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Nordeck CD, Kelly SM, Schwartz RP, Mitchell SG, Welsh C, O'Grady KE, Gryczynski J. Hospital admissions among patients with Comorbid Substance Use disorders: a secondary analysis of predictors from the NavSTAR Trial. Addict Sci Clin Pract 2024; 19:33. [PMID: 38678216 PMCID: PMC11056040 DOI: 10.1186/s13722-024-00463-9] [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: 07/14/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) frequently use acute hospital services. The Navigation Services to Avoid Rehospitalization (NavSTAR) trial found that a patient navigation intervention for hospitalized patients with comorbid SUDs reduced subsequent inpatient admissions compared to treatment-as-usual (TAU). METHODS This secondary analysis extends previous findings from the NavSTAR trial by examining whether selected patient characteristics independently predicted hospital service utilization and moderated the effect of the NavSTAR intervention. Participants were 400 medical/surgical hospital patients with comorbid SUDs. We analyzed 30- and 90-day inpatient readmissions (one or more readmissions) and cumulative incidence of inpatient admissions through 12 months using multivariable logistic and negative binomial regression, respectively. RESULTS Consistent with primary findings and controlling for patient factors, NavSTAR participants were less likely than TAU participants to be readmitted within 30 (P = 0.001) and 90 (P = 0.03) days and had fewer total readmissions over 12 months (P = 0.008). Hospitalization in the previous year (P < 0.001) was associated with cumulative readmissions over 12 months, whereas Medicaid insurance (P = 0.03) and index diagnoses of infection (P = 0.001) and injuries, poisonings, or procedural complications (P = 0.004) were associated with fewer readmissions. None of the selected covariates moderated the effect of the NavSTAR intervention. CONCLUSIONS Previous findings showed that patient navigation could reduce repeat hospital admissions among patients with comorbid SUDs. Several patient factors were independently associated with readmission. Future research should investigate risk factors for hospital readmission among patients with comorbid SUDs to optimize interventions. TRIAL REGISTRATION NIH ClinicalTrials.gov NCT02599818, Registered November 9, 2015 https://classic. CLINICALTRIALS gov/ct2/show/NCT02599818 .
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Affiliation(s)
- Courtney D Nordeck
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201.
| | - Sharon M Kelly
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
| | | | | | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue #103, Baltimore, MD, USA, 21201
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Gryczynski J, Mitchell SG, Whitter M, Fuller D, Mitchell MM, Edelman EJ, Schwartz RP. A trial of implementation facilitation to increase timely admission to methadone treatment. J Subst Use Addict Treat 2024; 162:209375. [PMID: 38642889 DOI: 10.1016/j.josat.2024.209375] [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] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/27/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND During the ongoing opioid epidemic, some Opioid Treatment Programs (OTPs) are unable to admit program applicants in a timely fashion. Interim methadone (IM) treatment (without routine counseling) is an effective approach to overcome this challenge when counseling capacity is inadequate to permit admissions within 14 days of request. It requires both federal and state approval and has been rarely utilized since its incorporation into the federal OTP regulations in 1993. METHODS We evaluated the impact of Implementation Facilitation (IF) on OTPs providing timely admission to methadone treatment (i.e., within 14 days of request), adopting IM, and changing admissions procedures. IF included data collection on admission processes and an external facilitator who engaged OTP leadership, Local Champions through site visits, remote academic detailing, and feedback. Local Champions and State Opioid Treatment Authorities (SOTAs) participated in learning collaboratives. Using a modified stepped wedge design, six OTPs in four US states on the east and west coasts were randomly assigned to one of two clusters that staggered the timing of IF receipt. Study Phases included: Pre-Implementation, IF, and Sustainability. OTPs submitted data on treatment requests and admissions for 28 months (N = 3108 requests for treatment). RESULTS Although none of the OTPs adopted IM, all six developed policies and procedures to enable its use. Some OTPs streamlined admissions processes prior to study launch and during the IF intervention. OTPs reduced admission delays over time, although there was substantial site heterogeneity. The IF Phase for the early cluster coincided with the onset of COVID-19, complicating the study. Rates of timely admission within 14 days of request were 56.2 % (Pre-Implementation), 55.8 % (IF), and 78.8 % (Sustainability). Compared to the Pre-Implementation Phase, the odds of timely admission were not significantly different during the IF Phase but significantly higher during the Sustainability Phase (OR = 2.35 [95 % CI = 1.34, 4.12]; p = 0.003). CONCLUSIONS Committing to study participation and IF activities may have prompted some OTPs to change practices that improved timely admission. Attributing changes to IF should be done with caution considering study limitations. Data collection for the study spanned the COVID-19 pandemic, which complicates interpretation. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT04188977.
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Affiliation(s)
- J Gryczynski
- Friends Research Institute, Inc., Baltimore, MD, United States of America.
| | - S G Mitchell
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - M Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - D Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - M M Mitchell
- MMM was with FRI at time of the study, United States of America
| | - E J Edelman
- Yale Schools of Medicine and Public Health, New Haven, CT, United States of America
| | - R P Schwartz
- Friends Research Institute, Inc., Baltimore, MD, United States of America
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Monico LB, Fletcher JB, Ross T, Schwartz RP, Fishman MJ, Gryczynski J, Mitchell SG. Patient and provider medication preferences affect treatment outcomes among adolescents and young adults with opioid use disorder. J Subst Use Addict Treat 2024; 162:209334. [PMID: 38531508 DOI: 10.1016/j.josat.2024.209334] [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] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The opioid epidemic in the United States has not spared youth or young adults, as evidenced by a six-fold increase in opioid use disorder (OUD) diagnoses in the last two decades. Given this dramatic rise, a call for greater uptake and accessibility of medications for opioid use disorder (MOUDs) among youth and young adults has ensued, resulting in an increasing number of MOUD treatment pathways for this vulnerable population. METHODS This secondary data analysis seeks to characterize patient and provider preferences for MOUD treatment pathways, and test for associations between baseline MOUD treatment preferences and opioid use and treatment adherence outcomes. Participants included 288 youth and young adults (age 15-21 years), recruited from a residential treatment program in Maryland. The study assessed patient preferences at baseline (n = 253) and provider preferences at patient treatment discharge (n = 224). Mixed-effects negative binomial regression models were conducted for opioid use outcomes, and logistic regressions were conducted for treatment adherence outcomes. RESULTS Results indicate that congruence of treatment with patients' (Incidence Rate Ratio [IRR] = 0.65) and providers' (IRR = 0.66) preferences was significantly associated with reduced self-reported days of opioid use in the past 90 days, but only for patients receiving extended-release naltrexone (XR-NTX). Results also indicated that patients were less likely to switch medication treatment pathways (e.g., from XR-NTX to buprenorphine, or vice versa) during follow-up if they received their preferred treatment at baseline, a finding which held true for both XR-NTX (Odds Ratio [OR] = 0.32) and buprenorphine (OR = 0.22). CONCLUSIONS Receipt of MOUD congruent with patient and provider preferences was associated with reduced opioid use and greater treatment adherence in this sample of youth and young adults with OUD.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute Inc, United States of America.
| | | | - Tyler Ross
- Memorial University of Newfoundland, United States of America
| | | | - Marc J Fishman
- Maryland Treatment Centers Inc, United States of America
| | - Jan Gryczynski
- Friends Research Institute Inc, United States of America
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Fuller DB, Gryczynski J, Schwartz RP, Halsted C, Mitchell SG, Whitter M. State guidance and system changes related to COVID-19: Impact on opioid treatment programs. J Subst Use Addict Treat 2024; 158:209214. [PMID: 38042301 PMCID: PMC10947927 DOI: 10.1016/j.josat.2023.209214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION In the United States, methadone treatment may only be provided through opioid treatment programs (OTPs), which operate under a complex system of federal and state regulations. During the pandemic, federal regulators relaxed several longstanding restrictions for OTPs by permitting expanded eligibility for take-home medication and allowing counseling and medication management through telehealth. The purpose of this study was to assess the guidance provided by states regarding the revised guidelines and efforts to protect staff and patients in response to the pandemic. METHODS Between September and October of 2020, The National Association of State Alcohol and Drug Abuse Directors (NASADAD) and Friends Research Institute, fielded a web-based qualitative survey of state opioid treatment authorities (SOTAs) across the United States, the District of Columbia, and Puerto Rico. The study conducted the survey prior to the availability of the COVID vaccines. It queried 42 SOTAs concerning state guidance provided to OTPs on treatment operations and practices for existing patients and new admissions; actions to protect staff and patients; changes in treatment need and operational capacity; and administrative practices regarding treatment. This study examines the responses of 42 SOTAs (65 %) who completed the survey. RESULTS Using content analysis, responses to the survey indicate that most states provided guidance to OTPs in response to the revised federal regulations and the need to protect staff and patients. All respondents reported that their states permitted increased number of take-homes doses for existing patients (100 %) and most reported doing so for new admissions (69 %; N=29). Ninety-eight percent (98 %; N=41) reported permitting remote counseling for existing patients and 90 % (N=38) permitting this for new admissions. SOTAs reported providing guidance on staff safety, operational procedures, oversight, and reforming billing practices to align with new models of service delivery. CONCLUSIONS SOTAs generally reported that federal guidance increased patient access, engagement, and retention. Increased take-home flexibilities were viewed as important for expanding access and continuity of treatment, with the majority of SOTAs stating that the revised treatment practices (e.g., expansion of telehealth, flexible medication dispensing practices) were beneficial. These regulatory flexibilities, many believe, promoted the continuation of treatment and successful patient outcomes during the pandemic.
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Affiliation(s)
- Douglas B Fuller
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
| | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Caroline Halsted
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Melanie Whitter
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
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Zhou X, Thompson LK, Pagano A, Rahman N, Patel S, Gibson D, Ibrahim A, Casanova B, Schwartz RP, Vocci FJ, Clarke DE. Patient Engagement in and Adaptations to Delivery of Outpatient Care for Opioid Use Disorder During the COVID-19 Pandemic. Psychiatr Serv 2024; 75:258-267. [PMID: 37855101 DOI: 10.1176/appi.ps.202100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The authors investigated adaptations to outpatient care delivery and changes in treatment demand and engagement among patients receiving medications for opioid use disorder (MOUD) in the months after the declaration of the COVID-19 public health emergency in 2020. METHODS Data were collected through an online survey (June-November 2020) of outpatient MOUD prescribers. The survey obtained information on outpatient practices' adaptations to MOUD treatment and urine drug screening (UDS) and elicited provider views on the effects of the COVID-19 pandemic on patient demand for, and engagement in, treatment. Multivariable regression analyses were used to examine associations among practice characteristics, patient engagement, and service adaptations. RESULTS Of 516 respondents, 74% reported adaptations to MOUD delivery during the pandemic. Most respondents implemented virtual visits for initial (67%) and follow-up (77%) contacts. Prescribers of buprenorphine were more likely than those who did not prescribe the medication to report MOUD adaptations. Among respondents reporting any MOUD adaptation, 77% made adaptations to their UDS practices. Among 513 respondents who answered COVID-19-related questions, 89% reported that the pandemic had affected the treatment and engagement of their patients. Of these respondents, 30% reported increased difficulty with patient engagement, and 45% reported that their patients preferred virtual visits during this period, whereas 18% endorsed patient preference for in-person visits. CONCLUSIONS Telehealth and federal regulatory easements in response to the COVID-19 pandemic enabled providers to continue treating patients for opioid use disorder in 2020. The results suggest that care adaptations and changes in patient demand and engagement were common in the practices surveyed.
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Affiliation(s)
- Xinzhe Zhou
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Laura K Thompson
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Anna Pagano
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Nusrat Rahman
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Sejal Patel
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Debbie Gibson
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Adila Ibrahim
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Barbara Casanova
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Robert P Schwartz
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Frank J Vocci
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
| | - Diana E Clarke
- Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke)
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Burruss-Cousins K, Mitchell SG, Gryczynski J, Whitter M, Fuller D, Ibrahim A, Schwartz RP. Opioid treatment program culture and philosophy: Views of OTP staff and state officials on implementing interim methadone treatment. J Subst Use Addict Treat 2024; 157:209265. [PMID: 38103832 PMCID: PMC10922701 DOI: 10.1016/j.josat.2023.209265] [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: 06/15/2023] [Revised: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION People seeking treatment at opioid treatment programs (OTPs) can face admission delays. Interim methadone (IM) treatment, an effective approach to expedite admissions when programs lack sufficient counseling staff, has been seldom implemented. A study of implementation facilitation to spur the use of IM was conducted among six OTPs and their state opioid treatment authorities (SOTAs) in four US states. Between study recruitment and launch, organizational changes at three OTPs eliminated their need for IM. Two OTPs' requests to their states to provide IM (one prior to study launch and one following launch) were deferred by the states due to internal issues that required resolution to comply with federal IM regulations. During the study, another OTP's delays resolved, and one OTP streamlined its admissions procedures. METHODS Virtual interviews were conducted with 16 OTP staff and SOTAs from six OTPs in four US states following their participation in the parent study. Interviews focused on the feasibility and acceptability of the implementation intervention for IM. We analyzed data using a constant comparative approach. RESULTS Two overarching themes emerged from the qualitative data with respect to the role that organizational culture plays in OTP staff views of efforts to implement interim methadone: (1) the contrasting views of interim methadone based on whether staff adopt a traditional treatment vs. harm reduction philosophy and (2) the importance of reconciling these philosophies in addressing the culture shift that would accompany the process of implementing IM. CONCLUSIONS Organizational treatment philosophy and program culture emerged as important factors determining the OTPs' staff's willingness to adopt new approaches to expedite admissions. Participants noted a tension between traditional treatment and harm reduction philosophies that impacted their views of IM, in part based on when they entered the drug treatment field. While understanding and addressing treatment philosophy and organizational culture and willingness to change is of importance when implementing new approaches in OTPs, leadership at the state and OTP level are powerful drivers of change.
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Affiliation(s)
| | | | - Jan Gryczynski
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - Melanie Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, DC, United States of America
| | - Douglas Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, DC, United States of America
| | - Adila Ibrahim
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., Baltimore, MD, United States of America
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Mitchell MM, G Mitchell S, Brooks JH, Akinwolere OG, Dusek K, O'Grady KE, Schwartz RP, Gryczynski J. The Relationship between Vaping Cannabis and Frequency of Cannabis Use and Cannabis-Related Problems among Urban High School Students. Subst Use Misuse 2024; 59:329-335. [PMID: 38063201 DOI: 10.1080/10826084.2023.2269573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Background: Vaping, including vaping cannabis, is increasing among adolescents. In this longitudinal study, we examined the relationship between vaping cannabis and frequency of cannabis use and related problems over 6 months among adolescents. Material and Methods: Data were from 233 participants (46.8% male, 93.1% African American, mean age = 16.4 years) reporting cannabis use. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) assessed frequency of past 30-day cannabis use and cannabis-related problems at baseline, 3- and 6-months post-baseline. We used latent growth curve modeling to compare vaping to non-vaping adolescents on trends in cannabis use frequency and ASSIST cannabis scores. Results: Adolescents who vaped cannabis (11.7%) had higher past 30-day frequency (mean = 17.89 days, SD = 10.49) of cannabis use at baseline compared to adolescents who had not vaped (mean = 12.1 days, SD = 10.93), but reported a significantly sharper decline in frequency of cannabis use (b = -0.34, p = 0.017). A significantly steeper decrease existed in the mean cannabis ASSIST scores for the vaping group than for the non-vaping group (b = -0.34, p = 0.014). Mean ASSIST scores on the cannabis subscale between the two groups were significantly different at 6-month follow-up (Vape mean = 6.00, SD = 8.12 vs. Non-vape mean = 9.6, SD = 9.39; p < 0.021). Conclusions: In a sample of cannabis-using adolescents, adolescents with experience vaping cannabis, compared to adolescents without vaping experience, on average reported sharper decreases in frequency of cannabis use and cannabis-related problems such as health or social problems.
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Affiliation(s)
| | | | | | | | - Kristi Dusek
- Friends Research Institute, Baltimore, Maryland, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Zarkin GA, Orme S, Dunlap LJ, Kelly SM, Mitchell SG, O'Grady KE, Schwartz RP. Corrigendum to "Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail" [Drug Alcohol Depend. 217 (2020) 108292]. Drug Alcohol Depend 2024; 254:110913. [PMID: 37580212 PMCID: PMC10843802 DOI: 10.1016/j.drugalcdep.2023.110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Gary A Zarkin
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States
| | - Stephen Orme
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States.
| | - Laura J Dunlap
- RTI, International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park,NC 27709-2194,United States
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive,College Park,MD 20742,United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103,Baltimore,MD 21201,United States
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Skogseth EM, Brant K, Harrison E, Apsley HB, Crowley M, Schwartz RP, Jones AA. Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals. Subst Use 2024; 18:11782218231222339. [PMID: 38433748 PMCID: PMC10906498 DOI: 10.1177/11782218231222339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Introduction The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.
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Affiliation(s)
- Emma M Skogseth
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Brant
- Department of Agricultural Economics, Society, and Education, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
| | - Eric Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Max Crowley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
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Apsley HB, Brant K, Brothers S, Harrison E, Skogseth E, Schwartz RP, Jones AA. Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them. Womens Health (Lond) 2024; 20:17455057231224181. [PMID: 38362719 PMCID: PMC10874161 DOI: 10.1177/17455057231224181] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. OBJECTIVES This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. DESIGN This study is based on qualitative semi-structured interviews. METHODS Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals. RESULTS Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system. CONCLUSION Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.
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Affiliation(s)
- Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Brant
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA
| | - Sarah Brothers
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, USA
| | - Eric Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Emma Skogseth
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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11
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Hochstatter KR, Nordeck C, Mitchell SG, Schwartz RP, Welsh C, Gryczynski J. Polysubstance use and post-discharge mortality risk among hospitalized patients with opioid use disorder. Prev Med Rep 2023; 36:102494. [PMID: 38116282 PMCID: PMC10728463 DOI: 10.1016/j.pmedr.2023.102494] [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: 07/20/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Polysubstance use is becoming increasingly common and presents several harms. This study aimed to examine the association of comorbid cocaine, alcohol (binge drinking), and sedative use with mortality among hospitalized patients with opioid use disorder (OUD). A subsample of adult medical/surgical hospital patients with OUD who were seen by a hospital addiction consultation service in Baltimore City and enrolled in a randomized trial of a patient navigation intervention were included in this study (N = 314; 45 % female; 48 % White; mean age = 44). Death certificate data from the Maryland Division of Vital Records was used, covering 3.3-5.5 years post-discharge. Multivariable proportional hazards Cox regression and competing risks regression were used to estimate all-cause mortality and overdose mortality, respectively, as a function of concurrent use of cocaine, alcohol (binge drinking), and non-prescribed sedatives at baseline. In the 30 days prior to hospital admission, 230 (73 %) participants used cocaine, 64 (20 %) binge drank, and 45 (14 %) used non-prescribed sedatives. Nearly one-third (N = 98; 31 %) died during the observation period. Drug overdose caused 53 % (N = 52) of deaths. Older age (HR = 1.03 [1.01,1.05]; P = 0.001), less than high school education (HR = 0.36 [0.24,0.54]; P < 0.001), and past 30-day sedative use (HR = 2.05 [1.20,3.50]; P = 0.008) were significantly associated with all-cause mortality. The risk of overdose mortality was 62 % lower (HR = 0.38 [0.22,0.66]; P = 0.001) for those who completed high school. No other characteristics were significantly associated with overdose mortality. The concurrent use of opioids and sedatives increases the post-discharge mortality risk among hospitalized patients with OUD. Interventions are needed to prevent mortality among this high-risk population.
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12
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Wartko PD, Bobb JF, Boudreau DM, Matthews AG, McCormack J, Lee AK, Qiu H, Yu O, Hyun N, Idu AE, Campbell CI, Saxon AJ, Liu DS, Altschuler A, Samet JH, Labelle CT, Zare-Mehrjerdi M, Stotts AL, Braciszewski JM, Murphy MT, Dryden D, Arnsten JH, Cunningham CO, Horigian VE, Szapocznik J, Glass JE, Caldeiro RM, Phillips RC, Shea M, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Lapham GT, Addis M, Bradley KA, Ghiroli MM, Hamilton LK, Hu Y, LaHue JS, Loree AM, Murphy SM, Northrup TF, Shmueli-Blumberg D, Silva AJ, Weinstein ZM, Wong MT, Burganowski RP. Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1343-1354. [PMID: 37902748 PMCID: PMC10616772 DOI: 10.1001/jamainternmed.2023.5701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments. Objective To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization. Design, Setting, and Participants The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after. Intervention The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine. Main Outcomes and Measures The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up. Results During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70). Conclusions and Relevance The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD. Trial Registration ClinicalTrials.gov Identifier: NCT03407638.
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Affiliation(s)
- Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Genentech Inc, South San Francisco, California
| | | | | | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Kaiser Permanente Washington, Renton
| | - Hongxiang Qiu
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, North Bethesda, Maryland
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jeffrey H Samet
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Colleen T Labelle
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Mohammad Zare-Mehrjerdi
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Angela L Stotts
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Douglas Dryden
- MultiCare Health System, Tacoma, Washington
- Now with Mosaic Medical, Bend, Oregon
| | - Julia H Arnsten
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Bronx, New York
- Now with New York State Office of Addiction Services and Supports, New York
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Ryan M Caldeiro
- Mental Health and Wellness Department, Kaiser Permanente Washington, Renton
| | | | - Mary Shea
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- University of Minnesota Medical School, Minneapolis
| | | | - Jennifer McNeely
- Department of Population Health, Grossman School of Medicine, New York University, New York
| | - Jane M Liebschutz
- Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Joseph O Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California
| | - Megan M Ghiroli
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Yong Hu
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Thomas F Northrup
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | | | | | - Zoe M Weinstein
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
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Gryczynski J, Sanchez K, Carswell SB, Schwartz RP. The Spanish language version of the TAPS tool: protocol for a validation and implementation study in primary care. Addict Sci Clin Pract 2023; 18:69. [PMID: 37974265 PMCID: PMC10652452 DOI: 10.1186/s13722-023-00423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The TAPS Tool ("Tobacco, Alcohol, Prescription drug, and illicit Substance use") is a screening and brief assessment for detecting unhealthy substance use in healthcare settings that was developed by the National Institute on Drug Abuse Clinical Trials Network and validated in a multisite study. Our team developed a Spanish language version of the TAPS Tool that supports provider- and self-administration screening using a mobile/web-based platform, the TAPS Electronic Spanish Platform (TAPS-ESP). METHODS This article describes the protocol and rationale for a study to validate the TAPS-ESP in a sample of Spanish-speaking primary care patients recruited from a network of community-based clinics in Texas (target N = 1,000). The TAPS-ESP will be validated against established substance use disorder diagnostic measures, alternative screening tools, and substance use biomarkers. The study will subsequently examine barriers and facilitators to screening with the TAPS-ESP from a provider workflow perspective using qualitative interviews with providers. DISCUSSION Validating a Spanish language version of the TAPS Tool could expand access to evidence-based, linguistically accurate, and culturally relevant substance use screening and brief assessment for an underserved health disparity population. TRIAL REGISTRATION The study was registered with www. CLINICALTRIALS gov : NCT05476588, 07/22/2022.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, COG Analytics, Baltimore, MD, USA
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14
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Orme S, Zarkin GA, Dunlap LJ, Monico LB, Gryczynski J, Fishman MJ, Schwartz RP, O'Grady KE, Mitchell SG. Health care use and cost of treatment for adolescents and young adults with opioid use disorder. J Subst Use Addict Treat 2023; 154:209137. [PMID: 37558183 PMCID: PMC10687977 DOI: 10.1016/j.josat.2023.209137] [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: 09/08/2022] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Few studies have examined the cost of medication for opioid use disorder (MOUD) with counseling for the adolescent and young adult population. This study calculated the health care utilization and cost of MOUD treatment, other substance use disorder treatment, and general health care for adolescents and young adults receiving treatment for opioid use disorder. METHODS The study randomized youth ages 15 to 21 (N = 288) equally into the two study conditions: extended-release naltrexone (XR-NTX) or treatment as usual (TAU). While participants committed to treatment based on randomization the study observed considerable nonadherence to both randomized conditions. Instead of using the randomly assigned study conditions, we present descriptive costs by the type of MOUD treatment received: XR-NTX only, buprenorphine only, any other combination of MOUD treatments, and no MOUD. Health care use was aggregated over the 6-month period for each participant, and we calculated average/participant utilization for each treatment group. To determine participant costs, we multiplied the unit costs of health care services obtained from the literature by the reported amount of health care utilization for each participant. We then calculated the mean, standard error, median and IQR for MOUD costs, other substance use disorder treatment costs and general healthcare cost from the health care sector perspective. RESULTS On average, participants in the XR-NTX only group received 2.6 doses of XR-NTX (equivalent to approximately 78 days of treatment). The buprenorphine only group had an average of 97 days of buprenorphine treatment. The XR-NTX only group had higher/patient costs compared to participants in the buprenorphine only group ($10,491 vs. $8765) and higher XR-NTX utilization would further increase costs. Participants in the any other MOUD combination group had the highest total costs ($14,627) while participants in the no MOUD group at the lowest ($3453). DISCUSSION Our cost analysis calculates the real-world cost of MOUD treatment and, while not generalizable, provides policy makers an estimate of costs for adolescents and young adults. We found that participants in the XR-NTX only group received fewer days of medication compared to the buprenorphine only group, but their medication costs were higher due to the cost of XR-NTX injections. While the buprenorphine only group had the highest number of days of medication utilization of all the groups, the average number of days of medication utilization was considerably shorter than the six-month treatment period.
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Affiliation(s)
- Stephen Orme
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA.
| | - Gary A Zarkin
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura J Dunlap
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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15
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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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Mitchell SG, Fletcher JB, Monico LB, Gryczynski J, Fishman MJ, O'Grady KE, Schwartz RP. Comparing outcomes of extended-release naltrexone in adolescents and young adults with opioid use disorder. J Subst Use Addict Treat 2023:209162. [PMID: 37730015 PMCID: PMC10948374 DOI: 10.1016/j.josat.2023.209162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Opioid use among youth is a public health concern in the United States, with >3300 overdose deaths occurring nationally each year. Unfortunately, youth in the United States are still prescribed medication for opioid use disorder (OUD) at a lower rate than their adult counterparts. METHODS From 10/2013 to 01/2018, adolescents (ages 15-17; n = 25) and young adults (ages 18-21; n = 263) with moderate to severe OUD enrolled in the parent trial of extended-release naltrexone (XR-NTX; n = 82) versus treatment-as-usual (TAU; either buprenorphine maintenance [n = 94] or counseling without buprenorphine maintenance [n = 112]). The study assessed opioid use outcomes for adolescents vs. young adults using timeline follow-back self-report procedures at baseline and 3-/6-month follow-up assessments. Mixed-effects longitudinal and clustered panel regression models compared treatment effects over time of XR-NTX and TAU on opioid use outcomes in this secondary analysis. RESULTS Though adolescent participants reported significantly less opioid use at baseline relative to their young adult counterparts (p < 0.05), the two age groups reported similar rates of opioid use throughout the intervention period. Additionally, both adolescents and young adults receiving XR-NTX evidenced lower rates of opioid use than those receiving TAU at all time points, and adolescents on XR-NTX were the only group who reduced their opioid use at all time points. Mixed-effects models indicated adolescents receiving XR-NTX demonstrated a 48 % lower rate of opioid use days [Incidence Rate Ratio (IRR) = 0.52; p = 0.020], while young adults receiving XR-NTX reported an estimated 26 % lower rate (IRR = 0.74; p = 0.009). CONCLUSIONS Results indicate that adolescents respond favorably to XR-NTX relative to TAU for treatment of OUD, demonstrating similar outcomes to young adults.
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Affiliation(s)
| | - Jesse B Fletcher
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University y 8Maryland, College Park, College Park, MD, USA.
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
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Wu LT, Mannelli P, John WS, Anderson A, Schwartz RP. Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff. Subst Abuse Treat Prev Policy 2023; 18:55. [PMID: 37697326 PMCID: PMC10496162 DOI: 10.1186/s13011-023-00563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The US federal regulations allow pharmacy administration and dispensing of methadone for opioid use disorder (PADMOUD) to increase the capability of opioid treatment programs (OTPs) in providing methadone maintenance treatment (MMT) for opioid use disorder (OUD) as part of a medication unit. However, there is a lack of research data from both pharmacy and OTP staff to inform the implementation of PADMOUD. METHODS Staff of a pharmacy (n = 8) and an OTP (n = 9) that participated in the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were recruited to participate in this qualitative interview study to explore implementation-related factors for PADMOUD. Each interview was recorded and transcribed verbatim. NVivo was used to help identify themes of qualitative interview data. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide the coding and interpretation of data. RESULTS Six pharmacy staff and eight OTP staff (n = 14) completed the interview. Results based on PARIHS domains were summarized, including evidence, context, and facilitation domains. Participants perceived benefits of PADMOUD for patients, pharmacies, OTPs, and payers. PADMOUD was considered to increase access for stable patients, provide additional patient service opportunities and revenues for pharmacies/pharmacists, enhance the capability of OTPs to treat more new patients, and reduce patients' cost when receiving medication at a pharmacy relative to an OTP. Both pharmacy and OTP staff were perceived to be supportive of the implementation of PADMOUD. Pharmacy staff/pharmacists were perceived to need proper training on addiction and methadone as well as a protocol of PADMOUD to conduct PADMOUD. Facilitators include having thought leaders to guide the operation, a certification program to ensure proper training of pharmacy staff/pharmacist, having updated pharmacy service software or technology to streamline the workflow of delivering PADMOUD and inventory management, and reimbursement for pharmacists. CONCLUSION This study presents the first findings on perspectives of PADMOUD from both staff of a community pharmacy and an OTP in the US. Finding on barriers and facilitators are useful data to guide the development of strategies to implement PADMOUD to help address the US opioid crisis.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Wu LT, John WS, Mannelli P, Morse ED, Anderson A, Schwartz RP. Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S. Addict Sci Clin Pract 2023; 18:45. [PMID: 37533071 PMCID: PMC10398989 DOI: 10.1186/s13722-023-00399-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients' perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis. METHODS Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes. RESULTS Seventeen participants completed the interview. Patients' perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists' training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD. CONCLUSION This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients' views and needs.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | | | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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19
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Bunting AM, Schwartz RP, Wu LT, Wahle A, Kline M, Subramaniam G, McNeely J. A Brief Screening and Assessment Tool for Opioid Use in Adults: Results from a Validation Study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool. J Addict Med 2023; 17:471-473. [PMID: 37579113 PMCID: PMC10404299 DOI: 10.1097/adm.0000000000001139] [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: 02/08/2023]
Abstract
OBJECTIVES This secondary analysis evaluated opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care. METHODS This study is a secondary data analysis of the TAPS validation study. Performance of the TAPS tool for screening for unhealthy opioid use (with a score of 1+ for heroin and/or prescription opioids representing a positive screen) was evaluated. Discriminative ability was examined in comparison with reference standard measures across the spectrum of unhealthy opioid use: timeline follow-back with and without oral fluid testing identifying past-month use and the modified Composite International Diagnostic Interview for past-year problem use, opioid use disorder (OUD), and moderate-severe OUD. RESULTS In a sample of 2000 primary care patients, 114 screened positive for opioids on the TAPS tool. With a TAPS cutoff equal to 1+, the TAPS accurately identified past-month use, problem use, any OUD, and moderate-severe OUD (sensitivities = 68%-85%, specificities = 97%-98%, area under the curve = 0.80-0.91). When past-month use was expanded to include timeline follow-back with oral fluid testing, accuracy declined (52% sensitivity [95% confidence interval, 43%-60%], 98% specific [95% confidence interval, 97%-98%]). CONCLUSIONS While further testing in a larger population sample may be warranted, given their brevity, simplicity, and accuracy when self-administered, the TAPS opioid items can be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings.
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Affiliation(s)
- Amanda M Bunting
- From the New York University Grossman School of Medicine, New York, NY (AMB, JM); Friends Research Institute, Baltimore, MD (RPS); Duke University School of Medicine, Durham, NC (L-TW); The Emmes Company, Rockville, MD (AW, MK); and National Institute on Drug Abuse, Rockville, MD (GS)
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20
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Sue KL, Chawarski M, Curry L, McNeil R, Coupet E, Schwartz RP, Wilder C, Tsui JI, Hawk KF, D’Onofrio G, O’Connor PG, Fiellin DA, Edelman EJ. Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department-Initiated Buprenorphine Programs. JAMA Netw Open 2023; 6:e2312718. [PMID: 37163263 PMCID: PMC10173026 DOI: 10.1001/jamanetworkopen.2023.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/24/2023] [Indexed: 05/11/2023] Open
Abstract
Importance An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. Objective To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. Design, Setting, and Participants This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. Main Outcomes and Measures Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. Results A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. Conclusions and Relevance In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.
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Affiliation(s)
- Kimberly L. Sue
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marek Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Leslie Curry
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Ryan McNeil
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Edouard Coupet
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Christine Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Judith I. Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Kathryn F. Hawk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick G. O’Connor
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
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21
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D’Onofrio G, Edelman EJ, Hawk KF, Chawarski MC, Pantalon MV, Owens PH, Martel SH, Rothman R, Saheed M, Schwartz RP, Cowan E, Richardson L, Salsitz E, Lyons MS, Freiermuth C, Wilder C, Whiteside L, Tsui JI, Klein JW, Coupet E, O’Connor PG, Matthews AG, Murphy SM, Huntley K, Fiellin DA. Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. JAMA Netw Open 2023; 6:e235439. [PMID: 37017967 PMCID: PMC10077107 DOI: 10.1001/jamanetworkopen.2023.5439] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/05/2023] [Indexed: 04/06/2023] Open
Abstract
Importance Emergency department (ED)-initiated buprenorphine for the treatment of opioid use disorder (OUD) is underused. Objective To evaluate whether provision of ED-initiated buprenorphine with referral for OUD increased after implementation facilitation (IF), an educational and implementation strategy. Design, Setting, and Participants This multisite hybrid type 3 effectiveness-implementation nonrandomized trial compared grand rounds with IF, with pre-post 12-month baseline and IF evaluation periods, at 4 academic EDs. The study was conducted from April 1, 2017, to November 30, 2020. Participants were ED and community clinicians treating patients with OUD and observational cohorts of ED patients with untreated OUD. Data were analyzed from July 16, 2021, to July 14, 2022. Exposure A 60-minute in-person grand rounds was compared with IF, a multicomponent facilitation strategy that engaged local champions, developed protocols, and provided learning collaboratives and performance feedback. Main Outcomes and Measures The primary outcomes were the rate of patients in the observational cohorts who received ED-initiated buprenorphine with referral for OUD treatment (primary implementation outcome) and the rate of patients engaged in OUD treatment at 30 days after enrollment (effectiveness outcome). Additional implementation outcomes included the numbers of ED clinicians with an X-waiver to prescribe buprenorphine and ED visits with buprenorphine administered or prescribed and naloxone dispensed or prescribed. Results A total of 394 patients were enrolled during the baseline evaluation period and 362 patients were enrolled during the IF evaluation period across all sites, for a total of 756 patients (540 [71.4%] male; mean [SD] age, 39.3 [11.7] years), with 223 Black patients (29.5%) and 394 White patients (52.1%). The cohort included 420 patients (55.6%) who were unemployed, and 431 patients (57.0%) reported unstable housing. Two patients (0.5%) received ED-initiated buprenorphine during the baseline period, compared with 53 patients (14.6%) during the IF evaluation period (P < .001). Forty patients (10.2%) were engaged with OUD treatment during the baseline period, compared with 59 patients (16.3%) during the IF evaluation period (P = .01). Patients in the IF evaluation period who received ED-initiated buprenorphine were more likely to be in treatment at 30 days (19 of 53 patients [35.8%]) than those who did not 40 of 309 patients (12.9%; P < .001). Additionally, there were increases in the numbers of ED clinicians with an X-waiver (from 11 to 196 clinicians) and ED visits with provision of buprenorphine (from 259 to 1256 visits) and naloxone (from 535 to 1091 visits). Conclusions and Relevance In this multicenter effectiveness-implementation nonrandomized trial, rates of ED-initiated buprenorphine and engagement in OUD treatment were higher in the IF period, especially among patients who received ED-initiated buprenorphine. Trial Registration ClinicalTrials.gov Identifier: NCT03023930.
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Affiliation(s)
- Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn F. Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marek C. Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael V. Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patricia H. Owens
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shara H. Martel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne Richardson
- Institute for Health Equity Research, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin Salsitz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Caroline Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christine Wilder
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle
| | - Jared W. Klein
- Department of Medicine, University of Washington, Seattle
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick G. O’Connor
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
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22
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Lyons MS, Chawarski MC, Rothman R, Whiteside L, Cowan E, Richardson LD, Hawk K, Tsui JI, Schwartz RP, O’Connor P, D’Onofrio G, Fiellin DA, Edelman EJ. Missed Opportunities for HIV and Hepatitis C Screening Among Emergency Department Patients With Untreated Opioid Use Disorder. J Addict Med 2023; 17:210-214. [PMID: 36170184 PMCID: PMC10023471 DOI: 10.1097/adm.0000000000001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed the frequency of emergency department (ED) HIV and hepatitis C (HCV) screening in a high-risk cohort of ED patients with untreated opioid use disorder (OUD). METHODS This analysis used data from a prospective, observational study of English-speaking adults with untreated OUD enrolled from April 2017 to December 2018 in 4 urban, academic EDs. Two cohorts were defined for this analysis by self-reported negative/unknown status for HIV (cohort 1) and HCV (cohort 2). Sites featured structured screening programs throughout the entire enrollment period for HIV and during at least part of the enrollment period for HCV. We calculated the proportion tested for HIV and HCV during the study enrollment ED visit. RESULTS Among 394 evaluated ED patients, 328 of 394 (83.2%) were not tested for HIV or HCV and 244 of 393 (62.1%) lacked a usual medical care provider. In cohort 1, 375 reported negative or unknown HIV status; 59/375 (15.7%) overall and 33/218 (15.1%) of those reporting recent injection drug use were tested for HIV. In cohort 2, 231 reported negative of unknown HCV status; 22/231 (9.5%) overall and 9/98 (9.2%) of those reporting recent injection drug use were tested for HCV. The proportion tested by the ED ranged from 3% to 25% for HIV and 4% to 32% for HCV across study sites. CONCLUSIONS Emergency department HIV and HCV screening remains infrequent among patients with untreated OUD, including those who inject drugs, even in EDs committed to screening. Targeted HIV/HCV screening should be considered as an adjunct strategy until the ideal of universal screening is more fully achieved.
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Affiliation(s)
- Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marek C. Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine Seattle WA USA
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Judith I. Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Patrick O’Connor
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
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23
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Gryczynski J, Monico LB, Garrison K, Dusek K, Oros M, Hosler C, Brown BS, Schwartz RP, O’Grady KE, Kirk A, Mitchell SG. Sustainability of Adolescent Screening and Brief Intervention Services in Primary Care After Removal of Implementation Supports. J Stud Alcohol Drugs 2023; 84:103-108. [PMID: 36799680 PMCID: PMC9948144 DOI: 10.15288/jsad.21-00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although many health care organizations have sought to increase the integration of substance use services into clinical practice, such practice changes can prove difficult to sustain. METHOD Seven primary care clinics participated in an implementation study of screening and brief intervention (BI) services for adolescent patients (ages 12-17). All sites delivered screening and brief advice (BA) for low-risk use using a uniform protocol. Clinics were randomized to deliver BI using generalist (provider-delivered) or specialist (behavioral health clinician-delivered) models. Implementation was facilitated by multiple supporting activities (e.g., trainings, local "champion," electronic health record [EHR] integration of screening and documentation, individualized feedback, project-specific materials, etc.). Data on the penetration of screening, BA, and BI delivery (N = 14,486 adolescent patient visits) were abstracted from the EHR for the 20-month implementation phase and a 12-month sustainability phase (during which implementation supports were removed). RESULTS Penetration of screening continued to slowly increase across the implementation-to-sustainability phases (62% vs. 70%; p = .04). Although uptake during implementation was low for BA (29%) and BI (22%), there was no significant decrease in service provision during the sustainability phase. Although overall delivery of BI was significantly higher in generalist compared with specialist sites (p < .001), sustainability did not differ by generalist versus specialist conditions. There were considerable differences in penetration across clinic sites. CONCLUSIONS Clinics sustained a high level of substance use screening. Uptake of intervention services was low but did not decrease further following the cessation of implementation supports. This study illustrates the challenges of successfully implementing and sustaining substance use services in adolescent primary care.
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Affiliation(s)
| | | | | | | | | | - Colleen Hosler
- University of Maryland Baltimore County, Baltimore, Maryland
| | - Barry S. Brown
- University of North Carolina at Wilmington, Wilmington, North Carolina
| | | | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, Maryland
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Saunders EC, Satcher MF, Monico LB, McDonald RD, Springer SA, Farabee D, Gryczynski J, Nyaku A, Reeves D, Kunkel LE, Schultheis AM, Schwartz RP, Lee JD, Marsch LA, Waddell EN. The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study. Health Justice 2022; 10:35. [PMID: 36529829 PMCID: PMC9760540 DOI: 10.1186/s40352-022-00199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Milan F Satcher
- Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Ryan D McDonald
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - David Farabee
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Amesika Nyaku
- Division of Infectious Diseases, Rutgers New Jersey Medical School, New Brunswick, NJ, USA
| | - Donald Reeves
- Rutgers University Correctional Health Care, Rutgers-Robert Wood Johnson Medical School, Trenton, NJ, USA
| | - Lynn E Kunkel
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA
| | - Elizabeth Needham Waddell
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
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25
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Hochstatter KR, Terplan M, Mitchell SG, Schwartz RP, Dusek K, Wireman K, Gryczynski J. Characteristics and correlates of fentanyl preferences among people with opioid use disorder. Drug Alcohol Depend 2022; 240:109630. [PMID: 36152404 PMCID: PMC9616126 DOI: 10.1016/j.drugalcdep.2022.109630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Fentanyl has come to dominate the U.S. illicit opioid supply. We aimed to characterize and examine correlates of preferences for fentanyl vs. other opioids among individuals starting OUD treatment. METHODS We interviewed 250 adults initiating buprenorphine treatment with positive fentanyl toxicology at intake. We characterized opioid preferences and examined bivariate associations between opioid preference (preference for heroin, fentanyl, heroin-fentanyl mix, or other opioid) and sociodemographic characteristics, psychosocial factors, and substance use behaviors. We then used multinomial logistic regression to examine factors independently associated with fentanyl preferences. RESULTS Over half (52.0 %) of participants preferred fentanyl (21.2 % fentanyl alone, 30.8 % heroin-fentanyl mix). In bivariate comparisons, participants who preferred fentanyl were a higher acuity group with respect to risks and problems in general. In the multinomial logistic regression, people who preferred fentanyl, either alone or mixed with heroin, used non-prescribed buprenorphine less in the 30 days preceding treatment entry compared to people who preferred heroin or other opioids (RRRalone= 0.88 [0.78, 0.99]; P = 0.037 and RRRmixed= 0.91 [0.84, 0.99]; P = 0.046). People who preferred fentanyl alone were also younger (RRR= 0.93 [0.90, 0.97]; P < 0.001) and more likely to have severe mental illness (RRR= 2.5 [1.1, 5.6]; P = 0.027) than people who prefer heroin or other opioids. CONCLUSIONS Many people with OUD report preferring fentanyl. People who express preference for fentanyl differ substantively from those with other opioid preferences, and may be at elevated risk for poor health outcomes. Understanding preferences surrounding fentanyl could inform treatment and harm reduction interventions.
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Affiliation(s)
- Karli R Hochstatter
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | | | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Kristi Dusek
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Kim Wireman
- Powell Recovery Center, 14S. Broadway, Baltimore, MD 21231, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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Karnik NS, Marsden J, McCluskey C, Boley RA, Bradley KA, Campbell CI, Curtis ME, Fiellin D, Ghitza U, Hefner K, Hser Y, McHugh RK, McPherson SM, Mooney LJ, Moran LM, Murphy SM, Schwartz RP, Shmueli‐Blumberg D, Shulman M, Stephens KA, Watkins KE, Weiss RD, Wu L. The opioid use disorder core outcomes set (OUD-COS) for treatment research: findings from a Delphi consensus study. Addiction 2022; 117:2438-2447. [PMID: 35293064 PMCID: PMC9543602 DOI: 10.1111/add.15875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/23/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM There is no gold-standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD-COS). DESIGN Four-round, e-Delphi expert panel consensus study and plenary research group discussion and targeted consultation. SETTING United States. PARTICIPANTS A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the network's affiliated clinical and community sites and the NIDA Centre for the CTN. MEASUREMENTS From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on-line questionnaire to rank items with defined specification on a 9-point scale for importance, with a standard 70% consensus criterion. FINDINGS After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient-reported (global impression of improvement and incident non-fatal overdose); one clinician-reported (illicit/non-medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). CONCLUSIONS An e-Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research.
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Affiliation(s)
- Niranjan S. Karnik
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Connor McCluskey
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - Randy A. Boley
- Institute for Juvenile Research, Department of PsychiatryUniversity of Illinois ChicagoChicagoILUSA
| | - Katharine A. Bradley
- Division of ResearchKaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | | | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - David Fiellin
- Yale School of Medicine, Internal MedicineProgram in Addiction MedicineNew HavenCTUSA
| | - Udi Ghitza
- National Institute on Drug Abuse, National Institutes of HealthNational Institute on Drug Abuse Center for Clinical Trials NetworkBethesdaMDUSA
| | - Kathryn Hefner
- Yale School of Medicine, Internal MedicineProgram in Addiction MedicineNew HavenCTUSA
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Yih‐Ing Hser
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital and Department of PsychiatryHarvard Medical School, McLean HospitalBelmontMAUSA
| | - Sterling M. McPherson
- Department of Community and Behavioral HealthWashington State University Elson S. Floyd College of MedicineSpokaneWAUSA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - Landhing M. Moran
- National Institute on Drug Abuse, National Institutes of HealthNational Institute on Drug Abuse Center for Clinical Trials NetworkBethesdaMDUSA
| | - Sean M. Murphy
- Department of Population Health SciencesWeill Cornell Medical CollegeNew YorkNYUSA
| | | | - Dikla Shmueli‐Blumberg
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Matisyahu Shulman
- Department of Psychiatry, Columbia University Irving Medical Center and Department of PsychiatryNew York State Psychiatric InstituteNew YorkNYUSA
| | - Kari A. Stephens
- Departments of Family Medicine, Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWAUSA
| | | | - Roger D. Weiss
- Emmes Company, LLCNational Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating CenterRockvilleMDUSA
| | - Li‐Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNCUSA
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Orme S, Zarkin GA, Dunlap LJ, Nordeck CD, Schwartz RP, Mitchell SG, Welsh C, O’Grady KE, Gryczynski J. Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population. Med Care 2022; 60:631-635. [PMID: 35687900 PMCID: PMC9382857 DOI: 10.1097/mlr.0000000000001743] [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: 11/26/2022]
Abstract
BACKGROUND A randomized clinical trial found that patient navigation for hospital patients with comorbid substance use disorders (SUDs) reduced emergency department (ED) and inpatient hospital utilization compared with treatment-as-usual. OBJECTIVE To compare the cost and calculate any cost savings from the Navigation Services to Avoid Rehospitalization (NavSTAR) intervention over treatment-as-usual. RESEARCH DESIGN This study calculates activity-based costs from the health care providers and uses a net benefits approach to calculate the cost savings generated from NavSTAR. NavSTAR provided patient navigation focused on engagement in SUD treatment, starting before hospital discharge and continuing for up to 3 months postdischarge. SUBJECTS Adult hospitalized medical/surgical patients with comorbid SUD for opioids, cocaine, and/or alcohol. COST MEASURES Cost of the 3-month NavSTAR patient navigation intervention and the cost of all inpatient days and ED visits over a 12-month period. RESULTS OF BASE CASE ANALYSIS NavSTAR generated $17,780 per participant in cost savings. Ninety-seven percent of bootstrapped samples generated positive cost savings, and our sensitivity analyses did not change our results. LIMITATIONS Participants were recruited at one hospital in Baltimore, MD through the hospital's addiction consultation service. Findings may not generalize to the broader population. Outpatient health care cost data was not available through administrative records. CONCLUSION Our findings show that patient navigation interventions should be considered by payors and policy makers to reduce the high hospital costs associated with comorbid SUD patients.
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Affiliation(s)
- Stephen Orme
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | - Gary A. Zarkin
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | - Laura J. Dunlap
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709
| | | | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201
| | | | - Christopher Welsh
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201
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Ludwig A, Monico LB, Blue T, Gordon MS, Schwartz RP, Mitchell SG. Development and use of a checklist for the implementation of medication for opioid use disorder in jails. Implementation Research and Practice 2022; 3:26334895221101214. [PMID: 37091098 PMCID: PMC9924266 DOI: 10.1177/26334895221101214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In light of short lengths of stay and proximity to communities of release, jails are well-positioned to intervene in opioid use disorder (OUD). However, a number of barriers have resulted in a slow and limited implementation. Methods: This paper describes the development and testing of a Medication for Opioid Use Disorder (MOUD) Implementation Checklist developed as part of a Building Bridges project, a two-year planning grant which supported 16 US jail systems as they prepared to implement or expand MOUD services. Results: Although initially developed to track changes within sites participating in the initiative, participants noted its utility for identifying evidence-based benchmarks through which the successful implementation of MOUDs could be tracked by correctional administrators. Conclusions: The findings suggest that this checklist can both help guide and illustrate progress toward vital changes facilitated through established processes and supports. Plain Language Summary: People incarcerated in jails are more likely to have opioid use disorder than the general population. Despite this, jails in the United States (U.S.) often offer limited or no access to Medication for Opioid Use Disorder (MOUD). The Building Bridges project was designed to address this gap in 16 U.S. jail systems as they prepared to implement or expand MOUD services. This article addresses the use of a MOUD checklist that was initially designed to help the jails track changes toward evidence-based benchmarks. The findings suggest that this checklist can both help guide and illustrate progress toward vital changes facilitated through established processes and supports.
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Affiliation(s)
- Ariel Ludwig
- Honors College, University of Houston, Houston, TX, USA
- Shannon Gwin Mitchell, Friends Research
Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | | | - Thomas Blue
- Friends Research Institute, Inc., Baltimore, MD, USA
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29
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Sharma A, Mitchell SG, Nordeck CD, Schwartz RP, Dusek K, O'Grady KE, Gryczynski J. Sexually Transmitted Infection Testing After Brief Intervention for Risk Behaviors in School-Based Health Centers. J Adolesc Health 2022; 70:577-583. [PMID: 35078735 DOI: 10.1016/j.jadohealth.2021.11.013] [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: 02/14/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The initiation and escalation of substance use and sex behaviors is prevalent during adolescence. School-based health centers (SBHCs) are well-equipped to provide interventions for risky behaviors and offer sexually transmitted infection (STI) testing services. This study examined receipt of STI testing following brief intervention (BI) among sexually active adolescents. METHODS This is a secondary analysis of data from a randomized trial comparing computer versus nurse practitioner-delivered BI approaches among adolescents (ages 14-18) with risky alcohol and/or cannabis use at two SBHCs within two urban high schools. Associations were examined among receipt of STI testing and participant characteristics, BI format, site, and frequency of substance use/sexual behaviors. RESULTS Among sexually active participants (N = 254), 64.2% received STI testing at their SBHC within 6 months of receiving a BI. Participants receiving nurse practitioner-delivered BI had higher odds of getting STI testing than participants receiving computer-delivered BI (adjusted odds ratio 2.51, 95% confidence interval 1.41-4.47, p = .002). Other variables associated with STI testing in multivariable logistic regression included female sex (p = .001), being in a serious relationship (p = .018), and SBHC site (p < .001). Frequency of substance use and sexual risk behaviors were not independently associated with receipt of STI testing services. CONCLUSION Sexually active adolescents who received in-person BI from a nurse practitioner were more likely to get STI testing than adolescents who received BI via computer. Nurse practitioners working in SBHCs can successfully engage adolescents in additional sexual health services subsequent to BI for risky behaviors.
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Affiliation(s)
| | | | - Courtney D Nordeck
- Friends Research Institute, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland
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Barbosa C, Cowell A, Dunlap L, Wedehase B, Dušek K, Schwartz RP, Gryczynski J, Barnosky A, Kirk AS, Oros M, Hosler-Moore C, O'Grady KE, Brown BS, Mitchell SG. Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care. J Stud Alcohol Drugs 2022; 83:231-238. [PMID: 35254246 PMCID: PMC8909920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE This study analyzed the marginal service and program costs, and conducted a cost-effectiveness analysis (CEA) of two models of implementation of adolescent substance screening, brief intervention, and referral to treatment (SBIRT). METHOD SBIRT was implemented at seven clinics in a multisite, cluster-randomized trial, through a Specialist model (behavioral health counselor-delivered brief intervention), and a Generalist model (primary care provider-delivered brief intervention). The CEA calculated marginal costs using an activity-based costing methodology for direct SBIRT services, and effectiveness was measured by the proportion of brief interventions delivered among patients who screened positive for alcohol, tobacco, or other drugs. Site-level program costs comprised start-up and maintenance (training and technical assistance). Costs were estimated in 2017 U.S. dollars. RESULTS The marginal cost of SBIRT per patient with a positive screen for brief intervention was $6.72 in the Specialist model and $6.05 in the Generalist model. Implementation effectiveness was 7.2% (SE = 2.9%) in the Specialist model and 37.7% (SE = 5.6%) in the Generalist model. The program costs to provide SBIRT for 1 year per site were $13,548 for the Specialist site and $12,081 for the Generalist. CONCLUSIONS The Generalist model was more effective in implementing brief intervention and less expensive than the Specialist model. Results were robust to sensitivity analysis. Brief intervention delivered by primary care providers rather than by handoff to a behavioral health counselor may ensure greater penetration and a lower cost of these services in primary care settings.
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Affiliation(s)
- Carolina Barbosa
- RTI International, Chicago, Illinois,Correspondence may be sent to Carolina Barbosa at RTI International, 230 West Monroe Street, Suite 2100, Chicago, IL 60606, or via email at:
| | | | - Laura Dunlap
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | | | - Alan Barnosky
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | - Kevin E. O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, Maryland
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31
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Barbosa C, Cowell A, Dunlap L, Wedehase B, Dušek K, Schwartz RP, Gryczynski J, Barnosky A, Kirk AS, Oros M, Hosler-Moore C, O'Grady KE, Brown BS, Mitchell SG. Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Laura Dunlap
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | | | - Alan Barnosky
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | - Kevin E. O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, Maryland
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Wu LT, John WS, Morse ED, Adkins S, Pippin J, Brooner RK, Schwartz RP. Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial. Addiction 2022; 117:444-456. [PMID: 34286886 PMCID: PMC8748270 DOI: 10.1111/add.15641] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 02/15/2021] [Revised: 05/18/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Pharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy. DESIGN Non-randomized, single-arm, open-label feasibility trial. SETTING One OTP and one community pharmacy in the United States. PARTICIPANTS One OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take-home methadone doses at 5-160 mg/day. INTERVENTION Patients' methadone administration and dispensing of take-home doses was transferred from the OTP to the pharmacy for 3 months. MEASUREMENTS Primary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction. FINDINGS Of 29 patients eligible at pre-screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non-study-related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call-back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study-related adverse events. All participants endorsed 'pharmacy is the right location for receiving methadone for MMT', 88% endorsed 'convenient or very convenient to receive methadone at the pharmacy' and 88% were satisfied or very satisfied with the quality of treatment offered. CONCLUSIONS This feasibility trial has found pharmacy administration and dispensing of physician-prescribed methadone for methadone maintenance treatment to be feasible and acceptable.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA,Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA,Duke Institute For Brain Sciences, Duke University, Durham, NC, USA,Corresponding author:
| | - William S. John
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Mitchell SG, Nordeck CD, Lertch E, Ross TE, Welsh C, Schwartz RP, Gryczynski J. Patients with substance use disorders receiving continued care in skilled nursing facilities following hospitalization. Subst Abus 2022; 43:848-854. [PMID: 35179452 PMCID: PMC9793431 DOI: 10.1080/08897077.2021.2007512] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: As hospitals in the US face pressures to reduce lengths of stay, healthcare systems are increasingly utilizing skilled nursing facilities (SNFs) to continue treating patients stable enough to leave the hospital, but not to return home. Substance use disorder (SUD) can complicate care of patients transferred to SNFs. The objective of this paper is to understand SNF experiences for this population of patients with comorbid SUD transferred to SNFs and examine care experiences in these facilities. Methods: This secondary mixed-methods analysis focuses on SNF experiences from a clinical trial of patient navigation services for medically-hospitalized adults with comorbid opioid, cocaine, and/or alcohol use disorder. This study compared baseline assessments and medical record review for participants (N = 400) with vs. without SNF transfer, and analyzed semi-structured qualitative interviews with a subsample of 15 participants purposively selected based on their transfer to a SNF. Results: Over 1 in 4 participants had a planned discharged to a SNF (26.8% sub-acute, 3.3% acute). Compared to participants with other types of discharge, participants discharged to a SNF had longer initial hospitalizations (4.9 vs. 11.8 days, p < 0.001), and were more likely to be White (38.6 vs. 50.8%; p = 0.02), female (38.9 vs. 52.5%; p = 0.01), have opioid use disorder (75.7 vs. 85.0%, p = 0.03), and be hospitalized for infection (43.6 vs. 58.3%; p = 0.007), and less likely to have worked prior to hospitalization (24.3 vs. 12.5%; p = 0.006). Qualitative narratives identified several themes from the SNF experience, including opioid analgesic dosing issues, challenges to the use of opioid agonist treatment of OUD, illicit opioid dealing/use, and limited access to addiction recovery support services during and following the SNF stay. Conclusions: SNFs are a common disposition for patients in need of subacute services following hospitalization but may be ill-equipped to properly manage patients in need of new or continuing SUD treatment.
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Affiliation(s)
| | - Courtney D. Nordeck
- Friends Research Institute, Inc., Baltimore, MD,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Christopher Welsh
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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35
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Waddell EN, Springer SA, Marsch LA, Farabee D, Schwartz RP, Nyaku A, Reeves R, Goldfeld K, McDonald RD, Malone M, Cheng A, Saunders EC, Monico L, Gryczynski J, Bell K, Harding K, Violette S, Groblewski T, Martin W, Talon K, Beckwith N, Suchocki A, Torralva R, Wisdom JP, Lee JD. Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS). J Subst Abuse Treat 2021; 128:108389. [PMID: 33865691 PMCID: PMC8384640 DOI: 10.1016/j.jsat.2021.108389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
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Affiliation(s)
- Elizabeth Needham Waddell
- School of Public Health and OHSU School of Medicine, Oregon Health & Science University, United States of America
| | | | | | | | | | - Amesika Nyaku
- The State University of New Jersey, New Jersey Medical School, United States of America
| | - Rusty Reeves
- Rutgers, University Correctional Health Care, Rutgers - Robert Wood Johnson Medical School, United States of America
| | | | | | - Mia Malone
- Friends Research Institute, United States of America
| | - Anna Cheng
- Friends Research Institute, United States of America
| | | | - Laura Monico
- Friends Research Institute, United States of America
| | | | | | - Kasey Harding
- Community Health Center, Inc, United States of America
| | | | | | | | - Kasey Talon
- ROAD to a Better Life, United States of America
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Mitchell SG, Harmon-Darrow C, Lertch E, Monico LB, Kelly SM, Sorensen JL, Schwartz RP. Views of barriers and facilitators to continuing methadone treatment upon release from jail among people receiving patient navigation services. J Subst Abuse Treat 2021; 127:108351. [PMID: 34134868 PMCID: PMC8217714 DOI: 10.1016/j.jsat.2021.108351] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/20/2020] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient navigation has potential for assisting patients who initiate methadone during pretrial detention to enter and remain in treatment following release, but we know little about participants' experiences with this service. METHODS This study drew a purposive sample of male and female participants (N = 17) from participants enrolled in a randomized trial of initiating methadone with vs. without patient navigation while in the Baltimore City Detention Center. The study interviewed participants in the community at 1 and 3 months following release and asked them about their experiences of reentry, methadone treatment continuation, drug use, and interactions with the patient navigator. The study recorded, transcribed, coded using Atlas.ti, and analyzed thematically the interviews. RESULTS Participants reported encountering four key challenges in the community: getting to treatment following release, assembling basic supports, managing criminal justice system demands, and staying in treatment. Participants' experiences of the patient navigator's support to address these challenges fell into six thematic groups: showing nonjudgmental caring and persistence, advocating within programs, brokering resources, managing interactions with the criminal justice system, balancing encouragement and self-determination, and offering genuine and familial-type support. CONCLUSION Nearly all participants appreciated the navigator's support and deemed it helpful. The previously reported randomized trial found that participants assigned to initiate methadone treatment with navigation had higher rates of receiving their first "guest" methadone dose in the community but did not have significantly different rates of treatment enrollment or of illicit opioid use compared to those assigned to begin methadone treatment without navigation. Treatment programs should work to improve retention and postrelease outcomes among this population.
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Affiliation(s)
| | - Caroline Harmon-Darrow
- University of Maryland Baltimore School of Social Work, 525 W Redwood St, Baltimore, MD, USA.
| | - Elizabeth Lertch
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
| | - James L Sorensen
- UCSF Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, SFGH Building 20, Rm. 2117, San Francisco, CA, USA.
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA.
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Boudreau DM, Lapham G, Johnson EA, Bobb JF, Matthews AG, McCormack J, Liu D, Campbell CI, Rossom RC, Binswanger IA, Yarborough BJ, Arnsten JH, Cunningham CO, Glass JE, Murphy MT, Zare M, Hechter RC, Ahmedani B, Braciszewski JM, Horigian VE, Szapocznik J, Samet JH, Saxon AJ, Schwartz RP, Bradley KA. Documented opioid use disorder and its treatment in primary care patients across six U.S. health systems. J Subst Abuse Treat 2021; 112S:41-48. [PMID: 32220410 DOI: 10.1016/j.jsat.2020.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/31/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The United States is in the middle of an opioid overdose epidemic, and experts are calling for improved detection of opioid use disorders (OUDs) and treatment with buprenorphine or extended release (XR) injectable naltrexone, which can be prescribed in general medical settings. To better understand the magnitude of opportunities for treatment among primary care (PC) patients, we estimated the prevalence of documented OUD and medication treatment of OUD among PC patients. METHODS This cross-sectional study included patients with ≥2 visits to PC clinics across 6 healthcare delivery systems who were ≥16 years of age during the study period (fiscal years 2014-2016). Diagnoses, prescriptions, and healthcare utilization were ascertained from electronic health records and insurance claims (5 systems that also offer health insurance). Documented OUDs were defined as ≥1 International Classification of Diseases code for OUDs (active or remission), and OUD treatment was defined as ≥1 prescription(s) for buprenorphine formulations indicated for OUD or naltrexone XR, during the 3-year study period. The prevalence of documented OUD and treatment (95% confidence intervals) across health systems were estimated, and characteristics of patients by treatment status were compared. Prevalence of OUD and OUD treatment were adjusted for age, gender, and race/ethnicity. Combined results were also adjusted for site. RESULT Among 1,403,327 eligible PC patients, 54-62% were female and mean age ranged from 46 to 51 years across health systems. The 3-year prevalence of documented OUD ranged from 0.7-1.4% across the health systems. Among patients with documented OUD, the prevalence of medication treatment (primarily buprenorphine) varied across health systems: 3%, 12%, 16%, 20%, 22%, and 36%. CONCLUSION The prevalence of documented OUD and OUD treatment among PC patients varied widely across health systems. The majority of PC patients with OUD did not have evidence of treatment with buprenorphine or naltrexone XR, highlighting opportunities for improved identification and treatment in medical settings. These results can inform initiatives aimed at improving treatment of OUD in PC. Future research should focus on why there is such variation and how much of the variation can be addressed by improving access to medication treatment.
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Affiliation(s)
- Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, United States of America.
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Eric A Johnson
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, United States of America
| | | | | | - David Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, United States of America
| | - Cynthia I Campbell
- Kaiser Permanente Northern California Division of Research, United States of America
| | | | - Ingrid A Binswanger
- Kaiser Permanente Colorado Institute for Health Research and Colorado Permanente Medical Group, United States of America
| | - Bobbi Jo Yarborough
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | | | | | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, United States of America
| | | | - Mohammad Zare
- University of Texas at Houston, United States of America
| | - Rulin C Hechter
- Kaiser Permanente Southern California Department of Research and Evaluation, United States of America
| | | | | | | | | | - Jeffrey H Samet
- Boston Medical Center, Boston University School of Medicine, United States of America
| | - Andrew J Saxon
- Veteran Affairs Puget Sound Health Care System, United States of America
| | | | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, United States of America
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Schwartz RP, Gibson D, Pagano A, Goldstein A, Ibrahim A, Doty B, Patel S, Vocci FJ, Clarke DE. Addiction Medicine Practice-Based Research Network (AMNet): Building Partnerships. Psychiatr Serv 2021; 72:845-847. [PMID: 33853378 PMCID: PMC8249311 DOI: 10.1176/appi.ps.202000390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the collaboration among the American Psychiatric Association (APA), American Society of Addiction Medicine, Friends Research Institute, and the National Institute on Drug Abuse to create the Addiction Medicine Practice-Based Research Network (AMNet). The collaboration, which aims to address the opioid overdose epidemic in the United States, leverages the APA's clinical data registry (PsychPRO) and is recruiting office-based addiction medicine and addiction psychiatry practices for AMNet. AMNet aims to address knowledge gaps regarding patient care in such practices, facilitate performance improvement efforts, and serve as a research platform.
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Affiliation(s)
- Robert P Schwartz
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Debbie Gibson
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Anna Pagano
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Amy Goldstein
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Adila Ibrahim
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Benjamin Doty
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Sejal Patel
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Frank J Vocci
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Diana E Clarke
- Friends Research Institute, Baltimore (Schwartz, Ibrahim, Vocci); American Psychiatric Association, Washington, D.C. (Gibson, Doty, Patel, Clarke); American Society of Addiction Medicine, Rockville, MD (Pagano); National Institute on Drug Abuse (NIDA), Rockville, MD (Goldstein). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
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Gryczynski J, Nordeck CD, Welsh C, Mitchell SG, O'Grady KE, Schwartz RP. Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. Ann Intern Med 2021; 174:899-909. [PMID: 33819055 DOI: 10.7326/m20-5475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE To determine whether patient navigation services reduce hospital readmissions. DESIGN Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION Single-site trial, which limits generalizability. CONCLUSION Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Courtney D Nordeck
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Christopher Welsh
- University of Maryland School of Medicine, Baltimore, Maryland (C.W.)
| | - Shannon G Mitchell
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | | | - Robert P Schwartz
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
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Clarke DE, Ibrahim A, Doty B, Patel S, Gibson D, Pagano A, Thompson L, Goldstein AB, Vocci F, Schwartz RP. Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures. Subst Abuse Rehabil 2021; 12:27-39. [PMID: 34211312 PMCID: PMC8240849 DOI: 10.2147/sar.s305972] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The need for innovative approaches to address the opioid epidemic in the United States is widely recognized. Many challenges exist to addressing this epidemic, including the obstacles outpatient substance use treatment practices face in implementing measurement-based care (MBC), quality measurement systems, and evidence-based treatments. Also, there are insufficient opportunities for clinicians in these settings to participate in research, resulting in diminished translation of research findings into community-based practice. To address these challenges, the Addiction Medicine Practice-Based Research Network (AMNet) was developed to facilitate the uptake of MBC in outpatient practices via implementation of patient-reported assessments and quality of care performance measures to improve patient outcomes. This network will offer clinicians in outpatient settings (not incuding opioid treatment programs [OTPs]) the opportunity to participate in future substance use disorder treatment research studies. METHODS A key step in the development of AMNet was the selection of substance use-specific assessment tools and quality of care performance measures for incorporation into the American Psychiatric Association's mental health patient registry, PsychPRO. A scoping review and multi-step consensus-based process were used to identify, review and select candidate assessment tools and quality of care performance measures for opioid use disorders (OUD) and substance use disorders (SUD). RESULTS Following a consensus-based methodology, 12 standardized assessment tools and 3 quality of care performance measures for OUD and SUD were selected to help facilitate the implementation of MBC and quality improvement for AMNet participants. These tools were further categorized as core and optional. CONCLUSION By offering a collection of carefully vetted assessment tools and quality measures through PsychPRO, AMNet will help participating clinicians with the systematic uptake of MBC and delivery of evidence-based treatment for patients with SUD. Also, AMNet will act as a centralized repository of data collected from patients and clinicians in non-OTP outpatient addiction medicine practices and serve as a platform for opioid treatment research.
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Affiliation(s)
- Diana E Clarke
- Division of Research, American Psychiatric Association, Washington, DC, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adila Ibrahim
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
| | - Benjamin Doty
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Sejal Patel
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Debbie Gibson
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Anna Pagano
- Quality and Science Department,American Society of Addiction Medicine, Rockville, MD, USA
| | - Laura Thompson
- Division of Research, American Psychiatric Association, Washington, DC, USA
| | - Amy B Goldstein
- Prevention Research Branch,National Institute on Drug Abuse, Bethesda, MD, USA
| | - Frank Vocci
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
| | - Robert P Schwartz
- Social Research Center, Friends Research Institute, Baltimore, MD, USA
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Ludwig A, Monico LB, Gryczynski J, Lertch E, Schwartz RP, Fishman M, Dionne R, Mitchell SG. Drug and sexual HIV-risk behaviors among adolescents and young adults with opioid use disorder. J Subst Abuse Treat 2021; 130:108477. [PMID: 34118711 DOI: 10.1016/j.jsat.2021.108477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Opioid use disorder (OUD) among adolescents and young adults (youth) is associated with drug use and sexual HIV-related risk behaviors and opioid overdose. This mixed methods analysis assesses risk behaviors among a sample of 15-21-year-olds (N = 288) who were being treated for OUD in a residential drug treatment program in Baltimore, Maryland. Participants were enrolled in a parent study in which they received either extended-release naltrexone (XR-NTX) or Treatment as Usual (TAU), consisting of outpatient counseling with or without buprenorphine, prior to discharge. At baseline, participants were administered the HIV-Risk Assessment Battery (RAB), and clinical intake records were reviewed to determine participants' history of sexual, physical, or other abuse, as well as parental and partner substance use. A sub-sample of study participants completed semi-structured qualitative interviews (N = 35) at baseline, three-, and six-month follow-up periods. This analysis identified gender (e.g., female IRR = 1.63, CI 1.10-2.42, p = .014), the experience of dependence (e.g., previous detoxification IRR = 1.08, CI 1.01-1.15, p = .033) and withdrawal (e.g., severe withdrawal symptoms IRR = 1.41, CI 1.08-1.84, p = .012), and the role of relationships (e.g., using with partner IRR = 2.45, CI 1.15-5.22, p = .021) as influencing high-risk substance use behaviors. Similarly, high-risk sex was influenced by gender (e.g., female IRR = 1.43, CI 1.28-1.59, p < .001), and the role of relationships (e.g., using with partner IRR = 0.78, CI 0.62-0.98, p = .036). These are key targets for future prevention, treatment, and intervention.
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Affiliation(s)
- Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Ross Dionne
- Pacifica Graduate Institute, 249 Lambert Rd., Carpinteria, CA 93013, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Mitchell SG, Monico LB, Gryczynski J, Fishman MJ, O'Grady KE, Schwartz RP. Extended-release naltrexone for youth with opioid use disorder. J Subst Abuse Treat 2021; 130:108407. [PMID: 34118699 DOI: 10.1016/j.jsat.2021.108407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/27/2020] [Revised: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few published research studies have examined the effectiveness of extended-release naltrexone (XR-NTX) for the treatment of opioid use disorder (OUD) among adolescents and young adults. METHODS This two-group randomized controlled trial recruited 288 youth, ages 15-21, with moderate/severe OUD from a residential addiction treatment program in Baltimore, Maryland. The study randomized the youth within the first week of treatment entry to receive either XR-NTX or treatment-as-usual (TAU; either buprenorphine maintenance treatment or treatment without OUD medication following medically managed withdrawal) prior to discharge, with continued treatment in the community for 6 months. However, due to various reasons spanning patients' and caregivers' preferences and constraints, considerable participant nonadherence to randomized condition occurred (i.e., only 30% of the participants randomized to XR-NTX received an initial injection, while 27% of participants randomized to TAU received an XR-NTX injection at treatment discharge, instead of their assigned treatment). The study used generalized linear mixed modeling (GLiMM) to examine self-reported 90-day opioid, cocaine, marijuana, and alcohol use as well as DSM-5 OUD criteria on "intention-to-treat" (as randomized), "as-received" (XR-NTX vs. not XR-NTX), and "as-medicated" (XR-NTX vs. buprenorphine vs. no medication) bases. RESULTS The condition x time interactions in the intention-to-treat analyses failed to reach significance for past-90-day self-reported use of illicit opioids, cocaine, marijuana, or alcohol, or in meeting DSM-5 OUD criteria at 3 or 6 months [all ps > 0.05]. However, these findings are of limited interpretive value due to participant nonadherence to their randomized condition. When the study analyzed results by the treatment received at discharge, the "as-received" group x time interaction for illicit opioid use was significant [p = .003], with the XR-NTX group reporting less opioid use in the past 90 days at 3 and 6 months. Participants who received their first XR-NTX dose at inpatient discharge (n = 82) received, on average, 1.3 subsequent injections in the community over the 6-month study follow-up period. Only 2 of the 82 study participants received XR-NTX continuously through the 6-month postdischarge follow-up period. Twelve serious adverse events (SAEs) occurred during the study, but the study determined that only 1 was possibly study related (hepatitis C/elevated liver function test results). CONCLUSION None of the condition x time interactions in the intention-to-treat analyses reached significance. Participants' nonadherence may have contributed to the failure to reject the null hypothesis. Irrespective of randomized condition, participants who received XR-NTX for OUD demonstrated low retention in treatment, receiving an average of only 1.3 subsequent injections, yet reported less opioid use at follow-up than participants who did not received XR-NTX. Treatment programs should consider XR-NTX as a treatment option for youth motivated to receive it. Future research should focus on building developmentally informed strategies to improve uptake of and adherence to relapse prevention medication in this population.
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Affiliation(s)
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
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Rindal DB, Asche SE, Gryczynski J, Kane SM, Truitt AR, Shea TL, Ziegenfuss JY, Schwartz RP, Worley DC, Mitchell SG. De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Protocol for a Cluster Randomized Trial. JMIR Res Protoc 2021; 10:e24342. [PMID: 33843594 PMCID: PMC8076983 DOI: 10.2196/24342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/16/2020] [Revised: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
Background Overdose deaths from prescription opioid analgesics are a continuing crisis in the United States. Opioid analgesics are among the most frequently prescribed drugs by dentists. An estimated 5 million people undergo third-molar extractions in the United States each year, resulting in postoperative pain. Studies show that, in most cases, the combination of ibuprofen and acetaminophen is an effective alternative to commonly prescribed opioid analgesics for the management of postextraction pain. Nevertheless, many dentists routinely prescribe opioids after dental extractions. Objective We describe the rationale, design, and methods for a randomized trial of interventions designed to de-implement opioid prescribing by dentists while implementing effective nonopioid analgesics following dental extractions. Methods Using a prospective, 3-arm, cluster randomized trial design with dentists as the unit randomized and patient-level prescribing data as the primary outcome, we will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients. The study will test the efficacy of 2 interventions to decrease opioid prescribing following dental extractions: clinical decision support with (CDS-E) and without patient education (CDS). Providers will be randomized to CDS, CDS-E, or standard practice. Patient-level outcomes will be determined via review of comprehensive electronic health records. We will compare study arms on differential change in prescribing patterns from pre- to postimplementation of the intervention. The primary outcome of interest is a binary indicator of whether or not the patient received an opioid prescription on the day of the extraction encounter. We will also examine recommendations or prescriptions for nonopioid analgesics, patients’ perceptions of shared decision making, and patients’ pain experiences following the extraction. Results The HealthPartners Institutional Review Board approved the study. All study materials including the CDS and patient education materials have been developed and pilot tested, and the protocol has been approved by the National Institute of Dental and Craniofacial Research. The intervention was implemented in February 2020, with 51 dentists who were randomized to 1 of the 3 arms. Conclusions If the intervention strategies are shown to be effective, they could be implemented more broadly in dental settings with high levels of opioid prescribing. Trial Registration ClinicalTrials.gov NCT03584789, https://clinicaltrials.gov/ct2/show/NCT03584789 International Registered Report Identifier (IRRID) DERR1-10.2196/24342
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Affiliation(s)
- D Brad Rindal
- HealthPartners Institute, Bloomington, MN, United States
| | | | - Jan Gryczynski
- Friends Research Institute Inc, Baltimore, MD, United States
| | - Sheryl M Kane
- HealthPartners Institute, Bloomington, MN, United States
| | | | - Tracy L Shea
- HealthPartners Institute, Bloomington, MN, United States
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Monico LB, Ludwig A, Lertch E, Dionne R, Fishman M, Schwartz RP, Mitchell SG. Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis. Addiction 2021; 116:865-873. [PMID: 32770757 DOI: 10.1111/add.15216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/23/2020] [Revised: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. DESIGN This study involved thematic analysis of interviews undertaken as part of a mixed-methods, randomized trial of extended release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for adolescents and young adults (aged 15-21 years) with opioid use disorder (OUD). SETTING Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. PARTICIPANTS/CASES As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. MEASUREMENTS Semi-structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. FINDINGS Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. CONCLUSIONS The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.
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Affiliation(s)
| | | | | | - Ross Dionne
- Pacifica Graduate Institute, Carpinteria, CA, USA
| | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, USA
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Mitchell MM, Kelly SM, O'Grady KE, Jaffe JH, Mitchell SG, Schwartz RP. HIV-Risk Behavior Among Adults with Opioid Use Disorder During 12 Months Following Pre-trial Detention: Results from a Randomized Trial of Methadone Treatment. AIDS Behav 2021; 25:1247-1256. [PMID: 33196937 PMCID: PMC7979478 DOI: 10.1007/s10461-020-03090-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/26/2022]
Abstract
This was a three group randomized clinical trial of interim methadone and patient navigation involving 225 pre-trial detainees with opioid use disorder in Baltimore. The HIV Risk Assessment Battery (RAB) was administered at baseline (in jail), and at 6 and 12 months post-release. Generalized linear mixed model analyses indicated the condition × time interaction effect failed to reach significance (ps > .05) for both the drug risk and sex risk subscale scores. Therefore, findings suggest that there were no intervention effects on drug or sex risk behaviors. However, increased use of cocaine at baseline was associated with increases in drug- (b = .04, SE = .02) and sex-risk (b = .01, SE = .003) behaviors. These results suggest that interventions targeting cocaine use among pre-trial detainees may serve as a means of reducing HIV risk associated with drug- and sex-risk behaviors.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.
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Affiliation(s)
- M M Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.
| | - S M Kelly
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - K E O'Grady
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - J H Jaffe
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - S G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - R P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
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You DS, Mardian AS, Darnall BD, Chen CYA, De Bruyne K, Flood PD, Kao MC, Karnik AD, McNeely J, Porter JG, Schwartz RP, Stieg RL, Mackey SC. A Brief Screening Tool for Opioid Use Disorder: EMPOWER Study Expert Consensus Protocol. Front Med (Lausanne) 2021; 8:591201. [PMID: 33869240 PMCID: PMC8044786 DOI: 10.3389/fmed.2021.591201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Growing concerns about the safety of long-term opioid therapy and its uncertain efficacy for non-cancer pain have led to relatively rapid opioid deprescribing in chronic pain patients who have been taking opioid for years. To date, empirically supported processes for safe and effective opioid tapering are lacking. Opioid tapering programs have shown high rates of dropouts and increases in patient distress and suicidal ideation. Therefore, safe strategies for opioid deprescribing that are more likely to succeed are urgently needed. In response to this demand, the EMPOWER study has been launched to examine the effectiveness of behavioral medicine strategies within the context of patient-centered opioid tapering in outpatient settings (https://empower.stanford.edu/). The EMPOWER protocol requires an efficient process for ensuring that collaborative opioid tapering would be offered to the most appropriate patients while identifying patients who should be offered alternate treatment pathways. As a first step, clinicians need a screening tool to identify patients with Opioid Use Disorder (OUD) and to assess for OUD severity. Because such a tool is not available, the study team composed of eight chronic pain and/or addiction experts has extended a validated screening instrument to develop a brief and novel consensus screening tool to identify OUD and assess for OUD severity for treatment stratification. Our screening tool has the potential to assist busy outpatient clinicians to assess OUD among patients receiving long-term opioid therapy for chronic pain.
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Affiliation(s)
- Dokyoung S You
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Aram S Mardian
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Beth D Darnall
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Chwen-Yuen A Chen
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Korina De Bruyne
- Division of Primary, Preventive, and Community Care, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Pamela D Flood
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Ming-Chih Kao
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anita D Karnik
- Phoenix VA Health Care System, Department of Psychiatry, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Jennifer McNeely
- Department of Population Health, Section on Tobacco, Alcohol, and Drug Use, New York University School of Medicine, New York, NY, United States
| | - Joel G Porter
- Intermountain Healthcare, Family Medicine, Layton, UT, United States
| | | | | | - Sean C Mackey
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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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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Campbell CI, Saxon AJ, Boudreau DM, Wartko PD, Bobb JF, Lee AK, Matthews AG, McCormack J, Liu DS, Addis M, Altschuler A, Samet JH, LaBelle CT, Arnsten J, Caldeiro RM, Borst DT, Stotts AL, Braciszewski JM, Szapocznik J, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Glass JE, Lapham GT, Murphy SM, Weinstein ZM, Yarborough BJH, Bradley KA. PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment. Addict Sci Clin Pract 2021; 16:9. [PMID: 33517894 PMCID: PMC7849121 DOI: 10.1186/s13722-021-00218-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 09/10/2020] [Accepted: 01/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use Disorders treatment (PROUD) trial tests whether implementation of a collaborative care model (Massachusetts Model) using a nurse care manager (NCM) to support medication treatment of OUD in primary care increases OUD treatment and improves outcomes. Specifically, it tests whether implementation of collaborative care, compared to usual primary care, increases the number of days of medication for OUD (implementation objective) and reduces acute health care utilization (effectiveness objective). The protocol for the PROUD trial is presented here. Methods PROUD is a hybrid type III cluster-randomized implementation trial in six health care systems. The intervention consists of three implementation strategies: salary for a full-time NCM, training and technical assistance for the NCM, and requiring that three primary care providers have DEA waivers to prescribe buprenorphine. Within each health system, two primary care clinics are randomized: one to the intervention and one to Usual Primary Care. The sample includes all patients age 16–90 who visited the randomized primary care clinics from 3 years before to 2 years after randomization (anticipated to be > 170,000). Quantitative data are derived from existing health system administrative data, electronic medical records, and/or health insurance claims (“electronic health records,” [EHRs]). Anonymous staff surveys, stakeholder debriefs, and observations from site visits, trainings and technical assistance provide qualitative data to assess barriers and facilitators to implementation. The outcome for the implementation objective (primary outcome) is a clinic-level measure of the number of patient days of medication treatment of OUD over the 2 years post-randomization. The patient-level outcome for the effectiveness objective (secondary outcome) is days of acute care utilization [e.g. urgent care, emergency department (ED) and/or hospitalizations] over 2 years post-randomization among patients with documented OUD prior to randomization. Discussion The PROUD trial provides information for clinical leaders and policy makers regarding potential benefits for patients and health systems of a collaborative care model for management of OUD in primary care, tested in real-world diverse primary care settings. Trial registration # NCT03407638 (February 28, 2018); CTN-0074 https://clinicaltrials.gov/ct2/show/NCT03407638?term=CTN-0074&draw=2&rank=1
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Affiliation(s)
- Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA.
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | | | | | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, Three White Flint North, 11601 Landsdown Street, North Bethesda, MD, 20852, USA
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Jeffrey H Samet
- Boston Medical Center/Boston University School of Medicine: Clinical Addiction Research & Education (CARE) Unit Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Colleen T LaBelle
- Boston Medical Center/Boston University School of Medicine: Clinical Addiction Research & Education (CARE) Unit Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington, 9800 4th Ave. N.E., Seattle, WA, 98115, USA
| | - Douglas T Borst
- Kootenai Clinic Family Medicine, 1919 Lincoln Way, Suite 315, Coeur d Alene, ID, 83814, USA
| | - Angela L Stotts
- Department of Family & Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston School, 7000 Fannin Street, Houston, TX, 77030, USA
| | - Jordan M Braciszewski
- Department of Psychiatry, Center for Health Policy and Health Services Research, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor, Miami, FL, 33136, USA
| | - Gavin Bart
- University of Minnesota/Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Jennifer McNeely
- NYU Grossman School of Medicine, 180 Madison Ave., New York, NY, 10016, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, 933West, Pittsburgh, PA, 15213, USA
| | - Judith I Tsui
- University of Washington/Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Joseph O Merrill
- University of Washington/Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Sean M Murphy
- Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | - Zoe M Weinstein
- Clinical Addiction Research & Education (CARE) Unit, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
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Karnik NS, Campbell CI, Curtis ME, Fiellin DA, Ghitza U, Hefner K, Hser YI, McHugh RK, Murphy SM, McPherson SM, Moran L, Mooney LJ, Wu LT, Shmueli-Blumberg D, Shulman M, Schwartz RP, Stephens KA, Watkins KE, Marsden J. Core outcomes set for research on the treatment of opioid use disorder (COS-OUD): the National Institute on Drug Abuse Clinical Trials Network protocol for an e-Delphi consensus study. Trials 2021; 22:102. [PMID: 33509278 PMCID: PMC7841754 DOI: 10.1186/s13063-021-05051-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core outcome set (COS) is a minimum set of outcome measures that are recommended for all studies of a particular condition. The National Drug Abuse Treatment Clinical Trials Network (CTN) Core Outcome Set for OUD (COS-OUD) is a development study to identify core constructs, meaningful outcomes, and their optimal measurement for all efficacy and effectiveness studies of OUD treatment and service delivery. METHODS/DESIGN Overseen by an expert workgroup, a modified, stepwise, e-Delphi methodology will be used to gain consensus among a panel of clinical practitioners and researchers involved in the treatment of OUD, who are members of the CTN. Sequential rounds of anonymous, online questionnaires will be used to identify, rate the importance of, and refine a core outcome set. A consensus threshold will be achieved if at least 70% of the panel rate the measure as critical for inclusion in the COS-OUD. Where consensus is not reached or there are suggestions for new measures, these will be brought forward to a further round of review prior to a consensus meeting. Products from this study will be communicated via peer-reviewed scientific journals and conferences. DISCUSSION This initiative will develop a COS for OUD intervention trials, treatment studies, and service delivery and will support the pooling of research and clinical practice data and efforts to develop measurement-based care within the OUD treatment cascade. TRIAL REGISTRATION http://www.comet-initiative.org/Studies/Details/1579.
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Affiliation(s)
- Niranjan S. Karnik
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60612 USA
| | - Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Megan E. Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - David A. Fiellin
- Yale School of Medicine, Internal Medicine, Program in Addiction Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520-8056 USA
| | - Udi Ghitza
- National Institute on Drug Abuse, National Institutes of Health, National Institute on Drug Abuse Center for Clinical Trials Network, 6001 Executive Blvd, Bethesda, MD 20892 USA
| | - Kathryn Hefner
- Yale School of Medicine, Internal Medicine, Program in Addiction Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520-8056 USA
- The Emmes Company, LLC, National Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating Center, 401 N Washington St, Rockville, MD 20850 USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, & Department of Psychiatry, Harvard Medical School, McLean Hospital, Proctor House 3, 115 Mill St, Belmont, MA 02478 USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA
| | - Sterling M. McPherson
- Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131 USA
| | - Landhing Moran
- National Institute on Drug Abuse, National Institutes of Health, National Institute on Drug Abuse Center for Clinical Trials Network, 6001 Executive Blvd, Bethesda, MD 20892 USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025 USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3903, Durham, NC 27710 USA
| | - Dikla Shmueli-Blumberg
- The Emmes Company, LLC, National Institute on Drug Abuse Data and Statistics Center and Clinical Coordinating Center, 401 N Washington St, Rockville, MD 20850 USA
| | - Matisyahu Shulman
- Department of Psychiatry, Columbia University Irving Medical Center & Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY USA
| | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201-5633 USA
| | - Kari A. Stephens
- Departments of Family Medicine, Biomedical Informatics & Medical Education, University of Washington, Seattle, WA 98195 USA
| | | | - John Marsden
- Addictions Department, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, DeCrespigny Park, Denmark Hill, London, SE5 8AF UK
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Joudrey PJ, Bart G, Brooner RK, Brown L, Dickson-Gomez J, Gordon A, Kawasaki SS, Liebschutz JM, Nunes E, McCarty D, Schwartz RP, Szapocnik J, Trivedi M, Tsui JI, Williams A, Wu LT, Fiellin DA. Research priorities for expanding access to methadone treatment for opioid use disorder in the United States: A National Institute on Drug Abuse Center for Clinical Trials Network Task Force report. Subst Abus 2021; 42:245-254. [PMID: 34606426 PMCID: PMC8790761 DOI: 10.1080/08897077.2021.1975344] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the US, methadone treatment can only be provided to patients with opioid use disorder (OUD) through federal and state-regulated opioid treatment programs (OTPs). There is a shortage of OTPs, and racial and geographic inequities exist in access to methadone treatment. The National Institute on Drug Abuse Center for Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD. This research agenda included mechanisms that are available within and outside the current regulations. The task force identified 6 areas where research is needed: (1) access to methadone in general medical and other outpatient settings; (2) the impact of methadone treatment setting on patient outcomes; (3) impact of treatment structure on outcomes in patients receiving methadone; (4) comparative effectiveness of different medications to treat OUD; (5) optimal educational and support structure for provision of methadone by medical providers; and (6) benefits and harms of expanded methadone access. In addition to outlining these research priorities, the task force identified important cross-cutting issues, including the impact of patient characteristics, treatment, and treatment system characteristics such as methadone formulation and dose, concurrent behavioral treatment, frequency of dispensing, urine or oral fluid testing, and methods of measuring clinical outcomes. Together, the research priorities and cross-cutting issues represent a compelling research agenda to expand access to methadone in the US.
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Affiliation(s)
- Paul J. Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lawrence Brown
- START Treatment and Recovery Centers, Brooklyn, New York, USA
| | - Julie Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adam Gordon
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sarah S. Kawasaki
- Department of Psychiatry and Behavioral Health, Penn State University, State College, Pennsylvania, USA
| | - Jane M. Liebschutz
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Dennis McCarty
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - José Szapocnik
- Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Madhukar Trivedi
- Division of Mood Disorders, Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Arthur Williams
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, New York, USA
| | - Li-Tzy Wu
- Department of Medicine and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - David A. Fiellin
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, Yale School of Public Health, New Haven, Connecticut, USA
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