Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

2020 ◽  
pp. 104973232097123
Author(s):  
Barbara Andraka-Christou ◽  
Olivia Randall-Kosich ◽  
Rachel Totaram
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorder ◽  
Professional Education ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
History Of ◽  
Disorder Treatment

Treatment preferences of people with opioid use disorder (OUD) have been underexplored, especially among those with a history of utilizing medications for opioid use disorder (MOUD). Therefore, we sought to understand preferred characteristics of substance use disorder treatment centers among people recovering from OUD with a history of MOUD utilization. We recruited 30 individuals from eight states through snowball sampling initiated at three syringe exchange programs. Telephone interviews were audio-recorded and transcribed in 2018–2019. Inductive thematic analysis in Dedoose software occurred iteratively with recruitment. The following were “ideal” treatment center themes: a menu of treatment options, including MOUD and nonspiritual peer support groups; an integrated system with multiple care levels (e.g., outpatient, residential); a harm reduction approach, including for goal setting and success measures; adjunctive support services (e.g., housing); and employees with recovery experience and professional education. Many preferences directly related to core principles of person-centered care and harm reduction.

scholarly journals A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Megan A. O’Grady ◽  
Patricia Lincourt ◽  
Belinda Greenfield ◽  
Marc W. Manseau ◽  
Shazia Hussain ◽  
...  
Keyword(s):  
Substance Use ◽  
Quality Improvement ◽  
Substance Use Disorder ◽  
Controlled Trial ◽  
Opioid Use Disorder ◽  
Treatment Quality ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
Randomized Controlled ◽  
Disorder Treatment

Abstract Background The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder. Methods A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data. Discussion This study will provide the field with a strong test of a multicomponent intervention to improve providers’ capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system. Trial registration Trial #NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020

scholarly journals LO91: Opioid poisoning and opioid use disorder in older trauma patients

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S40-S41
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
L. Moore ◽  
A. Cournoyer ◽  
M. Emond ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Proportional Hazards ◽  
Opioid Use Disorder ◽  
Cox Proportional Hazards ◽  
Trauma Patients ◽  
Opioid Use ◽  
Multicenter Cohort Study ◽  
Opioid Prescription ◽  
History Of

Introduction: Patients hospitalized following a trauma will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (< 3 months) opioid use after discharge and the risk of opioid poisoning (OP) or opioid use disorder (OUD) in older trauma patients Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients aged 65 years and older admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for OP and OUD from ICD-9 and ICD-10 code diagnosis that resulted in a hospitalization or a medical consultation after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not fill an opioid prescription during that period using Cox proportional hazards regressions. Results: A total of 70,314 participants were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3-months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.30%; 95%CI: 0.25%-0.35%) were hospitalized for OP and 73 (0.10%; 95%CI: 0.07%-0.13%) were diagnosed with OUD. Having filled an opioid prescription within 3-months of injury was associated with an increased hazard ratio of OP (2.6; 95%CI: 1.9-3.5) and OUD (4.0; 95%CI: 2.3-7.0). However, history of OP (2.7; 95%CI: 1.2-6.1), of substance use disorder (4.3; 95%CI: 2.4-7.9), or of opioid prescription filled (2.7; 95%CI: 2.1-3.5) before trauma were also related to OP or OUD. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with history of substance use disorder, opioid poisoning or opioid use during the past year.

Suicidology and Substance abuse in Adolescence

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Werner ◽  
J.-P. Kahn
Keyword(s):  
Substance Use ◽  
Childhood Abuse ◽  
Substance Use Disorder ◽  
Suicidal Behaviour ◽  
Treatment Protocol ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Opioid Use ◽  
Treatment And Prevention ◽  
History Of

Adolescence is a critical period for suicidal risk. Suicide currently ranks as the second or third leading cause of mortality among adolescents in developped countries. It has been shown that a history of suicidal act, of depressive disorder and of a substance use disorder (SUD), alcohol and drugs, are the most prominent risk factors for suicidal behaviour among adolescents.Data on alcohol and drug use disorders and suicide consisted primarily of reports on alcohol use disorders and, to a lesser extent, opioid use disorder. The magnitude of the association with other drugs is still unclear.The relationships between substance use disorder and suicidal behaviour are multiple: In the long term, SUD may be associated with increases in stress and co-occuring psychopathology (poor self esteem, feeling of worthlessness, isolation).These elements may reach a level where a suicide attempt is viewed as a means to cope with perceived unsolvable difficulties. During life crises, SUD can also be responsible for inhibiting adaptative coping and desinhibiting suicidal behaviour. Finally, SUD and suicidal behaviour share common vulnerability factors: history of childhood abuse, genetically determined dimensions such as impulsivity or psychiatric disorders, particularly unipolar depressive and bipolar disorder.Given the comorbidity between SUD and suicide, it is essential for treatment and prevention that all suicidal adolescents be screened for SUD and vice versa. Ideally, adolescents who receive diagnosis of SUD and co-occuring suicidality should follow an integrated treatment protocol that addresses both conditions.

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