Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment

Abstract Introduction Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) prevents HIV among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use, PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC-Baltimore. PrEP counseling was conducted from HCV treatment Day 0 until Week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried bloodspot TDF analysis. Results 198 participants were enrolled, of whom 185 (93%) were HIV-negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. 116 participants (62.7%) met 2014 CDC PrEP criteria due to IDU (82, 44.3%), sex (9, 4.9%), or both practices (25, 13.5%). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (IQR 28, 276), with 8 participants retained through Week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

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Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder

Contemporary Clinical Trials ◽

10.1016/j.cct.2021.106394 ◽

2021 ◽

Vol 105 ◽

pp. 106394

Author(s):

Nikhil Seval ◽

Cynthia A. Frank ◽

Alain H. Litwin ◽

Prerana Roth ◽

Meredith A. Schade ◽

...

Keyword(s):

Infectious Disease ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Opioid Use Disorder ◽

Opioid Use ◽

Care Model ◽

Disease Treatment ◽

Randomized Controlled ◽

Long Acting ◽

Design And Methods

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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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Integrated, Co-located, Telemedicine-based Treatment Approaches for Hepatitis C Virus Management in Opioid Use Disorder Patients on Methadone

Clinical Infectious Diseases ◽

10.1093/cid/ciy899 ◽

2018 ◽

Vol 69 (2) ◽

pp. 323-331 ◽

Cited By ~ 15

Author(s):

Andrew H Talal ◽

Phyllis Andrews ◽

Anthony Mcleod ◽

Yang Chen ◽

Clewert Sylvester ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Multiple Correspondence Analysis ◽

Opioid Use Disorder ◽

Hcv Rna ◽

Directly Observed Therapy ◽

Opioid Use ◽

Hcv Treatment ◽

Opioid Substitution Therapy ◽

Direct Acting

Abstract Background Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype, and noninvasive fibrosis assessments) were obtained onsite and direct-acting antivirals were coadministered with methadone using modified directly observed therapy. We used multiple correspondence analysis, least absolute shrinkage and selection operator, and logistic regression to identify variables associated with pursuit of HCV care. Results Sixty-two HCV RNA–positive patients (24% human immunodeficiency virus [HIV] infected, 61% male, 61% African American, 25.8% Hispanic) were evaluated. All patients were stabilized on methadone and all except 4 were HCV genotype 1 infected. Advanced fibrosis/cirrhosis was present in 34.5% of patients. Of the 45 treated patients, 42 (93.3%) achieved viral eradication. Of 17 evaluated patients who were not treated, 5 were discontinued from the drug treatment program or did not follow up after the evaluation, 2 had HIV adherence issues, and 10 had insurance authorization issues. Marriage and a mental health diagnosis other than depression were the strongest positive predictors of treatment pursuit, whereas being divorced, separated, or widowed was the strongest negative predictor. Conclusions HCV management via telemedicine integrated into an OST program is a feasible model with excellent virologic effectiveness. Psychosocial and demographic variables can assist in identification of subgroups with a propensity or aversion to pursue HCV treatment.

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Predictors of availability of long-acting medication for opioid use disorder

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2019.107586 ◽

2019 ◽

Vol 204 ◽

pp. 107586 ◽

Cited By ~ 2

Author(s):

Chelsea L. Shover ◽

Keith Humphreys

Keyword(s):

Opioid Use Disorder ◽

Opioid Use ◽

Long Acting

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Buprenorphine exposure alters the development and migration of interneurons in the cortex

10.1101/2020.10.26.356022 ◽

2020 ◽

Author(s):

Vanesa Nieto-Estévez ◽

Jennifer J. Donegan ◽

Courtney McMahon ◽

Hannah B. Elam ◽

Teresa A. Chavera ◽

...

Keyword(s):

Human Brain ◽

Fetal Brain ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Child Bearing ◽

Increased Risk ◽

Adverse Neonatal Outcomes ◽

And Migration ◽

Long Acting

ABSTRACTThe misuse of opioids has reached epidemic proportions over the last decade, with over 2.1 million people in the U.S. suffering from substance use disorders related to prescription opioid pain relievers. This increase in opioid misuse affects all demographics of society, including women of child-bearing age, which has led to a rise in opioid use during pregnancy. Opioid use during pregnancy has been associated with increased risk of obstetric complications and adverse neonatal outcomes, including neonatal abstinence syndrome. Currently, opioid use disorder in pregnant women is treated with long-acting opioid agonists, including buprenorphine. Although buprenorphine reduces illicit opioid use during pregnancy and improves infant outcomes at birth, few long-term studies of the neurodevelopmental consequences have been conducted. The goal of the current experiments was to examine the effects of buprenorphine on the development of the cortex using fetal brain tissue, 3D brain cultures, and rodent models. First, we demonstrated that we can grow cortical and subpallial spheroids, which model the cellular diversity, connectivity, and activity of the developing human brain. Next, we show that cells in the developing human cortex express the nociceptin opioid (NOP) receptor and that buprenorphine can signal through this receptor in cortical spheroids. Using subpallial spheroids to grow inhibitory interneurons, we show that buprenorphine can alter interneuron development and migration into the cortex. Finally, using a rodent model of prenatal buprenorphine exposure, we demonstrate that alterations in interneuron distribution can persist into adulthood. Together, these results suggest that more research is needed into the long-lasting consequences of buprenorphine exposure on the developing human brain.

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Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00275-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Noa Krawczyk ◽

Adetayo Fawole ◽

Jenny Yang ◽

Babak Tofighi

Keyword(s):

Harm Reduction ◽

Scoping Review ◽

English Language ◽

Data Extraction ◽

Home Delivery ◽

Opioid Use Disorder ◽

Opioid Use ◽

Policy And Practice ◽

Patient Centered ◽

Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

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Implementing a Low-threshold Audio-only Telehealth Model for Medication-assisted Treatment of Opioid Use Disorder at a Community-based Non-profit Organization in Washington, D.C.

10.21203/rs.3.rs-915722/v1 ◽

2021 ◽

Author(s):

Ellis Jaewon Yeo ◽

Hannah Kralles ◽

David Sternberg ◽

Dana McCullough ◽

Ajetha Nadanasabesan ◽

...

Keyword(s):

Patient Characteristics ◽

The United States ◽

Opioid Use Disorder ◽

Retention Rates ◽

People Who Use Drugs ◽

Opioid Use ◽

Treatment Access ◽

Community Based ◽

Medication Assisted Treatment ◽

Low Threshold

Abstract BackgroundThe COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the United States, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Case PresentationThis case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. ConclusionsLow-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

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