Screening for and Management of Opioid Use Disorder in Older Adults in Primary Care

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

Download Full-text

3543 Translating the complex medical jargon of opioid use disorder and medication assisted treatment into locally relevant messages in rural Colorado using Boot Camp Translation

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.222 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 97-98

Author(s):

Mary Fisher ◽

Donald E. Nease ◽

Linda Zittleman ◽

Jack Westfall ◽

Jennifer Ancona

Keyword(s):

Primary Care ◽

Local Community ◽

Boot Camp ◽

Opioid Use Disorder ◽

Research Network ◽

High Plains ◽

Opioid Use ◽

Community Members ◽

Medication Assisted Treatment ◽

South Central

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

Download Full-text

Primary Care of Opioid use Disorder: The End of “the French Model”?

European Addiction Research ◽

10.1159/000506630 ◽

2020 ◽

Vol 26 (6) ◽

pp. 346-354 ◽

Cited By ~ 1

Author(s):

Julie Dupouy ◽

Sandy Maumus-Robert ◽

Yohann Mansiaux ◽

Antoine Pariente ◽

Maryse Lapeyre-Mestre

Keyword(s):

Primary Care ◽

Private Practice ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

Access To Treatment ◽

Cross Sectional ◽

Number Of Patients ◽

French Model

Background: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. Objectives: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. Materials and Methods: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. Results: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. Conclusions: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

Download Full-text

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study

Substance Abuse ◽

10.1080/08897077.2017.1356792 ◽

2017 ◽

Vol 39 (1) ◽

pp. 52-58 ◽

Cited By ~ 6

Author(s):

Randi Sokol ◽

Chiara Albanese ◽

Deviney Chaponis ◽

Jessica Early ◽

George Maxted ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Opioid Use Disorder ◽

Opioid Use ◽

Patient Centered ◽

Group Visits ◽

Disorder Treatment

Download Full-text

Project ECHO and primary care buprenorphine treatment for opioid use disorder: Implementation and clinical outcomes

Substance Abuse ◽

10.1080/08897077.2021.1931633 ◽

2021 ◽

pp. 1-9

Author(s):

James B. Anderson ◽

Stephen A. Martin ◽

Anne Gadomski ◽

Nicole Krupa ◽

Daniel Mullin ◽

...

Keyword(s):

Primary Care ◽

Clinical Outcomes ◽

Opioid Use Disorder ◽

Opioid Use ◽

Project Echo ◽

Buprenorphine Treatment

Download Full-text

Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives (Preprint)

10.2196/preprints.25866 ◽

2020 ◽

Author(s):

Joseph E Glass ◽

Theresa E Matson ◽

Catherine Lim ◽

Andrea L Hartzler ◽

Kilian Kimbel ◽

...

Keyword(s):

Primary Care ◽

Drug Use ◽

Opioid Use Disorder ◽

User Centered Design ◽

Opioid Use ◽

Kaiser Permanente ◽

Secure Messaging ◽

Phone Calls ◽

Drug Use Disorders ◽

User Centered

BACKGROUND Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. OBJECTIVE This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. METHODS The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. RESULTS Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). CONCLUSIONS A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.

Download Full-text

Facilitators and barriers to utilization of medications for opioid use disorder in primary care in South Carolina

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217420946240 ◽

2020 ◽

Vol 56 (1) ◽

pp. 14-39

Author(s):

Sarah M Oros ◽

Lillian M Christon ◽

Kelly S Barth ◽

Carole R Berini ◽

Bennie L Padgett ◽

...

Keyword(s):

Primary Care ◽

South Carolina ◽

Focus Group ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

Focus Group Interviews ◽

Facilitators And Barriers ◽

Group Interviews

Objective Utilization of medications for opioid use disorder (MOUD) has not been widely adopted by primary care providers. This study sought to identify interprofessional barriers and facilitators for use of MOUD (specifically naltrexone and buprenorphine) among current and future primary care providers in a southeastern academic center in South Carolina. Method Faculty, residents, and students within family medicine, internal medicine, and a physician assistant program participated in focus group interviews, and completed a brief survey. Survey data were analyzed quantitatively, and focus group transcripts were analyzed using a deductive qualitative content analysis, based upon the theory of planned behavior. Results Seven groups ( N = 46) completed focus group interviews and surveys. Survey results indicated that general attitudes towards MOUD were positive and did not differ significantly among groups. Subjective norms around prescribing and controllability (i.e., beliefs about whether prescribing was up to them) differed between specialties and between level of training groups. Focus group themes highlighted attitudes about MOUD (e.g., “opens the flood gates” to patients with addiction) and perceived facilitators and barriers of using MOUD in primary care settings. Participants felt that although MOUD in primary care would improve access and reduce stigma for patients, prescribing requires improved provider education and an integrated system of care. Conclusions The results of this study provide an argument for tailoring education to specifically address the barriers primary care prescribers perceive. Results promote the utilization of active, hands-on learning approaches, to ultimately promote uptake of MOUD prescribing in the primary care setting in South Carolina.

Download Full-text