Pharmacotherapy for Opioid Use Disorders in Special Populations

2020 ◽  
pp. 185-202
Author(s):  
Tricia E. Wright
Keyword(s):  
At Risk ◽  
Pregnant Woman ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Special Populations ◽  
Opioid Use ◽  
Adverse Childhood ◽  
Psychiatric Conditions ◽  
Opioid Use Disorders ◽  
The Life Course

Three populations are most at risk for opioid use disorder: adolescents, pregnant women, and those with comorbid psychological or psychiatric disorders. Opioid use disorders present throughout the life course of an individual, often developing during adolescence. For women, these disorders commonly occur during peak childbearing years. In addition, the twin vulnerabilities of genetics and adverse childhood events often interact to impart a greater chance for co-occurring psychiatric conditions. Caring for the pregnant woman, the adolescent, or the person with a co-occurring mental disorder presents special challenges. This chapter focuses on special considerations when treating opioid use disorders in these populations.

scholarly journals 0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A98-A99
Author(s):  
L Gao ◽  
P Li ◽  
L Cui ◽  
Y Luo ◽  
C Vetter ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Bone Fractures ◽  
Inflammatory Diseases ◽  
Opioid Use Disorder ◽  
Uk Biobank ◽  
Opioid Use ◽  
Logistic Regression Models ◽  
Diagnostic Coding ◽  
Increased Risk ◽  
Opioid Use Disorders

Abstract Introduction In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse. Methods We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases). Results In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia. Conclusion Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

scholarly journals 1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A421-A421
Author(s):  
V B Krishnamurthy ◽  
N Hussain ◽  
K Puzino ◽  
S Yadav ◽  
S Del Tredici ◽  
...  
Keyword(s):  
Development Program ◽  
Severity Index ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Faculty Development Program ◽  
Specific Patient ◽  
Insomnia Disorder ◽  
Penn State ◽  
Psychiatric Conditions

Abstract Introduction Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID). Methods We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S. Results No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group. Conclusion OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population. Support Junior Faculty Development Program, Penn State College of Medicine

scholarly journals Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Warren J. Ferguson ◽  
Joan Johnston ◽  
Jennifer G. Clarke ◽  
Peter J. Koutoujian ◽  
Kathleen Maurer ◽  
...  
Keyword(s):  
Care Coordination ◽  
Institutional Design ◽  
Medical Condition ◽  
Training Group ◽  
Opioid Use Disorder ◽  
Community Treatment ◽  
Opioid Use ◽  
Treatment Protocols ◽  
Treatment Providers ◽  
Opioid Use Disorders

Abstract Background Opioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release. Results All four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release. Conclusions Adoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs.

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 Opioid Use Disorder Treatment Facilities With Programs for Special Populations

2020 ◽  
Vol 59 (3) ◽  
pp. e125-e133 ◽  
Author(s):  
Scott E. Hadland ◽  
Victoria A. Jent ◽  
Rachel H. Alinsky ◽  
Brandon D.L. Marshall ◽  
Pia M. Mauro ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Special Populations ◽  
Opioid Use ◽  
Treatment Facilities ◽  
Disorder Treatment

Medication-Assisted Treatment of Adolescents With Opioid Use Disorders

2018 ◽  
pp. 105-108
Author(s):  
Keyword(s):  
Substance Use ◽  
Young Adults ◽  
Developmentally Appropriate ◽  
Opioid Use Disorder ◽  
Age Group ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Appropriate Treatment ◽  
Opioid Use Disorders ◽  
New Treatments

Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.

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