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Castellanos S, Cooke A, Koenders S, Joshi N, Miaskowski C, Kushel M, Knight KR. Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics. SSM Ment Health 2023; 4:100243. [PMID: 38464953 PMCID: PMC10923552 DOI: 10.1016/j.ssmmh.2023.100243] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are underexamined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the likelihood of developing an OUD as an adult. However, the ACEs framework is criticized for failing to name the social and structural contexts that shape ACE vulnerabilities in families. Social scientific theory and ethnographic methods offer useful approaches to explore how interpersonally- and structurally-produced traumas inform the experiences of co-occurring CNCP, substance use, and mental health. We report findings from a qualitative and ethnographic longitudinal cohort study of patients with CNCP (n = 48) who received care in safety-net settings and their primary care providers (n = 23). We conducted semi-structured interviews and clinical and home-based participant observation from 2018 to 2020. Here we focus our analyses on how patients and providers explained and situated the role of patient trauma in the larger clinical context of reductions in opioid prescribing to highlight the political landscape of the United States opioid overdose crisis and its impact on clinical interactions. Findings reveal the disproportionate burden structurally-produced, racialized trauma places on CNCP, substance use and mental health symptoms that shapes patients' embodied experiences of pain and substance use, as well as their emotional experiences with their providers. Experiences of trauma impacted clinical care trajectories, yet providers and patients expressed limited options for redress. We argue for an adaptation of trauma-informed care approaches that contextualize the structural determinants of trauma and their interplay with interpersonal experiences to improve clinical care outcomes.
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Affiliation(s)
- Stacy Castellanos
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, United States
| | - Alexis Cooke
- Department of Community Health Systems, School of Nursing, University of California - San Francisco, 2 Koret Way, N505, San Francisco, CA, 94143-0608, United States
| | - Sedona Koenders
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, United States
| | - Neena Joshi
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, United States
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California - San Francisco, 2 Koret Way, 631, San Francisco, CA, 94143-0610, United States
| | - Margot Kushel
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California -San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, United States
| | - Kelly Ray Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, United States
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Suen LW, Steiger S, Shapiro B, Castellanos S, Joshi N, Lambdin BH, Knight KR. "Get in and get out, get on with life": Patient and provider perspectives on methadone van implementation for opioid use disorder treatment. Int J Drug Policy 2023; 121:104214. [PMID: 37778132 DOI: 10.1016/j.drugpo.2023.104214] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Expanding access to opioid use disorder (OUD) treatment, including methadone, is imperative to address the US overdose crisis. In June 2021, the Drug Enforcement Administration announced new regulations allowing all opioid treatment programs (OTPs) to deploy mobile medication units, or methadone vans, to dispense OUD medication treatment outside of clinic walls, ending a 13-year moratorium. We conducted a qualitative study evaluating one opioid treatment program's experience, including benefits and challenges with implementing a methadone van, to inform future policy and clinical practice. METHODS We recruited staff and patients receiving OUD medication treatment from an OTP in San Francisco, CA. The OTP had one operating van before March 2020 and began operating an additional van in response to COVID-19-related efforts to de-populate clinic settings. We interviewed 10 providers and 20 patients from August to November 2020. We transcribed, coded, and analyzed all interviews using modified grounded theory methodologies. RESULTS Both patients and providers perceived significant benefits with receiving OUD medications using methadone vans. Patients preferred dosing at the van over the clinic because they were able to "get in and out" faster. Both staff and patients appreciated being able to use phone counseling to connect with counselors which helped reduce in-person visits and streamline workflows. Providers also noted van implementation challenges, including daily van set up, urine drug testing, and delivering counseling to patients who lacked phones. CONCLUSIONS Eased restrictions on methadone van implementation represent a new strategy for expanding OUD treatment access. In our qualitative study, patients and staff were satisfied with methadone van implementation, though the OTP still faced implementation challenges. Audio-only counseling and other workflow solutions helped facilitate implementation, and several policy considerations like maintaining audio-only counseling flexibilities are key to ensuring future van success. Methadone vans offer the potential to expand treatment uptake, while prioritizing patient-centered care.
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Affiliation(s)
- Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Scott Steiger
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Brad Shapiro
- Division of Substance Abuse and Addiction Medicine, Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Stacy Castellanos
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Neena Joshi
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Barrot H Lambdin
- Research Triangle Institute International, Berkeley, CA, United States
| | - Kelly R Knight
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
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Cooke A, Castellanos S, Koenders S, Joshi N, Enriquez C, Olsen P, Miaskowski C, Kushel M, Knight KR. The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes. Drug Alcohol Depend 2023; 250:110893. [PMID: 37459819 DOI: 10.1016/j.drugalcdep.2023.110893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/13/2023] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Clinicians' bias related to patients' race and substance use history play a role in pain management. However, patients' or clinicians' understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States. METHODS We interviewed 46 clinicians and 94 patients, using semi-structured interview guides, from eight safety-net primary care clinics across the San Francisco Bay Area from 2013 to 2020. We used a modified grounded theory approach to code and analyze transcripts. RESULTS Clinicians discussed using opioid prescribing guidelines with the goals of increased opioid safety and reduced bias in patient monitoring. While patients acknowledged the validity of clinicians' concerns about opioid safety, they indicated that clinicians made assumptions about opioid misuse towards Black patients and patients suspected of substance use. Clinicians discussed evidence of discrimination in opioid prescribing at the clinic-wide level; racialized stereotypes about patients likely to misuse opioids; and their own struggles to overcome discriminatory practices regarding CNCP management. CONCLUSION While clinicians and patients acknowledged opioid safety concerns, the practical application of opioid prescribing guidelines impacted how patients perceived and engaged with CNCP care particularly for patients who are Black and/or report a history of substance use. We recommend healthcare system and clinic-level interventions that may remediate discriminatory practices and associated disparities.
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Affiliation(s)
- Alexis Cooke
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, 2 Koret Way, N505, San Francisco, CA94143-0608, United States
| | - Stacy Castellanos
- Department of Humanities and Social Sciences, School of Medicine, University of California-San Francisco490 Illinois Street, 7th Floor, San Francisco, CA94143-0850, United States
| | - Sedona Koenders
- Department of Humanities and Social Sciences, School of Medicine, University of California-San Francisco490 Illinois Street, 7th Floor, San Francisco, CA94143-0850, United States
| | - Neena Joshi
- Department of Humanities and Social Sciences, School of Medicine, University of California-San Francisco490 Illinois Street, 7th Floor, San Francisco, CA94143-0850, United States
| | - Celeste Enriquez
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California-San FranciscoUCSF Box 1339, San Francisco, CA94143-0608, United States
| | - Pamela Olsen
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California-San FranciscoUCSF Box 1339, San Francisco, CA94143-0608, United States
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California-San Francisco2 Koret Way, Rm 631, San Francisco, CA94143-0610, United States
| | - Margot Kushel
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California-San FranciscoUCSF Box 1339, San Francisco, CA94143-0608, United States
| | - Kelly R Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California-San Francisco490 Illinois Street, 7th Floor, San Francisco, CA94143-0850, United States.
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Olding M, Joshi N, Castellanos S, Valadao E, Hall L, Guzman L, Knight K. Saving lives in our homes: Qualitative evaluation of a tenant overdose response program in supportive, single-room occupancy (SRO) housing. Int J Drug Policy 2023; 118:104084. [PMID: 37300920 DOI: 10.1016/j.drugpo.2023.104084] [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: 03/08/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND People using opioids alone in private settings are at elevated risk of dying in the event of an overdose. In San Francisco, single room occupancy (SRO) tenants are 19 times more likely to die of overdose than non-SRO residents. The "SRO Project" pilot aimed to reduce fatal overdoses in SROs by recruiting and training tenants to distribute naloxone and provide overdose education in their buildings. We explore the implementation and program impacts of the SRO Project pilot in two permanent supportive housing SROs. METHODS We conducted eight months of ethnographic fieldwork (May 2021 - Feb 2022), including 35 days observing SRO Project pilot activities, and semi-structured interviews with 11 housing staff and 8 tenant overdose prevention specialists ('specialists'). Data were analyzed using a grounded theory approach to characterize program impacts, implementation strengths, and implementation challenges from the perspective of specialists and housing staff. FINDINGS We found that the SRO project increased awareness, access to, and understanding of naloxone; facilitated other mutual-aid practices; supported privacy and autonomy of tenants regarding their drug use; and improved rapport, communication and trust between tenants and housing staff. Strengths of the implementation process included involvement of tenants with diverse social locations and skill sets and, at one site, a team-based approach that fostered program innovation, tenant solidarity and a sense of collective ownership over the project. Program implementation was challenged by frequent turnover and capacity constraints of housing staff, particularly during overnight shifts when overdose risks were greatest. Additional challenges arose due to the psychosocial burden of overdose response work, gendered violence, issues with compensation methods, and scope creep in specialists' roles. CONCLUSION This evaluation contributes further evidence regarding the effectiveness of tenant-led naloxone distribution and overdose education in permanent supportive and SRO housing environments. Findings indicate program implementation and sustainability can be improved by expanding tenant specialist training, compensating specialists in cash, and building stronger psychosocial support for tenants responding to overdoses in their homes.
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Affiliation(s)
- Michelle Olding
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States.
| | - Neena Joshi
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States
| | - Stacy Castellanos
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Emily Valadao
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Lauren Hall
- Delivering Innovation in Supportive Housing (DISH), San Francisco, CA, United States
| | - Laura Guzman
- DOPE Project, National Harm Reduction Coalition, San Francisco, CA, United States
| | - Kelly Knight
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, United States
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Cooke A, Castellanos S, Enriquez C, Olsen P, Miaskowski C, Kushel M, Knight KR. Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care. BMC Health Serv Res 2023; 23:325. [PMID: 37005610 PMCID: PMC10067010 DOI: 10.1186/s12913-023-09330-w] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems. METHODS We interviewed patients with chronic non-cancer pain and history of substance use (n = 22) and their primary care clinicians (n = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews. RESULTS COVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through telehealth. None of the clinics used video visits due to low digital literacy/access. Benefits of telehealth included decreased patient burden and missed appointments and increased convenience and control of some chronic conditions (e.g., diabetes, hypertension). Telehealth challenges included loss of contact, greater miscommunication, and less comprehensive care interactions. CONCLUSIONS This study is one of the first to examine telehealth use in urban safety net primary care patients with co-occurring chronic non-cancer pain and substance use. Decisions to continue or expand telehealth should consider patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity.
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Affiliation(s)
- Alexis Cooke
- Department of Community Health Systems, School of Nursing, University of California - San Francisco, 2 Koret Way, N505, San Francisco, CA, 94143-0608, USA
| | - Stacy Castellanos
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA
| | - Celeste Enriquez
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Pamela Olsen
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California - San Francisco, 2 Koret Way, Rm 631, San Francisco, CA, 94143-0608, USA
| | - Margot Kushel
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, School of Medicine, University of California - San Francisco, UCSF Box 1339, San Francisco, CA, 94143-0608, USA
| | - Kelly Ray Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA.
- Department of Humanities and Social Sciences, School of Medicine, University of California - San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0608, USA.
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Mullady SSS, Castellanos S, Lopez L, Aguirre G, Weeks J, King S, Valle K, Goode C, Tsoy E, Possin K, Miller B, Kushel M, Lanata S. Neurocognitive health of older adults experiencing homelessness in Oakland, California. Front Neurol 2022; 13:905779. [PMID: 35937073 PMCID: PMC9353024 DOI: 10.3389/fneur.2022.905779] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background and objectives The homeless population in the US is aging. Cognitive impairment is prevalent in this population, yet little is known about the neurologic etiologies of such impairment. Addressing this gap in knowledge is important because homeless older adults with cognitive impairment due to neurodegenerative disease may need lifelong tailored support to obtain and maintain housing. In this study, we characterized the neurocognitive health of a sample of adults who experienced homelessness for the first time after age 50 using gold standard behavioral neurology examination practices. Methods We conducted a descriptive cross-sectional study of older adults who first experienced homelessness after age 50. We recruited our sample purposively from an ongoing longitudinal cohort study of adults who were aged 50 and over and homeless when they entered the cohort. For this sub study, we enrolled a convenience sample from those who reported their first episode of homelessness after age 50. We did not exclude individuals based on history of substance use. Neurologists conducted a structured neurocognitive history intake, neurological examination, neuropsychological evaluation, and functional assessment between November 2020 and February 2021. We screened all participants for neurocognitive disorders using gold standard clinical research diagnostic criteria. Results We evaluated 25 participants, most were men (76%) and Black (84%), with a median age of 61 years. The most common neurocognitive complaints included deficits in recent episodic memory (n = 15, 60%), executive functions (n = 13, 52%), and behavior/mood, with apathy being the most common complaint (n = 20, 80%). Neuropsychological testing revealed a high prevalence of socioemotional deficits (n = 20, 80%). Common neurological examination deficits included difficulties with coordination, such as impaired Luria task (n = 16, 64%), signs of distal peripheral neuropathy (n = 8, 32%), anosmia/hyposmia (n = 4, 21%), and signs of mild Parkinsonism (n = 5, 20%). The most common diagnoses were MCI (n = 7, 28%), bvFTD (n = 4, 16%), AD (n = 4, 16%), and DLB (n = 2, 8%). Discussion Our findings suggest that neurocognitive concerns and examination deficits are common among older homeless adults. Specific neurocognitive disorders may be overrepresented in this population, particularly frontotemporal disorders. Longitudinal studies involving brain biomarkers are needed to characterize the neurocognitive health of this vulnerable population more precisely.
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Affiliation(s)
- Sandeepa Satya-Sriram Mullady
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Sandeepa Satya-Sriram Mullady
| | - Stacy Castellanos
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Aguirre
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - John Weeks
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen King
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Karen Valle
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Collette Goode
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Possin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,Serggio Lanata
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Suen LW, Coe WH, Wyatt JP, Adams ZM, Gandhi M, Batchelor HM, Castellanos S, Joshi N, Satterwhite S, Pérez-Rodríguez R, Rodríguez-Guerra E, Albizu-Garcia CE, Knight KR, Jordan A. Structural Adaptations to Methadone Maintenance Treatment and Take-Home Dosing for Opioid Use Disorder in the Era of COVID-19. Am J Public Health 2022; 112:S112-S116. [PMID: 35349324 PMCID: PMC8965183 DOI: 10.2105/ajph.2021.306654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Leslie W Suen
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - William H Coe
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Janan P Wyatt
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Zoe M Adams
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Mona Gandhi
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Hannah M Batchelor
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Stacy Castellanos
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Neena Joshi
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Shannon Satterwhite
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rafael Pérez-Rodríguez
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Esther Rodríguez-Guerra
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Carmen E Albizu-Garcia
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Kelly R Knight
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Ayana Jordan
- Leslie W. Suen is with the National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. William H. Coe, Janan P. Wyatt, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY
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Wyatt JP, Suen LW, Coe WH, Adams ZM, Gandhi M, Batchelor HM, Castellanos S, Joshi N, Satterwhite S, Pérez-Rodríguez R, Rodríguez-Guerra E, Albizu-Garcia CE, Knight KR, Jordan A. Federal and State Regulatory Changes to Methadone Take-Home Doses: Impact of Sociostructural Factors. Am J Public Health 2022; 112:S143-S146. [PMID: 35349318 PMCID: PMC8965186 DOI: 10.2105/ajph.2022.306806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Janan P Wyatt
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Leslie W Suen
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - William H Coe
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Zoe M Adams
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Mona Gandhi
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Hannah M Batchelor
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Stacy Castellanos
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Neena Joshi
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Shannon Satterwhite
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Rafael Pérez-Rodríguez
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Esther Rodríguez-Guerra
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Carmen E Albizu-Garcia
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Kelly R Knight
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
| | - Ayana Jordan
- Janan P. Wyatt, William H. Coe, Zoe M. Adams, and Hannah M. Batchelor are with the Yale University School of Medicine, New Haven, CT. Leslie W. Suen is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Mona Gandhi is with Clifford Beers, New Haven, CT. Stacy Castellanos is with the UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA. Neena Joshi and Kelly R. Knight are with the Department of Humanities and Social Sciences, University of California, San Francisco. Shannon Satterwhite is with the Department of Family and Community Medicine, University of California, Davis. Rafael Pérez-Rodríguez and Esther Rodríguez-Guerra are with Physician Correctional-DCR, San Juan, Puerto Rico. Carmen E. Albizu-Garcia is with the Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan. Ayana Jordan is with the departments of Psychiatry and Population Health, Grossman School of Medicine, New York University New York
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Suen LW, Castellanos S, Joshi N, Satterwhite S, Knight KR. "The idea is to help people achieve greater success and liberty": A qualitative study of expanded methadone take-home access in opioid use disorder treatment. Subst Abuse 2022; 43:1143-1150. [PMID: 35499469 PMCID: PMC9710250 DOI: 10.1080/08897077.2022.2060438] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51 years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.
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Affiliation(s)
- Leslie W. Suen
- UCSF National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Stacy Castellanos
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, United States,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Neena Joshi
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Shannon Satterwhite
- Department of Family and Community Medicine, University of California, Davis, Davis, CA, United States
| | - Kelly R. Knight
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States
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Lugier O, Thakur N, Wu L, Vockenhuber M, Ekinci Y, Castellanos S. Bottom-Up Nanofabrication with Extreme-Ultraviolet Light: Metal-Organic Frameworks on Patterned Monolayers. ACS Appl Mater Interfaces 2021; 13:43777-43786. [PMID: 34463483 DOI: 10.1021/acsami.1c13667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The fabrication of integrated circuits with ever smaller (sub-10 nm) features poses fundamental challenges in chemistry and materials science. As smaller nanostructures are fabricated, thinner layers of materials are required, and surfaces and interfaces gain a more important role in the formation of nanopatterns. We present a new bottom-up approach in which we use the high optical resolution offered by extreme ultraviolet (EUV) lithography to print patterns on self-assembled monolayers (SAMs). Upon radiation, low-energy electrons induce chemical changes in the SAM so that the projected image is transferred to the substrate surface. We use the chemical differences between exposed and unexposed regions to promote a selective growth of hybrid structures that can act as an etch-resistant layer for further pattern transfer or can be used as functional nanostructures. The EUV doses required to promote selective growth on exposed areas are close to industrial requirements. Furthermore, this method allows for the independent tuning of different steps in the EUV lithography process (photo-induced chemistry, spatially resolved chemical contrast, and formation of nanopatterns), an advantage over current resists, in which the same material plays all roles.
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Affiliation(s)
- O Lugier
- Advanced Research Center for Nanolithography, Science Park 106, 1098XG Amsterdam, The Netherlands
| | - N Thakur
- Advanced Research Center for Nanolithography, Science Park 106, 1098XG Amsterdam, The Netherlands
| | - L Wu
- Advanced Research Center for Nanolithography, Science Park 106, 1098XG Amsterdam, The Netherlands
| | - M Vockenhuber
- Paul Scherrer Institute, Forschungstrasse 111, 5232 Villigen, Switzerland
| | - Y Ekinci
- Paul Scherrer Institute, Forschungstrasse 111, 5232 Villigen, Switzerland
| | - S Castellanos
- Advanced Research Center for Nanolithography, Science Park 106, 1098XG Amsterdam, The Netherlands
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Abstract
Progress and challenges in the development of photo-responsive metal organic frameworks.
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Affiliation(s)
- S. Castellanos
- Catalysis Engineering
- Chemical Engineering Department
- Delft University of Technology
- 2628 BL Delft, The Netherlands
| | - F. Kapteijn
- Catalysis Engineering
- Chemical Engineering Department
- Delft University of Technology
- 2628 BL Delft, The Netherlands
| | - J. Gascon
- Catalysis Engineering
- Chemical Engineering Department
- Delft University of Technology
- 2628 BL Delft, The Netherlands
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Vega O, Castellanos S, Eslava C, Salazar M, Rodriguez R, Amarista F. Genioplasty prevalence in orthognathic surgery at the Bogota Central Military Hospital oral and Maxillofacial Surgery Service. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brili S, McClements B, Castellanos S, Apostolidou M, Barbetseas J, Pitsavos C, Toutouzas P. Significance of an atrial septal aneurysm in the presence of an ostium secundum atrial septal defect. A transesophageal echocardiographic study. Cardiology 1995; 86:421-5. [PMID: 7585747 DOI: 10.1159/000176914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to elucidate the mechanism by which an atrial septal aneurysm is formed in the presence of an atrial septal defect by characterizing the distinguishing echocardiographic features of atrial septal defects between patients with and without an atrial septal aneurysm. The transesophageal echocardiograms of 30 consecutive patients who underwent surgical closure of a secundum atrial septal defect were compared with those of 8 normal controls. In patients with secundum atrial septal defect, the maximal diameter (mean +/- SD) of the fossa ovalis was 21.73 +/- 3.43 compared to 11.43 +/- 1.00 mm in the control group (p < 0.01). In the 7 (23%) patients with atrial septal aneurysm, the mean maximal diameter of the fossa ovalis was 25.28 +/- 3.03 compared to 20.65 +/- 2.78 mm in those without an atrial septal aneurysm (p < 0.01). The atrial septal defect was smaller in patients with than in those without an atrial septal aneurysm. In 4 patients with atrial septal aneurysm who had a history of a cerebrovascular event, the interatrial communication was only detected by contrast echocardiography. In conclusion, in patients with atrial septal aneurysm, atrial septal defects tend to be smaller but the incidence of cerebrovascular events is greater.
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Affiliation(s)
- S Brili
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece
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Abstract
We performed contrast echocardiography on 19 subjects who were asymptomatic in the postoperative period after surgical repair of atrial septal defects. Eighteen of these subjects had adequate right heart echocardiographic contrast to assess the presence or absence of right-to-left shunting. Multiple M-mode and two-dimensional echocardiographic views were studied during several contrast injections with and without the Valsalva manoeuvre. Six patients had postoperative shunts and 12 patients had no postoperative shunts. The age of the six patients with postoperative shunts was 26 +/- 10 years (mean +/- s.d.) and that of the 12 patients without postoperative shunts was 39 +/- 14 years. Four out of six of the postoperative shunt group were males and of these three had patch repairs compared with two males out of 12 with patch repair in the no shunt group. There were no definite differences between the two groups in the following variables: type of atrial septal defect (primum v. secundum), preoperative shunt size, pre-operative peak right ventricular pressure, pre-operative New York Heart Association functional class, pre- or postoperative right ventricular or left ventricular dimensions, aortic and left atrial dimensions. Four of the six patients with postoperative contrast echo shunting underwent cardiac catheterization, showing no significant step-up in oxygen saturation in three, and a significant shunt in one patient who had patch dehiscence at re-operation. We conclude that right-to-left shunts as demonstrated by contrast echocardiography are common in the late postoperative period after atrial septal defect repair. They need not indicate unsuccessful repair or a haemodynamically important residual shunt.
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Abstract
Cardiac events of early diastole were studied in 50 normal subjects and 46 patients with mitral stenosis (MS) by simultaneous recordings of the mitral valve echogram (MVE), phonocardiogram, and apexcardiogram (ACG). Left ventricular isovolumic relaxation time (IRT), measured between A2 and onset of the MVE opening motion, had almost the same values in normals 54 +/- 7 msec, and MS 51 +/- 16 msec. The interval between A2 and the ACG "O" point was approximately double that of IRT: 99 +/- 11 msec in normal subjects, 109 +/- 20 msec in MS. The normal MVE opening motion had a velocity 293 +/- 76 mm/sec and duration 45 +/- 6 msec, values significantly different (P less than 0.001) from 536 +/- 271 mm/sec, 23 +/- 7.5 msec found in MS patients. In atrial fibrillation the length of the cardiac cycle did not affect A2-O interval or mitral valve opening movement duration; however cycle length was clearly related to isovolumic relaxation time. This resulted in a variation in the interval between completion of the mitral valve opening (opening snap) and O point. This interval was longer after a short diastole and vice versa.
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