scholarly journals Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noa Krawczyk ◽  
Adetayo Fawole ◽  
Jenny Yang ◽  
Babak Tofighi
Keyword(s):  
Harm Reduction ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Home Delivery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Policy And Practice ◽  
Patient Centered ◽  
Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

scholarly journals ‘Communities are attempting to tackle the crisis’: a scoping review on community plans to prevent and reduce opioid-related harms

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028583 ◽  
Author(s):  
Pamela Leece ◽  
Triti Khorasheh ◽  
Nimitha Paul ◽  
Sue Keller-Olaman ◽  
Susan Massarella ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Harm Reduction ◽  
Lived Experience ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Grey Literature ◽  
Eligibility Criteria ◽  
Public Health Decision

ObjectivesWe sought to understand the implementation of multifaceted community plans to address opioid-related harms.DesignOur scoping review examined the extent of the literature on community plans to prevent and reduce opioid-related harms, characterise the key components, and identify gaps.Data sourcesWe searched MEDLINE, Embase, PsycINFO, CINHAL, SocINDEX and Academic Search Primer, and three search engines for English language peer-reviewed and grey literature from the past 10 years.Eligibility criteriaEligible records addressed opioid-related harms or overdose, used two or more intervention approaches (eg, prevention, treatment, harm reduction, enforcement and justice), involved two or more partners and occurred in an Organisation for Economic Co-operation and Development country.Data extraction and synthesisQualitative thematic and quantitative analysis was conducted on the charted data. Stakeholders were engaged through fourteen interviews, three focus groups and one workshop.ResultsWe identified 108 records that described 100 community plans in Canada and the USA; four had been evaluated. Most plans were provincially or state funded, led by public health and involved an average of seven partners. Commonly, plans used individual training to implement interventions. Actions focused on treatment and harm reduction, largely to increase access to addiction services and naloxone. Among specific groups, people in conflict with the law were addressed most frequently. Community plans typically engaged the public through in-person forums. Stakeholders identified three key implications to our findings: addressing equity and stigma-related barriers towards people with lived experience of substance use; improving data collection to facilitate evaluation; and enhancing community partnerships by involving people with lived experience of substance use.ConclusionCurrent understanding of the implementation and context of community opioid-related plans demonstrates a need for evaluation to advance the evidence base. Partnership with people who have lived experience of substance use is underdeveloped and may strengthen responsive public health decision making.

scholarly journals The impact of methamphetamine/amphetamine use on receipt and outcomes of medications for opioid use disorder: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Madeline C. Frost ◽  
Hannah Lampert ◽  
Judith I. Tsui ◽  
Matthew D. Iles-Shih ◽  
Emily C. Williams
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Data Extraction ◽  
Opioid Use Disorder ◽  
Small Samples ◽  
Future Research ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Amphetamine Use ◽  
The Impact

Abstract Background Methamphetamine/amphetamine use has sharply increased among people with opioid use disorder (OUD). It is therefore important to understand whether and how use of these substances may impact receipt of, and outcomes associated with, medications for OUD (MOUD). This systematic review identified studies that examined associations between methamphetamine/amphetamine use or use disorder and 3 classes of outcomes: (1) receipt of MOUD, (2) retention in MOUD, and (3) opioid abstinence during MOUD. Methods We searched 3 databases (PubMed/MEDLINE, PsycINFO, CINAHL Complete) from 1/1/2000 to 7/28/2020 using key words and subject headings, and hand-searched reference lists of included articles. English-language studies of people with documented OUD/opioid use that reported a quantitative association between methamphetamine/amphetamine use or use disorder and an outcome of interest were included. Study data were extracted using a standardized template, and risk of bias was assessed for each study. Screening, inclusion, data extraction and bias assessment were conducted independently by 2 authors. Study characteristics and findings were summarized for each class of outcomes. Results Thirty-nine studies met inclusion criteria. Studies generally found that methamphetamine/amphetamine use or use disorder was negatively associated with receiving methadone and buprenorphine; 2 studies suggested positive associations with receiving naltrexone. Studies generally found negative associations with retention; most studies finding no association had small samples, and these studies tended to examine shorter retention timeframes and describe provision of adjunctive services to address substance use. Studies generally found negative associations with opioid abstinence during treatment among patients receiving methadone or sustained-release naltrexone implants, though observed associations may have been confounded by other polysubstance use. Most studies examining opioid abstinence during other types of MOUD treatment had small samples. Conclusions Overall, existing research suggests people who use methamphetamine/amphetamines may have lower receipt of MOUD, retention in MOUD, and opioid abstinence during MOUD. Future research should examine how specific policies and treatment models impact MOUD outcomes for these patients, and seek to understand the perspectives of MOUD providers and people who use both opioids and methamphetamine/amphetamines. Efforts to improve MOUD care and overdose prevention strategies are needed for this population.

Methadone bioavailability and dose conversion implications with intravenous and enteral administration: A scoping review

2021 ◽  
Author(s):  
JiTong Liu ◽  
Kathryn E Smith ◽  
Richard R Riker ◽  
Wendy Y . Craig ◽  
Dina J McKelvy ◽  
...  
Keyword(s):  
Scoping Review ◽  
English Language ◽  
Human Subjects ◽  
Metastatic Cancer ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Current Recommendation ◽  
Individual Patient Level ◽  
Manual Search ◽  
Enteral Administration

Abstract Purpose Despite its availability for more than 70 years, many details concerning methadone remain contentious, such as the dosing equivalents for intravenous and enteral administration. A scoping review was performed to evaluate whether existing literature on methadone bioavailability in human subjects support the current recommendation that an equivalent enteral dose is twice the intravenous dose. Methods A librarian-assisted search of the PubMed and EMBASE databases identified all English-language articles with the terms methadone and bioavailability and/or conversion in the title or abstract published from inception though December 2019. A manual search of references was also performed to identify any additional articles. Studies were included in a scoping review if they were published in English and evaluated methadone bioavailability in human subjects. Results Among 65 publications initially identified, 6 studies involving a total of 50 patients were included in the review. Bioavailability (F) data for healthy volunteers and patients with opioid use disorder, metastatic cancer, chronic pain from malignant or nonmalignant disease were available for analysis. The pooled mean (95% confidence interval) F was 85.4% (75.2%-95.6%), with heterogeneity (I  2) of 0. In the 4 studies that provided individual patient–level data, F was >50% in 40 of 42 patient measurements (95.2%) and ≥75% in 33 of 42 patient measurements (78.6%). Conclusion Available evidence suggests the bioavailability of methadone is generally more than 75%, there is limited evidence for the currently recommended 1:2 ratio (intravenous:enteral), and a more appropriate dosing ratio may be 1:1.3. This scoping review underscores the need for further research to establish an effective and safe ratio when converting between intravenous and enteral dosing formulations of methadone.

scholarly journals Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Peter Treitler ◽  
Stephen Crystal ◽  
Richard Hermida ◽  
Jennifer Miles
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
The Elderly ◽  
Opioid Use Disorder ◽  
Chronic Obstructive ◽  
Medicare Beneficiaries ◽  
Older Individuals ◽  
Opioid Use ◽  
Policy And Practice ◽  
Obstructive Pulmonary Disease

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

Opioid use disorder treatment for people experiencing homelessness: A scoping review

2021 ◽  
pp. 108717
Author(s):  
Matthew F. McLaughlin ◽  
Rick Li ◽  
Nicolás Domínguez Carrero ◽  
Paul A. Bain ◽  
Avik Chatterjee
Keyword(s):  
Scoping Review ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study

2017 ◽  
Vol 39 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Randi Sokol ◽  
Chiara Albanese ◽  
Deviney Chaponis ◽  
Jessica Early ◽  
George Maxted ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Patient Centered ◽  
Group Visits ◽  
Disorder Treatment

scholarly journals Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022267 ◽  
Author(s):  
Tyler Marshall ◽  
Elizabeth N Kinnard ◽  
Myles Hancock ◽  
Susanne King-Jones ◽  
Karin Olson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Search Strategy ◽  
Opioid Use Disorder ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Opioid Use ◽  
Policy Makers ◽  
Cochrane Database

IntroductionOpioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment services have struggled to meet the demand. Evidence suggests when patients with chronic illnesses are matched with their treatment preferences and engaged in shared decision-making (SDM), health outcomes may improve. However, it is not known whether SDM could impact outcomes in specific substance use disorders such as OUD.Methods and analysisA scoping review will be conducted according to Arksey and O’Malley’s framework and by recommendations from Levacet al. The search strategy was developed to retrieve relevant publications from database inception and June 2017. MEDLINE, EMBASE, PsycINFO, Cochrane Database for Controlled Trials, Cochrane Database for Systematic Reviews and reference lists of relevant articles and Google Scholar will be searched. Included studies must be composed of adults with a diagnosis of OUD, and investigate SDM or its constituent components. Experimental, quasi-experimental, qualitative, case–control, cohort studies and cross-sectional surveys will be included. Articles will be screened for final eligibility according to title and abstract, and then by full text. Two independent reviewers will screen excluded articles at each stage. A consultation phase with expert clinicians and policy-makers will be added to set the scope of the work, refine research questions, review the search strategy and identify additional relevant literature. Results will summarise whether SDM impacts health and patient-centred outcomes in OUD.Ethics and disseminationScoping review methodology is considered secondary analysis and does not require ethics approval. The final review will be submitted to a peer-reviewed journal, disseminated at relevant academic conferences and will be shared with policy-makers, patients and clinicians.

scholarly journals Buprenorphine exposure alters the development and migration of interneurons in the cortex

2020 ◽  
Author(s):  
Vanesa Nieto-Estévez ◽  
Jennifer J. Donegan ◽  
Courtney McMahon ◽  
Hannah B. Elam ◽  
Teresa A. Chavera ◽  
...  
Keyword(s):  
Human Brain ◽  
Fetal Brain ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Child Bearing ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
And Migration ◽  
Long Acting

ABSTRACTThe misuse of opioids has reached epidemic proportions over the last decade, with over 2.1 million people in the U.S. suffering from substance use disorders related to prescription opioid pain relievers. This increase in opioid misuse affects all demographics of society, including women of child-bearing age, which has led to a rise in opioid use during pregnancy. Opioid use during pregnancy has been associated with increased risk of obstetric complications and adverse neonatal outcomes, including neonatal abstinence syndrome. Currently, opioid use disorder in pregnant women is treated with long-acting opioid agonists, including buprenorphine. Although buprenorphine reduces illicit opioid use during pregnancy and improves infant outcomes at birth, few long-term studies of the neurodevelopmental consequences have been conducted. The goal of the current experiments was to examine the effects of buprenorphine on the development of the cortex using fetal brain tissue, 3D brain cultures, and rodent models. First, we demonstrated that we can grow cortical and subpallial spheroids, which model the cellular diversity, connectivity, and activity of the developing human brain. Next, we show that cells in the developing human cortex express the nociceptin opioid (NOP) receptor and that buprenorphine can signal through this receptor in cortical spheroids. Using subpallial spheroids to grow inhibitory interneurons, we show that buprenorphine can alter interneuron development and migration into the cortex. Finally, using a rodent model of prenatal buprenorphine exposure, we demonstrate that alterations in interneuron distribution can persist into adulthood. Together, these results suggest that more research is needed into the long-lasting consequences of buprenorphine exposure on the developing human brain.

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