scholarly journals Assessing the impact of the Good Samaritan Law in the state of Connecticut: a system dynamics approach

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Nasim S. Sabounchi ◽  
Rebekah Heckmann ◽  
Gail D’Onofrio ◽  
Jennifer Walker ◽  
Robert Heimer
Keyword(s):  
Public Health ◽  
System Dynamics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Behavioral Changes ◽  
Opioid Use ◽  
Good Samaritan ◽  
Ed Visits ◽  
The Impact ◽  
Overdose Deaths

Abstract Background Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. Methods Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. Results The simulation model suggests that Connecticut’s GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. Conclusions The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.

scholarly journals “The idea is to help people achieve greater success and liberty”: a qualitative study of expanded methadone take-home access in opioid use disorder treatment

2021 ◽  
Author(s):  
Leslie W. Suen ◽  
Stacy Castellanos ◽  
Neena Joshi ◽  
Shannon Satterwhite ◽  
Kelly R. Knight
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Clinical Decision Making ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Housing Status ◽  
The Impact ◽  
Overdose Deaths

AbstractBackgroundPrior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California.MethodsWe interviewed 10 providers and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes.ResultsProviders discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making.ConclusionFederal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.

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 (>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 < 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 Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sara J. Becker ◽  
Cara M. Murphy ◽  
Bryan Hartzler ◽  
Carla J. Rash ◽  
Tim Janssen ◽  
...  
Keyword(s):  
Public Health ◽  
Patient Outcomes ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Implementation Outcomes ◽  
Cluster Randomized ◽  
Type 3

Abstract Background Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). Methods A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff’s extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff’s intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). Discussion There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. Trial registration: This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1

Opioid Overdose Education, Prevention, and Management (DRAFT)

2018 ◽  
Author(s):  
Bernd Wollschlaeger
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Death Rates ◽  
Overdose Prevention ◽  
Overdose Death ◽  
Good Samaritan ◽  
Opioid Deaths ◽  
Good Samaritan Laws

In reviewing the elements of opioid overdose education, prevention, and management, this chapter focuses particularly on practical interventions that are available and deserve advocacy; e.g., provision of naloxone to those with opioid use disorder and to possible first responders. It moves from a discussion of the epidemiology of opioid deaths to the more individual topic of patient risk for overdose. Prophylactic interventions in the form of education of the patient’s family and friends, and agreements for treatment with informed consent are described. There follows a discussion of management of the opioid poisoning itself, including use/distribution of naloxone injection. Two figures are included: drug overdose death rates in the United States (2014); a map describing the current states with naloxone or “good Samaritan” laws impacting opioid overdose management. A text box with resources includes directions for initiation of community overdose prevention and intervention schemes.

CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017–2020

2021 ◽  
pp. 009145092110521
Author(s):  
Brandon del Pozo
Keyword(s):  
Public Health ◽  
New York ◽  
Performance Metrics ◽  
Public Health Intervention ◽  
Police Department ◽  
Opioid Use Disorder ◽  
Health Staff ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Overdose Deaths

From 2017 to early 2020, the US city of Burlington, Vermont led a county-wide effort to reduce opioid overdose deaths by concentrating on the widespread, low-barrier distribution of medications for opioid use disorder. As a small city without a public health staff, the initiative was led out of the police department—with an understanding that it would not be enforcement-oriented—and centered on a local adaptation of CompStat, a management and accountability program developed by the New York City Police Department that has been cited as both yielding improvements in public safety and overemphasizing counterproductive police performance metrics if not carefully directed. The initiative was instrumental to the implementation of several novel interventions: low-threshold buprenorphine prescribing at the city’s syringe service program, induction into buprenorphine-based treatment at the local hospital emergency department, elimination of the regional waiting list for medications for opioid use disorder (MOUD), and the de-facto decriminalization of diverted buprenorphine by the chief of police and county prosecutor. An effort by local legislators resulted in a state law requiring all inmates with opioid use disorder be provided with MOUD as well. By the end of 2018, these interventions were collectively associated with a 50% (17 vs. 34) reduction in the county’s fatal overdose deaths, while deaths increased 20% in the remainder of Vermont. The reduction was sustained through the end of 2019. This article describes the effort undertaken by officials in Burlington to implement these interventions. It provides an example that other municipalities can use to take an evidence-based approach to reducing opioid deaths, provided stakeholders assent to sustained collaboration in the furtherance of a commitment to save lives. In doing so, it highlights that police-led public health interventions are the exception, and addressing the overdose crisis will require reform that shifts away from criminalization as a community’s default framework for substance use.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

scholarly journals The impact of project ECHO on physician preparedness to treat opioid use disorder: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hunter M. Puckett ◽  
Jenny S. Bossaller ◽  
Lincoln R. Sheets
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Professionals ◽  
Underserved Populations ◽  
Medical Condition ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Project Echo ◽  
The Impact

AbstractOpioid use disorder (OUD) is a medical condition that has evolved into a serious and deadly epidemic in the United States. Both medical and psychological interventions are called for to end this growing epidemic, but too few health care professionals are trained to treat OUD. One proven model of training physicians and cross-disciplinary teams in treating a variety of disorders is exemplified by Project ECHO (Extension for Community Healthcare Outcomes), a collaborative tele-mentoring program in which specialists train health-care workers to treat medical conditions, especially those that affect underserved populations. This systematic review found that Project ECHO has the potential to effectively extend current services to patients suffering from OUD, but that there is also a gap in knowledge regarding this type of training. The articles that we reviewed all presented evidence that Project ECHO improves healthcare provider preparedness to treat OUD, especially in regard to improving knowledge and self-efficacy.

Exploration of the STOP Act and Opioid Deaths in North Carolina, 2010–2018

2020 ◽  
Vol 110 (10) ◽  
pp. 1573-1577
Author(s):  
Phillip Hughes ◽  
Sheri Denslow ◽  
Bayla Ostrach ◽  
Carriedelle Fusco ◽  
Casey Tak
Keyword(s):  
North Carolina ◽  
Interrupted Time Series ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
The North ◽  
Opioid Deaths ◽  
The Impact ◽  
Overdose Deaths

Objectives. To examine the impact of North Carolina’s 2017 Strengthening Opioid Misuse Prevention (STOP) Act on opioid overdose deaths. Methods. We used quarterly data from the North Carolina Opioid Dashboard to conduct an interrupted time series analysis ranging from 2010 to 2018. Results were stratified by heroin–fentanyl deaths and other opioid deaths. Results. After the STOP Act, there was an initial rate increase of 0.60 opioid deaths per 100 000 population (95% confidence interval [CI] = 0.04, 1.15) and a decrease of 0.42 (95% CI = −0.56, −0.29) every quarter thereafter. Results differed by stratification. Conclusions. Our results suggest that North Carolina’s STOP Act was associated with a reduction in opioid deaths in the year following enactment. The changes in opioid overdose death trends coinciding with the STOP Act were similar to outcomes seen with previous opioid policies. Public Health Implications. Future policies designed to reduce the availability of opioids may benefit from encouraging and increasing the availability of evidence-based treatment of opioid use disorder.

scholarly journals Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl

2021 ◽  
Author(s):  
Anthony Spadaro ◽  
Abeed Sarker ◽  
Whitney Hogg-Bremmer ◽  
Jennifer S Love ◽  
Nicole O'Donnell ◽  
...  
Keyword(s):  
Social Media ◽  
Language Processing ◽  
Application Programming Interface ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Induction Strategy ◽  
Application Programming ◽  
The Impact ◽  
Media Data

Background: Buprenorphine is an evidence-based treatment for Opioid Use Disorder (OUD). Standard buprenorphine induction requires a period of opioid abstinence to minimize risk of precipitated opioid withdrawal (POW). Our objective was to study the impact of the increasing presence of fentanyl and its analogs in the opioid supply of the United States, on buprenorphine induction and POW, using social media data from Reddit. Methods: This is a data-driven, mixed methods study of opioid-related forums, called subreddits, on Reddit to analyze posts related to fentanyl, POW, and buprenorphine induction. The posts were collected from seven subreddits using an application programming interface for Reddit. We applied natural language processing to identify subsets of salient posts relevant to buprenorphine induction, and performed manual, qualitative, thematic analyses of them. Results: 267,136 posts were retrieved from seven subreddits. Fentanyl mentions increased from 3 in 2013 to 3870 in 2020, and POW mentions increased from 2 (2012) to 332 (2020). Manual review of 384 POW-mentioning posts and 106 'Bernese method' (a microdosing induction strategy) mentioning posts revealed common themes and peoples' experiences. Specifically, presence of fentanyl caused POWs despite long abstinence durations, and alternative induction via microdosing were frequently recommended in peer-to-peer discussions. Conclusions: This study found that increased social media chatter on Reddit about POW correlated with fentanyl mentions. A subset of posts described microdosing as a self-management strategy to avoid POW. Reddit posts suggest that people are utilizing these strategies to initiate buprenorphine due to challenges arising from fentanyl prevalence in the opioid supply.

A Public Health Guide to Ending the Opioid Epidemic

2019 ◽  
Keyword(s):  
Public Health ◽  
Primary Prevention ◽  
Substance Misuse ◽  
Traditional Approach ◽  
The United States ◽  
Public Health Approach ◽  
Opioid Use ◽  
The Public ◽  
Opioid Crisis ◽  
The Impact

Few contributions to the field concerning the current opioid crisis in the United States focus sufficient attention on the public health aspects of the epidemic and share examples that practitioners can use to prevent opioid use disorder and the broader issues of substance misuse and addiction. A great deal of prior published work has concentrated on health care and clinical perspectives related to the crisis, including developing prescribing guidelines, enhancing prescription drug monitoring programs, scaling up access to overdose reversal medication, and making medication-assisted treatment more widely available nationwide. This book adds to and complements this prior work by addressing the central tenets of the public health approach to the opioid crisis. Topics include how to best support community-based, primary prevention of substance misuse and addiction in various settings with diverse populations and how to effectively address the cultural, social, and environmental aspects of health that are driving the epidemic. Chapters describe how governmental public health agencies play a significant role in responding to the epidemic, in both public health’s traditional approach to disease surveillance and control and contemporary approaches to health promotion that include building community resilience, addressing the impact of adverse childhood events, and mitigating the root causes of addiction community-wide. This volume can be used to explore what it means to address primary prevention of addiction and how public health practitioners have led efforts to promote “opioid stewardship” at the local, state, and federal levels.

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