Buprenorphine/Naloxone for Opioid Use Disorder Among Alaska Native and American Indian People

OBJECTIVES

Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD).

METHODS

The sample was 240 ANAI adults in Anchorage, Alaska who received buprenorphine/naloxone treatment for an OUD. We gathered data from the electronic health record from January 1, 2015 to December 31, 2019. We used survival analysis to explore possible predictors (demographic variables, psychiatric comorbidity, medical severity, previous opioid prescriptions, previous injury, alcohol use disorder, and co-occurring substance use) of length of treatment retention (in days) while accounting for right censoring.

RESULTS

We found that 63% of the 240 patients were retained in buprenorphine/naloxone treatment at 90 days, 51% at 6 months, and 40% at 1 year, slightly lower than the general US population. Younger age (hazard ratio 1.69, 95% confidence intervals 1.17-2.45) and co-occurring substance use (hazard ratio 2.95, 95% confidence intervals 1.99-4.38) were associated with increased rate of buprenorphine/naloxone treatment discontinuation.

CONCLUSIONS

Younger patients and those with co-occurring substance use remain at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people. Treatment programs serving ANAI people may consider paying special attention to patients with these characteristics to prevent treatment discontinuation. Our study highlights the need to address poly-substance use among ANAI people in treatment.

Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People

OBJECTIVES

The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder.

METHODS

The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates.

RESULTS

After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates.

CONCLUSIONS

Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.

Simple anthropometrics are more correlated with health variables than are estimates of body composition in Yup'ik people

OBJECTIVES

To (1) evaluate the relationships between several indices of obesity with obesity-related risk factors; (2) compare the accuracy of body composition estimates derived from anthropometry and bioimpedance analysis (BIA) to estimates of body composition assessed by doubly-labeled water (DLW); and (3) establish equations for estimating fat mass (FM), fat-free mass (FFM), and percent body fat (PBF) in Yup'ik people.

DESIGN AND METHODS

Participants included 1,056 adult Yup'ik people from 11 communities in Southwestern Alaska. In a sub-study of 30 participants, we developed population-specific linear regression models for estimating FM, FFM, and PBF from anthropometrics, age, sex, and BIA against criterion measures derived from total body water assessed with DLW. These models were then used with the population cohort and we analyzed the relationships between obesity indices and several health-related and disease status variables: (1) fasting plasma lipids, (2) glucose, (3) HbA1c, (4) adiponectin, (5) blood pressure, (6) diabetes (DM), and (7) cerebrocoronary vascular disease (CCVD) which includes stroke and heart disease.

RESULTS

The best model for estimating FM in the sub-study used only three variables-sex, waist circumference (WC), and hip circumference and had multiple R(2) = 0.9730. FFM and PBF were calculated from FM and body weight.

CONCLUSION

WC and other anthropometrics were more highly correlated with a number of obesity-related risk factors than were direct estimates of body composition. Body composition in Yup'ik people can be accurately estimated from simple anthropometrics.

Community-based participatory research in a large cohort study of chronic diseases among Alaska native adults

BACKGROUND

In 2001, the National Cancer Institute (NCI) funded a project to develop methods to recruit American Indian and Alaska Native (AI/AN) adults for a prospective cohort study of chronic disease risk and protective factors.

OBJECTIVE

We describe how the use of community-based participatory research (CBPR) principles led to more effective study design and implementation in a study in Alaska.

METHODS

CBPR elements included collaboration between researchers and tribes at all stages of the project, capacity building through training AI/AN staff in research methods, and knowledge dissemination through presentations, newsletters, and individual and community health feedback based on results of the study.

RESULTS

Between March 2004 and August 2006, 3,821 AI/ AN adults from 26 Alaskan communities enrolled in the study. Retention in the study is high, with over 88% of participants successfully completing a 2-year follow-up questionnaire.

CONCLUSION

CBPR methods have facilitated effective development of study methods, recruitment and retention. Efforts are on-going to continue work with this unique AI/AN research participant community.