scholarly journals 2900. High Rates of Experienced and Witnessed Opioid Overdose in PWID Receiving HCV Treatment: Data From the ANCHOR Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S83-S83
Author(s):  
Elana S Rosenthal ◽  
Laura Nussdorf ◽  
Aaron D’Amore ◽  
Christopher Brokus ◽  
Rachel Silk ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Opioid Use Disorder ◽  
Morbidity And Mortality ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Single Center Study ◽  
Treatment Data ◽  
Evidenced Based ◽  
Chronic Hcv

Abstract Background People who inject drugs (PWID) have significant morbidity and mortality associated with hepatitis C (HCV); however, harms associated with ongoing injecting drug use (IDU)—such as opioid overdose—may pose a more imminent risk, and often are not addressed as part of HCV treatment. Naloxone distribution is a simple, evidenced-based strategy to reduce mortality associated with opioid overdose. Methods ANCHOR is a single-center study embedded in an urban harm-reduction program evaluating treatment of HCV in PWID with chronic HCV, opioid use disorder (OUD), and IDU. Participants received HCV treatment and were offered collocated buprenorphine. At each study visit, patients self-reported experienced and witnessed overdose and were offered naloxone. Results The 100 enrolled participants are predominantly male (75%), median 57 years, black (93%) and inject opioids at least daily (58%). At baseline, 65% had ever experienced overdose, 91% had ever witnessed an overdose, and 35% had ever administered naloxone. Between day 0 and week 48, 15 patients (15%) experienced overdose; of which, 4 (4%) were fatal. The rate of experienced overdose was 15 overdoses per 100 person-years. In addition, 59 (59%) patients witnessed at least one overdose between day 0 and week 48. Seventy-three patients were dispensed naloxone at least once, and of those who witnessed an overdose, 48 (81%) administered naloxone. Nineteen (40%) patients who administered naloxone had never used naloxone before starting HCV treatment. Conclusion PWID with HCV, OUD, and ongoing IDU have high rates of personal and witnessed overdose during and after HCV treatment. Dispensing naloxone at HCV-related visits is highly acceptable among PWID, and results in high rates of naloxone utilization. To reduce morbidity and mortality in patients and their communities, ID providers should complement treatment of infections by prescribing naloxone for patients with OUD, ideally as part of a comprehensive package of harm reduction and OUD treatment. Disclosures All Authors: No reported Disclosures.

scholarly journals Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Shoshana V. Aronowitz ◽  
Eden Engel-Rebitzer ◽  
Abby Dolan ◽  
Kehinde Oyekanmi ◽  
David Mandell ◽  
...  
Keyword(s):  
Harm Reduction ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Access To Treatment ◽  
Provider Perspectives ◽  
The Usa ◽  
Disorder Treatment

Abstract Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. Methods We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. Results Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients’ access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients’ access to treatment via telehealth may hinge on clinician perceptions of patient “stability” rather than patient preferences. Conclusions Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed “unstable” via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.

scholarly journals 2897. Collocated Buprenorphine Is Associated with Improved HCV Visit Adherence in People Who Inject Drugs (PWID): Data From the ANCHOR Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S82-S82
Author(s):  
Elana S Rosenthal ◽  
Rachel Silk ◽  
Poonam Mathur ◽  
Rahwa Eyasu ◽  
Laura Nussdorf ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
People Who Use Drugs ◽  
High Risk Population ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Visit Adherence ◽  
Chronic Hcv

Abstract Background Engaging PWID in HCV treatment and monitoring for reinfection is critical to eliminate HCV and improve health in people who use drugs. However, PWID are often marginalized and can be difficult to engage and retain in care. The collocation of HCV treatment with buprenorphine to treat opioid use disorder (OUD) may improve visit adherence in this population. Methods ANCHOR is a single-center study evaluating treatment of HCV in PWID with chronic HCV, OUD, and IDU. Participants receive sofosbuvir/velpatasvir x12 weeks and are offered collocated buprenorphine. HCV visits occur at weeks 4, 12, 24, 48, 72 and 96. Results At screening, the 100 enrolled patients were predominantly male (76%), black (93%), middle-aged (median 57years), injected opioids daily or more (58%), and were not on OAT (67%). Fifty-five (55%) patients were initiated on collocated buprenorphine at some point after day 0. Being on collocated buprenorphine at the time of HCV visit was associated with increased likelihood of visit attendance at weeks 12 (P = 0.002), 24 (P = 0.01), 48 (P = 0.02), 72 (P = 0.003), and 96 (P = 0.04). For patients who attended study visits, being on collocated buprenorphine was associated with a shorter time between planned visit and actual visit at weeks 12 (P = 0.03), 24 (P = 0.04), and 48 (P = 0.04). When looking at patients not on collocated buprenorphine, being on noncollocated opioid agonist therapy vs. not being on OUD treatment did not impact visit adherence. Conclusion Evidence-based treatment of HCV and OUD are critical to improving health in PWID. The collocation of HCV treatment with office-based buprenorphine may improve adherence to visits and visit timing, especially in long-term follow-up. Infectious disease providers should offer collocated buprenorphine as a tool to improve long-term outcomes and engagement in this high-risk population. Disclosures All Authors: No reported Disclosures.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

Predicting Opioid Overdose Readmission and Opioid Use Disorder with Machine Learning

2020 ◽  
Author(s):  
Sarah McDougall ◽  
Priyanka Annapureddy ◽  
Praveen Madiraju ◽  
Nicole Fumo ◽  
Stephen Hargarten
Keyword(s):  
Machine Learning ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

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

2018 ◽  
Vol 69 (2) ◽  
pp. 323-331 ◽  
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.

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

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.

scholarly journals Opioid-Related Diagnoses and Concurrent Claims for HIV, HBV, or HCV among Medicare Beneficiaries, United States, 2015

2019 ◽  
Vol 8 (11) ◽  
pp. 1768 ◽  
Author(s):  
Man-Huei Chang ◽  
Ramal Moonesinghe ◽  
Lyna Z. Schieber ◽  
Benedict I. Truman
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Opioid Overdose ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Cross Sectional ◽  
Using Data ◽  
Chronic Hcv ◽  
Demographic Attributes

Unsterile opioid injection increases risk for infection transmission, including HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV). We assess prevalence of and risk factors associated with opioid overdose and infections with HIV, HBV, or HCV among Medicare beneficiaries with opioid-related fee-for-service claims during 2015. We conducted a cross-sectional analysis to estimate claims for opioid use and overdose and HIV, HBV, or HCV infections, using data from US Medicare fee-for-service claims. Beneficiaries with opioid-related claims had increased odds for HIV (2.3; 95% confidence interval (CI), 2.3–2.4), acute HBV (6.7; 95% CI, 6.3–7.1), chronic HBV (5.0; 95% CI, 4.7–5.4), acute HCV (9.6; 95% CI, 9.2–10.0), and chronic HCV (8.9; 95% CI, 8.7–9.1). Beneficiaries with opioid-related claims and for HIV, HBV, or HCV infection, respectively, had a 1.1–1.9-fold odds for having a claim for opioid overdose. Independent risk factors for opioid overdose and each selected infection outcome included age, sex, race/ethnicity, region, and residence in a high-vulnerability county. Having opioid-related claims and selected demographic attributes were independent, significant risk factors for having HIV, HBV, or HCV claims among US Medicare beneficiaries. These results might help guide interventions intended to reduce incidences of HIV, HCV, and HBV infections among beneficiaries with opioid-related claims.

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