scholarly journals The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

2020 ◽  
Author(s):  
Pengyue Zhang ◽  
Chien-Wei Chiang ◽  
Sara Quinney ◽  
Macarius Donneyong ◽  
Bo Lu ◽  
...  
Keyword(s):  
Large Scale ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
P Value ◽  
Opioid Use ◽  
Pain Medications ◽  
Real World Evidence ◽  
Opioid Medications ◽  
Buprenorphine Treatment

ABSTRACTIntroductionRetention in buprenorphine treatment for opioid use disorder (OUD) yields better opioid abstinence and reduces all-cause mortality for patients with OUD. Despite significant efforts have been made to expand the availability and use of buprenorphine in the United States, its retention rates remain on a low level. The current study examines discontinuation of buprenorphine with respect to concurrent initiation of other medications using real-world evidence.MethodsCase-crossover study was conducted to examine discontinuation of buprenorphine using a large-scale longitudinal health dataset including 148,306 commercially-insured individuals initiated on medications for opioid use disorder (MOUD). Odds ratios and Bonferroni adjusted p-values were calculated for medications and therapeutic classes of medications.ResultsClonidine was associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone (OR = 1.583 and adjusted p-value = 1.22 × 10−6) and using naltrexone as a comparison drug (OR = 2.706 and adjusted p-value = 4.11 × 10−5). Opioid medications (oxycodone, morphine and fentanyl) and methocarbamol were associated with increased discontinuation risk of buprenorphine using the buprenorphine dataset alone (adjusted p-value < 0.05), but not significant using naltrexone as a comparison drug. 6 drug therapeutic classes were associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone and using naltrexone as a comparison drug (adjusted p-value < 0.05).ConclusionConcurrent initiation of medications is associated with increased discontinuation risk of buprenorphine. Opioid medications are prescribed among patients on MOUD and associated with increased discontinuation risk of buprenorphine. Analgesics is associated with increased discontinuation risk of buprenorphine for patients without previous exposure of pain medications.

Neurofeedback for Opioid Dependent Patients in an Outpatient Setting: A Pilot Feasibility Study

2021 ◽  
Author(s):  
Helena A. Rempala ◽  
Justin A. Barterian
Keyword(s):  
Large Scale ◽  
The United States ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
High Rate ◽  
Treatment Center ◽  
Opioid Use ◽  
Treatment As Usual ◽  
Factors Affecting ◽  
Study Approach

Abstract Background: Neurofeedback (NF) has been described as “probably efficacious” when used in conjunction with other interventions for substance use disorders, including the most recent studies in population of individuals with opioid use disorder. Despite these promising outcomes, the seriousness of the opioid epidemic, and the high rate of relapse even with the most effective medication-assisted maintenance treatments NF continues to be an under-researched treatment modality. This article explores factors that affected the feasibility of adding Alpha/Theta Neurofeedback to treatment as usual for opioid dependence in an outpatient urban treatment center. The study strived to replicate previous research completed in Iran that found benefits of NF for opioid dependence.Methods: Out of approximately two dozen patients eligible for Alpha/Theta NF, about 60% (n=15) agreed to participate; however, only 2 participants completed treatment. The rates of enrollment in response to active treatment were monitored. Results: The 4 factors affecting feasibility were: 1) the time commitment required of participants, 2) ineffectiveness of standard incentives to promote participation, 3) delayed effects of training, and 4) the length and number of treatments required.Conclusion: The findings indicate a large scale study examining the use of NF for the treatment of opioid use disorder in the United States will likely be difficult to accomplish without modification to the traditional randomized control study approach and suggests challenges to the implementation of this treatment in an outpatient setting.

scholarly journals 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.

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.

scholarly journals Illicit Opioid Intoxication: Diagnosis and Treatment

2011 ◽  
Vol 5 ◽  
pp. SART.S7090
Author(s):  
A. Fareed ◽  
S. Stout ◽  
J. Casarella ◽  
S. Vayalapalli ◽  
J. Cox ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Heroin Use ◽  
Treatment And Prevention ◽  
Pain Medications ◽  
Opioid Intoxication ◽  
Opioid Drugs ◽  
Opioid Medications

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

scholarly journals Disparities in Opioid Use Disorder Treatment Admissions in the United States

2020 ◽  
Vol 7 (1) ◽  
pp. 85-93
Author(s):  
Peter Mallow ◽  
Michael Mercado ◽  
Michael Topmiller
Keyword(s):  
United States ◽  
Wait Time ◽  
The United States ◽  
Opioid Use Disorder ◽  
P Value ◽  
Opioid Use ◽  
Data Set ◽  
Significant Difference ◽  
Receive Treatment ◽  
To Receive

Objectives: The Cincinnati region has been at the epicenter of the nation’s unfolding opioid epidemic. The objectives of this study were twofold: (1) to compare the Cincinnati region to the United States in length of time to obtain treatment and planned medication-assisted therapy for the treatment for opioid use disorder (OUD); and (2) to assess racial disparities within the Cincinnati region in wait time and type of treatment. Methods: The 2017 Treatment Episode Data Set: Admissions (TEDS-A) from the Substance Abuse and Mental Health Services Administration (SAMHSA) was used to identify a cohort of eligible individuals with a primary substance use of opioids, including opioid derivatives. Logistic regression models were performed to assess the differences for treatment wait time and type of planned treatment. Model covariates included patient demographics and socioeconomic characteristics. Three different models were performed to assess the influence of covariates of the outcomes. Results: There were 678 766 US and 3298 Cincinnati region individuals admitted for OUD treatment in 2017. The rate per 1000 for treatment admissions was 2.08 and 1.51 (P value < 0.0001) for the United States and Cincinnati, respectively. The fully saturated regression results found that the odds of Cincinnati individuals receiving planned medication-assisted therapy were 0.497 (95% CI, 0.451–0.546; P value < 0.001). The odds of waiting longer for treatment in Cincinnati were higher than in the United States as a whole: 2.33 (95% CI, 2.19–2.48; P value < 0.001). In Cincinnati, there were 3102 Caucasian, 123 African American, and 73 Other admissions. The fully saturated model results found that Caucasians and Other had an increased likelihood of receiving planned medication-assisted therapy (OR 1.89, P value 0.039; OR 7.07, P value 0.002, respectively) compared to African Americans. Within Cincinnati, there was not a statistically significant difference in the likelihood of waiting time to receive treatment by race. Conclusion: Individuals seeking treatment for OUD in Cincinnati were less likely to receive planned medication-assisted therapy and were more likely to wait longer than individuals in the United States as a whole. These results suggest that the demand for treatment is greater than the supply in Cincinnati. Within Cincinnati, there does not appear to be a racial disparity in treatment type or length of time to receive treatment for OUD.

Analyzing Opioid-Use Disorder Websites In The United States: An Optimized Website Usability Study (Preprint)

2021 ◽  
Author(s):  
Shuhan He ◽  
Saishravan Shyamsundar ◽  
Paul Chong ◽  
Jasmine Kannikal ◽  
Joshua David Calvano ◽  
...  
Keyword(s):  
United States ◽  
Usability Testing ◽  
The United States ◽  
Opioid Use Disorder ◽  
Previous Literature ◽  
Accurate Information ◽  
P Value ◽  
Opioid Use ◽  
Website Usability ◽  
Google Search

BACKGROUND As the United States continues to tackle the opioid epidemic, it is imperative for digital healthcare organizations to provide internet users accurate and accessible online resources so that they can make informed decisions with regards to their health. The aim of this study was to analyze the usability of opioid-use disorder (OUD) websites. OBJECTIVE The primary objectives of this study were based on the objectives established by previous literature but were adapted towards analyzing usability of OUD-related websites. The objectives were to adapt and modify a previously established usability methodology from literature, apply this modified methodology in order to analyze OUD websites, and make important recommendations that OUD-related digital health organizations may utilize to improve their online presence. METHODS A list of 208 websites (later refined to sample size of “n=96” websites) were generated for usability testing using a modified Google search methodology established by previous literature. Four keywords were chosen and used in the search: “DEA-X Waiver Training”, “OUD Initiatives”, “Buprenorphine Assisted Treatment” and “Opioid-Use Disorder Websites”. The list was compiled between April 20, 2021 and April 23, 2021. Using an usability methodology established by previous literature, website usability testing was performed from April 24, 2021 to May 19, 2021. Usability analysis was performed concurrently with optimization of the methodology. OUD websites were analyzed and scored on several usability categories. RESULTS “DEA-X Waiver Training” yielded websites that scored the highest average in “Accessibility” (0.84), while “Opioid-Use Disorder Websites” yielded websites that scored the highest average in “Content Quality” (0.67). “Buprenorphine Assisted Treatment” yielded websites that scored the highest average across “Marketing” (0.52), “Technology” (0.89), “General Usability” (0.69), and “Overall Usability” (0.68). “Technology” was the highest scoring usability category among all of the keywords. “Marketing” was the lowest scoring category among all keywords. Statistical T-test analysis revealed that each usability, except “Marketing” had a pair of one or more keywords that were significantly different with a P-value that was equal to or less than 0.05. CONCLUSIONS Based on the findings, we recommend that digital organizations in the OUD space should improve their “General Usability” score by making their websites more discoverable (thereby improving their “Marketing” usability score as well). Doing so, may allow many users, especially individuals in the OUD space, to discover pertinent and accurate information that they are seeking. In conclusion, the primary objectives of this study were addressed. A previously established usability methodology was adapted and modified for the analysis of OUD websites. Based on the study findings, we made important recommendations that OUD-related digital organizations may utilize in order to improve website usability as well as overall reach.

Two Different Buprenorphine Treatment Settings With Similar Retention Rates: Implications for Expanding Access to Treatment for Opioid Use Disorder

2018 ◽  
Vol 25 (4) ◽  
pp. 305-313
Author(s):  
Matthew Tierney ◽  
Katerina Melino ◽  
Adebowale Adeniji ◽  
Martha Shumway ◽  
Isabel E. Allen ◽  
...  
Keyword(s):  
Primary Care Clinic ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Retention Rates ◽  
Opioid Use ◽  
Access To Treatment ◽  
Care Clinic ◽  
Similar Treatment ◽  
Buprenorphine Treatment ◽  
Treatment Settings

INTRODUCTION: There is considerable need for effective and accessible treatment for opioid use disorder. AIMS: Our study explored differences in buprenorphine treatment retention and duration, with a focus on selected sociodemographic factors and treatment indicators, in two different settings: an office-based buprenorphine induction and stabilization clinic (OBIC) and a community-based primary care clinic (CPC). METHOD: This nonexperimental retrospective chart review compared demographic information and buprenorphine treatment details, including treatment retention and duration. RESULTS: There were no statistically significant differences in buprenorphine treatment indicators between the OBIC and CPC groups, with two exceptions: the number of written buprenorphine prescriptions was significantly greater for the OBIC group, as was the number of filled buprenorphine prescriptions. CONCLUSIONS: Given similar treatment retention and duration in two different buprenorphine treatment settings, our findings suggest that access to buprenorphine treatment in standard integrated care settings can be supplemented by novel treatment structures such as the OBIC in order to increase access to care during the current opioid epidemic.

scholarly journals Pharmacy Technicians, Stigma, and Compassion Fatigue: Front-Line Perspectives of Pharmacy and the US Opioid Epidemic

2021 ◽  
Vol 18 (12) ◽  
pp. 6231
Author(s):  
Alina Cernasev ◽  
Shane Desselle ◽  
Kenneth C. Hohmeier ◽  
Joanne Canedo ◽  
Britney Tran ◽  
...  
Keyword(s):  
Compassion Fatigue ◽  
Phenomenological Approach ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Pharmacy Technician ◽  
Pharmacy Technicians ◽  
Opioid Medications ◽  
Use Behavior

The opioid epidemic in the United States has led to a quadrupling of opioid overdoses since the 1990s. Stigmas exist among healthcare professionals, and it is essential to educate the next generation of pharmacy technicians regarding opioid use disorder. The main objective of this study was to characterize the phenomenon of stigma through the pharmacy technician lens when taking care of patients who are using opioid medications. Grounded in Van Manen’s phenomenological approach and the Link and Phelan stigmatization model, a qualitative study was conducted from February to June 2020 to understand pharmacy technicians’ perceptions and attitudes towards patients using opioid medications. Focus groups (n = 46) with pharmacy technicians were conducted in-person and online over five months in 2020. Thematic analysis identified three themes that characterize the stigma and the relationship between pharmacy technicians and patients taking opioid medications: (1) pharmacy technician perspectives on stigma and patients with addictive opioid-use behavior; (2) current approaches of pharmacy technicians towards patients with addictive opioid-use behavior; (3) future approaches of pharmacy technicians towards patients with addictive opioid-use behavior. The findings highlight an “ever-present” negative connotation associated with the stigma that is formed from patient interaction. It is necessary to develop proper resources and educational materials to manage the stigma that exists in pharmacies throughout the nation. These resources will facilitate how to address and prevent the stigma among pharmacy technicians in the U.S.

scholarly journals 139. Social Support Decreases No-Show Rates Among Patients with Injection-Drug-Use-Related Infections and Opioid Use Disorder

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S84-S85
Author(s):  
James A Grubbs ◽  
Sarah R Blevins ◽  
Ryan Weeks ◽  
Tiffany Stivers ◽  
Kathryn Sabitus ◽  
...  
Keyword(s):  
Social Support ◽  
Hepatitis C ◽  
Infectious Diseases ◽  
Support Services ◽  
The United States ◽  
Primary Diagnosis ◽  
Opioid Use Disorder ◽  
P Value ◽  
Opioid Use ◽  
Clinic Visits

Abstract Background Opioid overdose is the leading cause of injury-related death in the United States. Kentucky ranks in the top 5 states for overdose death and has one of the highest rates of acute hepatitis C (HCV). Fifty-four of Kentucky’s counties are among the 220 U.S. counties identified as high risk for rapid dissemination of HIV and HCV. Poverty, legal issues, and transportation are barriers to effective treatment of opioid use disorder (OUD) and related infections. The WRAP project (Wrap-around Recovery for Addiction and infectious Diseases project) is an ongoing multi-disciplinary program to expand access to OUD treatment at University of Kentucky HealthCare. This program provides social support including transportation assistance, case management, and counseling. Missed visits have been associated with multiple adverse outcomes. Methods We compared missed infectious diseases clinic visits (n=620) of patients enrolled in WRAP to those of patients who were referred and eligible, but not enrolled using chi-square tests for odds ratios. Results We enrolled 35% of eligible, referred patients. The majority (70%) of patients not enrolled were referred while inpatient and discharged before they could be enrolled. WRAP-enrolled patients missed 21% of visits, whereas WRAP-eligible, non-enrolled patients missed 31% of visits (OR 0.59, 95% CI 0.49 to 0.72, p-value &lt; 0.001), Figure 1. This finding was consistent for WRAP-referred patients with a diagnosis of HIV who were also eligible for Ryan White support services: WRAP-enrolled patients missed 17% of visits and WRAP-eligible, non-enrolled patients missed 25% of visits (OR 0.26, 95% CI 0.20 to 0.35, p-value 0.002). For HCV patients who were mostly referred as outpatients, WRAP-enrolled patients missed 25% of visits while WRAP-eligible, non-enrolled patients missed 39% (OR 0.54, 95% CI 0.41 to 0.72 , p-value 0.0003), Figure 2. Figure 1. ID clinic visit attendance among WRAP eligible, non-enrolled and WRAP enrolled patients. WRAP-enrolled patients missed 21% of visits, whereas WRAP-eligible, non-enrolled patients missed 31% of visits (OR 0.59, 95% CI 0.49 to 0.72, p-value &lt; 0.001). Figure 2. ID clinic attendance among WRAP eligible, non-enrolled and WRAP enrolled patients with HIV and hepatitis C primary diagnoses. A. WRAP-enrolled patients with a primary diagnosis of HIV missed 17% of visits and WRAP-eligible, non-enrolled patients missed 25% of visits (OR 0.26, 95% CI 0.20 to 0.35, p-value 0.002). B. WRAP-enrolled patients with a primary diagnosis of hepatitis C missed 25% of visits while WRAP-eligible, non-enrolled patients missed 39% (OR 0.54, 95% CI 0.41 to 0.72, p-value 0.0003). Conclusion Providing patients with social support services to address barriers to attending clinic visits was associated with fewer missed ID clinic visits. Higher engagement in care is a step towards implementing evidence-based treatment to lessen overdose deaths and injection-related infections. Future projects will include investigating whether WRAP enrollment is associated with fewer hospital admission and ER visits. 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.

scholarly journals “It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Elizabeth C. Saunders ◽  
Sarah K. Moore ◽  
Olivia Walsh ◽  
Stephen A. Metcalf ◽  
Alan J. Budney ◽  
...  
Keyword(s):  
Qualitative Study ◽  
The United States ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Medical Setting ◽  
Integrated Models ◽  
Opioid Use ◽  
Medical Settings ◽  
Psychosocial Services ◽  
Treatment Models

Abstract Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

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