scholarly journals Machine Learning Applied to Clinical Laboratory Data Predicts Patient-Specific, Near-Term Relapse in Patients in Medication for Opioid Use Disorder Treatment

2020 ◽  
Author(s):  
Paul Pyzowski ◽  
Barbara Herbert ◽  
Wasim Q. Malik
Keyword(s):  
Addiction Treatment ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Opioid Use Disorder ◽  
Data Driven ◽  
Treatment Programs ◽  
Patient Specific ◽  
Opioid Use ◽  
Disorder Treatment ◽  
Near Term

We have developed a data-driven, algorithmic method for identifying patients in an outpatient buprenorphine program at high risk for relapse in the following seven days. This method uses data already available in clinical laboratory data, can be made available in a timely matter, and is easily understandable and actionable by clinicians. Use of this method could significantly reduce the rate of relapse in addiction treatment programs by targeting interventions at those patients most at risk for near term relapse.

Inpatient Opioid Use Disorder Treatment by Generalists is Associated With Linkage to Opioid Treatment Programs After Discharge

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hannah R. Tierney ◽  
Christopher L. Rowe ◽  
Diana A. Coffa ◽  
Shashi Sarnaik ◽  
Phillip O. Coffin ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Disorder Treatment

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.

Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration

2015 ◽  
Vol 11 (6) ◽  
pp. 459 ◽  
Author(s):  
Marcus A. Bachhuber, MD, MSHP ◽  
Christopher B. Roberts, MPH ◽  
Stephen Metraux, PhD ◽  
Ann Elizabeth Montgomery, PhD
Keyword(s):  
At Risk ◽  
Addiction Treatment ◽  
Women Veterans ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Male Veterans

Objective: To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Setting: Addiction treatment programs operated by the US Department of Veterans Affairs (VA).Participants: All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA’s national homelessness screener. Main outcome measures: Self-reported homelessness or imminent risk of homelessness.Results: The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively).Conclusions: The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

scholarly journals Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US

2021 ◽  
Vol 40 (2) ◽  
pp. 317-325
Author(s):  
Tamara Beetham ◽  
Brendan Saloner ◽  
Marema Gaye ◽  
Sarah E. Wakeman ◽  
Richard G. Frank ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Cost Of Care ◽  
Treatment Programs ◽  
Opioid Use ◽  
The Us

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 Hospital Buprenorphine Program for Opioid Use Disorder Is Associated With Increased Inpatient and Outpatient Addiction Treatment

2021 ◽  
Vol 16 (6) ◽  
Author(s):  
Nicholaus Christian ◽  
Richard Bottner ◽  
Amber Baysinger ◽  
Alanna Boulton ◽  
Blair Walker ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
Hospital Setting ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Inpatient Setting ◽  
Opioid Use ◽  
Outpatient Appointment ◽  
Addiction Medicine ◽  
Outpatient Program ◽  
Life Saving

Despite evidence that medications for patients with opioid use disorder (OUD) reduce mortality and improve engagement in outpatient addiction treatment, these life-saving medications are underutilized in the hospital setting. This study reports the outcomes of the B-Team (Buprenorphine-Team), a hospitalist-led interprofessional program created to identify hospitalized patients with OUD, initiate buprenorphine in the inpatient setting, and provide bridge prescription and access to outpatient treatment programs. During the first 2 years of the program, the B-Team administered buprenorphine therapy to 132 patients in the inpatient setting; 110 (83%) of these patients were bridged to an outpatient program. Of these patients, 65 patients (59%) were seen at their first outpatient appointment; 42 (38%) attended at least one subsequent appointment 1 to 3 months after discharge from the hospital; 29 (26%) attended at least one subsequent appointment between 3 and 6 months after discharge; and 24 (22%) attended at least one subsequent appointment after 6 months. This model is potentially replicable at other hospitals because it does not require dedicated addiction medicine expertise.

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