scholarly journals Neurocognitive, psychiatric, and substance use characteristics in a diverse sample of persons with OUD who are starting methadone or buprenorphine/naloxone in opioid treatment programs

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Travis M. Scott ◽  
Julia Arnsten ◽  
James Patrick Olsen ◽  
Franchesca Arias ◽  
Chinazo O. Cunningham ◽  
...  
Keyword(s):  
Substance Use ◽  
Learning And Memory ◽  
Substance Use Disorders ◽  
Neurocognitive Impairment ◽  
Opioid Use Disorder ◽  
Neurocognitive Functioning ◽  
Treatment Programs ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Treatment

Abstract Background Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). Persons with OUD have high rates of neurocognitive impairment and psychiatric and substance use disorders, but few studies have examined these characteristics in diverse patients initiating OAT in opioid treatment programs (OTPs). Additionally, in these individuals, poor neurocognitive functioning and psychiatric/other substance use disorders are associated with poor OUD treatment outcomes. Given rapid changes in the opioid epidemic, we sought to replicate findings from our pilot study by examining these characteristics in a large diverse sample of persons with OUD starting OTP-based OAT. Methods Ninety-seven adults with OUD (M age = 42.2 years [SD = 10.3]; M education = 11.4 years [SD = 2.3]; 27% female; 22% non-Hispanic white) were enrolled in a randomized longitudinal trial evaluating methadone versus buprenorphine/naloxone on neurocognitive functioning. All participants completed a comprehensive neurocognitive, psychiatric, and substance use evaluation within one week of initiating OAT. Results Most of the sample met criteria for learning (79%) or memory (69%) impairment. Half exhibited symptoms of current depression, and comorbid substance use was highly prevalent. Lifetime cannabis and cocaine use disorders were associated with better neurocognitive functioning, while depression was associated with worse neurocognitive functioning. Conclusions Learning and memory impairment are highly prevalent in persons with OUD starting treatment with either methadone or buprenorphine/naloxone in OTPs. Depression and comorbid substance use are prevalent among these individuals, but neither impact learning or memory. However, depression is associated with neurocognitive impairment in other domains. These findings might allow clinicians to help persons with OUD starting OAT to develop compensatory strategies for learning and memory, while providing adjunctive treatment for depression. Trial Registration NCT, NCT01733693. Registered November 4, 2012, https://clinicaltrials.gov/ct2/show/NCT01733693.

Medical Care for Patients with Substance Use Disorders

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.

Adverse events among adult Medicaid enrollees with opioid use disorder and co-occurring substance use disorders

2021 ◽  
Vol 221 ◽  
pp. 108555
Author(s):  
Peggy O’Brien ◽  
Rachel Mosher Henke ◽  
Mary Beth Schaefer ◽  
Janice Lin ◽  
Timothy B. Creedon
Keyword(s):  
Substance Use ◽  
Adverse Events ◽  
Substance Use Disorders ◽  
Opioid Use Disorder ◽  
Opioid Use

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

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

Mental Health Conditions and Substance Use Disorders Among Youth Subsequently Diagnosed With Opioid Use Disorder or Opioid Poisoning

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Edeanya Agbese ◽  
Bradley D. Stein ◽  
Benjamin G. Druss ◽  
Andrew W. Dick ◽  
Rosalie L. Pacula ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Opioid Use Disorder ◽  
Health Conditions ◽  
Opioid Use ◽  
Mental Health Conditions

scholarly journals Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes

2021 ◽  
Vol 12 ◽  
Author(s):  
Holly Ann Russell ◽  
Brian Smith ◽  
Mechelle Sanders ◽  
Elizabeth Loomis
Keyword(s):  
Medical Education ◽  
Substance Use ◽  
Family Medicine ◽  
Substance Use Disorders ◽  
Opioid Use Disorder ◽  
Training Data ◽  
Attitude Score ◽  
Opioid Use ◽  
Provider Attitudes ◽  
Treatment Interventions

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.

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

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.

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

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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