Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

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Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽

10.1017/cem.2020.438 ◽

2020 ◽

Vol 22 (6) ◽

pp. 784-792 ◽

Cited By ~ 1

Author(s):

Patrick McLane ◽

Ken Scott ◽

Zainab Suleman ◽

Karen Yee ◽

Brian R. Holroyd ◽

...

Keyword(s):

Emergency Department ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Emergency Department Care ◽

Improvement Project ◽

Health Crisis ◽

Opioid Agonist Treatment ◽

Before And After ◽

Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

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Opioid usage trends in treatment – Trends from the field

International Journal of Healthcare ◽

10.5430/ijh.v5n1p29 ◽

2019 ◽

Vol 5 (1) ◽

pp. 29

Author(s):

Jeri Wheeler ◽

Siobhan Morse ◽

Brian Bride

Keyword(s):

Opioid Use Disorder ◽

Prescription Opioids ◽

Opioid Use ◽

Cross Sectional ◽

Before And After ◽

Polysubstance Abuse ◽

Group 2 ◽

Legislative Changes ◽

Treatment Trends ◽

Group 1

Objective: As legislative changes limiting access to prescription opioids were enacted, the population of opioid use disorder patients seeking private residential treatment also changed. This study is designed to examine some of the specific changes that were observed between opioid used disorder patients entering treatment before and after the legislative restrictions were enacted.Study design: Retrospective cross-sectional cohort design.Results: Significant changes from Group 1 (patients presenting for treatment in 2009-2011) to Group 2 (patients presenting for treatment in 2014) include a substantial decrease in the usage of prescription opiates. Alongside this reduction, a significant increase was shown in reported heroin abuse with concurrent polysubstance abuse (Cannabis, Amphetamines, and Sedatives), as well as noted employment and family issues.Conclusions: The identified patient presenting to treatment for Opioid Use Disorder has changed over the last several years and treatment should reflect those changes. Not only has this disease become one of opioid usage but of polysubstance abuse and disruption in other areas of life as heroin usage becomes more prominent in patients.

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Dispositional Mindfulness and Aggression Among Adults in Residential Treatment for Opioid Use Disorder: Preliminary Findings From an Applied Setting

Violence and Victims ◽

10.1891/vv-d-18-00036 ◽

2020 ◽

Vol 35 (6) ◽

pp. 828-840

Author(s):

Meagan J. Brem ◽

Ryan C. Shorey ◽

Scott Anderson ◽

Gregory L. Stuart

Keyword(s):

Residential Treatment ◽

Physical Aggression ◽

Negative Relationship ◽

Opioid Use Disorder ◽

Hierarchical Regression ◽

Regression Analyses ◽

Opioid Misuse ◽

Opioid Use ◽

Dispositional Mindfulness ◽

Before And After

Individuals with opioid use disorder (OUD) evidenced high levels of aggression both before and after the onset of opioid misuse. Continued aggression after abstinence suggested that abstinence alone may be inadequate. The present study investigated dispositional mindfulness in relation to aggressive attitudes, and verbal and physical aggression, by reviewing medical records of 163 adults in residential treatment for OUD. Results of hierarchical regression analyses, controlling for age and alcohol/drug use and problems, revealed a negative relationship between dispositional mindfulness and both aggressive attitudes and verbal aggression. Although dispositional mindfulness negatively related to physical aggression at the bivariate level, only alcohol use and problems related to physical aggression in regression analyses. Mindfulness-based treatments may be a useful avenue for targeting aggression within this population.

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Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States

PLoS Medicine ◽

10.1371/journal.pmed.1003119 ◽

2020 ◽

Vol 17 (5) ◽

pp. e1003119

Author(s):

Tyler N. A. Winkelman ◽

Becky R. Ford ◽

Rebecca J. Shlafer ◽

Anna McWilliams ◽

Lindsay K. Admon ◽

...

Keyword(s):

United States ◽

Retrospective Study ◽

Criminal Justice ◽

Pregnant Women ◽

The United States ◽

Opioid Use Disorder ◽

Medicaid Expansion ◽

Opioid Use ◽

Before And After

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An Integrated Hospital Protocol for Persons With Injection-Related Infections May Increase Medications for Opioid Use Disorder Use but Challenges Remain

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa005 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S499-S505

Author(s):

Ellen F Eaton ◽

Rachael A Lee ◽

Andrew O Westfall ◽

R E Mathews ◽

Brandi McCleskey ◽

...

Keyword(s):

Sociodemographic Factors ◽

Infectious Complications ◽

Opioid Use Disorder ◽

University Of Alabama ◽

Opioid Use ◽

Addiction Medicine ◽

Before And After ◽

History Of ◽

Infectious Diseases Consultation ◽

The University

Abstract Background Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge. Methods This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018. The protocol, the intravenous antibiotic and addiction team (IVAT), included Addiction Medicine and Infectious Diseases consultation and a 9-item risk assessment. We quantified MOUD use before and after IVAT and used logistic regression to determine factors associated with MOUD. We explored barriers to MOUD uptake using chart review. Results A total of 37 and 98 patients met criteria in the pre- and post-IVAT periods, respectively. With IVAT, the percentage with OUD receiving MOUD significantly increased (29% pre-IVAT and 37% post-IVAT; P = .026) and MOUD use was higher in “high risk” participants (62%). Clinical and sociodemographic factors were not associated with MOUD receipt. Conclusions A hospital-based protocol may increase the use of MOUD; however, the uptake of MOUD remains suboptimal (<50%).

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Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder

Psychopharmacology ◽

10.1007/s00213-018-4966-9 ◽

2018 ◽

Vol 235 (9) ◽

pp. 2713-2723 ◽

Cited By ~ 15

Author(s):

Kenzie L. Preston ◽

William J. Kowalczyk ◽

Karran A. Phillips ◽

Michelle L. Jobes ◽

Massoud Vahabzadeh ◽

...

Keyword(s):

Drug Use ◽

Opioid Use Disorder ◽

Stressful Events ◽

Opioid Use ◽

Before And After ◽

The Hours

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Social Work Students’ Attitudes and Skills Self-Efficacy Toward Collaborative Practice Improve After Interprofessional Opioid Use Disorder Case Discussion

Advances in Social Work ◽

10.18060/23661 ◽

2020 ◽

Vol 20 (2) ◽

pp. 204-215

Author(s):

Isok Kim ◽

Diane E. Elze ◽

Patricia J. Ohtake

Keyword(s):

Social Work ◽

Self Efficacy ◽

Social Work Students ◽

Opioid Use Disorder ◽

Opioid Use ◽

Case Discussion ◽

Before And After ◽

Students Attitudes ◽

Work Education ◽

Work Student

Few studies have examined social work student outcomes after engagement in interprofessional (IP) learning experiences. We examined self-reported attitudes and skills self-efficacy among social work students before and after their engagement in IP Forums. The data comes from social work students who participated in 2016-2018 Fall IP Forums focusing on opioid use disorder. Using the Interprofessional Attitudes Scale (IPAS) and the Interprofessional Collaborative Competency Attainment Scale, revised (ICCAS), we assessed students’ self-reported attitudes (IPAS) and skills self-efficacy (ICCAS) before and after the Fall IP Forums. Paired t-tests identified significant changes in IPAS and ICCAS scores. Students reported increases in their IP attitudes and skills self-efficacy following participation in the IP Forum as measured by pre-IPAS score (n=236, M=4.56, SD=0.29) to post-IPAS score (M=4.68, SD=0.27; t(156)=-5.31, p<.001). Post-ICCAS score also increased (n=48, M=4.26, SD=0.69; t(33)= -5.75, p<.001) from the pre-ICCAS score (M=3.55, SD=0.92). The 2015 Council on Social Work Education Accreditation Standards require that social work students learn how to value and engage in interprofessional teams. Given the self-reported increases in IP attitudes and skills self-efficacy seen in this study, IP Forum participation will help foster greater engagement and contribution to overall IP experiences for social work students.

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Changing student attitudes and perceptions toward opioid use disorder

Mental Health Clinician ◽

10.9740/mhc.2018.09.222 ◽

2018 ◽

Vol 8 (5) ◽

pp. 222-226 ◽

Cited By ~ 7

Author(s):

Haley Countey ◽

Claire Steinbronn ◽

Sarah E. Grady

Keyword(s):

Student Attitudes ◽

Treatment Options ◽

Panel Discussion ◽

Opioid Use Disorder ◽

Depth Information ◽

Opioid Use ◽

Care Needs ◽

Before And After ◽

Negative Perceptions ◽

Good Resource

Abstract Introduction: With the opioid epidemic creating a group of patients with unique health care needs, pharmacists have an opportunity to be a good resource for patients recovering from opioid use disorder (OUD). To accomplish this, it is essential that pharmacists are knowledgeable and unbiased toward this patient population. Methods: Because the curriculum in place to obtain a PharmD at Drake University does not include in-depth information on substance use disorders, study investigators offered students an opportunity to receive more intensive education. Faculty members at Drake University provided didactic and panel discussion presentations on topics such as opioid pharmacology, OUD, and treatment options. The students were assessed for their perception of knowledge and stigma before and after the summit by using a 5-point Likert scale to measure their attitudes toward 10 statements. Results: Total knowledge scores showed a significant change of 3.1, indicating an increase in perceived understanding of materials presented (P < .0001). Total stigma scores also changed by 1.4, illustrating a statistically significant decrease in negative perceptions (P = .0198). Discussion: By providing more in-depth education, the summit showed that increasing pharmacy student knowledge about OUD and its treatment may decrease associated stigma.

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