scholarly journals Applying and advancing best practices in opioid use disorder and addiction treatment: Introduction to the special issue on implementation science and quality improvement scholarship

2018 ◽  
Vol 39 (2) ◽  
pp. 125-128
Author(s):  
Adam J. Gordon ◽  
Elizabeth M. Oliva
Keyword(s):  
Quality Improvement ◽  
Best Practices ◽  
Implementation Science ◽  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Special Issue ◽  
Opioid Use

scholarly journals Introduction to the Special Issue: Opioids and the Workplace—Urgent Action Needed

2021 ◽  
pp. 104829112110484
Author(s):  
Jonathan Rosen ◽  
Jennifer R. Zelnick ◽  
Jeanette Zoeckler ◽  
Paul Landsbergis
Keyword(s):  
Addiction Treatment ◽  
Workplace Safety ◽  
Opioid Use Disorder ◽  
Special Issue ◽  
Opioid Use ◽  
Access To Treatment ◽  
Assistance Programs ◽  
Worker Training ◽  
Drug Policies ◽  
Recovery Resources

The workplace has been a neglected element in the national response to the opioid crisis. This ignores that workplace safety and health and drug policies have become important factors in opioid use disorder among workers. This results from physical or emotional pain related to workplace injuries, illnesses, and stress, and through punitive workplace drug policies, failure to address stigma, and inadequate access to treatment and recovery resources. This comprehensive New Solutions special issue encompasses timely cutting-edge research, commentaries, activism, and calls for action on primary prevention in the workplace and intervention research. It also addresses the convergence of the COVID-19 and the opioid crises, high-risk occupations and industries, health inequalities, employer and union programs, peer advocacy and member assistance programs, worker training, health parity for addiction treatment and recovery services, protection of first responders and site clean-up workers, working conditions of substance use treatment workers, and calls for necessary funding.

scholarly journals The association between cannabis use and outcome in pharmacological treatment for opioid use disorder

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tea Rosic ◽  
Raveena Kapoor ◽  
Balpreet Panesar ◽  
Leen Naji ◽  
Darren B. Chai ◽  
...  
Keyword(s):  
Side Effects ◽  
Pharmacological Treatment ◽  
Addiction Treatment ◽  
Age Of Onset ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Self Report ◽  
Opioid Use ◽  
Differential Outcomes ◽  
Urine Drug

Abstract Background With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users. Methods Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: “What effect does marijuana have on your treatment?”. Results Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87–1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared  with occasional use (OR = 0.61, 95% CI 0.47–0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment. Conclusion Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives

2021 ◽  
Author(s):  
Utsha G. Khatri ◽  
Elizabeth A. Samuels ◽  
Ruiying Xiong ◽  
Brandon D.L. Marshall ◽  
Jeanmarie Perrone ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Emergency Department Visit ◽  
Opioid Use Disorder ◽  
Opioid Use

Current Best Practices for Acute and Chronic Management of Patients with Opioid Use Disorder

2022 ◽  
Vol 106 (1) ◽  
pp. 61-80
Author(s):  
Alyssa Peterkin ◽  
Jordana Laks ◽  
Zoe M. Weinstein
Keyword(s):  
Best Practices ◽  
Opioid Use Disorder ◽  
Opioid Use

Use of Buprenorphine for the Treatment of Opioid Use Disorder

2020 ◽  
pp. 155-168
Author(s):  
Paul J. Fudala ◽  
Anne Cramer Andorn
Keyword(s):  
Opioid Dependence ◽  
Addiction Treatment ◽  
Partial Agonist ◽  
The United States ◽  
Opioid Use Disorder ◽  
Sublingual Administration ◽  
Opioid Use ◽  
The Us ◽  
Monthly Administration ◽  
Drug Addiction Treatment

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.

scholarly journals Receipt of Timely Addiction Treatment and Association of Early Medication Treatment With Retention in Care Among Youths With Opioid Use Disorder

2018 ◽  
Vol 172 (11) ◽  
pp. 1029 ◽  
Author(s):  
Scott E. Hadland ◽  
Sarah M. Bagley ◽  
Jonathan Rodean ◽  
Michael Silverstein ◽  
Sharon Levy ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
Retention In Care ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medication Treatment

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.

Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration

2015 ◽  
Vol 11 (6) ◽  
pp. 459 ◽  
Author(s):  
Marcus A. Bachhuber, MD, MSHP ◽  
Christopher B. Roberts, MPH ◽  
Stephen Metraux, PhD ◽  
Ann Elizabeth Montgomery, PhD
Keyword(s):  
At Risk ◽  
Addiction Treatment ◽  
Women Veterans ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Male Veterans

Objective: To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Setting: Addiction treatment programs operated by the US Department of Veterans Affairs (VA).Participants: All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA’s national homelessness screener. Main outcome measures: Self-reported homelessness or imminent risk of homelessness.Results: The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively).Conclusions: The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

scholarly journals Novel treatment of opioid use disorder using ibogaine and iboga in two adults

2020 ◽  
Author(s):  
Claire Wilson ◽  
Trevor Millar ◽  
Zak Matieschyn
Keyword(s):  
Addiction Treatment ◽  
Case Series ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Safety Risks ◽  
Short Period ◽  
Multiple Treatments

AbstractIbogaine is a naturally occurring psychedelic medicine with anti-addictive properties. While research on ibogaine is limited, several observational studies have shown ibogaine can mitigate opioid withdrawal, as seen with reductions in clinical and subjective opioid withdrawal scores and reduced drug use severity (Noller, Frampton, & Yazar-Klosinski, 2018; Brown & Alper 2018). Furthermore, the psychoactive experience may help individuals to realign their values, purpose and sense of connection, as seen with post treatment reductions in depression scores (Noller et al., 2018; Mash et al., 2000).Case seriesThis case series describes two cases of individuals accessing ibogaine through private unregulated clinics in the Vancouver area to treat their opioid use disorder.ConclusionsIn case 1, the client achieved total abstinence from all opioids within 5–6 days of starting ibogaine treatment, did not experience any opioid withdrawal symptoms after ibogaine treatment and maintained abstinence from opioids for 3 years. In case 2, the patient took ibogaine/iboga in multiple treatments over a short period of time (<4 months). The patient stopped all non-medical opioids after the first iboga treatment and then used ibogaine to aid with further dose reductions of her opioid agonist therapy (OAT) and has maintained abstinence from opioids for 2 years. Ibogaine offers a unique and novel therapeutic approach to treating opioid use disorder. Further studies are needed to establish the safety, risks and potential role for ibogaine as a mainstream, evidence-based addiction treatment.

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