scholarly journals Outcomes Associated with Expanded Take-Home Eligibility for Outpatient Treatment with Medications for Opioid Use Disorder: A Mixed-Methods Analysis

2021 ◽  
Author(s):  
Oanh Kieu Nguyen ◽  
Scott Steiger ◽  
Hannah Snyder ◽  
Matthew Perrotta ◽  
Leslie W. Suen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
San Francisco ◽  
Low Income ◽  
Opioid Use Disorder ◽  
Unintended Consequences ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Opioid Use ◽  
Provider Perceptions ◽  
Ed Visits

Background Access to medications for opioid use disorder (MOUD) in the U.S. is highly restricted. In March 2020, to reduce transmission of COVID-19, SAMHSA issued emergency regulations allowing up to two weeks of take-home doses for most patients. Objectives We evaluated the benefits and unintended consequences of these new regulations expanding take-home eligibility to inform MOUD policy post-pandemic Methods We conducted a mixed-methods evaluation of an opioid treatment program in San Francisco caring for a diverse, low-income urban population. We assessed clinic-level intake, retention, and take-home prescribing; individual-level acute care utilization and mortality; and patient/provider perceptions of benefits, harms and challenges of the new regulations. Results Clinic volume, intake and retention were largely unchanged after implementation of the new regulations, though the average monthly proportion of individuals receiving take-homes significantly increased from 31% to 47% (p<0.001). Among 506 established patients (≥90 days of care), the 10-month mortality was 2.7% among those who never received take-homes versus 3.2% among those newly started (p=0.79) and 0.8% among those with increases in take-homes (p=0.24). Individuals who never received take-homes had higher rates of emergency department visits (47.0%) and hospitalizations (19.7%) versus those with new starts (ED visits 29.2%, p<0.001; hospitalizations 14.3%, p=0.19) or increases in take-homes (ED visits 17.5%, p<0.001; hospitalizations 10.0%, p=0.02). Both patients and providers reported increased treatment flexibility, leading to increased engagement and stabilization. Conclusions Given the benefit and lack of appreciable harms, policymakers should consider extending expanded MOUD take-home eligibility after COVID-19, with careful monitoring for unintended outcomes.

scholarly journals Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach

2021 ◽  
Vol 18 (11) ◽  
pp. 6163
Author(s):  
Rosemarie Martin ◽  
Augustine W. Kang ◽  
Audrey A. DeBritz ◽  
Mary R. Walton ◽  
Ariel Hoadley ◽  
...  
Keyword(s):  
Substance Use ◽  
Mixed Methods ◽  
Telephone Counseling ◽  
Opioid Use Disorder ◽  
Appropriate Technology ◽  
Counseling Services ◽  
Opioid Use ◽  
Qualitative Evidence ◽  
Positive Experiences ◽  
Anxiety Depression

Using quantitative and qualitative evidence, this study triangulates counselors’ perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors’ experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients’ anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (&gt;45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P &lt; 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

scholarly journals Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

2018 ◽  
Vol 44 (5) ◽  
pp. E14 ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Zaid Aljuboori ◽  
Maxwell Boakye
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Dependence ◽  
Degenerative Spondylolisthesis ◽  
Opioid Use Disorder ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Opioid Use ◽  
Opioid Dependency ◽  
Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

scholarly journals Preexisting Opioid Use Disorder and Outcomes After Lower Extremity Arthroplasty: A Multistate Analysis, 2007–2014

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3624-3634
Author(s):  
Stephanie A Chen ◽  
Robert S White ◽  
Virginia Tangel ◽  
Soham Gupta ◽  
Jeffrey B Stambough ◽  
...  
Keyword(s):  
Health Care ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Lower Extremity ◽  
Health Care Utilization ◽  
Hospital Mortality ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Present On Admission

Abstract Objective The aim of this study was to examine the association of preexisting opioid use disorder and postoperative outcomes in patients undergoing total hip or knee arthroplasty (THA and TKA, respectively) in the overall population and in the Medicare-only population. Methods This retrospective cohort study examined data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007–2014 from California, Florida, New York, Maryland, and Kentucky. We compared patients with and without opioid use disorders on unadjusted rates and calculated adjusted odds ratios (aORs) of in-hospital mortality, postoperative complications, length of stay, and 30-day and 90-day readmission status; analyses were repeated in a subgroup of Medicare insurance patients only. Subjects After applying our exclusion criteria, our study included 1,422,210 adult patients undergoing lower extremity arthroplasties, including 818,931 Medicare insurance patients. In our study, 0.4% of THA patients and 0.3% of TKA patients had present-on-admission opioid use disorder. Results Opioid use disorder patients were at higher risk for in-hospital mortality (aOR = 3.10), 30- and 90-day readmissions (aORs = 1.81, 1.81), and pulmonary and infectious complications (aORs = 1.25, 1.96). Conclusions Present-on-admission opioid use disorder was a risk factor for worse postoperative outcomes and increased health care utilization in the lower extremity arthroplasty population. Opioid use disorder is a potentially modifiable risk factor for mortality, postoperative complications, and health care utilization, especially in the at-risk Medicare population.

scholarly journals The effects of opioid-agonist treatments on HIV risk and social stability: A mixed methods study of women with opioid use disorder in Ukraine

2017 ◽  
Vol 83 ◽  
pp. 36-44 ◽  
Author(s):  
Emily Hoff ◽  
Ruthanne Marcus ◽  
Martha J. Bojko ◽  
Iuliia Makarenko ◽  
Alyona Mazhnaya ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hiv Risk ◽  
Opioid Use Disorder ◽  
Mixed Methods Study ◽  
Social Stability ◽  
Opioid Use ◽  
Opioid Agonist

scholarly journals Hospital Care of Opioid-Exposed Newborns: Clinical and Psychosocial Challenges

2020 ◽  
Vol 15 (10) ◽  
pp. 613-618
Author(s):  
Neera K Goyal ◽  
Jennifer McAllister
Keyword(s):  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Discharge Planning ◽  
Hospital Costs ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Maternal Experience ◽  
Medication Assisted Treatment ◽  
Experience Of Care

In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.

scholarly journals Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

2021 ◽  
Author(s):  
Leslie W. Suen ◽  
Thibaut Davy-Mendez ◽  
Kathy T. LeSaint ◽  
Elise D. Riley ◽  
Phillip Coffin
Keyword(s):  
Emergency Department ◽  
Drug Toxicity ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
Stimulant Use ◽  
Care Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Psychiatric Complications

Abstract Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

scholarly journals Relapse In Opioid Use Disorder: Implications For Health Care Utilization And Costs

2016 ◽  
Vol 19 (3) ◽  
pp. A188 ◽  
Author(s):  
B Brady ◽  
J Tkacz ◽  
V Nadipelli ◽  
J Volpicelli ◽  
N Ronquest ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use
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