scholarly journals Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis

2020 ◽  
Vol 60 (6) ◽  
pp. e173-e178 ◽  
Author(s):  
Aaron Salwan ◽  
Nicholas E. Hagemeier ◽  
Fred Tudiver ◽  
KariLynn Dowling-McClay ◽  
Kelly N. Foster ◽  
...  
Keyword(s):  
Community Pharmacist ◽  
Descriptive Analysis ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Prevention And Treatment ◽  
Disorder Prevention

scholarly journals 1203. A Descriptive Analysis of an Opioid Use Disorder Care Continuum in an Infectious Diseases Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S692-S692
Author(s):  
Sarah R Blevins ◽  
James A Grubbs ◽  
Tiffany Stivers ◽  
Kathryn Sabitus ◽  
Ryan Weeks ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Clinic Visit ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Care Continuum ◽  
Patient Attrition ◽  
Small Team ◽  
Overdose Deaths

Abstract Background On December 17, 2020, U.S. CDC released an advisory reporting the highest drug overdose rate on record. Kentucky ranks in the top 5 states for opioid overdose deaths. Retention in opioid use disorder (OUD) treatment is associated with decreased overdose deaths. University of Kentucky HealthCare’s infectious disease division (UKID) implemented a multi-disciplinary approach to expand access to medication for opioid use disorder (MOUD) for patients with injection drug use-associated infections (IDU-AI). This program is modelled after the Ryan White Cares Act to engage and retain patients. Methods . This ongoing project began enrollment in June 2019. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. Patients are eligible for transportation assistance, mental health services, and medical case management. They may start MOUD with UKID or be referred elsewhere. In this analysis, we describe our opioid use disorder care continuum and identify reasons for patient attrition and areas to improve Results Our continuum components are referral, eligible, enrolled, start MOUD, and retention at month 1, 3, and 6. To date, 533 patients have been referred. Of these, 383 (71.9%) were eligible and 150 (39%) enrolled. Reasons patients did not enroll: discharged stable (41.5%), left AMA (16.9%), declined (10.8%), deceased (6.7%), discharged to other hospital (3.6%), missed clinic visit (9.7%), hospice (1%), other (10.8%). Reasons patients declined: no reason (28.6%), refused to discuss (19.1%), no interest (14.3%), travel (4.8%), declined ID follow-up (4.8%), time limits (9.5%). Ninety-three patients have been enrolled ≥6 months; 83 are on MOUD. Sixty-seven, 29, and 20 patients were retained at month 1, 3, and 6, respectively. Conclusion UKID engages patients in OUD treatment, but retention rates are comparable to those described in non-ID settings. Most attrition occurs between eligibility and month 3, suggesting patients are most vulnerable when they consider change and start MOUD. These time points should be priority for patient engagement by clinic staff. Also our staff size struggles to meet the demand. The number of referrals is prohibitive for our small team to approach everyone in a timely manner. More programs like this one are needed. Disclosures All Authors: No reported disclosures

scholarly journals 83. A Descriptive Analysis of a Multi-disciplinary Approach to Opioid Use Disorder Treatment Within an Infectious Diseases Clinic

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S173-S173
Author(s):  
Sarah R Blevins ◽  
Tiffany Stivers ◽  
Kathryn Sabitus ◽  
Ryan Weeks ◽  
J Zachary Porterfield ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Financial Burden ◽  
Descriptive Analysis ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Additional Time ◽  
Medication Assisted Treatment ◽  
The Us ◽  
Overdose Deaths

Abstract Background Opioid overdose is the leading cause of injury-related death in the US. Kentucky ranks in the top 5 states for opioid overdose deaths. The rate of injection drug use-associated infections (IDU-AI) has risen; the University of Kentucky Infectious Diseases division (UKID) treated 401 endocarditis cases in 2018, of which 73% were IDU-AI. To curb overdose deaths, ease financial burden on healthcare, and improve patient outcomes, patients need tools for recovery from opioid use disorder (OUD). Access to OUD treatment in Kentucky and much of the US is limited. Poverty, unemployment, and legal issues are barriers. Methods UKID implemented a multi-disciplinary approach to expand access to medication assisted treatment (MAT). This is an ongoing study. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. At enrollment and at three additional time points, patients complete both a study specific and Government Performance and Results Act (GPRA) survey. Patients may start MAT and mental health counseling with UKID or be referred elsewhere and are eligible for transportation assistance and medical case management. Results To date, there have been 127 referrals. Of these, 87 (69%) were eligible and 54 enrolled (62% of eligible). Primary IVDU-AI includes HIV (n=4; 7%), HCV (n=5; 9%), HIV/HCV (n=3; 6%), endocarditis (n=32; 59%), and other (n=10; 19%). Patients are 48% male (n=26) and 91% white (n=91) with a median age of 34 years (IQR: 16); 35% are receiving MAT (n=19) with 14.8% (n=8) managed by UKID. Other service data are available for 51 patients. Naloxone was dispensed to 45 (88%) patients, 24 (47%) received relapse prevention services, 13 (25%) engaged in peer support, 9 (18%) participated in self-help groups, and 10 (20%) received transportation aid. Conclusion Increasing engagement in MAT and wrap-around services is an important touchpoint for OUD. We present a comprehensive program to achieve this for patients who would otherwise be discharged without follow-up for OUD. This program shows proof of concept that patients can be engaged in MAT by ID providers. Ongoing analysis will include longitudinal review of patient progress and outcomes, including hospital readmission, and a study to determine patients’ perceived impact on their quality of life. Disclosures All Authors: No reported disclosures

A Mobile Health Intervention to Monitor and Provide Support along the Continuum of Hepatitis C Care for People with Opioid Use Disorder: Protocol for a Randomized Trial (Preprint)

2018 ◽  
Author(s):  
Karli Rae Hochstatter ◽  
David H Gustafson Sr ◽  
Gina Landucci ◽  
Klaren Pe-Romashko ◽  
Adam Maus ◽  
...  
Keyword(s):  
Mobile Health ◽  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Hcv Rna ◽  
Opioid Use ◽  
The Past ◽  
Treatment Services ◽  
Prevention And Treatment ◽  
Hcv Antibody ◽  
The Continuum

BACKGROUND People who inject opioids are at a disproportionate risk for contracting hepatitis C virus (HCV). However, use of HCV prevention and treatment services remains suboptimal among people with substance use disorders due to various health system, societal, and individual barriers. Incorporating HCV-specific resources into addiction treatment services, such as mobile-health applications, may reduce the transmission of HCV and improve screening and treatment rates among people with opioid use disorder. OBJECTIVE The goals of this manuscript are to (1) describe the development of the HCV-specific functionality of a mobile-health innovation called A-CHESS and its implementation and evaluation through a randomized control trial and (2) discuss early implementation issues encountered while monitoring and supporting participants’ movement across the continuum of HCV care. METHODS Opioid users from two addiction treatment centers in Massachusetts were randomly assigned to receive either medication assisted treatment (MAT) alone (control arm) or MAT + A-CHESS (experimental arm), and are followed for 24 months. Data on patient’s HCV risk behaviors and stage of care were collected upon enrollment by telephone interview and used to assign a baseline stage of HCV care. Individual’s stage of care are updated through subsequent weekly surveys delivered electronically through the A-CHESS application. Private messages were sent to individuals’ tailored to their stage of HCV care. Additional HCV prevention and treatment resources were incorporated into A-CHESS including multimedia health education content, access to online resources, and location-specific testing facilities and clinical care. RESULTS Between April 2016 and April 2018, 416 individuals were enrolled and completed the baseline interview; 207 were randomly assigned to the control arm and 209 were assigned to the intervention arm. The sample was 86% non-Hispanic white and 55% male with a mean age of 37 years. The majority of the sample (72%) was receiving methadone at the time of enrollment and heroin was the most commonly used opioid. At baseline, 202 individuals (49%) reported ever testing HCV-antibody positive. Of those, 180 (89%) reported receiving HCV-RNA confirmatory testing, of which 139 (77%) tested HCV-RNA positive. Of those who reported testing HCV-RNA positive, 44 (32%) had ever been prescribed HCV treatment and 32 (23%) had been cured. Of the remaining 214 individuals who had never tested anti-HCV positive, 31% (n=129) reported testing HCV-antibody negative within the past year and 20% (n=85) reported not being tested within the past year. CONCLUSIONS The A-CHESS mobile-health system allows for the implementation of a bundle of services and the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders. This study will provide preliminary evidence to determine whether HCV-specific services embedded into the A-CHESS program can increase the frequency of HCV testing, linkage to care, and treatment for people engaged in addiction treatment. CLINICALTRIAL NCT02712034

scholarly journals Experiences and opinions of health professional students participating in an opioid use disorder educational event

2020 ◽  
Vol 10 (2) ◽  
pp. 49-54
Author(s):  
Erin L. Winstanley ◽  
Gina M. Baugh ◽  
Mark Garofoli ◽  
Andrew J. Muzyk
Keyword(s):  
Health Professional ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
Clinical Practices ◽  
Professional Students ◽  
Treatment Services ◽  
Personal Experiences ◽  
Prevention And Treatment ◽  
Health Professional Students

Abstract Introduction The objectives of this study were to describe health professional students' experiences and opinions about patients with opioid-use disorder (OUD), to summarize evaluation results from an OUD educational event and to compare results by sex, discipline, and clinical experience. Methods The OUD educational event lasted 75 minutes and covered the epidemiology of the opioid epidemic, evidence-based prevention and treatment services, stigma, and recommendations on how to improve care. An anonymous pre-event survey collected information on attendees' experiences and opinions about patients with OUD. The postevent survey collected information on the attendees' evaluation of the event. Results Forty percent of students reported having a friend or family member who has/had an OUD. A minority (29.1%) reported that they would be uncomfortable working with patients with OUD or would prefer not to interact with patients with OUD (27.7%). Overall, the event evaluation results were very positive, and 85.5% reported that the information would change or influence their clinical practices. The open-ended responses found that the content was informative (n = 36); the attendees liked the inclusion of statistics (n = 19) and that the content was locally focused (n = 13). Discussion Health professional students participating in this event had fewer negative opinions of patients with OUD than previous research has found, and this may, in part, be explained by their personal experiences. Overall, health professional students want to learn more about patients with OUD.

scholarly journals The prescription opioid epidemic: a review of qualitative studies on the progression from initial use to abuse

2017 ◽  
Vol 19 (3) ◽  
pp. 259-269 ◽  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Opioid Use Disorder ◽  
Qualitative Approach ◽  
Prescription Opioid ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Structured Interviews ◽  
Initial Exposure ◽  
Prevention And Treatment

Most research designed to answer the “why” of the prescription opioid epidemic has relied on structured interviews, which rigidly attempt to capture the complex reasons people use opioids. In contrast this systematic literature review focuses on peer-reviewed studies that have used a qualitative approach to examine the development of an opioid-use disorder from the point of initial exposure. Rather than simply providing a “high,” opioids reportedly relieve psychological/emotional problems or provide an escape from life stressors. As use continues, avoidance of withdrawal sickness becomes an overriding concern, with all other benefits playing minor roles in persistent use. These studies indicate that terms used in structured interviews, such as “nontherapeutic use” or variations thereof, poorly capture the complex range of needs opioids satisfy. Both quantitative/structured studies and more qualitative ones, as well as more focused studies, have an important role in better informing prevention and treatment efforts.

scholarly journals A Descriptive analysis of urine drug screen results in patients with opioid use disorder managed in a primary care setting

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Halle G. Sobel ◽  
Jill S. Warrington ◽  
Samuel Francis-Fath ◽  
Abigail M. Crocker ◽  
Claudia A. Berger
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Descriptive Analysis ◽  
Opioid Use Disorder ◽  
Positive Test ◽  
List Type ◽  
Test Results ◽  
Opioid Use ◽  
Urine Drug

Abstract Background Urine drug screening (UDS) is commonly used as part of treatment for opioid use disorder (OUD), including treatment with buprenorphine-naloxone for OUD in a primary care setting. Very little is known about the value of UDS, the optimum screening frequency in general, or its specific use for buprenorphine treatment in primary care. To address this question, we thought that in a stable population receiving buprenorphine-naloxone in the primary care setting it would be useful to know how often UDS yielded expected and unexpected results. Methods We present a descriptive analysis of UDS results in patients treated with buprenorphine-naloxone for OUD in a primary care setting over a two-year period. An unexpected test result is: A negative test for buprenorphine and/or A positive test for opioids, methadone, cocaine and/or heroin. Results A total of 161 patients received care during the study period and a total of 2588 test results were analyzed from this population. We found that 64.4% of the patient population (n = 104 patients) demonstrated both treatment adherence (as measured by buprenorphine positive test results) and no apparent unexpected test findings, as defined by negative tests for opioids, methadone, cocaine and heroin. Of the 161 patients, 20 results were positive for opioids, 5 for methadone, 39 for heroin and 2 for cocaine. Analysis at the UDS level demonstrated that, of the 2588 test results, 38 (1.5%) results did not have buprenorphine. Of the 2588, 28 (1.1%) test results were positive for opioids, 8 (0.3%) were positive for methadone, 39 (1.5%) for cocaine and 2 (0.1%) for heroin. Conclusion Given that the majority of patients in our study had expected urine results, it may be reasonable for less frequent urine testing in certain patients.

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