1203. A Descriptive Analysis of an Opioid Use Disorder Care Continuum in an Infectious Diseases Clinic

Abstract Background On December 17, 2020, U.S. CDC released an advisory reporting the highest drug overdose rate on record. Kentucky ranks in the top 5 states for opioid overdose deaths. Retention in opioid use disorder (OUD) treatment is associated with decreased overdose deaths. University of Kentucky HealthCare’s infectious disease division (UKID) implemented a multi-disciplinary approach to expand access to medication for opioid use disorder (MOUD) for patients with injection drug use-associated infections (IDU-AI). This program is modelled after the Ryan White Cares Act to engage and retain patients. Methods . This ongoing project began enrollment in June 2019. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. Patients are eligible for transportation assistance, mental health services, and medical case management. They may start MOUD with UKID or be referred elsewhere. In this analysis, we describe our opioid use disorder care continuum and identify reasons for patient attrition and areas to improve Results Our continuum components are referral, eligible, enrolled, start MOUD, and retention at month 1, 3, and 6. To date, 533 patients have been referred. Of these, 383 (71.9%) were eligible and 150 (39%) enrolled. Reasons patients did not enroll: discharged stable (41.5%), left AMA (16.9%), declined (10.8%), deceased (6.7%), discharged to other hospital (3.6%), missed clinic visit (9.7%), hospice (1%), other (10.8%). Reasons patients declined: no reason (28.6%), refused to discuss (19.1%), no interest (14.3%), travel (4.8%), declined ID follow-up (4.8%), time limits (9.5%). Ninety-three patients have been enrolled ≥6 months; 83 are on MOUD. Sixty-seven, 29, and 20 patients were retained at month 1, 3, and 6, respectively. Conclusion UKID engages patients in OUD treatment, but retention rates are comparable to those described in non-ID settings. Most attrition occurs between eligibility and month 3, suggesting patients are most vulnerable when they consider change and start MOUD. These time points should be priority for patient engagement by clinic staff. Also our staff size struggles to meet the demand. The number of referrals is prohibitive for our small team to approach everyone in a timely manner. More programs like this one are needed. Disclosures All Authors: No reported disclosures

Download Full-text

83. A Descriptive Analysis of a Multi-disciplinary Approach to Opioid Use Disorder Treatment Within an Infectious Diseases Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.393 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S173-S173

Author(s):

Sarah R Blevins ◽

Tiffany Stivers ◽

Kathryn Sabitus ◽

Ryan Weeks ◽

J Zachary Porterfield ◽

...

Keyword(s):

Infectious Diseases ◽

Financial Burden ◽

Descriptive Analysis ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Additional Time ◽

Medication Assisted Treatment ◽

The Us ◽

Overdose Deaths

Abstract Background Opioid overdose is the leading cause of injury-related death in the US. Kentucky ranks in the top 5 states for opioid overdose deaths. The rate of injection drug use-associated infections (IDU-AI) has risen; the University of Kentucky Infectious Diseases division (UKID) treated 401 endocarditis cases in 2018, of which 73% were IDU-AI. To curb overdose deaths, ease financial burden on healthcare, and improve patient outcomes, patients need tools for recovery from opioid use disorder (OUD). Access to OUD treatment in Kentucky and much of the US is limited. Poverty, unemployment, and legal issues are barriers. Methods UKID implemented a multi-disciplinary approach to expand access to medication assisted treatment (MAT). This is an ongoing study. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. At enrollment and at three additional time points, patients complete both a study specific and Government Performance and Results Act (GPRA) survey. Patients may start MAT and mental health counseling with UKID or be referred elsewhere and are eligible for transportation assistance and medical case management. Results To date, there have been 127 referrals. Of these, 87 (69%) were eligible and 54 enrolled (62% of eligible). Primary IVDU-AI includes HIV (n=4; 7%), HCV (n=5; 9%), HIV/HCV (n=3; 6%), endocarditis (n=32; 59%), and other (n=10; 19%). Patients are 48% male (n=26) and 91% white (n=91) with a median age of 34 years (IQR: 16); 35% are receiving MAT (n=19) with 14.8% (n=8) managed by UKID. Other service data are available for 51 patients. Naloxone was dispensed to 45 (88%) patients, 24 (47%) received relapse prevention services, 13 (25%) engaged in peer support, 9 (18%) participated in self-help groups, and 10 (20%) received transportation aid. Conclusion Increasing engagement in MAT and wrap-around services is an important touchpoint for OUD. We present a comprehensive program to achieve this for patients who would otherwise be discharged without follow-up for OUD. This program shows proof of concept that patients can be engaged in MAT by ID providers. Ongoing analysis will include longitudinal review of patient progress and outcomes, including hospital readmission, and a study to determine patients’ perceived impact on their quality of life. Disclosures All Authors: No reported disclosures

Download Full-text

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.

Download Full-text

CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017–2020

Contemporary Drug Problems ◽

10.1177/00914509211052107 ◽

2021 ◽

pp. 009145092110521

Author(s):

Brandon del Pozo

Keyword(s):

Public Health ◽

New York ◽

Performance Metrics ◽

Public Health Intervention ◽

Police Department ◽

Opioid Use Disorder ◽

Health Staff ◽

Opioid Overdose ◽

Opioid Use ◽

Overdose Deaths

From 2017 to early 2020, the US city of Burlington, Vermont led a county-wide effort to reduce opioid overdose deaths by concentrating on the widespread, low-barrier distribution of medications for opioid use disorder. As a small city without a public health staff, the initiative was led out of the police department—with an understanding that it would not be enforcement-oriented—and centered on a local adaptation of CompStat, a management and accountability program developed by the New York City Police Department that has been cited as both yielding improvements in public safety and overemphasizing counterproductive police performance metrics if not carefully directed. The initiative was instrumental to the implementation of several novel interventions: low-threshold buprenorphine prescribing at the city’s syringe service program, induction into buprenorphine-based treatment at the local hospital emergency department, elimination of the regional waiting list for medications for opioid use disorder (MOUD), and the de-facto decriminalization of diverted buprenorphine by the chief of police and county prosecutor. An effort by local legislators resulted in a state law requiring all inmates with opioid use disorder be provided with MOUD as well. By the end of 2018, these interventions were collectively associated with a 50% (17 vs. 34) reduction in the county’s fatal overdose deaths, while deaths increased 20% in the remainder of Vermont. The reduction was sustained through the end of 2019. This article describes the effort undertaken by officials in Burlington to implement these interventions. It provides an example that other municipalities can use to take an evidence-based approach to reducing opioid deaths, provided stakeholders assent to sustained collaboration in the furtherance of a commitment to save lives. In doing so, it highlights that police-led public health interventions are the exception, and addressing the overdose crisis will require reform that shifts away from criminalization as a community’s default framework for substance use.

Download Full-text

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.

Download Full-text

Understanding Medical Students’ Knowledge of Opioid Use Disorder: A Preliminary Study

Innovation in Aging ◽

10.1093/geroni/igaa057.706 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 219-219

Author(s):

Sweta Tewary ◽

Ariel Kidron ◽

Naushira Pandya ◽

Jim Howell ◽

Marie Florent-Caree ◽

...

Keyword(s):

Medical Students ◽

Current Knowledge ◽

Progressive Increase ◽

Opioid Use Disorder ◽

Survey Method ◽

Opioid Overdose ◽

Clinical Knowledge ◽

Opioid Use ◽

Preliminary Study ◽

Overdose Deaths

Abstract The rise of the opioid epidemic over the last two decades has increased the mortality rate, healthcare cost, and drug overdose deaths across the country. Practicing physicians are lacking in education regarding non-opioid alternatives to pain management, prevention, diagnosis, and treatment of opioid use disorder (OUD). Existing literature suggest a link between knowledge discrepancy and opioid use among clinicians resulting in patient’s abuse of opioids. Therefore, it is important to educate medical students at the start of their career. This preliminary study assesses the current knowledge and perceived skills of medical students regarding (OUD)/opioid misuse and related content in order to identify gaps and provide necessary education. The study used a pre-post survey method to understand the demographics, medical, and clinical knowledge about opioid use, abuse, and clinical knowledge regarding patient opioid overdose. The self-administered survey was administered to all students 18 years or older, M1- M4 enrolled in NSU-KPCOM. A total of 1164 students met these criteria. However, only 137 students participated in the Pre-survey collected from August 2019 to September 2019. Approximately 12% of the eligible students participated in the pre-survey. Data was analyzed using frequencies and percentages. Results of the pre-survey suggest a progressive increase in opioid knowledge from M1 to M4 years. Results of the study suggest investigating a relationship between medical education and knowledge of opioid usage, with a specific lens aimed at assessing the efficacy of opioid education during second and third years of medical school

Download Full-text

Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report

Mental Health Clinician ◽

10.9740/mhc.2017.11.287 ◽

2017 ◽

Vol 7 (6) ◽

pp. 287-289

Author(s):

Shuang Ouyang ◽

Troy Moore

Keyword(s):

Case Report ◽

Alcohol Use Disorder ◽

White Male ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Stimulant Use ◽

Pubmed Search ◽

Abuse Treatment ◽

Overdose Deaths

Abstract Opioid overdose–related morbidity and mortality remain one of the most pressing public health crises. Overdose education and naloxone distribution have emerged as an effective initiative for mitigating overdose deaths. This case highlights areas of patient education essential to optimizing treatment outcome when using a naloxone reversal kit. The patient is a 46-year-old white male with a past medical history significant for opioid use disorder, alcohol use disorder, stimulant use disorder, sedative-hypnotic use disorder, and posttraumatic stress disorder. The patient received an intranasal naloxone kit during residential substance abuse treatment. Five months later, the patient requested a new kit and was asked about the disposition of his previous kit. The patient recounted how he was telephoned to pick up an unconscious friend (and fellow veteran) from a nonresidential location. Upon arrival, the patient recognized opioid products near his friend and took steps to reverse the suspected opioid overdose with his 2 mg/2 mL naloxone intranasal kit. The reversal was successful, but many critical rescue response steps were omitted. This case report may guide future changes to educating patients on appropriate responses to opioid overdoses with naloxone. A PubMed search located one other case report of successful naloxone reversal of opioid overdose in the veteran population, which involved fentanyl sold as heroin. In our case report, a veteran successfully used his naloxone kit to reverse a suspected opioid overdose in another veteran, but he incompletely provided the rescue response. This experience may influence content changes for future overdose education and naloxone distribution training.

Download Full-text

Exploration of the STOP Act and Opioid Deaths in North Carolina, 2010–2018

American Journal of Public Health ◽

10.2105/ajph.2020.305748 ◽

2020 ◽

Vol 110 (10) ◽

pp. 1573-1577

Author(s):

Phillip Hughes ◽

Sheri Denslow ◽

Bayla Ostrach ◽

Carriedelle Fusco ◽

Casey Tak

Keyword(s):

North Carolina ◽

Interrupted Time Series ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Interrupted Time Series Analysis ◽

Opioid Use ◽

The North ◽

Opioid Deaths ◽

The Impact ◽

Overdose Deaths

Objectives. To examine the impact of North Carolina’s 2017 Strengthening Opioid Misuse Prevention (STOP) Act on opioid overdose deaths. Methods. We used quarterly data from the North Carolina Opioid Dashboard to conduct an interrupted time series analysis ranging from 2010 to 2018. Results were stratified by heroin–fentanyl deaths and other opioid deaths. Results. After the STOP Act, there was an initial rate increase of 0.60 opioid deaths per 100 000 population (95% confidence interval [CI] = 0.04, 1.15) and a decrease of 0.42 (95% CI = −0.56, −0.29) every quarter thereafter. Results differed by stratification. Conclusions. Our results suggest that North Carolina’s STOP Act was associated with a reduction in opioid deaths in the year following enactment. The changes in opioid overdose death trends coinciding with the STOP Act were similar to outcomes seen with previous opioid policies. Public Health Implications. Future policies designed to reduce the availability of opioids may benefit from encouraging and increasing the availability of evidence-based treatment of opioid use disorder.

Download Full-text

Reducing the stigma surrounding opioid use disorder: evaluating an opioid overdose prevention training program applied to a diverse population

Harm Reduction Journal ◽

10.1186/s12954-022-00589-6 ◽

2022 ◽

Vol 19 (1) ◽

Author(s):

Nicholas Alexander Bascou ◽

Benjamin Haslund-Gourley ◽

Katrina Amber-Monta ◽

Kyle Samson ◽

Nathaniel Goss ◽

...

Keyword(s):

Primary Outcome ◽

Opioid Use Disorder ◽

Health Concern ◽

Opioid Overdose ◽

Opioid Use ◽

Overdose Prevention ◽

Faculty Advisors ◽

The Usa ◽

Attitudes And Knowledge ◽

Overdose Deaths

Abstract Background The opioid epidemic is a rapidly growing public health concern in the USA, as the number of overdose deaths continues to increase each year. One strategy for combating the rising number of overdoses is through opioid overdose prevention programs (OOPPs). Objective To evaluate the effectiveness of an innovative OOPP, with changes in knowledge and attitudes serving as the primary outcome measures. Methods The OOPP was developed by a group of medical students under guidance from faculty advisors. Training sessions focused on understanding stigmatizing factors of opioid use disorder (OUD), as well as protocols for opioid overdose reversal through naloxone administration. Pre- and post-surveys were partially adapted from the opioid overdose attitudes and knowledge scales and administered to all participants. Paired t-tests were conducted to assess differences between pre- and post-surveys. Results A total of 440 individuals participated in the training; 381 completed all or the majority of the survey. Participants came from a diverse set of backgrounds, ages, and experiences. All three knowledge questions showed significant improvements. For attitude questions, significant improvements were found in all three questions evaluating confidence, two of three questions assessing attitudes towards overdose reversal, and four of five questions evaluating stigma and attitudes towards individuals with OUD. Conclusions Our innovative OOPP was effective not only in increasing knowledge but also in improving attitudes towards overdose reversal and reducing stigma towards individuals with OUD. Given the strong improvements in attitudes towards those with OUD, efforts should be made to incorporate the unique focus on biopsychosocial and sociohistorical components into future OOPPs.

Download Full-text

Epigenetic and Genetic Factors Associated With Opioid Use Disorder: Are These Relevant to African American Populations

Frontiers in Pharmacology ◽

10.3389/fphar.2021.798362 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christopher A. Blackwood ◽

Jean Lud Cadet

Keyword(s):

Genetic Factors ◽

Clinical Manifestations ◽

The United States ◽

Opioid Use Disorder ◽

Treatment Programs ◽

Opioid Overdose ◽

Racial Groups ◽

Epigenetic Alterations ◽

Opioid Use ◽

Overdose Deaths

In the United States, the number of people suffering from opioid use disorder has skyrocketed in all populations. Nevertheless, observations of racial disparities amongst opioid overdose deaths have recently been described. Opioid use disorder is characterized by compulsive drug consumption followed by periods of withdrawal and recurrent relapses while patients are participating in treatment programs. Similar to other rewarding substances, exposure to opioid drugs is accompanied by epigenetic changes in the brain. In addition, genetic factors that are understudied in some racial groups may also impact the clinical manifestations of opioid use disorder. These studies are important because genetic factors and epigenetic alterations may also influence responses to pharmacological therapeutic approaches. Thus, this mini-review seeks to briefly summarize what is known about the genetic bases of opioid use disorder in African Americans.

Download Full-text

“The idea is to help people achieve greater success and liberty”: a qualitative study of expanded methadone take-home access in opioid use disorder treatment

10.1101/2021.08.20.21262382 ◽

2021 ◽

Author(s):

Leslie W. Suen ◽

Stacy Castellanos ◽

Neena Joshi ◽

Shannon Satterwhite ◽

Kelly R. Knight

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Clinical Decision Making ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Housing Status ◽

The Impact ◽

Overdose Deaths

AbstractBackgroundPrior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California.MethodsWe interviewed 10 providers and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes.ResultsProviders discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making.ConclusionFederal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.

Download Full-text