Commentary on Shand et al. (2011): Opioid use disorder as a condition of graded severity, similar to other substance use disorders

Objective: Substance use disorders remain highly stigmatized. Access to medications for opioid use disorder is poor. There are many barriers to expanding access including stigma and lack of medical education about substance use disorders. We enriched the existing, federally required, training for clinicians to prescribe buprenorphine with a biopsychosocial focus in order to decrease stigma and expand access to medications for opioid use disorder.Methods: We trained a family medicine team to deliver an enriched version of the existing buprenorphine waiver curriculum. The waiver training was integrated into the curriculum for all University of Rochester physician and nurse practitioner family medicine residents and also offered to University of Rochester residents and faculty in other disciplines and regionally. We used the Brief Substance Abuse Attitudes Survey to collect baseline and post-training data.Outcomes: 140 training participants completed attitude surveys. The overall attitude score increased significantly from pre to post-training. Additionally, significant changes were observed in non-moralism from pre-training (M = 20.07) to post-training (M = 20.98, p < 0.001); treatment optimism from pre-training (M = 21.56) to post-training (M = 22.33, p < 0.001); and treatment interventions from pre-training (M = 31.03) to post-training (M = 32.10, p < 0.001).Conclusion: Increasing medical education around Opioid Use Disorder using a Family Medicine trained team with a biopsychosocial focus can improve provider attitudes around substance use disorders. Enriching training with cases may improve treatment optimism and may help overcome the documented barriers to prescribing medications for opioid use disorder and increase access for patients to lifesaving treatments.

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Meeting at the crossroads of pain and addiction: An ethical analysis of pain management with palliative care for individuals with substance use disorders

Journal of Opioid Management ◽

10.5055/jom.2021.0631 ◽

2021 ◽

Vol 17 (3) ◽

pp. 207-214

Author(s):

Adele Flaherty, MA, PhD Candidate ◽

Fahmida Hossain, MS, HEC-C, PhD Candidate ◽

Alexa Vercelli, MA

Keyword(s):

Palliative Care ◽

Substance Use ◽

Pain Management ◽

Substance Use Disorders ◽

Opioid Use Disorder ◽

Ethical Analysis ◽

Need For Care ◽

Opioid Use ◽

Number Of Individuals ◽

The Relationship

A growing number of individuals live with an opioid use disorder (OUD). While many go on to recover from such disorders, certainly, there will be individuals in palliative care (PC) at some point who still suffer with OUD. One of the major barriers to PC for individuals recovering and currently suffering from an OUD is the stigma related to having an OUD. Therefore, in the context of PC, it is important to understand the relationship that exists between PC, OUDs, and how stereotypes related to substance use disorders affect patient engagement in PC. For this paper, the focus will be on how stereotypes affect pain management in PC for persons with an OUD. A review of current literature regarding OUDs and pain management indicates a need for care specific to the needs of those in PC who formerly and/or currently suffer from an OUD in order to avoid relapse or worsening of their affliction while still managing their pain. The striking lack of knowledge and resources regarding OUDs and their treatment indicates a need to strengthen/increase resources for physicians to educate on treating OUDs as well as alternatives for pain management. This article presents dignity-enhancing care as a gateway to fairly treat individuals with an OUD and to get rid of the stigma associated with OUD patients.

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Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder

Psychodynamic Psychiatry ◽

10.1521/pdps.2021.49.3.388 ◽

2021 ◽

Vol 49 (3) ◽

pp. 388-403

Author(s):

William H. Gottdiener

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Psychodynamic Psychotherapy ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Use ◽

Self Medication ◽

The Core ◽

Wide Range ◽

Opioid Use Disorders

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

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Medical Care for Patients with Substance Use Disorders

ASAM Handbook of Addiction Medicine ◽

10.1093/med/9780197506172.003.0014 ◽

2020 ◽

pp. 313-348

Author(s):

Megan Buresh ◽

Darius A. Rastegar

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Methadone Maintenance ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Reduction Strategies ◽

Primary Care Clinicians ◽

Prolonged Qt Syndrome

Primary care clinicians commonly encounter patients with substance use disorders and can provide effective treatment for their problems. Many of the medical complications associated with drug use are due to the use of needles; these include transmission of HIV and hepatitis C, soft tissue infections, and endocarditis. Harm reduction strategies reduce the harms associated with drug use without targeting use itself; these include syringe distribution, safe consumption facilities, naloxone distribution, and pre-exposure HIV prophylaxis. Patients on opioid agonist treatment may develop a number of problems, including hypogonadism, constipation, and psychomotor impairment; those on methadone may develop prolonged QT syndrome. Other issues include drug interactions, treatment of acute pain, and perioperative care. Treating pain in patients with substance use disorder can be complicated; for many, especially those with opioid use disorder, treatment with buprenorphine or enrollment in methadone maintenance is the best option.

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Utilization of treatment by Medicaid enrollees with opioid use disorder and co-occurring substance use disorders

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2020.108261 ◽

2020 ◽

Vol 217 ◽

pp. 108261

Author(s):

Peggy O’Brien ◽

Rachel Mosher Henke ◽

Mary Beth Schaefer ◽

Janice Lin ◽

Timothy B. Creedon

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Opioid Use Disorder ◽

Opioid Use

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Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00249-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sarah M. Bagley ◽

Laura Chavez ◽

Jordan M. Braciszewski ◽

Mary Akolsile ◽

Denise M. Boudreau ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Substance Use ◽

Health Systems ◽

Substance Use Disorders ◽

Mental Health Disorders ◽

Opioid Use Disorder ◽

Opioid Use ◽

Medication Treatment ◽

Health Disorders

Abstract Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

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Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

Translational Psychiatry ◽

10.1038/s41398-021-01372-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Veer Vekaria ◽

Budhaditya Bose ◽

Sean M. Murphy ◽

Jonathan Avery ◽

George Alexopoulos ◽

...

Keyword(s):

New York ◽

Mental Illness ◽

Substance Use ◽

Healthcare Utilization ◽

Substance Use Disorders ◽

Opioid Use Disorder ◽

Opioid Use ◽

Related Services ◽

Comparison Groups ◽

Utilization Patterns

AbstractSubstance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30–180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0–180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.

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