Telehealth for Medication for Opioid Use Disorder Treatment

Medication for Opioid Use Disorder (mOUD), a type of Medications for Addiction Treatment (MAT), has proven to be the most efficacious and cost-effective treatment for individuals suffering from opioid use disorder (OUD). Early initiation of mOUD has been shown to increase retention in addiction treatment. Models of care integrating telehealth with mOUD offer the potential to implement mOUD in point-of-care settings, achieving effective tertiary prevention. Integrating telehealth and mOUD also addresses barriers to addiction treatment continuity, like transportation concerns and stigma. Funding for use of telehealth for addiction treatment is achieved primarily through government grants and insurance reimbursements. There are many legal constructs regarding the dissemination of mOUD, and while not usually permitted, guidelines during the COVID-19 pandemic have allowed for practitioners to be able to prescribe mOUD via telehealth without the requirement of an initial in-person examination.

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“It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00213-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Elizabeth C. Saunders ◽

Sarah K. Moore ◽

Olivia Walsh ◽

Stephen A. Metcalf ◽

Alan J. Budney ◽

...

Keyword(s):

Qualitative Study ◽

The United States ◽

Opioid Use Disorder ◽

Integrated Treatment ◽

Medical Setting ◽

Integrated Models ◽

Opioid Use ◽

Medical Settings ◽

Psychosocial Services ◽

Treatment Models

Abstract Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

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

Harm Reduction Journal ◽

10.1186/s12954-021-00468-6 ◽

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.

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Use of Buprenorphine for the Treatment of Opioid Use Disorder

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0009 ◽

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.

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

JAMA Pediatrics ◽

10.1001/jamapediatrics.2018.2143 ◽

2018 ◽

Vol 172 (11) ◽

pp. 1029 ◽

Cited By ~ 39

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

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

Journal of Opioid Management ◽

10.5055/jom.2019.0531 ◽

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.

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

Journal of Opioid Management ◽

10.5055/jom.2015.0298 ◽

2015 ◽

Vol 11 (6) ◽

pp. 459 ◽

Cited By ~ 5

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.

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

Journal of Psychedelic Studies ◽

10.1556/2054.2020.00133 ◽

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

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/10482911211048438 ◽

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.

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Identifying patient-important outcomes in medication-assisted treatment for opioid use disorder patients: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025059 ◽

2018 ◽

Vol 8 (12) ◽

pp. e025059 ◽

Cited By ~ 4

Author(s):

Nitika Sanger ◽

Hamnah Shahid ◽

Brittany B Dennis ◽

Jackie Hudson ◽

David Marsh ◽

...

Keyword(s):

Clinical Trials ◽

Addiction Treatment ◽

Treatment Success ◽

Opioid Use Disorder ◽

Primary Objective ◽

Cochrane Library ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Study Results ◽

Clinical Trials Registry

IntroductionIllicit opioid use has become a national crisis in Canada, with over 65 000 people seeking treatment for opioid use disorder (OUD) in Ontario and British Columbia alone. Medication-assisted treatment (MAT) is a common treatment for OUD. There is substantial variability in treatment outcomes used to evaluate effectiveness of MAT, making it difficult to establish clinically and scientifically relevant treatment effect. Furthermore, patients are often excluded from the process of determining these outcomes. The primary objective of this review is to examine outcomes currently used to measure MAT effectiveness and to identify patient-relevant outcomes to enhance effectiveness of treatment options. This review refers to patient-important outcomes as those outcomes patients consider important to or markers of treatment success.Methods and analysisMEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, National Institutes for Health Clinical Trials Registry and WHO International Clinical Trials Registry Platform databases will be searched. We will search databases from inception to the date the search is ran. Studies of interest include those evaluating the effectiveness of MAT for patients with OUD, with or without consultation with patients regarding what they consider to be important as an indicator of treatment success. Results will be analysed using thematic analysis and qualitative analysis where possible. This will result in comprehensive synthesis of all outcomes and measures found related to OUD treatment effectiveness.Ethics and disseminationWe are collaborating with Canadian Addiction Treatment Centres which provide MAT to patients with OUD who will participate in disseminating study results. Dissemination strategies will involve sharing study results through workshops, presentations, peer-reviewed publications, study reports, community presentations and resources in primary care settings.PROSPERO registration numberCRD42018095553.

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