Have Waivers Allowing Nurse Practitioners to Treat Opioid Use Disorder Made a Difference in the Opioid Epidemic?

Objective: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD).Design: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge.Setting: The primary study setting included clinicians practicing in outpatient care.Participants: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/Pas that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD.Results: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed.Conclusions: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.

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Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder

Journal of Addictions Nursing ◽

10.1097/jan.0000000000000366 ◽

2020 ◽

Vol 31 (4) ◽

pp. 261-268

Author(s):

Jennifer Jones ◽

Matthew Tierney ◽

Gabrielle Jacobs ◽

Shao-Yun Chien ◽

Sandra Mallisham

Keyword(s):

Mental Health ◽

Nurse Practitioners ◽

Opioid Use Disorder ◽

Opioid Use ◽

Mental Health Nurse ◽

Health Nurse

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What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals

Public Health Reports ◽

10.1177/0033354920968805 ◽

2020 ◽

pp. 003335492096880

Author(s):

Berkeley Franz ◽

Cory E. Cronin ◽

Jose A. Pagan

Keyword(s):

The United States ◽

National Sample ◽

Opioid Use Disorder ◽

Opioid Abuse ◽

Public Health Issue ◽

Evidence Based ◽

Opioid Epidemic ◽

Opioid Use ◽

Nonprofit Hospitals ◽

Community Benefit

Objectives Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.

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Epidemiology of Substance Use Disorders

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0001 ◽

2020 ◽

pp. 3-28

Author(s):

L. Morgan Snell ◽

Andrew J. Barnes ◽

Peter Cunningham

Keyword(s):

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Prescription Opioids ◽

Opioid Epidemic ◽

Provider Education ◽

Opioid Use ◽

Prescribing Practices ◽

The Us ◽

Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

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Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions

Journal of Patient Experience ◽

10.1177/2374373520948401 ◽

2020 ◽

Vol 7 (6) ◽

pp. 964-968

Author(s):

Jeffrey Schlaudecker ◽

Olivia Zamudio ◽

Keesha Goodnow ◽

Harini Pallerla ◽

Saundra Regan

Keyword(s):

Attitude Change ◽

Educational Interventions ◽

Opioid Use Disorder ◽

Opioid Epidemic ◽

Opioid Use ◽

Voice Change ◽

Patient Voice ◽

Barriers To Change ◽

Provider Role ◽

The Voice

Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.

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Infectious Disease (ID) Learning Unit: What the ID Clinician Needs to Know About Buprenorphine Treatment for Opioid Use Disorder

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw251 ◽

2016 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Amanda A. Westlake ◽

Mark P. Eisenberg

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Maintenance Therapy ◽

Injection Drug Use ◽

Infectious Complications ◽

Opioid Use Disorder ◽

Clinical Use ◽

Opioid Epidemic ◽

Opioid Use ◽

Buprenorphine Treatment

Abstract In the context of an escalating opioid epidemic, infectious disease clinicians increasingly treat the infectious complications of injection drug use. In this learning unit, we review the history, pharmacology, and clinical use of buprenorphine as maintenance therapy for opioid use disorder, and we describe the process by which clinicians can obtain a buprenorphine waiver.

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Partnering with State Health Departments to Address Injection-Related Infections during the Opioid Epidemic: Experience at a Safety Net Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab208 ◽

2021 ◽

Author(s):

Rebecca H Burns ◽

Cassandra M Pierre ◽

Jai G Marathe ◽

Glorimar Ruiz-Mercado ◽

Jessica L Taylor ◽

...

Keyword(s):

Bacterial Infections ◽

Medical Center ◽

Safety Net ◽

Opioid Use Disorder ◽

Lessons Learned ◽

Opioid Epidemic ◽

Opioid Use ◽

Persons Who Inject Drugs ◽

Curative Therapy ◽

Safety Net Hospital

Abstract Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health (MDPH) and Boston Medical Center (BMC), the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus (HCV) in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for opioid use disorder (MOUD), harm reduction services including overdose education and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.

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Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

JMIR Public Health and Surveillance ◽

10.2196/23426 ◽

2021 ◽

Vol 7 (4) ◽

pp. e23426

Author(s):

Anthony Xiang ◽

Wei Hou ◽

Sina Rashidian ◽

Richard N Rosenthal ◽

Kayley Abell-Hart ◽

...

Keyword(s):

New York ◽

Regression Model ◽

Census Tract ◽

New York State ◽

Opioid Use Disorder ◽

Opioid Epidemic ◽

Opioid Use ◽

Cross Sectional ◽

York State ◽

Census Tract Level

Background Opioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD). Objective We aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State. Methods This cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation. Results Several areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors. Conclusions At the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.

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Tales from the frontlines: An alarming rise in hospitalizations related to opioid use disorder in the era of COVID-19

Journal of Opioid Management ◽

10.5055/jom.2021.0608 ◽

2021 ◽

Vol 17 (1) ◽

pp. 5-7

Author(s):

Noel Ivey, MD ◽

Dana Cooley Clifton, MD

Keyword(s):

Hospital Setting ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Opioid Epidemic ◽

Care Providers ◽

Opioid Use ◽

Sharp Rise ◽

Negative Effect ◽

Additional Education ◽

Harmful Effects

The coronavirus disease 2019 (COVID-19) pandemic has had harmful effects on the opioid epidemic. While a negative effect was predicted, we report on this reality in the hospital setting. We have seen a sharp rise in hospitalized patients with opioid use disorder (OUD). Our data should encourage ongoing efforts to reduce barriers in accessing medications for treatment, harm reduction interventions and additional education for trainees, primary care providers, and hospitalists alike. In the current climate, these interventions are critical to save the lives of patients with OUD.

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Responding to the Opioid Epidemic

Community Resilience ◽

10.1093/oso/9780197559383.003.0007 ◽

2021 ◽

pp. 77-91

Keyword(s):

Rural Areas ◽

Complex Disease ◽

Opioid Use Disorder ◽

Opioid Addiction ◽

Rural Populations ◽

Opioid Epidemic ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Correctional Settings ◽

Opioid Use Disorders

Chapter 6 examines the complex disease of opioid use disorder and the barriers that exist within the very system designed to help. It also highlights some promising pockets of progress, focusing especially on two environments hit hard by opioid addiction: correctional settings and rural areas. Elizabeth Connolly argues that medication-assisted treatment (MAT) improves outcomes for incarcerated individuals with opioid use disorders and presents examples of successful MAT programs in Massachusetts and Colorado. John Gale explains the complex factors that contribute to opioid addiction among rural populations and why those communities are disproportionately impacted by this epidemic. The chapter concludes with a look at why more progress has not been made.

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