) reported unstable housing. Two patients (0.5%) received ED-initiated buprenorphine during the baseline period, compared with 53 patients (14.6%) during the IF evaluation period (P < .001). Forty patients (10.2%) were engaged with OUD treatment during the baseline period, compared with 59 patients (16.3%) during the IF evaluation period (P = .01). Patients in the IF evaluation period who received ED-initiated buprenorphine were more likely to be in treatment at 30 days (19 of 53 patients [35.8%]) than those who did not 40 of 309 patients (12.9%; P < .001). Additionally, there were increases in the numbers of ED clinicians with an X-waiver (from 11 to 196 clinicians) and ED visits with provision of buprenorphine (from 259 to 1256 visits) and naloxone (from 535 to 1091 visits). Conclusions and Relevance In this multicenter effectiveness-implementation nonrandomized trial, rates of ED-initiated buprenorphine and engagement in OUD treatment were higher in the IF period, especially among patients who received ED-initiated buprenorphine. Trial Registration ClinicalTrials.gov Identifier: NCT03023930.
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Affiliation(s)
- Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn F. Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marek C. Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael V. Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patricia H. Owens
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shara H. Martel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne Richardson
- Institute for Health Equity Research, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin Salsitz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Caroline Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christine Wilder
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle
| | - Jared W. Klein
- Department of Medicine, University of Washington, Seattle
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick G. O’Connor
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
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Lim S, Cherian T, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, MacDonald R, Lee JD. Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails 2011-17. Addiction 2023; 118:459-467. [PMID: 36305669 PMCID: PMC9898114 DOI: 10.1111/add.16071] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/27/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Opioid overdose is a leading cause of death during the immediate time after release from jail or prison. Most jails in the United States do not provide methadone and buprenorphine treatment for opioid use disorder (MOUD), and research in estimating its impact in jail settings is limited. We aimed to test the hypothesis that in-jail MOUD is associated with lower overdose mortality risk post-release. DESIGN, SETTING AND PARTICIPANTS Retrospective, observational cohort study of 15 797 adults with opioid use disorder who were released from New York City jails to the community in 2011-2017. They experienced 31 382 incarcerations and were followed up to 1 year. MEASUREMENTS The primary outcomes were death caused by accidental drug poisoning and all-cause death. The exposure was receipt of MOUD (17 119 events) versus out-of-treatment (14 263 events) during the last 3 days before community re-entry. Covariates included demographic, clinical, behavioral, housing, health-care utilization and legal characteristics variables. We performed a multivariable, mixed-effect Cox regression analysis to test association between in-jail MOUD and deaths. FINDINGS The majority were male (82%) and their average age was 42 years. Receiving MOUD was associated with misdemeanor charges, being female, injection drug use and homelessness. During 1 year post-release, 111 overdose deaths occurred and crude death rates were 0.49 and 0.83 per 100 person-years for in-jail MOUD and out-of-treatment groups, respectively. Accounting for confounding and random effects, in-jail MOUD was associated with lower overdose mortality risk [adjusted hazard ratio (aHR) = 0.20, 95% confidence interval (CI) = 0.08-0.46] and all-cause mortality risk (aHR = 0.22, 95% CI = 0.11-0.42) for the first month post-release. CONCLUSIONS Methadone and buprenorphine treatment for opioid use disorder during incarceration was associated with an 80% reduction in overdose mortality risk for the first month post-release.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Monica Katyal
- Health and Hospital Correctional Health Services, New York, NY
| | | | - Ryan McDonald
- New York University Grossman School of Medicine, New York, NY
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Maria Khan
- New York University Grossman School of Medicine, New York, NY
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Queens, NY
| | | | - Ali Jalali
- Weill Cornell Medical School, New York, NY
| | | | - Ross MacDonald
- Health and Hospital Correctional Health Services, New York, NY
| | - Joshua D. Lee
- New York University Grossman School of Medicine, New York, NY
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Ryan DA, Montoya ID, Koutoujian PJ, Siddiqi K, Hayes E, Jeng PJ, Cadet T, McCollister KE, Murphy SM. Budget impact tool for the incorporation of medications for opioid use disorder into jail/prison facilities. J Subst Use Addict Treat 2023; 146:208943. [PMID: 36880906 PMCID: PMC10084043 DOI: 10.1016/j.josat.2022.208943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/02/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Given the personal and public consequences of untreated/undertreated OUD among persons involved in the justice system, an increasing number of jails and prisons are incorporating medication for opioid use disorder (MOUD) into their system. Estimating the costs of implementing and sustaining a particular MOUD program is vital to detention facilities, which typically face modest, fixed health care budgets. We developed a customizable budget impact tool to estimate the implementation and sustainment costs of numerous MOUD delivery models for detention facilities. METHODS The aim is to describe the tool and present an application of a hypothetical MOUD model. The tool is populated with resources required to implement and sustain various MOUD models in detention facilities. We identified resources via micro-costing techniques alongside randomized clinical trials. The resource-costing method is used to assign values to resources. Resources/costs are categorized as (a) fixed, (b) time-dependent, and (c) variable. Implementation costs include (a), (b), and (c) over a specified timeframe. Sustainment costs include (b) and (c). The MOUD model example entails offering all three FDA-approved medications, with methadone and buprenorphine provided by vendors, and naltrexone by the jail/prison facility. RESULTS Fixed resources/costs are incurred only once, including accreditation fees and trainings. Time-dependent resources/costs are recurring, but fixed over a given time-period; e.g., medication delivery and staff meetings. Variable resources/costs are those that are a direct function of the number of persons treated, such as the medication provided to each patient. Using nationally representative prices, we estimated fixed/sustainment costs to be $2919/patient, over 1 year. This article estimates annual sustainment costs to be $2885/patient. CONCLUSION The tool will serve as a valuable asset to jail/prison leadership, policymakers, and other stakeholders interested in identifying/estimating the resources and costs associated with alternative MOUD delivery models, from the planning stages through sustainment.
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Affiliation(s)
- Danielle A Ryan
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America.
| | - Iván D Montoya
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Peter J Koutoujian
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Kashif Siddiqi
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Edmond Hayes
- Franklin County Jail, 160 Elm St., Greenfield, MA 01301, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Techna Cadet
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Kathryn E McCollister
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
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Sung ML, Viera A, Esserman D, Tong G, Davidson D, Aiudi S, Bailey GL, Buchanan AL, Buchelli M, Jenkins M, John B, Kolakowski J, Lame A, Murphy SM, Porter E, Simone L, Paris M, Rash CJ, Edelman EJ. Contingency Management and Pre-Exposure Prophylaxis Adherence Support Services (CoMPASS): A hybrid type 1 effectiveness-implementation study to promote HIV risk reduction among people who inject drugs. Contemp Clin Trials 2023; 125:107037. [PMID: 36460267 PMCID: PMC9918697 DOI: 10.1016/j.cct.2022.107037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND HIV disproportionally affects persons who inject drugs (PWID), but engagement with HIV pre-exposure prophylaxis (PrEP) is low. We describe the rationale and study design for a new study, "Contingency Management and Pre-Exposure Prophylaxis (PrEP) Adherence Support Services (CoMPASS)," a hybrid type 1 effectiveness-implementation trial to promote HIV risk reduction among PWID. METHODS In four community-based programs in the northeastern United States, PrEP-eligible PWID (target n = 526) are randomized to treatment as usual or Contingency Management (CM) and, as indicated, stepped up to PrEP Adherence Support Services (CoMPASS) over 24 weeks. During CM sessions, participants receive timely tangible rewards for verifiable activities demonstrating 1) PrEP initiation and adherence, and 2) engagement with medications for opioid use disorder (MOUD) and other OUD-related care. Participants who do not have high levels of biomarker-confirmed PrEP adherence at week 12 will be stepped up to receive PrEP Adherence Support Services (PASS) consisting of strengths-based case management over 12 weeks. Interventions are delivered by trained PrEP navigators, staff embedded within the respective sites. The primary outcome is sustained PrEP adherence by dried blood spot testing at 24 weeks. To inform future implementation, we are conducting implementation-focused process evaluations throughout the clinical trial. CONCLUSIONS Results from this protocol are anticipated to yield novel findings regarding the impact and scalability of CoMPASS to promote HIV prevention among PWID in partnership with community-based organizations. http://ClinicalTrials.gov identifier: NCT04738825.
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Affiliation(s)
- Minhee L Sung
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Daniel Davidson
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Sherry Aiudi
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Genie L Bailey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Stanley Street Treatment and Resources (SSTAR) Inc., Fall River, MA, USA
| | - Ashley L Buchanan
- College of Pharmacy, Department of Pharmacy Practice University of Rhode Island, South Kingston, RI, USA
| | | | - Mark Jenkins
- Connecticut Harm Reduction Alliance, Hartford, CT, USA
| | - Betsey John
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | | | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Laura Simone
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carla J Rash
- UConn Health School of Medicine, Farmington, CT, USA
| | - E Jennifer Edelman
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Murphy SM, Hathcock CD, Espinoza TN, Fresquez PR, Berryhill JT, Stanek JE, Sutter BJ, Gaukler SM. Comparative spatially explicit approach for testing effects of soil chemicals on terrestrial wildlife bioindicator demographics. Environ Pollut 2023; 316:120541. [PMID: 36336177 DOI: 10.1016/j.envpol.2022.120541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
Wildlife species are often used as bioindicators to evaluate the extent and severity of environmental contamination and the effectiveness of remediation practices. A common approach for investigating population- or community-level impacts on bioindicators compares demographic parameter estimates (e.g., population size or density) between sites that were subjected to different levels of contamination. However, the traditional analytical method used in such studies is nonspatial capture-recapture, which results in conclusions about potential relationships between demographics and contaminants being inferred indirectly. Here, we extend this comparative approach to the spatially explicit framework, allowing direct estimation of said relationships and comparisons between study areas, by applying spatial capture-recapture (SCR) models to bioindicator (deer mice [Peromyscus spp.]) detection data from two study areas that were subjected to different industrial activities and remediation practices. Bioindicator density differed by 178% between the neighboring study areas, and the area with the highest soil concentrations of polychlorinated biphenyls, chromium, and zinc had the highest bioindicator density. Under the traditional nonspatial approach, we might have concluded that soil chemical levels had negligible influences on demographics. However, by modeling density as a spatial function of select chemical concentrations using SCR models, we found strong support for a positive relationship between density and soil chromium concentrations in one study area (β = 0.82), which was not masked by or associated with habitat-related metrics. To obtain reliable inferences about potential effects of environmental contamination on bioindicator demographics, we contend that a comparative spatially explicit approach using SCR ought to become standard.
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Affiliation(s)
- Sean M Murphy
- Department of Forestry and Natural Resources, University of Kentucky, Lexington, KY, USA.
| | - Charles D Hathcock
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Tatiana N Espinoza
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA; Space Science and Applications Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Philip R Fresquez
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Jesse T Berryhill
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Jenna E Stanek
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Benjamin J Sutter
- Infrastructure Program Office, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Shannon M Gaukler
- Environmental Stewardship Group, Los Alamos National Laboratory, Los Alamos, NM, USA.
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Wartko PD, Qiu H, Idu AE, Yu O, McCormack J, Matthews AG, Bobb JF, Saxon AJ, Campbell CI, Liu D, Braciszewski JM, Murphy SM, Burganowski RP, Murphy MT, Horigian VE, Hamilton LK, Lee AK, Boudreau DM, Bradley KA. Baseline representativeness of patients in clinics enrolled in the PRimary care Opioid Use Disorders treatment (PROUD) trial: comparison of trial and non-trial clinics in the same health systems. BMC Health Serv Res 2022; 22:1593. [PMID: 36581845 PMCID: PMC9801668 DOI: 10.1186/s12913-022-08915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pragmatic primary care trials aim to test interventions in "real world" health care settings, but clinics willing and able to participate in trials may not be representative of typical clinics. This analysis compared patients in participating and non-participating clinics from the same health systems at baseline in the PRimary care Opioid Use Disorders treatment (PROUD) trial. METHODS This observational analysis relied on secondary electronic health record and administrative claims data in 5 of 6 health systems in the PROUD trial. The sample included patients 16-90 years at an eligible primary care visit in the 3 years before randomization. Each system contributed 2 randomized PROUD trial clinics and 4 similarly sized non-trial clinics. We summarized patient characteristics in trial and non-trial clinics in the 2 years before randomization ("baseline"). Using mixed-effect regression models, we compared trial and non-trial clinics on a baseline measure of the primary trial outcome (clinic-level patient-years of opioid use disorder (OUD) treatment, scaled per 10,000 primary care patients seen) and a baseline measure of the secondary trial outcome (patient-level days of acute care utilization among patients with OUD). RESULTS Patients were generally similar between the 10 trial clinics (n = 248,436) and 20 non-trial clinics (n = 341,130), although trial clinics' patients were slightly younger, more likely to be Hispanic/Latinx, less likely to be white, more likely to have Medicaid/subsidized insurance, and lived in less wealthy neighborhoods. Baseline outcomes did not differ between trial and non-trial clinics: trial clinics had 1.0 more patient-year of OUD treatment per 10,000 patients (95% CI: - 2.9, 5.0) and a 4% higher rate of days of acute care utilization than non-trial clinics (rate ratio: 1.04; 95% CI: 0.76, 1.42). CONCLUSIONS trial clinics and non-trial clinics were similar regarding most measured patient characteristics, and no differences were observed in baseline measures of trial primary and secondary outcomes. These findings suggest trial clinics were representative of comparably sized clinics within the same health systems. Although results do not reflect generalizability more broadly, this study illustrates an approach to assess representativeness of clinics in future pragmatic primary care trials.
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Affiliation(s)
- Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States.
| | - Hongxiang Qiu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
- Department of Biostatistics, University of Washington, 1705 NE Pacific Street, Seattle, WA, 98195, United States
- Department of Statistics and Data Science, University of Pennsylvania, 3451 Walnut St Philadelphia, Philadelphia, PA, 19104, United States
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Jennifer McCormack
- The Emmes Company, 401 N Washington St #700, Rockville, MD, 20850, United States
| | - Abigail G Matthews
- The Emmes Company, 401 N Washington St #700, Rockville, MD, 20850, United States
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, United States
| | - Cynthia I Campbell
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, United States
| | - David Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, Three White Flint North, 11601 Landsdown Street, North Bethesda, MD, 20852, United States
| | | | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, United States
| | - Rachael P Burganowski
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Mark T Murphy
- MultiCare Health System, 315 Martin Luther King Jr. Way, Tacoma, WA, 98415, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St, CRB 919, Miami, FL, 33136, United States
| | - Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
- Genentech, 1 DNA Way, South San Francisco, CA, 94080, United States
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, United States
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Jalali A, Tamimi RM, McPherson SM, Murphy SM. Econometric Issues in Prospective Economic Evaluations Alongside Clinical Trials: Combining the Nonparametric Bootstrap With Methods That Address Missing Data. Epidemiol Rev 2022; 44:67-77. [PMID: 36104860 PMCID: PMC10362933 DOI: 10.1093/epirev/mxac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/09/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022] Open
Abstract
Prospective economic evaluations conducted alongside clinical trials have become an increasingly popular approach in evaluating the cost-effectiveness of a public health initiative or treatment intervention. These types of economic studies provide improved internal validity and accuracy of cost and effectiveness estimates of health interventions and, compared with simulation or decision-analytic models, have the advantage of jointly observing health and economics outcomes of trial participants. However, missing data due to incomplete response or patient attrition, and sampling uncertainty are common concerns in econometric analysis of clinical trials. Missing data are a particular problem for comparative effectiveness trials of substance use disorder interventions. Multiple imputation and inverse probability weighting are 2 widely recommended methods to address missing data bias, and the nonparametric bootstrap is recommended to address uncertainty in predicted mean cost and effectiveness between trial interventions. Although these methods have been studied extensively by themselves, little is known about how to appropriately combine them and about the potential pitfalls and advantages of different approaches. We provide a review of statistical methods used in 29 economic evaluations of substance use disorder intervention identified from 4 published systematic reviews and a targeted search of the literature. We evaluate how each study addressed missing data bias, whether the recommended nonparametric bootstrap was used, how these 2 methods were combined, and conclude with recommendations for future research.
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Affiliation(s)
- Ali Jalali
- Correspondence to Dr. Ali Jalali, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065 (e-mail: )
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Linas BP, Morgan JR, Murphy SM, Walley AY, Schackman BR, Marshall BDL. Evaluating equity in community-based naloxone access among racial/ethnic groups in Massachusetts. Drug Alcohol Depend 2022; 241:109668. [PMID: 36309001 PMCID: PMC9833886 DOI: 10.1016/j.drugalcdep.2022.109668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts. METHODS We used data from: the Massachusetts Department of Public Health on community-based overdose education and naloxone distribution (OEND) programs; the Massachusetts Office of the Chief Medical Examiner on opioid-related overdose deaths, and; the United States Census American Community Survey for regional demographic/socioeconomic details to estimate community populations by race/ethnicity and racial segregation between African American/Black and white residents. Race/ethnicity groups included in the analysis were African American/Black (non-Hispanic), Hispanic, white (non-Hispanic), and "other" (non-Hispanic). We evaluated racial/ethnic differences in naloxone distribution across regions in Massachusetts and neighborhoods in Boston descriptively and spatially, plotting the race/ethnicity-specific number of kits per opioid-related overdose death per jurisdiction. Lastly, we constructed generalized estimating equations models with a negative binomial distribution to compare the race/ethnicity-specific naloxone distribution rate by OEND programs. RESULTS From 2016-2019, the median annual rate of naloxone kits received from OEND programs in Massachusetts per racial/ethnicity group ranged between 160 and 447 per 100,000. In a multivariable analysis, we found that the naloxone distribution rates for racial/ethnic minorities were lower than the rate for white residents. We also found naloxone was more likely to be distributed in racially segregated communities than non-segregated communities. CONCLUSION We identified racial/ethnic inequities in naloxone receipt by individuals in Massachusetts. Additional resources focused on designing and implementing OEND programs for racial/ethnic minorities are warranted to ensure equitable access to naloxone.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 8 Third Street, Second Floor, Providence, RI 02906, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA.
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Zang X, Bessey SE, Krieger MS, Hallowell BD, Koziol JA, Nolen S, Behrends CN, Murphy SM, Walley AY, Linas BP, Schackman BR, Marshall BDL. Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island. JAMA Netw Open 2022; 5:e2241174. [PMID: 36350649 PMCID: PMC9647481 DOI: 10.1001/jamanetworkopen.2022.41174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. OBJECTIVE To compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs). DESIGN, SETTING, AND PARTICIPANTS In this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island. INTERVENTIONS Distribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach). MAIN OUTCOMES AND MEASURES Witnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates. RESULTS A total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo. CONCLUSIONS AND RELEVANCE In this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Sam E. Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Maxwell S. Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | | | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Czarina N. Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Alexander Y. Walley
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Brandon D. L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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Morgan JR, Murphy SM, Assoumou SA, Linas BP. Estimating Absenteeism Related to Nonalcohol Substance Use in a US National Cohort of Full-Time Employees. J Occup Environ Med 2022; 64:899-904. [PMID: 35901222 PMCID: PMC9637773 DOI: 10.1097/jom.0000000000002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to estimate absenteeism due to substance use disorder among full-time employees. METHODS We used the 2018 National Survey on Drug Use and Health to identify a sample of individuals employed full time. We used a survey-weighted multivariable negative binomial model to evaluate the association between absenteeism and type of substance use disorder controlling for available demographic information. RESULTS In the adjusted model, we estimated that opioid use without a disorder had the highest absenteeism for use, and polysubstance use disorder had the highest absenteeism among use disorders. In a hypothetical firm of 10,000 employees, we estimate $232,000 of lost wage value annually. CONCLUSIONS Substance use is associated with absenteeism and presents a compelling argument for employers to promote programs that support treatment for employees and reduce downstream costs associated with absenteeism and turnover.
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Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts (Dr Morgan); Department of Population Health Sciences, Weill Cornell Medical College, New York, New York (Dr Murphy); Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts (Dr Assoumou, Dr Linas); Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts (Dr Assoumou, Dr Linas); and Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (Dr Linas)
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Green TRF, Murphy SM, Rowe RK. Comparisons of quantitative approaches for assessing microglial morphology reveal inconsistencies, ecological fallacy, and a need for standardization. Sci Rep 2022; 12:18196. [PMID: 36307475 PMCID: PMC9616881 DOI: 10.1038/s41598-022-23091-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022] Open
Abstract
Microglial morphology is used to measure neuroinflammation and pathology. For reliable inference, it is critical that microglial morphology is accurately quantified and that results can be easily interpreted and compared across studies and laboratories. The process through which microglial morphology is quantified is a key methodological choice and little is known about how this choice may bias conclusions. We applied five of the most commonly used ImageJ-based methods for quantifying the microglial morphological response to a stimulus to identical photomicrographs and individual microglial cells isolated from these photomicrographs, which allowed for direct comparisons of results generated using these approaches. We found a lack of comparability across methods that analyzed full photomicrographs, with significant discrepancies in results among the five methods. Quantitative methods to analyze microglial morphology should be selected based on several criteria, and combinations of these methods may give the most biologically accurate representation of microglial morphology.
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Affiliation(s)
- Tabitha R. F. Green
- grid.134563.60000 0001 2168 186XDepartment of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA ,grid.266190.a0000000096214564Department of Integrative Physiology, University of Colorado, 2860 Wilderness Place, Boulder, CO 80301 USA
| | - Sean M. Murphy
- grid.134563.60000 0001 2168 186XDepartment of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA
| | - Rachel K. Rowe
- grid.134563.60000 0001 2168 186XDepartment of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA ,grid.266190.a0000000096214564Department of Integrative Physiology, University of Colorado, 2860 Wilderness Place, Boulder, CO 80301 USA
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Jalali A, Jeng PJ, Polsky D, Poole S, Ku YC, Woody GE, Murphy SM. Cost-effectiveness of extended-release injectable naltrexone among incarcerated persons with opioid use disorder before release from prison versus after release. J Subst Abuse Treat 2022; 141:108835. [PMID: 35933942 PMCID: PMC9508988 DOI: 10.1016/j.jsat.2022.108835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is highly prevalent among incarcerated populations, and the risk of fatal overdose following release from prison is substantial. Despite efficacy, few correctional facilities provide evidence-based addiction treatment. Extended-release injectable naltrexone (XR-NTX) administered prior to release from incarceration may improve health and economic outcomes. METHODS We conducted an economic evaluation alongside a randomized controlled trial testing the effectiveness of XR-NTX before release from prison (n = 38) vs. XR-NTX referral after release (n = 48) of incarcerated participants with OUD, both groups continuing treatment at a community addiction treatment center. The incremental cost-effectiveness ratio (ICER) assessed the cost-effectiveness of XR-NTX before release compared to referral after release for three stakeholder perspectives at 12- and 24-week periods: state policymaker, health care sector, and societal. Effectiveness measures included quality-adjusted life-years (QALYs) and abstinent years from opioids. In addition, we categorized resources as OUD-related and non-OUD-related medical care, state transfer payments, and other societal costs (productivity, criminal justice resources, etc.). RESULTS Results showed an association between XR-NTX and greater OUD-related costs and total costs from the state policymaker perspective. QALYs gained were positive but statistically insignificant between arms; however, results showed XR-NTX had an estimated 15.5 more days of opioid abstinence over 24 weeks and statistically significant at a 95 % confidence level based on the distribution of bootstrapped samples. We found that estimated ICERs to be > $500,000 per QALY for all stakeholder perspectives. For the abstinent-year effectiveness measure, we found XR-NTX before release to be cost-effective at a 95 % confidence level for willingness-to-pay values >$49,000 per abstinent-year, across all perspectives. CONCLUSIONS XR-NTX administered to persons who are incarcerated with OUD before release may provide value for stakeholders and bridge a well-known treatment gap for this vulnerable population. Lower than expected participant engagement and missing data limit our results, and study outcomes may be sensitive to methods that address missing data if replicated.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sabrina Poole
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi-Chien Ku
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Academy for the Judiciary, Ministry of Justice, Taiwan
| | - George E Woody
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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Green TRF, Murphy SM, Moreno-Montano MP, Audinat E, Rowe RK. Reactive morphology of dividing microglia following kainic acid administration. Front Neurosci 2022; 16:972138. [PMID: 36248637 PMCID: PMC9556904 DOI: 10.3389/fnins.2022.972138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
The microglial response to a pathological microenvironment is hallmarked by a change in cellular morphology. Following a pathological stimulus, microglia become reactive and simultaneously divide to create daughter cells. Although a wide array of microglial morphologies has been observed, the exact functions of these distinct morphologies are unknown, as are the morphology and reactivity status of dividing microglia. In this study, we used kainic acid to trigger microglial activation and cell division. Following a cortical kainic acid injection, microglial morphology and proliferation were examined at 3 days post-injection using immunohistochemistry for ionized calcium binding adapter molecule 1 (Iba1) to stain for microglia, and KI67 as a marker of cell division. Individual microglial cells were isolated from photomicrographs and skeletal and fractal analyses were used to examine cell size and spatial complexity. We examined the morphology of microglia in both wildtype and microglia-specific tumor necrosis factor (TNF)-α knockout mice. Data were analyzed using generalized linear mixed models or a two-way ANOVA. We found that dividing microglia had a more reactive morphology (larger cell body area, longer cell perimeter, and less ramification) compared to microglia that were not dividing, regardless of microglial release of TNF-α. However, we also observed dividing microglia with a complex, more ramified morphology. Changes in microglial morphology and division were greatest near the kainic acid injection site. This study uses robust and quantitative techniques to better understand microglial cell division, morphology, and population dynamics, which are essential for the development of novel therapeutics that target microglia.
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Affiliation(s)
- Tabitha R. F. Green
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Maria P. Moreno-Montano
- Institute of Functional Genomics (IGF), University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Etienne Audinat
- Institute of Functional Genomics (IGF), University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Rachel K. Rowe
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States
- *Correspondence: Rachel K. Rowe,
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Karnik NS, Marsden J, McCluskey C, Boley RA, Bradley KA, Campbell CI, Curtis ME, Fiellin D, Ghitza U, Hefner K, Hser Y, McHugh RK, McPherson SM, Mooney LJ, Moran LM, Murphy SM, Schwartz RP, Shmueli‐Blumberg D, Shulman M, Stephens KA, Watkins KE, Weiss RD, Wu L. The opioid use disorder core outcomes set (OUD-COS) for treatment research: findings from a Delphi consensus study. Addiction 2022; 117:2438-2447. [PMID: 35293064 PMCID: PMC9543602 DOI: 10.1111/add.15875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/23/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM There is no gold-standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD-COS). DESIGN Four-round, e-Delphi expert panel consensus study and plenary research group discussion and targeted consultation. SETTING United States. PARTICIPANTS A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the network's affiliated clinical and community sites and the NIDA Centre for the CTN. MEASUREMENTS From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on-line questionnaire to rank items with defined specification on a 9-point scale for importance, with a standard 70% consensus criterion. FINDINGS After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient-reported (global impression of improvement and incident non-fatal overdose); one clinician-reported (illicit/non-medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). CONCLUSIONS An e-Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research.
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Affiliation(s)
- Niranjan S. Karnik
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Connor McCluskey
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - Randy A. Boley
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - Katharine A. Bradley
- Division of ResearchKaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | | | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - David Fiellin
- Yale School of Medicine, Internal MedicineProgram in Addiction MedicineNew HavenCTUSA
| | - Udi Ghitza
- National Institute on Drug Abuse, National Institutes of HealthNational Institute on Drug Abuse Center for Clinical Trials NetworkBethesdaMDUSA
| | - Kathryn Hefner
- Yale School of Medicine, Internal MedicineProgram in Addiction MedicineNew HavenCTUSA
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Yih‐Ing Hser
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital and Department of PsychiatryHarvard Medical School, McLean HospitalBelmontMAUSA
| | - Sterling M. McPherson
- Department of Community and Behavioral HealthWashington State University Elson S. Floyd College of MedicineSpokaneWAUSA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - Landhing M. Moran
- National Institute on Drug Abuse, National Institutes of HealthNational Institute on Drug Abuse Center for Clinical Trials NetworkBethesdaMDUSA
| | - Sean M. Murphy
- Department of Population Health SciencesWeill Cornell Medical CollegeNew YorkNYUSA
| | | | - Dikla Shmueli‐Blumberg
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Matisyahu Shulman
- Department of Psychiatry, Columbia University Irving Medical Center and Department of PsychiatryNew York State Psychiatric InstituteNew YorkNYUSA
| | - Kari A. Stephens
- Departments of Family Medicine, Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWAUSA
| | | | - Roger D. Weiss
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Li‐Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNCUSA
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Savinkina A, Madushani RWMA, Yazdi GE, Wang J, Barocas JA, Morgan JR, Assoumou SA, Walley AY, Linas BP, Murphy SM. Population-level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost-effectiveness analysis. Addiction 2022; 117:2450-2461. [PMID: 35315162 PMCID: PMC9377514 DOI: 10.1111/add.15879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Medications for opioid use disorder (MOUD) are shown to reduce opioid use and the risk of overdose. People with opioid use disorder (OUD) who exit inpatient medically managed withdrawal programs (detox) without initiating MOUD and linking to outpatient care have high rates of overdose. While detox encounters provide a theoretical opportunity for MOUD initiation, this is not ubiquitous in the United States. We used simulation modeling to estimate the population-level health effects and cost-effectiveness of a policy encouraging MOUD initiation during inpatient detox encounters. DESIGN, SETTING AND PARTICIPANTS We employed a dynamic population state-transition model to evaluate the effectiveness and cost-effectiveness of using detox programs as venues for initiating MOUD in Massachusetts, United States. We compared standard of care, where no detox patients initiate MOUD or link to outpatient MOUD providers, to strategies of offering MOUD to detox patients and linking those patients to outpatient MOUD. MEASURES Budgetary impact to the Massachusetts health-care sector, incremental cost-effectiveness ratios (ICER) and total counts and percentage differences of fatal overdoses prevented. FINDINGS Initiating MOUD in detox with perfect linkage to outpatient MOUD would reduce fatal overdoses by 4.5% [95% confidence interval (CI) = 2.3-5.9], at an ICER of $56 000 per quality-adjusted life-year (QALY) gained, compared with the standard of care. With moderate linkage, fatal overdoses would be reduced by 2.3% (95% CI= 1.2-3.1) with an ICER of $78 500 per QALY gained, compared with standard of care. Budgetary increase to Massachusetts health-care spending ranged from 0.5-1%. CONCLUSION A simulation model indicates that initiation of medications for opioid use disorder and linkage policies among detox patients in Massachusetts, USA could prevent fatal opioid overdoses in the opioid use disorder population and would be cost-effective from a health-care sector perspective.
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Affiliation(s)
- Alexandra Savinkina
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - R. W. M. A. Madushani
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Golnaz Eftekhari Yazdi
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Jianing Wang
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Joshua A. Barocas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Jake R. Morgan
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Grayken Center for Addiction at Boston Medical Center, Boston, MA, USA, 02118
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065
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Morgan JR, Freibott CE, Jalali A, Jeng PJ, Walley AY, Chatterjee A, Green TC, Nolan ML, Linas BP, Marshall BD, Murphy SM. The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City. Drug Alcohol Depend Rep 2022; 4:100083. [PMID: 36337350 PMCID: PMC9631422 DOI: 10.1016/j.dadr.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Naloxone distributed to people at risk for opioid overdose has been associated with reduced overdose death rates; however, associations of retail pharmacy-distributed naloxone with overdose mortality have not been evaluated. Methods Our analytic cohort uses retail pharmacy claims data; three health departments' community distribution data; federal opioid overdose data; and American Community Survey data. Data were analyzed by 3-digit ZIP Code and calendar quarter-year (2016Q1-2018Q4), and weighted by population. We regressed opioid-related overdose mortality on retail-pharmacy and community naloxone distribution, and community-level demographics using a linear model, hypothesizing that areas with high overdose rates would have higher current levels of naloxone distribution but that increasing naloxone distribution from one quarter to the next would be associated with lower overdose. Results From Q1-2016 to Q4-2018, the unadjusted naloxone distribution rate increased from 97 to 257 kits per 100,000 persons, while the unadjusted opioid overdose mortality rate fell from 8.1 to 7.2 per 100,000 persons. The concurrent level of naloxone distribution (both pharmacy and community) was positively and significantly associated with fatal opioid overdose rates. We did not detect associations between change in naloxone distribution rates and overdose mortality. Conclusion Naloxone distribution volumes were correlated with fatal opioid overdose, suggesting medication was getting to communities where it was needed most. Amid high rates of overdose driven by fentanyl in the drug supply, our findings suggest additional prevention, treatment, and harm reduction interventions are required-and dramatically higher naloxone volumes needed-to reverse the opioid overdose crisis in the US.
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Affiliation(s)
- Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
- Corresponding author.
| | - Christina E. Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J. Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Traci C. Green
- Brandeis University Heller School for Social Policy and Management, Rhode Island Hospital, RI, United States of America
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Michelle L. Nolan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Benjamin P. Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
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Rowe RK, Green TRF, Giordano KR, Ortiz JB, Murphy SM, Opp MR. Microglia Are Necessary to Regulate Sleep after an Immune Challenge. Biology 2022; 11:biology11081241. [PMID: 36009868 PMCID: PMC9405260 DOI: 10.3390/biology11081241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
Microglia play a critical role in the neuroimmune response, but little is known about the role of microglia in sleep following an inflammatory trigger. Nevertheless, decades of research have been predicated on the assumption that an inflammatory trigger increases sleep through microglial activation. We hypothesized that mice (n = 30) with depleted microglia using PLX5622 (PLX) would sleep less following the administration of lipopolysaccharide (LPS) to induce inflammation. Brains were collected and microglial morphology was assessed using quantitative skeletal analyses and physiological parameters were recorded using non-invasive piezoelectric cages. Mice fed PLX diet had a transient increase in sleep that dissipated by week 2. Subsequently, following a first LPS injection (0.4 mg/kg), mice with depleted microglia slept more than mice on the control diet. All mice were returned to normal rodent chow to repopulate microglia in the PLX group (10 days). Nominal differences in sleep existed during the microglia repopulation period. However, following a second LPS injection, mice with repopulated microglia slept similarly to control mice during the dark period but with longer bouts during the light period. Comparing sleep after the first LPS injection to sleep after the second LPS injection, controls exhibited temporal changes in sleep patterns but no change in cumulative minutes slept, whereas cumulative sleep in mice with repopulated microglia decreased during the dark period across all days. Repopulated microglia had a reactive morphology. We conclude that microglia are necessary to regulate sleep after an immune challenge.
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Affiliation(s)
- Rachel K. Rowe
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80301, USA
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Correspondence: ; Tel.: +1-303-735-0309
| | - Tabitha R. F. Green
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Katherine R. Giordano
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012, USA
| | - J. Bryce Ortiz
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012, USA
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Mark R. Opp
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80301, USA
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44
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Rivenburg RE, Murphy SM, Jones CT, Martin KW. Arthroscopic-Assisted Toggle Rod Stabilization in Canine Coxofemoral Luxation: A Cadaveric Study. Vet Comp Orthop Traumatol 2022; 35:298-304. [PMID: 35853474 DOI: 10.1055/s-0042-1748880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe an arthroscopic-assisted technique for coxofemoral toggle rod placement, and to report on the feasibility, drill tunnel trajectory and accuracy of tunnel aperture location using this method. STUDY DESIGN Cadaveric pilot study. SAMPLE POPULATION Eight coxofemoral joints. METHODS Craniodorsal coxofemoral joint luxations were artificially created. A simulated open hip reduction and stabilization with a toggle rod were performed through a limited arthrotomy under arthroscopic guidance. Computed tomography scans were performed to evaluate drill hole trajectory across the femoral neck, and joints were disarticulated and photographed. Digital imaging software was used to determine the percent overlap of the drill hole apertures relative to the origin and insertion of the round ligament on the acetabulum and fovea. RESULTS The exit point of the tunnel was entirely within the fovea capitis in five of eight femurs, three of eight femoral drill apertures were only partially within the target area. Of the eight acetabular bone tunnels examined, all were centred occupying the acetabular fossa. CONCLUSIONS Coxofemoral toggle rod placement can be performed under arthroscopic guidance through a limited arthrotomy. Comparable femoral tunnel accuracy with the standard open technique should be achieved with the current method prior to its clinical use.
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Affiliation(s)
- Rachel E Rivenburg
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, United States
| | - Sean M Murphy
- WestVet Animal Specialty & Emergency Center, Garden City, Idaho, United States
| | | | - Kyle W Martin
- Colorado Animal Specialty & Emergency, Boulder, Colorado, United States
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45
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Fanucchi LC, Murphy SM, Surratt H, Kapadia SN, Walsh SL, Grubbs JA, Thornton AC, Nuzzo P, Lofwall MR. Design and protocol of the Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT) study: a randomized clinical trial of integrated outpatient treatment of opioid use disorder and severe, injection-related infections. Ther Adv Infect Dis 2022; 9:20499361221108005. [PMID: 35847566 PMCID: PMC9277431 DOI: 10.1177/20499361221108005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/01/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction A marked increase in hospitalizations for severe, injection-related infections (SIRI) has been associated with the opioid epidemic. Outpatient parenteral antibiotic therapy (OPAT) is typically not offered to persons with opioid use disorder (OUD) and SIRI, though increasing evidence suggests it may be feasible and safe. This study evaluates the efficacy and cost-effectiveness of an integrated care model combining Buprenorphine treatment of OUD with OPAT for SIRI (B-OPAT) compared with treatment as usual on key OUD, infectious disease, and health economic outcomes. B-OPAT expands and incorporates key elements of established clinical models, including inpatient initiation of buprenorphine for OUD, inpatient infectious disease consultation for SIRI, office-based treatment of OUD, and OPAT, and includes more frequent clinical outpatient visits than standard OPAT. A qualitative evaluation is included to contextualize effectiveness outcomes and identify barriers and facilitators to intervention adoption and implementation. Methods B-OPAT is a single-site, randomized, parallel-group, superiority trial recruiting 90 adult inpatients hospitalized with OUD and SIRI who require at least 2 weeks of intravenous (IV) antibiotic therapy. After screening, eligible participants are randomized 1:1 to either discharge once medically stable to an integrated outpatient treatment care model combining Buprenorphine and OPAT (B-OPAT) or to Treatment As Usual (TAU). The primary outcome measure is the proportion of urine samples negative for illicit opioids in the 12 weeks after discharge from the hospital. Key secondary OUD outcomes include self-reported number of days of illicit opioid abstinence and 12-week retention in buprenorphine treatment. The infection outcomes are completion of recommended IV antibiotic therapy, peripherally inserted central catheter (PICC) complications, and readmission related to primary SIRI. Conclusions The B-OPAT study will help address the important question of whether it is clinically effective and cost-effective to discharge persons with OUD and SIRI to an integrated outpatient care model combining OUD treatment with OPAT relative to TAU (Clinicaltrials.gov Identifier: NCT04677114).
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Affiliation(s)
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA
| | - Hilary Surratt
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA,Department of Behavioral Science, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Shashi N. Kapadia
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA,Division of Infectious Diseases, Weill Cornell
Medicine, New York, NY, USA
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA,Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA,Department of Pharmaceutical Sciences, College
of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - James A. Grubbs
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Alice C. Thornton
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Paul Nuzzo
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA,Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA
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46
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vonHoldt BM, Hinton JW, Shutt AC, Murphy SM, Karlin ML, Adams JR, Waits LP, Brzeski KE. Reviving ghost alleles: Genetically admixed coyotes along the American Gulf Coast are critical for saving the endangered red wolf. Sci Adv 2022; 8:eabn7731. [PMID: 35767623 PMCID: PMC9242586 DOI: 10.1126/sciadv.abn7731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
The last known red wolves were captured in southwestern Louisiana and eastern Texas in 1980 to establish a captive breeding population. Before their extirpation, gene flow with coyotes resulted in the persistence of endangered red wolf genetic variation in local coyote populations. We assessed genomic ancestry and morphology of coyotes in southwestern Louisiana. We detected that 38 to 62% of the coyote genomes contained red wolf ancestry acquired in the past 30 years and have an admixture profile similar to that of the canids captured before the extirpation of red wolves. We further documented a positive correlation between ancestry and weight. Our findings highlight the importance of hybrids and admixed genomes as a reservoir of endangered species ancestry for innovative conservation efforts. Together, this work presents an unprecedented system that conservation can leverage to enrich the recovery program of an endangered species.
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Affiliation(s)
- Bridgett M. vonHoldt
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | | | | | - Sean M. Murphy
- Forestry and Natural Resources, University of Kentucky, Lexington, KY, USA
| | - Melissa L. Karlin
- Department of Physics and Environmental Science, St. Mary’s University, San Antonio, TX, USA
| | - Jennifer R. Adams
- Laboratory for Ecological, Evolutionary and Conservation Genetics, Department of Fish and Wildlife Sciences, University of Idaho, Moscow, ID, USA
| | - Lisette P. Waits
- Laboratory for Ecological, Evolutionary and Conservation Genetics, Department of Fish and Wildlife Sciences, University of Idaho, Moscow, ID, USA
| | - Kristin E. Brzeski
- College of Forest Resources and Environment Science, Michigan Technological University, Houghton, MI, USA
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47
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Hackworth ZJ, Felch JM, Murphy SM, Cox JJ. Detectability of common ravens (
Corvus corax
) in the eastern
USA
: Rapid assessment of a recolonizing species. Ecosphere 2022. [DOI: 10.1002/ecs2.4148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zachary J. Hackworth
- Department of Forestry and Natural Resources University of Kentucky Lexington Kentucky USA
| | - Joshua M. Felch
- Department of Forestry and Natural Resources University of Kentucky Lexington Kentucky USA
| | - Sean M. Murphy
- Department of Forestry and Natural Resources University of Kentucky Lexington Kentucky USA
| | - John J. Cox
- Department of Forestry and Natural Resources University of Kentucky Lexington Kentucky USA
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48
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Kumar A, Linas BP, Morgan JR, Murphy SM, Walley AY, Yan S, Schackman BR, Marshall BDL. Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island. Addiction 2022; 117:1372-1381. [PMID: 34825427 PMCID: PMC8983544 DOI: 10.1111/add.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. METHODS We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. RESULTS Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. CONCLUSIONS There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, Providence, RI, USA.,The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.,Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Aranshi Kumar
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Shapei Yan
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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49
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Gutkind S, Starbird L, Murphy SM, Teixeira P, Gooden L, Matheson T, Feaster DJ, Jain MK, Masson CL, Perlman DC, Del Rio C, Metsch LR, Schackman BR. Cost of Hepatitis C care facilitation for HIV/Hepatitis C Co-infected people who use drugs. Drug Alcohol Depend 2022; 232:109265. [PMID: 35042101 PMCID: PMC9238179 DOI: 10.1016/j.drugalcdep.2022.109265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Using data from a randomized trial, we evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder. METHODS Participants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. We used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD. We conducted sensitivity analyses varying care facilitator caseloads and examined offsetting savings using participant self-reported healthcare utilization. RESULTS The average site start-up cost was $6320 (site range: $4320-$7000), primarily consisting of training. The mean weekly cost per participant was $20 (site range: $4-$30) for care facilitation visits and contacts, $360 (site range: $130- $700) for supervision and client outreach, and $70 (site range: $20-$180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1-6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to $110. Weekly participant time and travel costs averaged $7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms. CONCLUSION Weekly HCV care facilitation costs were approximately $450 per participant, but approximately $110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.
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Affiliation(s)
- Sarah Gutkind
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065, USA.
| | - Laura Starbird
- Columbia University School of Nursing, 560 West 168th St, NY, NY 10032, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, NY, NY 10065, USA
| | - Paul Teixeira
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, NY, NY 10065, USA
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, NY, NY 10032, USA
| | - Tim Matheson
- San Francisco Department of Health, 101 Grove St, San Francisco, CA 94102, USA.
| | - Daniel J. Feaster
- Department of Epidemiology and Public Health, University of Miami School of Medicine, 1120 NW 14th St Miami, FL 33136, USA
| | - Mamta K. Jain
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Carmen L. Masson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Carlos Del Rio
- Department of Global Health, Rollins School of Public Health at Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, NY, NY 10032, USA
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, NY, NY 10065, USA
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50
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Franklin SP, Stoker AM, Murphy SM, Kowaleski MP, Gillick M, Kim SE, Karlin M, Cross A, Cook JL. Corrigendum: Outcomes Associated With Osteochondral Allograft Transplantation in Dogs. Front Vet Sci 2022; 8:843760. [PMID: 35127887 PMCID: PMC8815024 DOI: 10.3389/fvets.2021.843760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samuel P. Franklin
- Colorado Canine Orthopedics and Rehab, Colorado Springs, CO, United States
- *Correspondence: Samuel P. Franklin
| | - Aaron M. Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| | - Sean M. Murphy
- WestVet Animal Emergency and Specialty Center, Garden City, ID, United States
| | - Michael P. Kowaleski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Mitchell Gillick
- Toronto Veterinary Emergency and Referral Hospital, Toronto, ON, Canada
| | - Stanley E. Kim
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Michael Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Alan Cross
- BluePearl Pet Hospital, Atlanta, GA, United States
| | - James L. Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
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