Changing Policy Landscape: How a Hospital-Based Opioid Treatment Program Adapted Care for Patients With Opioid Use Disorder During the COVID-19 Pandemic

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry.

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Impact of Office-based Opioid Treatment on Emergency Visits and Hospitalization in Adolescents with Opioid Use Disorder

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.12.058 ◽

2020 ◽

Vol 219 ◽

pp. 236-242

Author(s):

Kim S. Walker ◽

Andrea E. Bonny ◽

Erin R. McKnight ◽

Milap C. Nahata

Keyword(s):

Opioid Use Disorder ◽

Opioid Use ◽

Emergency Visits ◽

Opioid Treatment

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The Pregnancy Recovery Center: A women-centered treatment program for pregnant and postpartum women with opioid use disorder

Addictive Behaviors ◽

10.1016/j.addbeh.2018.05.016 ◽

2018 ◽

Vol 86 ◽

pp. 124-129 ◽

Cited By ~ 17

Author(s):

Elizabeth E. Krans ◽

Stephanie Bobby ◽

Michael England ◽

Robert H. Gedekoh ◽

Judy C. Chang ◽

...

Keyword(s):

Treatment Program ◽

Opioid Use Disorder ◽

Postpartum Women ◽

Opioid Use

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Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00268-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sara J. Becker ◽

Cara M. Murphy ◽

Bryan Hartzler ◽

Carla J. Rash ◽

Tim Janssen ◽

...

Keyword(s):

Public Health ◽

Patient Outcomes ◽

The United States ◽

Opioid Use Disorder ◽

Treatment Programs ◽

Opioid Use ◽

Opioid Treatment ◽

Implementation Outcomes ◽

Cluster Randomized ◽

Type 3

Abstract Background Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). Methods A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff’s extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff’s intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). Discussion There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. Trial registration: This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1

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How to Find a Treatment Program for Opioid Use Disorder

PsycEXTRA Dataset ◽

10.1037/e503962019-001 ◽

2018 ◽

Keyword(s):

Treatment Program ◽

Opioid Use Disorder ◽

Opioid Use

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Effectiveness of a substance use treatment program for veterans with chronic pain and opioid use disorder

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2021.108635 ◽

2021 ◽

pp. 108635

Author(s):

Ralph Ward ◽

Yi-lang Tang ◽

Robert Neal Axon ◽

Jennifer Casarella ◽

Natasha Whitfield ◽

...

Keyword(s):

Chronic Pain ◽

Substance Use ◽

Treatment Program ◽

Opioid Use Disorder ◽

Substance Use Treatment ◽

Opioid Use

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Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice

Addiction Science & Clinical Practice ◽

10.1186/s13722-019-0175-z ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Jarratt D. Pytell ◽

Megan E. Buresh ◽

Ryan Graddy

Keyword(s):

Retrospective Chart Review ◽

Internal Medicine Resident ◽

Patient Characteristics ◽

Opioid Use Disorder ◽

Opioid Use ◽

Continuity Clinic ◽

Opioid Treatment ◽

Attitudes And Practices ◽

Medicine Resident ◽

Resident Continuity Clinic

Abstract Background The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices. Methods A novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes. Results Twelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9–15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD. Conclusions OBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.

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Federally Qualified Health Centers Can Expand Rural Access to Buprenorphine for Opioid Use Disorder in Arizona

Health Services Insights ◽

10.1177/11786329211037502 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110375

Author(s):

Benjamin R Brady ◽

Rachel Gildersleeve ◽

Bryna D Koch ◽

Doug E Campos-Outcalt ◽

Daniel J Derksen

Keyword(s):

Rural Areas ◽

Underserved Populations ◽

Opioid Use Disorder ◽

Health Centers ◽

Opioid Use ◽

Federally Qualified Health Centers ◽

Treatment Access ◽

Opioid Treatment ◽

Rural Access ◽

The Impact

Medication for Opioid Use Disorder (MOUD) is recommended, but not always accessible to those who desire treatment. This study assessed the impact of expanding access to buprenorphine through federally qualified health centers (FQHCs) in Arizona. We calculated mean drive-times to Arizona opioid treatment (OTP) locations, office-based opioid treatment (OBOT) locations, and FQHCs clinics using January 2020 location data. FQHCs were designated as OBOT or non-OBOT clinics to explore opportunities to expand treatment access to non-OBOT clinics (potential OBOTs) to further reduce drive-times for rural and underserved populations. We found that OTPs had the largest mean drive times (16.4 minutes), followed by OBOTs (7.1 minutes) and potential OBOTs (6.1 minutes). Drive times were shortest in urban block groups for all treatment types and the largest differences existed between OTPs and OBOTs (50.6 minutes) in small rural and in isolated rural areas. OBOTs are essential points of care for opioid use disorder treatment. They reduce drive times by over 50% across all urban and rural areas. Expanding buprenorphine through rural potential OBOT sites may further reduce drive times to treatment and address a critical need among underserved populations.

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Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county

PLoS ONE ◽

10.1371/journal.pone.0250324 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0250324

Author(s):

Ayaz Hyder ◽

Jinhyung Lee ◽

Ashley Dundon ◽

Lauren T. Southerland ◽

David All ◽

...

Keyword(s):

Public Safety ◽

Public Transit ◽

Safety Data ◽

Opioid Use Disorder ◽

Spatial Accessibility ◽

Opioid Overdose ◽

Opioid Use ◽

Treatment Provider ◽

Opioid Treatment ◽

White Adults

Objectives An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. Methods We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. Results A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Conclusions Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.

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