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Wyte-Lake T, Cohen DJ, Williams S, Casey D, Chan M, Frank B, Levander XA, Stein D, White KK, Bailey SR. Patients' and Clinicians' Experiences with In-person, Video, and Phone Modalities for Opioid Use Disorder Treatment: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-023-08586-6. [PMID: 38228990 DOI: 10.1007/s11606-023-08586-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) is a chronic condition that requires regular visits and care continuity. Telehealth implementation has created multiple visit modalities for OUD care. There is limited knowledge of patients' and clinicians' perceptions and experiences related to multi-modality care and when different modalities might be best employed. OBJECTIVE To identify patients' and clinicians' experiences with multiple visit modalities for OUD treatment in primary care. DESIGN Comparative case study, using video- and telephone-based semi-structured interviews. PARTICIPANTS Patients being treated for OUD (n = 19) and clinicians who provided OUD care (n = 15) from two primary care clinics within the same healthcare system. APPROACH Using an inductive approach, interviews were analyzed to identify patients' and clinicians' experiences with receiving/delivering OUD care via different visit modalities. Clinicians' and patients' experiences were compared using a group analytical process. KEY RESULTS Patients and clinicians valued having multiple modalities available for care, with flexibility identified as a key benefit. Patients highlighted the decreased burden of travel and less social anxiety with telehealth visits. Similarly, clinicians reported that telehealth decreased medical intrusion into the lives of patients stable in recovery. Patients and clinicians saw the value of in-person visits when establishing care and for patients needing additional support. In-person visits allowed the ability to conduct urine drug testing, and to foster relationships and trust building, which were more difficult, but not impossible via a telehealth visit. Patients preferred telephone over video visits, as these were more private and more convenient. Clinicians identified benefits of video, including being able to both hear and see the patient, but often deferred to patient preference. CONCLUSIONS Considerations for utilization of visit modalities for OUD care were identified based on patients' needs and preferences, which often changed over the course of treatment. Continued research is needed determine how visit modalities impact patient outcomes.
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Affiliation(s)
- Tamar Wyte-Lake
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Shannon Williams
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David Casey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Matt Chan
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian Frank
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Dan Stein
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Katie Kirkman White
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Mitchell SG, Jester J, Gryczynski J, Whitter M, Fuller D, Halsted C, Schwartz RP. Impact of COVID-19-related methadone regulatory flexibilities: views of state opioid treatment authorities and program staff. Addict Sci Clin Pract 2023; 18:61. [PMID: 37848970 PMCID: PMC10580566 DOI: 10.1186/s13722-023-00417-7] [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: 12/16/2022] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, federal regulations in the USA for methadone treatment of opioid use disorder (OUD) were temporarily revised to reduce clinic crowding and promote access to treatment. METHODS As part of a study seeking to implement interim methadone without routine counseling to hasten treatment access in Opioid Treatment Programs with admission delays, semi-structured qualitative interviews were conducted via Zoom with participating staff (N = 11) in six OTPs and their State Opioid Treatment Authorities (SOTAs; N = 5) responsible for overseeing the OTPs' federal regulatory compliance. Participants discussed their views on the response of OTPs in their states to the pandemic and the impact of the COVID-related regulatory flexibilities on staff, established patients, and new program applicants. Interviews were audio recorded, transcribed, and a content analysis was conducted using ATLAS.ti. RESULTS All SOTAs requested the blanket take-home exemption and supported the use of telehealth for counseling. Participants noted that these changes were more beneficial for established patients than program applicants. Established patients were able to obtain a greater number of take-homes and attend individual counseling remotely. Patients with limited resources had greater difficulty or were unable to access remote counseling. The convenience of intake through telehealth did not extend to new program applicants because the admission physical exam requirement was not waived. CONCLUSIONS The experienced reflections of SOTAs and OTP providers on methadone practice changes during the COVID-19 pandemic offer insights on SAMHSA's proposed revisions to its OTP regulations. Trial registration Clinicaltrials.gov # NCT04188977.
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Affiliation(s)
| | | | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, Baltimore, MD, 21201, USA
| | - Melanie Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Douglas Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Caroline Halsted
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., USA
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Baltimore, MD, 21201, USA
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3
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Silwal A, Talbert J, Bohler RM, Kelsch J, Cook C, Blevins D, Gallivan M, Hunt T, Hatcher SM, Thomas CP, Williams S, Fanucchi L, Lofwall MR. State alignment with federal regulations in 2022 to relax buprenorphine 30-patient waiver requirements. Drug Alcohol Depend Rep 2023; 7:100164. [PMID: 37234704 PMCID: PMC10206439 DOI: 10.1016/j.dadr.2023.100164] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
Background In 2021, the Department of Health and Human Services released guidelines allowing waiver-eligible providers seeking to treat up to 30 patients to be exempt from waiver training (WT) and the counseling and other ancillary services (CAS) attestation. This study evaluates if states and the District of Columbia had more restrictive policies preventing adoption of the 2021 federal guidelines. Methods First, the Westlaw database was searched for buprenorphine regulations. Second, state medical, osteopathic, physician assistant, nursing boards, and single state agencies (SSA) were surveyed to assess for the WT and CAS requirements and if they were discussing the 2021 guidelines. Results were recorded and compared by state and waiver-eligible provider types. Results The Westlaw search revealed seven states with regulations requiring the WT and ten states requiring CAS. Survey results showed ten state boards/SSAs required WT for at least one waiver-eligible practitioner type and eleven state boards/SSAs required CAS. In some states, the WT and CAS requirements only applied in special circumstances. Eleven states had discrepancies between the Westlaw and survey results among three waiver-eligible provider types. Conclusions Despite the 2021 federal change intended to increase access to buprenorphine, several states had regulations and/or provider boards and SSAs that were not supportive. Now, the Mainstreaming Addiction Treatment (MAT) Act of 2022 eliminated the federal x-waiver requirement to prescribe buprenorphine. However, these states may continue to have barriers to treatment access despite the MAT Act. Strategies to engage states with these restrictive policies are needed to improve buprenorphine treatment capacity.
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Affiliation(s)
- Anita Silwal
- Substance Use Priority Research Area (SUPRA), University of Kentucky, Lexington KY, USA
- Department of Communication, College of Communication and Information, University of Kentucky, Lexington, KY, USA
| | - Jeffery Talbert
- Division of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Robert M. Bohler
- Heller School for Social Policy and Management at Brandeis University, Waltham, MA, USA
| | - Jordan Kelsch
- Substance Use Priority Research Area (SUPRA), University of Kentucky, Lexington KY, USA
| | - Christopher Cook
- Substance Use Priority Research Area (SUPRA), University of Kentucky, Lexington KY, USA
| | - Derek Blevins
- Division of Substance Use Disorders, New York State Psychiatric Institute / Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Molly Gallivan
- Substance Use Priority Research Area (SUPRA), University of Kentucky, Lexington KY, USA
| | - Timothy Hunt
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | | | - Cindy Parks Thomas
- Heller School for Social Policy and Management at Brandeis University, Waltham, MA, USA
| | - Soncere Williams
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Laura Fanucchi
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
- Division of Infectious Diseases, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
- Departments of Behavioral Science and Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA
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Amaro H, Kong Y, Marsh JC, Khachikian T, Guerrero EG. Identifying gender differences in risk profiles and in opioid treatment outcomes in Los Angeles County. Eval Program Plann 2023; 97:102240. [PMID: 36702006 PMCID: PMC10121834 DOI: 10.1016/j.evalprogplan.2023.102240] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients' risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1035 clients), 2013 (77 programs, 3671 clients), 2015 (75 programs, 4625 clients), and 2017 (69 programs, 4106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.
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Affiliation(s)
- Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, FL 33199, United States
| | - Yinfei Kong
- California State University, Fullerton College of Business and Economics, 800 N State College Blvd, Fullerton CA 92831, United States
| | - Jeanne C Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025, United States.
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Guerrero EG, Amaro H, Kong Y, Khachikian T, Marsh JC. Understanding the role of financial capacity in the delivery of opioid use disorder treatment. BMC Health Serv Res 2023; 23:166. [PMID: 36797752 PMCID: PMC9933309 DOI: 10.1186/s12913-023-09179-z] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Opioid treatment programs must have adequate financial capacity to sustain operations and deliver a high standard of care for individuals suffering from opioid use disorder. However, there is limited consistency in the health services literature about the concept and relationship of organizational financial capacity and key outcome measures (wait time and retention). In this study, we explored five common measures of financial capacity that can be applied to opioid treatment programs: (a) reserve ratio, (b) equity ratio, (c) markup, (d) revenue growth, and (e) earned revenue. We used these measures to compare financial capacity among 135 opioid treatment programs across four data collection points: 2011 (66 programs), 2013 (77 programs), 2015 (75 programs), and 2017 (69 programs). We examined the relationship between financial capacity and wait time and retention. Findings from the literature review show inconsistencies in the definition and application of concepts associated with financial capacity across business and social service delivery fields. The analysis shows significant differences in components of financial capacity across years. We observed an increase in average earned revenue and markup in 2017 compared to prior years. The interaction between minorities and markup was significantly associated with higher likelihood of waiting (IRR = 1.077, p < .05). Earned revenue (IRR = 0.225, p < .05) was related to shorter wait time in treatment. The interaction between minorities and equity ratio is also significantly associated with retention (IRR = 0.796, p < .05). Our study offers a baseline view of the role of financial capacity in opioid treatment and suggests a framework to determine its effect on client-centered outcomes.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Health Disparities Corp, I-Lead Institute, 12300 Wilshire Blvd., Suite 210, Los Angeles, CA 90025 USA
| | - Hortensia Amaro
- grid.65456.340000 0001 2110 1845Herbert Werthein College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th St., AHC4, Miami, FL 33199 USA
| | - Yinfei Kong
- grid.253559.d0000 0001 2292 8158College of Business and Economics, California State University Fullerton, 800 N. State College Blvd., Fullerton, CA 92831 USA
| | - Tenie Khachikian
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
| | - Jeanne C. Marsh
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
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6
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Knudsen HK, Hartman J, Walsh SL. The effect of Medicaid expansion on state-level utilization of buprenorphine for opioid use disorder in the United States. Drug Alcohol Depend 2022; 232:109336. [PMID: 35123365 PMCID: PMC8885876 DOI: 10.1016/j.drugalcdep.2022.109336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Research on the impact of Medicaid expansion on buprenorphine utilization has largely focused on the Medicaid program. Less is known about its associations with total buprenorphine utilization and non-Medicaid payers. METHODS Monthly prescription data (June 2013-May 2018) for proprietary and generic sublingual as well as buccal buprenorphine products were purchased from IQVIA®. Population-adjusted state-level utilization measures were constructed for Medicaid, commercial insurance, Medicare, cash, and total utilization. A difference-in-differences (DID) approach with population weights estimated the association between Medicaid expansion and buprenorphine utilization, while controlling for treatment capacity. RESULTS Monthly total buprenorphine prescriptions increased by 68% overall and increased 283% for Medicaid, 30% for commercial insurance, and 143% for Medicare. Cash prescriptions decreased by 10%. The DID estimate for Medicaid expansion was not statistically significant for total utilization (-19.780, 95% CI = -45.118, 5.558, p = .123). For Medicaid buprenorphine utilization, there was a significant increase of 27.120 prescriptions per 100,000 total state residents (95% CI = 9.458, 44.782, p = .003) in expansion states versus non-expansion states post-Medicaid expansion. Medicaid expansion had a negative effect on commercial insurance (DID estimate = -37.745, 95% CI = -62.946, -12.544, p = .004), cash utilization (DID estimate = -6.675, 95% CI = -12.627, -0.723, p = .029), and Medicare utilization (DID estimate = -1.855, 95% CI = -3.697, -0.013, p = .048). DISCUSSION The associations between Medicaid expansion and buprenorphine utilization varied across different types of payers, such that the overall impact of Medicaid expansion on buprenorphine utilization was not significant.
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA.,Corresponding author: Hannah K. Knudsen, PhD, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508. Telephone: (859) 323-3947; fax: (859) 257-5232;
| | - Jeanie Hartman
- Substance Use Research Priority Area, University of Kentucky, 845 Angliana Avenue, Room 121, Lexington, KY 40508, USA.
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA
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Gupta A, Shebl FM, Tong Y, Wagner K, Bassett IV, Page K, Winstanley EL. Association of co-occurring mental health problems with hepatitis C status among young people who inject drugs in rural New Mexico, 2016-2018. Addict Sci Clin Pract 2022; 17:58. [PMID: 36266666 PMCID: PMC9583516 DOI: 10.1186/s13722-022-00340-3] [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: 02/07/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Injection drug use (IDU) remains the strongest risk factor for hepatitis C virus (HCV) in the United States. HCV rates are increasing in rural areas among young adult people who inject drugs (PWID). People with HCV and PWID have disproportionate rates of mental health problems; however, it is unclear whether risky injection behaviors mediate the association between mental health problems and HCV. We examined the association between mental health problems and HCV in a rural cohort of young adult PWID, with the goal of informing rural service delivery. METHODS We conducted a secondary analysis of cross-sectional data from a convenience sample of young adult PWID in 2 rural counties in New Mexico. Participants were recruited from 2 community venues between September 2016 and May 2018. Associations between mental health problems and HCV were examined using bivariate (Fisher's exact) and multivariable modified Poisson regression analyses (with robust standard errors). Using structural equation modeling (SEM), we assessed duration of IDU and receptive syringe sharing (RSS) as mediators of this relationship. RESULTS A total of 263 patients were enrolled, with a median age of 26.1 years. The majority were male (66.3%) and Hispanic/Latino (a) (87.6%). The median age first injected was 19 years, and over half reported having ever engaged in RSS (53.4%). At least one mental health problem was reported by 60.1% of participants, with post-traumatic stress disorder (PTSD) being the most prevalent condition (42.2%). A majority (60.9%) tested positive for HCV antibody, and just under half (45.7%) of all participants tested positive for HCV ribonucleic acid. In SEM, PTSD had a significant total effect on HCV (τ = 0.230, P = 0.05), and this relationship was partially mediated by duration of IDU (αβ = 0.077, P = 0.03). The association between mental health problems and HCV was partially mediated by duration of IDU and the sequential mediation of duration of IDU and RSS (αβ + αββ = 0.091, P = 0.05). CONCLUSIONS High HCV rates among young adult PWID in rural New Mexico may be partly explained by mental health problems, duration of IDU and RSS. Mental health services for young adult PWID in rural areas may help decrease HCV transmission in rural areas. Trial Registration N/A.
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Affiliation(s)
- Akash Gupta
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA.
| | - Fatma M. Shebl
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Yao Tong
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Katherine Wagner
- grid.266832.b0000 0001 2188 8502University of New Mexico, Albuquerque, NM USA
| | - Ingrid V. Bassett
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Kimberly Page
- grid.266832.b0000 0001 2188 8502University of New Mexico, Albuquerque, NM USA
| | - Erin L. Winstanley
- grid.268154.c0000 0001 2156 6140West Virginia University, Morgantown, WV USA
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Gormley MA, Pericot-Valverde I, Diaz L, Coleman A, Lancaster J, Ortiz E, Moschella P, Heo M, Litwin AH. Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review. Drug Alcohol Depend 2021; 229:109123. [PMID: 34700201 DOI: 10.1016/j.drugalcdep.2021.109123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/28/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer recovery support services (PRSS) have been increasingly incorporated during the recovery process for opioid use disorder (OUD), yet little is known about the effects of PRSS on clinical outcomes of individuals who misuse opioids. This study systematically synthesized existing literature reporting the effectiveness of PRSS interventions on stages of the OUD treatment cascade. METHODS A search conducted on five databases identified studies from database inception to January 26th 2021 that evaluated the effects of PRSS on PRSS engagement, medication for OUD (MOUD) initiation, MOUD retention, opioid and non-opioid misuse, and remission. Characteristics of PRSS interventions, study design, and clinical outcomes were extracted. Methodological quality was assessed with the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. RESULTS Of 123 titles, 22 were subjected to full-text review and 12 ultimately met inclusion criteria. Only two studies were randomized control trials, half compared the outcomes of PRSS participants to those of a counterfactual group. Most PRSS were unstandardized and broadly described, involving linkage to treatment (91.7%) or follow-up support (91.7%). MOUD initiation was reported the most often (66.7%), followed by PRSS engagement (33.3%) and opioid use (25.0%). No studies reported findings for MOUD retention or remission. Findings for available outcomes were inconsistent and difficult to compare due to the heterogeneity of PRSS interventions and methodological limitations. CONCLUSION Effectiveness of PRSS interventions on stages of the OUD treatment cascade remain inconclusive. Additional research is necessary before supporting the implementation of PRSS on a broad scale.
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Affiliation(s)
- Mirinda Ann Gormley
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA.
| | - Irene Pericot-Valverde
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA
| | - Liam Diaz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Greenville County Behavioral Health AmeriCorps VISTA Program, 130 Industrial Dr. Suite B, Greenville, SC, 29607, USA
| | - Ashley Coleman
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Jonathan Lancaster
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University College of Behavioral, Social, and Health Science, Department of Psychology, 418 Brackett Hall, Clemson SC, 29634, USA
| | - Erik Ortiz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Phillip Moschella
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Prisma Health Department of Emergency Medicine, 701 Grove Rd., Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA
| | - Moonseong Heo
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Alain H Litwin
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA; Prisma Health Department of Internal Medicine, 876 W Faris Rd., Greenville, SC, 29605, USA
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9
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Mitchell MM, Schwartz RP, Choo TH, Pavlicova M, O’Grady KE, Gryczynski J, Stitzer ML, Nunes EV, Rotrosen J. An alternative analysis of illicit opioid use during treatment in a randomized trial of extended-release naltrexone versus buprenorphine-naloxone: A per-protocol and completers analysis. Drug Alcohol Depend 2021; 219:108422. [PMID: 33352487 PMCID: PMC8034542 DOI: 10.1016/j.drugalcdep.2020.108422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/18/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The distinct pharmacological properties and clinical uses of extended-release naltrexone (XR-NTX) and sublingual buprenorphine-naloxone (BUP-NX) present challenges in analyzing patient outcomes. METHODS We conducted a secondary analysis of a multi-site randomized trial comparing XR-NTX with sublingual BUP-NX treatment for opioid use disorder initiated during inpatient detoxification and continued in outpatient treatment. Urine testing data for non-study opioids from the last 22 weeks of the 24-week trial were analyzed in both a per-protocol sample (n = 474 participants who received at least one dose of medication) and a completers sample (n = 211 participants who received all XR-NTX doses or all BUP-NX prescriptions). The present analyses sought to identify differences in the weekly percentages of opioid-positive urine tests between participants treated with the two medications. RESULTS The proportion of opioid-positive tests in both conditions was less than 20 % for 21 of the 22 weeks in the per-protocol sample and all 22 weeks in the completers sample. Generalized linear mixed model analyses revealed a significant treatment (XR-NTX vs. BUP-NX) X week (weeks 3-24) interaction in the per-protocol sample but not the completers sample. In the per-protocol analysis, the BUP-NX, compared to XR-NTX, had significantly greater proportions of opioid-positive tests in 14 out of the 22 weeks. CONCLUSIONS Longitudinal modeling approaches that utilize flexible procedures for handling missing data can offer a different perspective on study findings. Results from the present analyses suggest that XR-NTX appeared to be somewhat more effective than BUP-NX in reducing illicit opioid use in the per-protocol sample.
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Affiliation(s)
- Mary M. Mitchell
- Friends Research Institute, Baltimore, MD, USA,Corresponding author at: Friends Research Institute, 1040 Park Ave., Suite 103, Baltimore, MD, 21201, USA. (M.M. Mitchell)
| | | | - Tse-Hwei Choo
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10031, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY, 10032, USA
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, 20742, USA
| | | | | | - Edward V. Nunes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10031, USA
| | - John Rotrosen
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
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10
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Staton M, Webster JM, Leukefeld C, Tillson M, Marks K, Oser C, Bush HM, Fanucchi L, Fallin-Bennett A, Garner BR, McCollister K, Johnson S, Winston E. Kentucky Women's Justice Community Opioid Innovation Network (JCOIN): A type 1 effectiveness-implementation hybrid trial to increase utilization of medications for opioid use disorder among justice-involved women. J Subst Abuse Treat 2021; 128:108284. [PMID: 33455828 DOI: 10.1016/j.jsat.2021.108284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/13/2020] [Revised: 12/03/2020] [Accepted: 01/05/2021] [Indexed: 01/20/2023]
Abstract
The opioid crisis has disproportionately affected women, but research on approaches to increase initiation of medications for opioid use disorder (MOUD) among women is limited. The Kentucky Justice Community Opioid Innovation Network (JCOIN) will implement a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pretreatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community. The overall goal of the project is to increase initiation and maintenance of MOUD among high-risk justice-involved women during community reentry to reduce opioid relapse and overdose. This project and other studies through the JCOIN network have the potential to significantly impact the OUD treatment field by contributing empirical evidence about the effectiveness and implementation of innovative technologies to increase initiation and maintenance of MOUD during a critical, high-risk time of community reentry among vulnerable, justice-involved individuals in both urban and nonurban communities.
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Affiliation(s)
- Michele Staton
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA.
| | - J Matthew Webster
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA
| | - Carl Leukefeld
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA
| | - Martha Tillson
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA; University of Kentucky College of Arts & Sciences, Department of Sociology, Lexington, KY 40508, USA
| | - Katherine Marks
- Kentucky Cabinet for Health and Family Services, Department of Behavioral Health, 275 East Main Street, Frankfort, KY, 40621, USA
| | - Carrie Oser
- University of Kentucky College of Arts & Sciences, Department of Sociology, Lexington, KY 40508, USA
| | - Heather M Bush
- University of Kentucky College of Public Health, Department of Biostatistics, 760 Press Avenue, Healthy Kentucky Bldg, Suite 260, Lexington, KY 40536-0082, USA
| | - Laura Fanucchi
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA; University of Kentucky College of Medicine, Division of Infectious Diseases, 740 S. Limestone St., K512, Lexington, KY 40356, USA
| | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, 520 College of Nursing Building, Lexington, KY 40536, USA
| | - Bryan R Garner
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA
| | - Kathryn McCollister
- University of Miami, Department of Public Health Sciences, 1120 N.W. 14th Street, Suite 1019, Miami, FL 33136, USA
| | - Sarah Johnson
- Kentucky Department of Corrections, 2439 Lawrenceburg Road, Frankfort, KY 40602, USA
| | - Erin Winston
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA
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11
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Caton L, Yuan M, Louie D, Gallo C, Abram K, Palinkas L, Brown CH, McGovern M. The prospects for sustaining evidence-based responses to the US opioid epidemic: state leadership perspectives. Subst Abuse Treat Prev Policy 2020; 15:84. [PMID: 33148283 PMCID: PMC7640430 DOI: 10.1186/s13011-020-00326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The US 21st Century Cures Act provided $7.5 billion in grant funding to states and territories for evidence-based responses to the opioid epidemic. Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding. METHODS Using an inductive, conventional content analysis, we conducted key informant interviews with former and current state leaders (n = 16) about barriers/facilitators to sustainment and strategies for sustaining time-limited grants. RESULTS Financing and reimbursement, service integration, and workforce capacity were the most cited barriers to sustainment. Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns. CONCLUSIONS Understanding the strategies that leaders have successfully used to sustain programs in the past can inform how to continue future time-limited, grant-funded initiatives.
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Affiliation(s)
- Lauren Caton
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mina Yuan
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dexter Louie
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carlos Gallo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Abram
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - C Hendricks Brown
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark McGovern
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA. .,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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12
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Rose-Jacobs R, Trevino-Talbot M, Vibbert M, Lloyd-Travaglini C, Cabral HJ. Pregnant women in treatment for opioid use disorder: Material hardships and psychosocial factors. Addict Behav 2019; 98:106030. [PMID: 31301645 DOI: 10.1016/j.addbeh.2019.106030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/13/2019] [Revised: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND While pregnant women in treatment for opioid use disorder (OUD) face considerable challenges, common material hardships- food insecurity and housing instability, known to negatively impact maternal-child health, have been inadequately researched within this population. This study describes food/housing hardships and evaluates associations with key psychosocial factors. METHODS A single-site prospective study, 100 3rd trimester women receiving prenatal care and medication-assisted treatment for OUD were interviewed, including screening for food/housing hardships, depressive symptoms, intimate partner vulnerability; and self-reported post-traumatic stress disorder (PTSD) history. We developed a three-level categorization combining food/housing screening outcomes: 1) "both insecure"; 2) "either secure"; and 3) "both secure". Bivariate analyses and linear path analyses evaluated associations among psychosocial variables using "both secure" as the referent group. RESULTS Of 100 women, 56% reported food insecurity; 61% housing instability; 42% "both insecure"; 33% "either insecure"; 25% "both secure". In unadjusted food/housing groups "either insecure" and "both insecure" reported significantly greater depressive symptoms; "both insecure" additionally reported significantly greater intimate partner vulnerability. Path analyses adjusted for PTSD and compared with "both secure" (adjusted mean = 6.2): "either insecure" had greater depressive symptom scores (adjusted means = 9.8, p = .01) while "both insecure" had greater depressive scores (adjusted means 10.5, p = .002). In addition, "both insecure" had a clinically important 5.7 point greater intimate partner vulnerability score. There were no significant interactions between food/housing and PTSD. CONCLUSIONS Even in women receiving prenatal care and treatment for OUD, food/housing material hardships and associated psychosocial factors are of major concern, requiring screening and remediation.
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Affiliation(s)
- Ruth Rose-Jacobs
- Boston University School of Medicine, Department of Pediatrics, 771 Albany Street, Room G509, Boston, MA 02118, United States.
| | - Michelle Trevino-Talbot
- Boston Medical Center, Department of Developmental and Behavioral Pediatrics, 72 E. Concord Street, Vose 426, Boston, MA 02118, United States.
| | - Martha Vibbert
- Boston University School of Medicine, Departments of Pediatrics and Psychiatry, 255 River Street, Mattapan, MA 02126, United States.
| | - Christine Lloyd-Travaglini
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, 85 East Newton Street, Room 957A, Boston, MA 02118, United States.
| | - Howard J Cabral
- Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, Room 310, Boston, MA 02118, United States.
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13
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Knudsen HK, Brown R, Jacobson N, Horst J, Kim JS, Collier E, Starr S, Madden LM, Haram E, Toy A, Molfenter T. Physicians' satisfaction with providing buprenorphine treatment. Addict Sci Clin Pract 2019; 14:34. [PMID: 31446893 PMCID: PMC6709557 DOI: 10.1186/s13722-019-0163-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/26/2019] [Accepted: 08/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Buprenorphine is a critically important treatment for addressing the opioid epidemic, but there are virtually no studies of physicians’ job satisfaction with providing buprenorphine. Physicians’ job satisfaction has been linked to burnout and turnover as well as patients’ adherence to treatment recommendations, so it is important to understand how physicians’ satisfaction with providing buprenorphine treatment compares to their overall job satisfaction. Methods As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 55 physicians working in 38 organizations in Florida, Ohio, and Wisconsin completed a baseline web-based survey. Study measures included global job satisfaction, career satisfaction, and specialty satisfaction. Physicians who were waivered to prescribe buprenorphine were asked to rate their satisfaction with their current buprenorphine practice. Results Overall, physicians were generally satisfied with their jobs, their careers, and their specialties. When waivered physicians (n = 40) were compared to non-waivered physicians (n = 15) on 13 satisfaction items, there were no statistically significant differences. Among waivered physicians, ratings for buprenorphine work were significantly lower than ratings for general medical practice for finding such work personally rewarding, being pleased with such work, and overall satisfaction. Conclusions Although waivered and non-waivered physicians both reported high global job satisfaction, these data suggest that some waivered physicians may view their buprenorphine work as somewhat less satisfying than their global medical practice. Given that job dissatisfaction is a risk factor for turnover and burnout, managers of treatment organizations should consider whether strategies may be able to mitigate some sources of lower satisfaction in the context of buprenorphine treatment. Trial registration ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave., Room 204, Lexington, KY, 40508, USA.
| | - Randy Brown
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct., Madison, WI, 53715-1896, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, 4116 Signe Skott Cooper Hall, 701 Highland Ave., Madison, WI, 53705, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
| | - Jee-Seon Kim
- , 1067 Educational Sciences, 1025 West Johnson St., Madison, WI, 53706-1706, USA
| | | | - Sanford Starr
- Ohio Department of Mental Health and Addiction Services, 30 E. Broad St., 8th Floor, Columbus, OH, 43215, USA
| | - Lynn M Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT, 06511, USA.,Department of Internal Medicine, Yale University, New Haven, USA
| | - Eric Haram
- Haram Consulting, 413 River Road, Bowdoinham, ME, 04008, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA
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14
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Miele GM, Caton L, Freese TE, McGovern M, Darfler K, Antonini VP, Perez M, Rawson R. Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and anticipated impact. J Subst Abuse Treat 2019; 108:20-25. [PMID: 31399272 DOI: 10.1016/j.jsat.2019.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 02/14/2019] [Revised: 05/25/2019] [Accepted: 07/22/2019] [Indexed: 11/18/2022]
Abstract
As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the implementation plan in California's Hub and Spoke system. Training and technical assistance are designed to: increase the number and capacity of waivered prescribers; enhance skills of prescribers and multidisciplinary teams; and create systems change. Activities include buprenorphine waiver trainings and provider support, a practice facilitator program, Project ECHO sessions, webinars, clinical skills trainings, and regional learning collaboratives. This overview highlights the steps California is taking to build treatment capacity to address the opioid epidemic.
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Affiliation(s)
- Gloria M Miele
- University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America.
| | - Lauren Caton
- Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America.
| | - Thomas E Freese
- University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America.
| | - Mark McGovern
- Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America.
| | - Kendall Darfler
- University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America.
| | - Valerie Pearce Antonini
- University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America.
| | - Marlies Perez
- California Department of Health Care Services, 1500 Capitol Ave, Sacramento, CA 95814, United States of America.
| | - Richard Rawson
- University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; Center for Behavior and Health, University of Vermont, 1 So Prospect Street, Burlington, VT 05405, United States of America.
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15
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Knudsen HK, Cook J, Lofwall MR, Walsh SL, Studts JL, Havens JR. A mixed methods study of HIV-related services in buprenorphine treatment. Subst Abuse Treat Prev Policy 2017; 12:37. [PMID: 28814313 PMCID: PMC5559779 DOI: 10.1186/s13011-017-0122-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers' medical specialty and across practice settings. METHODS Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers' medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states. RESULTS Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings. CONCLUSIONS Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 204, Lexington, KY, 40508, USA.
| | - Jennifer Cook
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 214, Lexington, KY, 40508, USA
| | - Michelle R Lofwall
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 203, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 202, Lexington, KY, 40508, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building, Room 127, Lexington, KY, 40536-0086, USA
| | - Jennifer R Havens
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 201, Lexington, KY, 40508, USA
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16
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Bray JW, Aden B, Eggman AA, Hellerstein L, Wittenberg E, Nosyk B, Stribling JC, Schackman BR. Quality of life as an outcome of opioid use disorder treatment: A systematic review. J Subst Abuse Treat 2017; 76:88-93. [PMID: 28190543 DOI: 10.1016/j.jsat.2017.01.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 08/15/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The recent opioid epidemic has prompted renewed interest in opioid use disorder treatment, but there is little evidence regarding health-related quality-of-life (HRQoL) outcomes in treatment programs. Measuring HRQoL represents an opportunity to consider outcomes of opioid use disorder treatment that are more patient-centered and more relevant to overall health than abstinence alone. We conducted a systematic literature review to explore the extent to which the collection of HRQoL by opioid treatment programs is documented in the treatment program literature. MATERIALS AND METHODS We searched PubMed, Embase PsycINFO and Web of Science for papers published between 1965 and 2015 that reported HRQoL outcome measures from substance abuse treatment programs. RESULTS Of the 3014 unduplicated articles initially identified for screening, 99 articles met criteria for further review. Of those articles, 7 were unavailable in English; therefore 92 articles were reviewed. Of these articles, 44 included any quality-of-life measure, 17 of which included validated HRQoL measures, and 10 supported derivation of quality-adjusted life year utility weights. The most frequently used validated measure was the Addiction Severity Index (ASI). Non-U.S. and more recent studies were more likely to include a measure of HRQoL. CONCLUSIONS HRQoL measures are rarely used as outcomes in opioid treatment programs. The field should incorporate HRQoL measures as standard practice, especially measures that can be used to derive utility weights, such as the SF-12 or EQ-5D. These instruments provide policy makers with evidence on the impact of programs on patients' lives and with data to quantify the value of investing in opioid use disorder treatments.
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Affiliation(s)
- Jeremy W Bray
- Department of Economics, The University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402, United States.
| | - Brandon Aden
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Ashley A Eggman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Leah Hellerstein
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA 02115, United States.
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
| | - Judy C Stribling
- Samuel J. Wood Library, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States.
| | - Bruce R Schackman
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
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