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Verinumbe T, Lesko CR, Moore RD, Fojo AT, Keruly J, Snow LN, Hutton H, Chander G, Pytell JD, Falade-Nwulia O. The association of changes in depression severity after the onset of the COVID-19 pandemic and viral nonsuppression among people with HIV. AIDS 2024; 38:887-894. [PMID: 38170505 PMCID: PMC10997444 DOI: 10.1097/qad.0000000000003828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study sought to characterize changes in depressive symptom severity during the COVID-19 pandemic and the association of these changes with HIV viral nonsuppression among people with HIV (PWH). DESIGN A clinical cohort study. METHODS We included PWH in the Johns Hopkins HIV Clinical Cohort who completed the Patient Health Questionnaire 8 (PHQ-8) prepandemic (1 March 2018 to 28 February 2020) and during the COVID-era (1 September 2020 to 28 February 2022). PWH were classified according to depression severity categories prepandemic and during the COVID-era as: consistently depressed (prepandemic PHQ-8 >4 and no change in severity category); consistently nondepressed (prepandemic PHQ-8 ≤4 and no change in severity category); worsened (changed to a higher severity category) and; improved (change to a lower severity category). The association between changes in depressive symptom severity and viral nonsuppression (HIV RNA >200 copies/ml on the earliest viral load measured 7 days before to 12 months after the COVID-era PHQ-8 survey) was assessed using multivariable logistic regression. RESULTS Of 793 PWH, mean age was 56 (SD 10) years, 60% were male individuals and 88% were Black. After the onset of the pandemic, 60% were consistently nondepressed, 9% were consistently depressed, 15% worsened and 16% improved. PWH who worsened had 2.47 times the odds of viral nonsuppression (95% CI: 1.09-5.55) compared with the nondepressed group. Associations among other groups were not statistically significant. CONCLUSION Worsening depression during the COVID-era was associated with HIV viral nonsuppression. Strategies to monitor and address depression among PWH may contribute to reduced risk of viral nonsuppression.
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Affiliation(s)
- Tarfa Verinumbe
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony T Fojo
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne Keruly
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - LaQuita N Snow
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Geetanjali Chander
- University of Washington School of Medicine, Division of General Internal Medicine, Seattle, WA
| | - Jarratt D Pytell
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Pytell JD, Binswanger IA. Addressing Opioid Use Disorder in Primary Care: Revisiting Core Primary Care Principles to Confidently Initiate Treatment. J Gen Intern Med 2024:10.1007/s11606-024-08727-5. [PMID: 38519747 DOI: 10.1007/s11606-024-08727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Jarratt D Pytell
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Internal Medicine, Denver Health Medical Center, Denver, CO, USA.
- Institute of Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
| | - Ingrid A Binswanger
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Institute of Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Colorado Permanente Medical Group, Denver, CO, USA
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Lesko CR, Falade-Nwulia OO, Pytell JD, Hutton HE, Fojo AT, Keruly JC, Moore RD, Chander G. Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014-2019. Addiction 2023; 118:2193-2202. [PMID: 37491566 PMCID: PMC10592031 DOI: 10.1111/add.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
AIMS To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression. DESIGN Retrospective clinical cohort study with repeated observations within individuals. SETTING Baltimore, Maryland, United States. PARTICIPANTS 1881 patients contributed 10 794 observations. MEASUREMENTS The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1 year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder. FINDINGS On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%-10.0%), the RD was 5.5% (95% CI = 1.2%-9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%-6.5%) for recent substance use without a SUD. CONCLUSIONS Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.
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Affiliation(s)
- Catherine R Lesko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jarratt D Pytell
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Heidi E Hutton
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anthony T Fojo
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Pytell JD, Fojo AT, Keruly JC, Snow LN, Falade-Nwulia O, Moore RD, Chander G, Lesko CR. Measuring time in buprenorphine treatment stages among people with HIV and opioid use disorder by retention definition and its association with cocaine and hazardous alcohol use. Addict Sci Clin Pract 2023; 18:51. [PMID: 37660116 PMCID: PMC10474763 DOI: 10.1186/s13722-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND We use a novel, longitudinal approach to describe average time spent in opioid use disorder (OUD) cascade of care stages for people with HIV (PWH) and with OUD, incorporating four definitions of treatment retention. Using this approach, we describe the impact of cocaine or hazardous alcohol use on time spent retained on buprenorphine. METHODS We followed PWH with OUD enrolled in the Johns Hopkins HIV Clinical Cohort from their first buprenorphine treatment episode between 2013 and 2020. We estimated 4-year restricted mean time spent on buprenorphine below buprenorphine retention threshold, on buprenorphine above retention threshold, off buprenorphine and in HIV care, loss to follow-up, and death. Retention definitions were based on retention threshold (180 vs 90 days) and allowable treatment gap (7 vs 30 days). Differences in 2-year restricted mean time spent retained on buprenorphine were estimated for patients with and without cocaine or hazardous alcohol use. RESULTS The study sample (N = 179) was 63% male, 82% non-Hispanic Black, and mean age was 53 (SD 8) years. Patients spent on average 13.9 months (95% CI 11.4, 16.4) on buprenorphine over 4 years. There were differences in time spent retained on buprenorphine based on the retention definition, ranging from 6.5 months (95% CI 4.6, 8.5) to 9.6 months (95% CI 7.4, 11.8). Patients with cocaine use spent fewer months retained on buprenorphine. There were no differences for patients with hazardous alcohol use. CONCLUSIONS PWH with OUD spend relatively little time receiving buprenorphine in their HIV primary care clinic. Concurrent cocaine use at buprenorphine initiation negatively impact time on buprenorphine.
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Affiliation(s)
- Jarratt D Pytell
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - LaQuita N Snow
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Thakrar AP, Pytell JD, Stoller KB, Walters V, Weiss RD, Chander G. Transitioning off methadone: A qualitative study exploring why patients discontinue methadone treatment for opioid use disorder. J Subst Use Addict Treat 2023; 150:209055. [PMID: 37088398 PMCID: PMC10330232 DOI: 10.1016/j.josat.2023.209055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Patients who discontinue methadone for opioid use disorder are at increased risk of overdose and death. We know little about how patients make the decision to stop treatment. This study explored reasons why patients discontinue methadone treatment. METHODS We conducted 20 individual semi-structured patient interviews and two staff focus groups, each with five participants, at two opioid treatment programs in Baltimore, MD, in the United States from June 2021 to May 2022. Patient interviews and staff focus groups covered three domains: 1) reasons why patients may want to discontinue methadone; 2) perspectives about the ideal length of methadone treatment; and 3) changes that could improve retention. We used a modified grounded theory approach to code interviews, identify emergent themes, and develop a conceptual model. RESULTS We identified three themes related to patients' internal relationships to methadone: patients (1) viewed methadone as a bridge to opioid-free recovery, (2) believed that long-term methadone damages the body, and (3) felt that methadone increases craving for cocaine; and three themes related to their external relationships with opioid treatment programs and society at large: patients (4) viewed daily dosing as burdensome, (5) feared methadone inaccessibility could trigger relapse, and (6) experienced stigma from friends, family, and peers. Patients with internal reasons planned to stop as soon as possible and asked for education about perceived side effects and treatment for cocaine craving to promote retention. Patients with external reasons were willing to continue for longer and asked for adaptive take-home policies and reduced societal stigma around methadone. CONCLUSIONS Patients want to discontinue methadone either because of their internal relationship to methadone and its real or perceived side effects, or because of their external experiences with opioid treatment programs and societal stigma of methadone. To improve retention, clinical and policy changes should consider responses to both of these categories of reasons.
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Affiliation(s)
- Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, United States of America; Leonard Davis Institute of Health Economics University of Pennsylvania, Philadelphia, United States of America.
| | - Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America.
| | - Kenneth B Stoller
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States of America.
| | | | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Geetanjali Chander
- Department of Medicine, University of Washington, United States of America.
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Pytell JD, Rubenstein LV. So What Do We Do Now? New Opioid Prescribing Guidelines, Implementation Science, and How to Improve the Care of Patients Receiving Long-Term Opioid Therapy in Primary Care. J Gen Intern Med 2023; 38:1791-1793. [PMID: 36922469 PMCID: PMC10271967 DOI: 10.1007/s11606-023-08138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
| | - Lisa V Rubenstein
- RAND Corporation, Santa Monica, CA, USA
- University of California Los Angeles David Geffen School of Medicine and Fielding School of Public Health, CA, Los Angeles, USA
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Pytell JD, Li X, Thompson C, Lesko CR, McCaul ME, Hutton H, Scott Batey D, Cachay E, Mayer KH, Napravnik S, Christopoulos K, Yang C, Crane HM, Chander G, Lau B. The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV. Am J Med Open 2023; 9:100020. [PMID: 37476695 PMCID: PMC10357948 DOI: 10.1016/j.ajmo.2022.100020] [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] [Indexed: 07/22/2023]
Abstract
Background Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear. Setting Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014. Methods A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately. Results Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58-0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97). Conclusion Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - Heidi Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA, USA
| | - Kenneth H. Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katerina Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi M. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pytell JD, Whitley P, Passik SD, Bundy WL, Dawson E, Saloner B. Association of Patients' Direct Addition of Buprenorphine to Urine Drug Test Specimens With Clinical Factors in Opioid Use Disorder. JAMA Psychiatry 2023; 80:459-467. [PMID: 36947029 PMCID: PMC10034668 DOI: 10.1001/jamapsychiatry.2023.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/26/2023] [Indexed: 03/23/2023]
Abstract
Importance The direct addition of buprenorphine to urine drug test specimens to mimic results suggestive of adherence is a clinically significant result, yet little is known about the phenomenon. Objective To characterize factors associated with the direct addition of buprenorphine to urine specimens among patients prescribed buprenorphine for opioid use disorder. Design, Setting, and Participants This cross-sectional study of urine drug test specimens was conducted from January 1, 2017, to April 30, 2022, using a national database of urine drug test specimens ordered by clinicians from primary care, behavioral health, and substance use disorder treatment clinics. Urine specimens with quantitative norbuprenorphine and buprenorphine concentrations from patients with opioid use disorder currently prescribed buprenorphine were analyzed. Exposures Nonprescribed opioid or stimulant co-positive, clinical setting, collection year, census division, patient age, patient sex, and payor. Main Outcomes and Measures Norbuprenorphine to buprenorphine ratio less than 0.02 identified direct addition of buprenorphine. Unadjusted trends in co-positivity for stimulants and opioids were compared between specimens consistent with the direct addition of buprenorphine. Factors associated with the direct addition of buprenorphine were examined with generalized estimating equations. Results This study included 507 735 urine specimens from 58 476 patients. Of all specimens, 261 210 (51.4%) were obtained from male individuals, and 137 254 (37.7%) were from patients aged 25 to 34 years. Overall, 9546 (1.9%) specimens from 4550 (7.6%) patients were suggestive of the direct addition of buprenorphine. The annual prevalence decreased from 2.4% in 2017 to 1.2% in 2020. Opioid-positive with (adjusted odds ratio [aOR], 2.01; 95% CI, 1.85-2.18) and without (aOR, 2.02; 95% CI, 1.81-2.26) stimulant-positive specimens were associated with the direct addition of buprenorphine to specimens, while opioid-negative/stimulant-positive specimens were negatively associated (aOR, 0.78; 95% CI, 0.71-0.85). Specimens from patients aged 35 to 44 years (aOR, 1.59; 95% CI, 1.34-1.90) and primary care (aOR, 1.60; 95% CI, 1.44-1.79) were associated with the direct addition of buprenorphine. Differences by treatment setting decreased over time. Specimens from the South Atlantic census region had the highest association (aOR, 1.4; 95% CI, 1.25-1.56) and New England had the lowest association (aOR, 0.54; 95% CI, 0.46-0.65) with the direct addition of buprenorphine. Conclusions and Relevance In this cross-sectional study, the direct addition of buprenorphine to urine specimens was associated with other opioid positivity and being collected in primary care settings. The direct addition of buprenorphine to urine specimens is a clinically significant finding, and best practices specific for this phenomenon are needed.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | | | | | | | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Pytell JD, Chander G, Thakrar AP, Ogunwole SM, McGinty EE. Does a Survivorship Model of Opioid Use Disorder Improve Public Stigma or Policy Support? A General Population Randomized Experiment. J Gen Intern Med 2023; 38:1638-1646. [PMID: 36394698 PMCID: PMC10212853 DOI: 10.1007/s11606-022-07865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The chronic disease model of opioid use disorder (OUD) is promoted by many public health authorities, yet high levels of stigma persist along with low support for policies that would benefit people with OUD. OBJECTIVE Determine if a survivorship model of OUD, which does not imply a chronic, relapsing disease state, compared to a chronic disease model improves public stigma and support for opioid-related policies. Explore if race or gender moderates any effect. DESIGN Online, vignette-based randomized study. PARTICIPANTS US adults recruited through a market research firm. INTERVENTION Participants viewed one of 8 vignettes depicting a person with OUD in sustained remission. Vignettes varied in terms of the OUD model (survivorship, chronic disease) and vignette individual's race (Black, White) and gender (man, woman). MAIN MEASURES (1) Public stigma measured by desire for social distance, perceptions of dangerousness, and overall feelings toward the vignette individual. (2) Support for 7 opioid-related policies. Overall feelings were measured on a feelings thermometer (0/cold-100/warm). Stigma and policy support responses were measured on Likert scales dichotomized to indicate a positive (4, 5) or negative/indifferent (1-3) response. KEY RESULTS Of 1440 potential participants, 1172 (81%) were included in the analysis. Exposure to the survivorship model resulted in warmer feelings (mean 72, SD 23) compared to the chronic disease (mean 67, SD 23; difference 4, 95%CI 1-6). There was no effect modification from the vignette individual's race or gender. There was no significant difference between OUD models on other measures of public stigma or support for policies. CONCLUSIONS The survivorship model of OUD improved overall feelings compared to the chronic disease model, but we did not detect an effect of this model on other domains of public stigma or support for policies. Further refinement and testing of this novel, survivorship model of OUD could improve public opinions.
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Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - S Michelle Ogunwole
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pytell JD, Rubenstein LV. So What Do We Do Now? New Opioid Prescribing Guidelines, Implementation Science, and How to Improve the Care of Patients Receiving Long-Term Opioid Therapy in Primary Care. J Gen Intern Med 2023:10.1007/s11606-023-08111-9. [PMID: 36897541 DOI: 10.1007/s11606-023-08111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Mail Stop B180, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
| | - Lisa V Rubenstein
- RAND Corporation, Santa Monica, CA, USA.,David Geffen School of Medicine and Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
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Kroll-Desrosiers A, Gutierrez J, Pytell JD. From the Editor's Desk: Ethics in Reviewing. J Gen Intern Med 2023; 38:1-2. [PMID: 36223041 PMCID: PMC9849655 DOI: 10.1007/s11606-022-07832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Jeydith Gutierrez
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Pytell JD, Shen NM, Keruly JC, Lesko CR, Lau B, Fojo AT, Baum MK, Gorbach PM, Javanbakht M, Kipke M, Kirk GD, Mustanski B, Shoptaw S, Siminski S, Moore RD, Chander G. The relationship of alcohol and other drug use during the COVID-19 pandemic among people with or at risk of HIV; A cross-sectional survey of people enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109382. [PMID: 35331580 PMCID: PMC8891146 DOI: 10.1016/j.drugalcdep.2022.109382] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use during the COVID-19 pandemic increased. People living with HIV or at risk for HIV acquisition often have psycho-social and structural barriers or co-occurring substance use making them vulnerable to the adverse effects of alcohol. We describe factors associated with alcohol use during the COVID-19 pandemic in this group. METHODS From May 2020 to February 2021, 1984 people enrolled in 6 existing cohort studies completed surveys about alcohol and other drug use during the COVID-19 pandemic. We describe the past-month prevalence of no alcohol use, low-risk use, and hazardous use. We use multinomial regression to describe factors associated with low-risk or hazardous alcohol use relative to no alcohol use. RESULTS Forty-five percent of participants reported no alcohol use, 33% low-risk use, and 22% hazardous use in the past 30 days. Cannabis and stimulant use were associated with a higher prevalence of low-risk use relative to no use. Tobacco, stimulant, cannabis use and recent overdose were associated with a higher prevalence of hazardous use relative to no use. Substance use treatment and living with HIV were associated with a lower prevalence of low-risk or hazardous use relative to no use. CONCLUSIONS Stimulant use was strongly associated with a higher prevalence of hazardous alcohol use while engagement in substance use treatment or living with HIV was associated with a lower prevalence. Ascertaining hazardous alcohol and other drug use, particularly stimulants, in clinical care could identify people at higher risk for adverse outcome and harm reduction counseling.
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Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA.
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Susanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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14
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Pytell JD, Thakrar AP, Chander G, Colantuoni E. Changes in Alcohol Consumption by Beverage Type Attributable to the COVID-19 Pandemic for 10 States, March 2020 to November 2020: An Ecological Simulation-based Analysis. J Addict Med 2022; 16:e412-e416. [PMID: 35749776 PMCID: PMC9653060 DOI: 10.1097/adm.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Consumption of high potency alcohol is associated with greater healthcare burden, yet little attention has been placed on the change in types of alcohol consumed during the COVID-19 pandemic. We estimate the change in alcohol consumption by beverage type attributable to the COVID-19 pandemic. METHODS The National Institute on Alcohol Abuse and Alcoholism provided apparent alcohol consumption ("consumption") by beverage type for 10 states for January 2017 through November 2020 based on sales and tax data. The 38-month period to February 2020 was used to train quasi-Poisson regression models. The models then predicted the monthly consumption based on the historical trends in the absence of the COVID-19 pandemic from March through November 2020. The difference between the observed and predicted is the change in consumption attributable to the COVID-19 pandemic. RESULTS Beyond what was expected based on historical trends, spirits consumption increased significantly for 6 states (Colorado, Massachusetts, Missouri, North Dakota, Minnesota, and Tennessee) ranging from 4% (95% confidence interval [CI] 1%-6%) to 17% (95% CI 6%-28%) which is equivalent to 7 (95% CI 2-18) to 32 95% CI 12-48) excess standard spirits drinks per-capita; Alaska, Florida, Illinois, and Kentucky had no significant change. Wine consumption increased 10% (95% CI 3%-18%) in Colorado and 8% (95% CI 3%-12%) in Tennessee. Wine consumption in Alaska decreased 6% (95% CI, 3%-10%) and beer consumption decreased 8% (95% CI 4%-11%). CONCLUSIONS During the COVID-19 pandemic, spirits consumption increased relative to wine and beer. Increased consumption of higher potency alcohol beverages could lead to higher alcohol-related healthcare and societal burden.
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Pytell JD, Sklar MD, Carrese J, Rastegar DA, Gunn C, Chander G. "I'm a Survivor": Perceptions of Chronic Disease and Survivorship Among Individuals in Long-Term Remission from Opioid Use Disorder. J Gen Intern Med 2022; 37:593-600. [PMID: 34027611 PMCID: PMC8141362 DOI: 10.1007/s11606-021-06925-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND While opioid use disorder (OUD) is prevalent, little is known about what patients with OUD in sustained remission think about the chronic disease model of OUD and their perspectives of the cause, course, and ongoing treatment needs of their OUD. OBJECTIVE To (1) examine patient perceptions of the chronic disease model of addiction and disease identity and (2) use an explanatory model framework to explore how these perceptions inform ongoing treatment needs and help maintain abstinence. DESIGN Qualitative study of a cross-sectional cohort of patients with OUD in long-term sustained remission currently receiving methadone or buprenorphine. Participants completed a single in-depth, semi-structured individual interview. PARTICIPANTS Twenty adults were recruited from two opioid treatment programs and two office-based opioid treatment programs in Baltimore, MD. Half of the participants were Black, had a median (IQR) age of 46.5 (43-52) years and the median (IQR) time since the last non-prescribed opioid was 12 (8-15) years. APPROACH Hybrid deductive-inductive thematic analysis of the transcribed interviews. KEY RESULTS Some participants described a chronic OUD disease identity where they continue to live with OUD. Participants who maintain an OUD identity describe inherent traits or predetermination of developing OUD. Maintaining a disease identity helps them remain vigilant against returning to drug use. Others described a post-OUD/survivor identity where they no longer felt they had OUD, but the experience remains. Each perspective informed attitudes about continued treatment with methadone or buprenorphine and strategies to remain in remission. CONCLUSIONS The identity that people with OUD in sustained remission maintain was the lens through which they viewed other aspects of their OUD including cause and ongoing treatment needs. An alternative, post-OUD/survivorship model emerged or was accepted by participants who did not identify as currently having OUD. Understanding patient perspectives of OUD identity might improve patient-centered care and improve outcomes.
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Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Michael D Sklar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Joseph Carrese
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Darius A Rastegar
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Christine Gunn
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Geetanjali Chander
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Levander XA, Pytell JD, Stoller KB, Korthuis PT, Chander G. COVID-19-related policy changes for methadone take-home dosing: A multistate survey of opioid treatment program leadership. Subst Abus 2022; 43:633-639. [PMID: 34666636 PMCID: PMC8810732 DOI: 10.1080/08897077.2021.1986768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: In the United States, methadone for treatment of opioid use disorder is dispensed via highly-regulated accredited opioid treatment programs (OTP). During the COVID-19 pandemic, federal regulations were loosened, allowing for greater use of take-home methadone doses. We sought to understand how OTP leaders responded to these policy changes. Methods: We distributed a multistate electronic survey from September to November 2020 of OTP leadership to members of the American Association for the Treatment of Opioid Dependence (AATOD) who self-identified as leaders of OTPs. We asked study participants about how their OTP(s) implemented COVID-19-related policy changes into their clinical practice focusing on provision of take-home methadone doses, factors used to determine patient stability, and potential concerns about increased take-home doses. We used Chi-square test to compare survey responses between characterizations of the OTPs. Results: Of 170 survey respondents (17% response rate), the majority represented leadership of for-profit OTPs (69%) and were in a Southern state (54%). Routine allowances and practices related to take-home methadone doses varied across OTPs during the COVID-19 pandemic: 80 (47%) reported 14 days for newly enrolled patients (within past 90 days), 89 (52%) reported 14 days for "less stable" patients, and 112 (66%) reported 28 days for "stable" patients. Conclusions: We found that not all eligible OTP leaders adopted the practice of routinely allowing newly enrolled, "less stable," and "stable" patients on methadone to have increased take-home doses up to the limit allowed by federal regulations during COVID-19. The pandemic provides an opportunity to critically re-evaluate long-established methadone and OTP regulations in preparation for future emergencies.
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Affiliation(s)
- Ximena A. Levander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kenneth B. Stoller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P. Todd Korthuis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pytell JD, Rastegar DA. Down the drain: Reconsidering routine urine drug testing during the COVID-19 pandemic. J Subst Abuse Treat 2020; 120:108155. [PMID: 33298297 PMCID: PMC7534596 DOI: 10.1016/j.jsat.2020.108155] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/30/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic and the move to telemedicine for office-based opioid treatment have made the practice of routine urine drug tests (UDT) obsolete. In this commentary we discuss how COVID-19 has demonstrated the limited usefulness and possible harms of routine UDT. We propose that practitioners should stop using routine UDT and instead use targeted UDT, paired with clinical reasoning, as part of a patient-centered approach to care. The COVID-19 pandemic made the practice of “routine” urine drug testing obsolete in office-based opioid treatment Requiring routine urine drug testing has limited benefits and possible harms Urine drug testing should be targeted rather than routine and complement patient-centered office-based opioid treatment
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Affiliation(s)
- Jarratt D Pytell
- Addiction Medicine and General Internal Medicine Fellowships, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd floor, Baltimore, MD 21224, United States of America.
| | - Darius A Rastegar
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd floor, Baltimore, MD 21224, United States of America.
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Pytell JD, Sharfstein JM, Olsen Y. Additional Barriers to Methadone Use in Hospitals and Skilled Nursing Facilities-Reply. JAMA Intern Med 2020; 180:615. [PMID: 32250404 DOI: 10.1001/jamainternmed.2020.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jarratt D Pytell
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yngvild Olsen
- Institutes for Behavior Resources, Inc, REACH Health Services, Baltimore, Maryland
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19
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Affiliation(s)
- Jarratt D Pytell
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yngvild Olsen
- Institutes for Behavior Resources Inc, REACH Health Services, Baltimore, Maryland
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Pytell JD, Buresh ME, Graddy R. Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice. Addict Sci Clin Pract 2019; 14:46. [PMID: 31856915 PMCID: PMC6921403 DOI: 10.1186/s13722-019-0175-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/29/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices. METHODS A novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes. RESULTS Twelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9-15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD. CONCLUSIONS OBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.
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Affiliation(s)
- Jarratt D Pytell
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA.
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Graddy
- Division of Addiction Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, East Tower, 2nd Floor, Baltimore, MD, 21224, USA
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Abstract
Peyronie’s disease (PD), more commonly known as penile curvature, is caused by plaque formation in the connective tissue of the penis. PD affects 0.3% to 8.9% of men, most commonly between ages 40 and 60 years and can cause significant psychological distress, regardless of severity. There is a rich history behind the initial reports of PD, initial beliefs about pathogenesis, and initial treatment. This article aims to discuss the history of PD as well as the evolution of causes and treatments throughout time up to present-day theories of pathogenesis and treatment.
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Affiliation(s)
- Stephen P. Carriere
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Jarratt D. Pytell
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Amanda F. Saltzman
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
| | - Harold A. Fuselier
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA
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