scholarly journals A neuroeconomic signature of opioid craving: How fluctuations in craving bias drug-related and nondrug-related value

2021 ◽  
Author(s):  
Kathryn Biernacki ◽  
Silvia Lopez-Guzman ◽  
John C. Messinger ◽  
Nidhi V. Banavar ◽  
John Rotrosen ◽  
...  
Keyword(s):  
Drug Use ◽  
Negative Mood ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Psychological States ◽  
Economic Motivation ◽  
Economic Decisions ◽  
Maintenance Medication ◽  
The Moment ◽  
Selective Increase

AbstractHow does craving bias decisions to pursue drugs over other valuable, and healthier, alternatives in addiction? To address this question, we measured the in-the-moment economic decisions of people with opioid use disorder as they experienced craving, shortly after receiving their scheduled opioid maintenance medication and ~24 h later. We found that higher cravers had higher drug-related valuation, and that moments of higher craving within-person also led to higher drug-related valuation. When experiencing increased opioid craving, participants were willing to pay more for personalized consumer items and foods more closely related to their drug use, but not for alternative “nondrug-related” but equally desirable options. This selective increase in value with craving was greater when the drug-related options were offered in higher quantities and was separable from the effects of other fluctuating psychological states like negative mood. These findings suggest that craving narrows and focuses economic motivation toward the object of craving by selectively and multiplicatively amplifying perceived value along a “drug relatedness” dimension.

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

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.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

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

10.2196/25866 ◽  
2021 ◽  
Vol 23 (7) ◽  
pp. e25866
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.

Motivations for Diverted Buprenorphine Use in a Multisite Qualitative Study

2020 ◽  
Vol 50 (4) ◽  
pp. 550-565 ◽  
Author(s):  
Philip R. Kavanaugh ◽  
Katherine McLean
Keyword(s):  
Drug Use ◽  
Qualitative Study ◽  
Illicit Drug ◽  
Opioid Use Disorder ◽  
Drug Control ◽  
Risk Minimization ◽  
Opioid Use ◽  
Heroin Use ◽  
Site Variation ◽  
Treatment Policies

Drawing on a multisite sample of 40 persons who sell, share, or use diverted buprenorphine to manage opioid use disorder, in this study we describe why individuals seek to obtain buprenorphine outside of formal treatment contexts, and between-site variation regarding their motives and means. Findings indicate that both the provision and purchase of diverted buprenorphine support user-defined risk minimization strategies to avoid withdrawal, reduce heroin use, and satiate opioid cravings in periods of lowered tolerance. We also found that a subset of the sample used buprenorphine recreationally, and that it functioned to extend or augment illicit drug use careers. Implications of the findings are discussed in light of federal and state drug control and treatment policies.

scholarly journals Psycho-Social Correlates of Opioid Use Disorder among the US Adult Population: Evidence from the National Survey on Drug Use and Health, 2015–2018

2020 ◽  
Vol 55 (12) ◽  
pp. 2002-2010
Author(s):  
Mohammad Rifat Haider ◽  
Monique J. Brown ◽  
Rajat Das Gupta ◽  
Sabrina Karim ◽  
Bankole Olatosi ◽  
...  
Keyword(s):  
Drug Use ◽  
National Survey ◽  
Adult Population ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Social Correlates ◽  
The Us

Screen of drug use: Diagnostic accuracy for opioid use disorder

2019 ◽  
Vol 198 ◽  
pp. 176-179 ◽  
Author(s):  
Quyen Q. Tiet ◽  
Yani E. Leyva ◽  
Rudolf H. Moos
Keyword(s):  
Drug Use ◽  
Diagnostic Accuracy ◽  
Opioid Use Disorder ◽  
Opioid Use
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