Efficacy and Cost-Benefit of Onsite Contraceptive Services With and Without Incentives Among Women With Opioid Use Disorder at High Risk for Unintended Pregnancy

2021 ◽  
Author(s):  
Sarah H. Heil ◽  
Heidi S. Melbostad ◽  
Alexis K. Matusiewicz ◽  
Catalina N. Rey ◽  
Gary J. Badger ◽  
...  
Keyword(s):  
High Risk ◽  
Unintended Pregnancy ◽  
Cost Benefit ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Contraceptive Services

scholarly journals Effect of a Mobile-Health Intervention (A-CHESS) on Hepatitis C Testing Uptake Among People with Opioid Use Disorder: A Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Karli R Hochstatter ◽  
David H Gustafson Sr ◽  
Gina Landucci ◽  
Klaren Pe-Romashko ◽  
Olivia Cody ◽  
...  
Keyword(s):  
Hepatitis C ◽  
High Risk ◽  
Drug Use ◽  
Risk Behaviors ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Injection Equipment ◽  
Testing Uptake ◽  
Hcv Antibody ◽  
Hcv Testing

BACKGROUND The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of persons with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD is critical. A-CHESS is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medication-assisted treatment (MAT) to improve long-term recovery. OBJECTIVE We incorporated HCV content and functionality into A-CHESS to (1) to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and (2) determine whether incorporating HCV content and functionality into A-CHESS increases HCV testing. METHODS HCV intervention content, including dissemination of educational information, private messages tailored to individual’s stage of HCV care, and a public discussion forum, were implemented into the A-CHESS platform. Individuals with OUD were randomly assigned to receive MAT alone (control arm) or MAT + A-CHESS (experimental arm). Quarterly telephone interviews, conducted from baseline to month 24, assessed risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess overall whether individuals who received A-CHESS were tested for HCV (including either antibody or RNA tested) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of individuals at highest risk for HCV, additional analyses examined the effect of the intervention among individuals who injected drugs and shared injection equipment. RESULTS Between April 2016 and April 2020, 416 individuals with OUD were enrolled. Overall, 44% of the study population was HCV-antibody positive, 30% were HCV-antibody negative, and 25% were considered untested at baseline. At month 24 there was no difference in HCV testing uptake between intervention and control participants overall. However, among the subset of 109 individuals who engaged in injection drug use, there was a slight trend towards increased HCV testing uptake among those who received A-CHESS (89% versus 85%; Hazard Ratio: 1.34; 95% CI: 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 individuals who reported sharing injection equipment (87% versus 56%; Hazard Ratio: 2.92; 95% CI: 0.959-8.86; P=.059). CONCLUSIONS Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high risk behaviors such as sharing contaminated injection equipment; however, studies that are powered to detect differences in HCV testing among high risk groups are needed. CLINICALTRIAL ClinicalTrials.gov, NCT02712034. Registered on 14 March 2016. INTERNATIONAL REGISTERED REPORT RR2-10.2196/12620

Naloxone provision to emergency department patients recognized as high-risk for opioid use disorder

2020 ◽  
Author(s):  
Bennett H. Lane ◽  
Michael S. Lyons ◽  
Uwe Stolz ◽  
Rachel M. Ancona ◽  
Richard J. Ryan ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Emergency Department Patients

Perinatal Navigator Approach to Smoking Cessation for Women With Prevalent Opioid Dependence

2019 ◽  
Vol 41 (8) ◽  
pp. 1103-1120 ◽  
Author(s):  
Amanda Fallin-Bennett ◽  
Kathy Rademacher ◽  
Holly Dye ◽  
Alex Elswick ◽  
Kristin Ashford ◽  
...  
Keyword(s):  
High Risk ◽  
Social Services ◽  
Opioid Dependence ◽  
Risk Group ◽  
Opioid Use Disorder ◽  
High Risk Group ◽  
Opioid Use ◽  
Tobacco Treatment ◽  
Psychosocial Barriers ◽  
Perinatal Women

Women who smoke during pregnancy face psychosocial barriers to cessation, and women with opioid use disorder (OUD) face amplified barriers. We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women ( N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services. Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day ( p = .05) at postintervention and were less dependent on nicotine ( p < .01). Mean postnatal depression scores ( p = .03) and perceived stress ( p = .03) decreased postintervention. Participants received at least one referral at baseline ( n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers. The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Treatment for Opioid Use Disorder during Pregnancy in a High-Risk Urban Canadian Cohort: Perinatal, Neonatal, and Placental Effects

2018 ◽  
Vol 40 (6) ◽  
pp. 845
Author(s):  
Caragh Miller ◽  
David Grynspan ◽  
Emanuela Ferretti ◽  
Laura Gaudet ◽  
Amy McGee ◽  
...  
Keyword(s):  
High Risk ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Expanding Contraception Access for Women With Opioid-Use Disorder: A Qualitative Study of Opportunities and Challenges

2020 ◽  
Vol 34 (8) ◽  
pp. 909-918 ◽  
Author(s):  
Emily A. Hurley ◽  
Alex Duello ◽  
Sarah Finocchario-Kessler ◽  
Kathy Goggin ◽  
Stephani Stancil ◽  
...  
Keyword(s):  
Qualitative Interviews ◽  
Unmet Need ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Patient Centered ◽  
Essential Components ◽  
Catchment Areas ◽  
Contraceptive Services ◽  
Access To Contraception

Purpose: As almost nine in ten pregnancies among women with opioid use disorder (OUD) are unintended, expanding access to contraception is an underutilized but potentially effective strategy in increasing reproductive agency and reducing the overall burden of neonatal abstinence syndrome. We aimed to identify where and how contraceptive services could be integrated into existing points-of-contact for women with OUD. Approach: In-depth qualitative interviews. Setting: Three diverse catchment areas in Missouri. Participants: Women with OUD (n = 15) and professional stakeholders (n = 16) representing five types of existing OUD service points: syringe exchange programs, recovery support programs, substance use treatment programs, emergency departments, and Federally Qualified Health Centers. Method: Interviews were audio-recorded, transcribed, and thematically coded using Dedoose software. Results: Six themes emerged as essential components for integrating contraceptive services into existing points-of-contact for women with OUD: (1) reach women with unmet need; (2) provide free or affordable contraception; (3) maximize service accessibility; (4) provide patient-centered care; (5) employ willing, qualified contraceptive providers; and (6) utilize peer educators. Participants affirmed the overall potential benefit of contraceptive service integration and illuminated various opportunities and challenges relevant to each type of existing service point. Conclusion: As health promotion initiatives look to increase access to contraception among women with OUD, these six’ participant-identified components offer essential guidance in selecting advantageous points-of-contact and addressing remaining gaps in services.

scholarly journals Non-Opioid Substances Acute Poisonings with Suicidal Intent in Patients with Opioid Use Disorder

Folia Medica ◽  
2020 ◽  
Vol 62 (1) ◽  
pp. 117-123
Author(s):  
Natasha K. Simonovska ◽  
Vesna V. Stefanovska ◽  
Aleksandra Babulovska
Keyword(s):  
High Risk ◽  
Suicide Attempt ◽  
Severity Score ◽  
Suicide Attempts ◽  
Acute Poisoning ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Suicidal Intent ◽  
Number Of Patients ◽  
Opioid Administration

Introduction: Several epidemiological studies have evaluated the role of illicit drug use in suicide behaviour. &nbsp; Aim: To assess patients with opioid use disorder and suicidal intent related to behavior, severity of acute poisoning and the most commonly used non-opioid substances. &nbsp; Materials and methods: This cross sectional study included 67 patients diagnosed with opioid use disorder. The study was conducted at the University Clinic of Toxicology in Skopje over a 5-year period (2013-2017). The following variables were examined: gender, age, duration and route of opioid administration, duration of hospitalization, and types of substances used in acute poisoning. Assessment of patients&rsquo; behavior and severity of poisoning was made by using the Suicide Behaviours Questionnaire-Revised and the Poison severity score. &nbsp; Results: The majority of patients were male (88.1%). The mean age of patients was 30&plusmn;6.1 years. The average duration of opioid use disorder was 8.5&plusmn;3.9. A single poisoning was found in 62.7%, double poisoning in 25.4%, and triple poisoning in 11.9% of participants. Benzodiazepines were most commonly used by the patients (55.2%). The largest number of patients (32.8%) had minor Poison severity score (PSS), and only 17.9% had severe PSS. None of the patients had a fatal suicide attempt. 86.6% of patients had a score of &ge;7 indicating a high risk of repeat suicide attempts. &nbsp; Conclusion: Benzodiazepines were most commonly used as a single or combined substance in patients with opioid use disorder. PSS indicated that most of the participants were with minor PSS and with high risk of a repeat suicide attempt.

What's in a number? Recommending practicality in the DATA 2000 patient limits

2016 ◽  
Vol 12 (4) ◽  
pp. 243
Author(s):  
Andrea G. Barthwell, MD, DFASAM ◽  
Jonathan M. Young, JD, PhD ◽  
Michael C. Barnes, JD ◽  
Shruti R. Kulkarni, JD
Keyword(s):  
Addiction Treatment ◽  
Cost Benefit ◽  
Opioid Use Disorder ◽  
Full Time ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Access To Treatment ◽  
The Us ◽  
Final Rule ◽  
Receive Treatment

According to the Substance Abuse and Mental Health Services Administration, 2.4 million individuals have an opioid use disorder (OUD). Yet, nearly 80 percent of them—more than 1.9 million people—do not receive treatment. Medication-assisted treatment (MAT), specifically with buprenorphine, has proven to be effective in treating patients with OUDs while also reducing costs to the healthcare system, criminal justice system, and workforce. Despite its effectiveness, barriers to MAT continue to exist. Consequently, many individuals must wait months, if not years, to receive treatment. This article analyzes the US Department of Health and Human Services’ final rule (Final Rule) on MAT, common barriers to treatment, and the cost-benefit of treatment in light of the current opioid abuse epidemic. The article finds that while the Final Rule was a step in the right direction, it does not go far enough to adequately address the epidemic. Finally, the article proposes practical recommendations for increasing patient access to treatment for OUDs, including increasing the patient limit for highly qualified addiction treatment providers so that they can practice addiction medicine on a full-time basis and exempting buprenorphine products labeled by the US Food and Drug Administration for direct administration from the practitioner's patient limit.

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