Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care

Abstract Introduction Patients receiving medication assisted therapy (MAT) for opioid use disorder have high cigarette smoking rates. Cigarette smoking interventions have had limited success. We evaluated an intervention to increase cigarette abstinence rates in patients receiving buprenorphine-assisted therapy. Methods Cigarette smokers (N = 175; 78% male; 69% Caucasian; 20% Hispanic), recruited from a buprenorphine clinic were randomly assigned to either an extended innovative system intervention (E-ISI) or to Standard Treatment Control (STC). The E-ISI combined motivational intervention with extended treatment (long-term nicotine replacement therapy , varenicline, and extended cognitive behavioral therapy). STC received written information about quit-lines, medication, and resources. Assessments were held at baseline and 3, 6, 12, and 18 months. Seven-day biochemically verified point-prevalence cigarette abstinence was the primary outcome measure. Results Fifty-four percent of E-ISI participants entered the extended treatment intervention; E-ISI and STC differed at 3 months on abstinence status but not at months 6, 12, and 18. E-ISI participants were more likely to attempt to quit, to have a goal of complete abstinence, and to be in a more advanced stage of change than STC participants. A higher number of cigarettes smoked and the use of cannabis in the previous 30 days predicted continued smoking Conclusions The E-ISI was successful in increasing motivation to quit smoking but did not result in long-term abstinence. The failure of treatments that have been efficacious in the general population to produce abstinence in patients receiving MAT of opioid use disorder suggests that harm reduction and other innovative interventions should be explored. Implications This study demonstrates that an intervention combining motivational interviewing with an extended treatment protocol can increase cigarette quit attempts, enhance cigarette abstinence goals, and further movement through stages of change about quitting smoking in patients receiving MAT for opioid use disorder who smoke cigarettes. The intervention did not increase abstinence rates over those observed in a standard treatment control, however. The latter finding supports those of earlier investigators who also failed to find efficacy for smoking cessation in this population and who also used interventions effective in the general population. This pattern of findings suggests that patients with opioid use disorder can be motivated to change smoking behavior, but alternative and innovative approaches to cigarette smoking treatment should be studied.

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Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations

Annals of Pharmacotherapy ◽

10.1177/10600280211003875 ◽

2021 ◽

pp. 106002802110038

Author(s):

Emily Brandl ◽

Zachery Halford ◽

Matthew D. Clark ◽

Chris Herndon

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Health Care Professionals ◽

Data Extraction ◽

Clinical Care ◽

Genomic Medicine ◽

Opioid Use Disorder ◽

Patient Specific ◽

Therapeutic Effects ◽

Opioid Use

Objective: To provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder. Data Sources: A literature review was conducted using the search terms pain management, pharmacogenomics, pharmacogenetics, pharmacokinetics, pharmacodynamics, and opioids on PubMed (inception to February 1, 2021), CINAHL (2016 through February 1, 2021), and EMBASE (inception through February 1, 2021). Study Selection and Data Extraction: All relevant clinical trials, review articles, package inserts, and guidelines evaluating applicable pharmacogenotypes were considered for inclusion. Data Synthesis: More than 300 Food and Drug Administration–approved medications contain pharmacogenomic information in their labeling. Genetic variability may alter the therapeutic effects of commonly prescribed pain medications. Pharmacogenomic-guided therapy continues to gain traction in clinical practice, but a multitude of barriers to widespread pharmacogenomic implementation exist. Relevance to Patient Care and Clinical Practice: Pain is notoriously difficult to treat given the need to balance safety and efficacy when selecting pharmacotherapy. Pharmacogenomic data can help optimize outcomes for patients with pain. With improved technological advances, more affordable testing, and a better understanding of genomic variants resulting in treatment disparities, pharmacogenomics continues to gain popularity. Unfortunately, despite these and other advancements, pharmacogenomic testing and implementation remain underutilized and misunderstood in clinical care, in part because of a lack of health care professionals trained in assessing and implementing test results. Conclusions: A one-size-fits-all approach to pain management is inadequate and outdated. With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.

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Measuring What Matters: How the Laboratory Contributes Value in the Opioid Crisis

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa162 ◽

2020 ◽

Vol 5 (6) ◽

pp. 1378-1390

Author(s):

Jill S Warrington ◽

Kathleen Swanson ◽

Monique Dodd ◽

Sheng-Ying Lo ◽

Aya Haghamad ◽

...

Keyword(s):

Clinical Laboratory ◽

Improve Patient Safety ◽

Clinical Care ◽

Active Role ◽

Opioid Use Disorder ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Crisis ◽

Clinical Laboratories ◽

National Quality

Abstract With over 20 years of the opioid crisis, our collective response has evolved to address the ongoing needs related to the management of opioid use and opioid use disorder. There has been an increasing recognition of the need for standardized metrics to evaluate organizational management and stewardship. The clinical laboratory, with a wealth of objective and quantitative health information, is uniquely poised to support opioid stewardship and drive valuable metrics for opioid prescribing practices and opioid use disorder (OUD) management. To identify laboratory-related insights that support these patient populations, a collection of 5 independent institutions, under the umbrella of the Clinical Laboratory 2.0 movement, developed and prioritized metrics. Using a structured expert panel review, laboratory experts from 5 institutions assessed possible metrics as to their relative importance, usability, feasibility, and scientific acceptability based on the National Quality Forum criteria. A total of 37 metrics spanning the topics of pain and substance use disorder (SUD) management were developed with consideration of how laboratory insights can impact clinical care. Monitoring these metrics, in the form of summative reports, dashboards, or embedded in laboratory reports themselves may support the clinical care teams and health systems in addressing the opioid crisis. The clinical insights and standardized metrics derived from the clinical laboratory during the opioid crisis exemplifies the value proposition of clinical laboratories shifting into a more active role in the healthcare system. This increased participation by the clinical laboratories may improve patient safety and reduce healthcare costs related to OUD and pain management.

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Expanding Access to Treatment and Recovery Services Using a Hub-and-Spoke Model of Care

A Public Health Guide to Ending the Opioid Epidemic ◽

10.1093/oso/9780190056810.003.0010 ◽

2019 ◽

pp. 95-106

Author(s):

Anne Van Donsel ◽

Anthony Folland ◽

Mark Levine

Keyword(s):

Clinical Care ◽

Well Being ◽

Opioid Use Disorder ◽

Opioid Use ◽

Care Needs ◽

Access To Treatment ◽

Hub And Spoke ◽

Medication Assisted Treatment ◽

Treatment Providers ◽

Abuse Treatment

This chapter describes Vermont’s hub-and-spoke system of care for treatment of opioid use disorders. The system not only addresses the clinical care needs of patients but also assists those in treatment in building the skills needed to address other aspects of well-being, such as self-care, parenting, and employment. The program is a collaborative effort of the state’s Medicaid program, the Department of Health, substance abuse treatment providers, and primary care practices. The goals of the system are to increase total access to care, decrease the risk of overdose and transmission of infectious disease, normalize care for substance use disorder, and link patients to other needed services. Both hubs and spokes use evidence-based medication-assisted treatment (MAT) to treat opioid use disorder. Individuals for whom MAT is not desired or indicated may receive non-MAT residential, intensive outpatient, or outpatient treatment, and a wide array of recovery support services.

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OpiTrack

Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies ◽

10.1145/3478107 ◽

2021 ◽

Vol 5 (3) ◽

pp. 1-29

Author(s):

Bhanu Teja Gullapalli ◽

Stephanie Carreiro ◽

Brittany P. Chapman ◽

Deepak Ganesan ◽

Jan Sjoquist ◽

...

Keyword(s):

Time Window ◽

Electrodermal Activity ◽

Clinical Care ◽

Opioid Use Disorder ◽

Physiological Signals ◽

Physiological Data ◽

Opioid Use ◽

Painful Condition ◽

Targeted Interventions ◽

Opioid Administration

Opioid use disorder is a medical condition with major social and economic consequences. While ubiquitous physiological sensing technologies have been widely adopted and extensively used to monitor day-to-day activities and deliver targeted interventions to improve human health, the use of these technologies to detect drug use in natural environments has been largely underexplored. The long-term goal of our work is to develop a mobile technology system that can identify high-risk opioid-related events (i.e., development of tolerance in the setting of prescription opioid use, return-to-use events in the setting of opioid use disorder) and deploy just-in-time interventions to mitigate the risk of overdose morbidity and mortality. In the current paper, we take an initial step by asking a crucial question: Can opioid use be detected using physiological signals obtained from a wrist-mounted sensor? Thirty-six individuals who were admitted to the hospital for an acute painful condition and received opioid analgesics as part of their clinical care were enrolled. Subjects wore a noninvasive wrist sensor during this time (1-14 days) that continuously measured physiological signals (heart rate, skin temperature, accelerometry, electrodermal activity, and interbeat interval). We collected a total of 2070 hours (≈ 86 days) of physiological data and observed a total of 339 opioid administrations. Our results are encouraging and show that using a Channel-Temporal Attention TCN (CTA-TCN) model, we can detect an opioid administration in a time-window with an F1-score of 0.80, a specificity of 0.77, sensitivity of 0.80, and an AUC of 0.77. We also predict the exact moment of administration in this time-window with a normalized mean absolute error of 8.6% and R2 coefficient of 0.85.

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Four single nucleotide polymorphisms in genes involved in neuronal signaling are associated with opioid use disorder in West Virginia

Journal of Opioid Management ◽

10.5055/jom.2019.0491 ◽

2019 ◽

Vol 15 (2) ◽

pp. 103-109 ◽

Cited By ~ 1

Author(s):

Shane W. Kaski, BS, MD/PhD ◽

Stephan Brooks, MPH ◽

Sijin Wen, PhD ◽

Marc W. Haut, PhD ◽

David P. Siderovski, PhD ◽

...

Keyword(s):

Substance Use ◽

Pilot Study ◽

General Population ◽

Single Nucleotide Polymorphisms ◽

West Virginia ◽

Addiction Treatment ◽

Opioid Use Disorder ◽

Nucleotide Polymorphisms ◽

Opioid Use ◽

Single Nucleotide

Objective: Pilot study to assess utility in opioid use disorder (OUD) of a panel of single nucleotide polymorphisms (SNPs) in genes previously related to substance use disorder (SUD) and/or phenotypes that predispose individuals to OUD/SUD. Design: Genetic association study.Setting: West Virginia University’s Chestnut Ridge Center Comprehensive Opioid Addiction Treatment (COAT) clinic for individuals diagnosed with OUD. Patients: Sixty patients 18 years of age or older with OUD undergoing medication (buprenorphine/naloxone)-assisted treatment; all 60 patients recruited contributed samples for genetic analysis.Outcome measure(s): Minor allele frequencies for SNPs.Results: Four of the 14 SNPs examined were present at frequencies that are statistically significantly different than in a demographically matched general population. Conclusions: For the purposes of testing WV individuals via genetic means for predisposition to OUD, at least four SNPs in three genes are likely to have utility in predicting susceptibility. Additional studies with larger populations will need to be conducted to confirm these results before use in a clinical setting.

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