scholarly journals Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jordana Laks ◽  
Jessica Kehoe ◽  
Natalija M. Farrell ◽  
Miriam Komaromy ◽  
Jonathan Kolodziej ◽  
...  
Keyword(s):  
Methadone Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Treatment Programs ◽  
Opiate Withdrawal ◽  
Opioid Use ◽  
Case Presentation ◽  
Opioid Treatment ◽  
Life Threatening

Abstract Background In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The “72-hour rule” allows non-OTP providers to administer methadone for emergency opioid withdrawal management while arranging ongoing care. Low-barrier substance use disorder (SUD) bridge clinics provide rapid access to buprenorphine but offer an opportunity to treat acute opioid withdrawal while facilitating OTP linkage. We describe the case of a patient with OUD who received methadone for opioid withdrawal in a bridge clinic and linked to an OTP within 72 h. Case presentation A 54-year-old woman with severe OUD was seen in a SUD bridge clinic requesting OTP linkage and assessed with a clinical opiate withdrawal scale (COWS) score of 12. She reported daily nasal use of 1 g heroin/fentanyl. Prior OUD treatment included buprenorphine-naloxone, which was only partially effective. Her acute opioid withdrawal was treated with a single observed oral dose of methadone 20 mg. She returned the following day with persistent opioid withdrawal (COWS score 11) and was treated with methadone 40 mg. On day 3, the patient was successfully admitted to a local OTP, where she remained engaged 3 months later. Conclusions While patients continue to face substantial access barriers, bridge clinics can play an important role in treating opioid withdrawal, building partnerships with OTPs to initiate methadone on demand, and preventing life-threatening delays to methadone treatment. Federal policy reform is urgently needed to make methadone more accessible to people with OUD.

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

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 Methadone Distribution Trends from 2017-2019 in the United States

2020 ◽  
Author(s):  
John A. Furst ◽  
Nicholas J. Mynarski ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Rhode Island ◽  
Distribution Patterns ◽  
The United States ◽  
Opioid Use Disorder ◽  
Primary Objective ◽  
Treatment Programs ◽  
Opioid Use ◽  
Drug Enforcement ◽  
The Us

AbstractObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

Psychoeducational Strategies During Outpatient Transition to Extended-Release Naltrexone for Patients With Opioid Use Disorder

2018 ◽  
Vol 25 (4) ◽  
pp. 272-279
Author(s):  
Abigail Zavod ◽  
Sarah C. Akerman ◽  
Martha M. Snow ◽  
Matt Tierney ◽  
Maria A. Sullivan
Keyword(s):  
Treatment Adherence ◽  
Extended Release ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Major Barrier ◽  
Supportive Interventions ◽  
Outpatient Utilization ◽  
Withdrawal Management

BACKGROUND: The United States is experiencing an opioid epidemic. Better approaches to encourage outpatient utilization of Food and Drug Administration–approved medications for the treatment of opioid use disorder, including extended-release naltrexone (XR-NTX), are needed. Withdrawal management before initiation of XR-NTX is challenging for clinicians and patients and represents a major barrier to treatment. AIMS: To review psychoeducational strategies that support patients during outpatient withdrawal management and transition to XR-NTX. METHOD: We reviewed the literature on psychoeducational strategies used during opioid withdrawal management and described the role that nurses can play in facilitating transition to XR-NTX in a Phase 3, placebo-controlled, outpatient trial comparing induction regimens. RESULTS: Supportive interventions include general psychoeducation on addiction, overcoming ambivalence, treatment adherence, anticipating XR-NTX induction, managing psychological and physiological aspects of opioid withdrawal, risks of opioid use, and sources of support during recovery. CONCLUSIONS: Psychoeducational strategies led by nurses can promote treatment adherence during withdrawal management and induction onto XR-NTX.

scholarly journals Buprenorphine therapy in the setting of induced opioid withdrawal from oral naltrexone: a case report

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Laura M. Szczesniak ◽  
Vincent J. Calleo ◽  
Ross W. Sullivan
Keyword(s):  
Emergency Department ◽  
Acute Treatment ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Accidental Ingestion ◽  
Heroin Use ◽  
Case Presentation ◽  
Acute Withdrawal ◽  
Oral Naltrexone

Abstract Background Patients with opioid use disorder (OUD) frequently present to the emergency department for acute treatment of overdose and withdrawal. Case presentation A 29-year-old male presented to the emergency room after intravenous heroin use followed by accidental ingestion of naltrexone. He was treated with buprenorphine with significant improvement in his Clinical Opioid Withdrawal Score, from moderately severe to mild withdrawal symptoms within a few hours. Conclusion Buprenorphine and minimal supportive care can be used to treat acute withdrawal precipitated by oral naltrexone in patients with OUD.

scholarly journals Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Walter C. Prozialeck ◽  
Peter C. Lamar ◽  
Michael Krupp ◽  
Matthew Moon ◽  
Laura E. Phelps ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Southeast Asia ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Potential Harm ◽  
History Of ◽  
Chronic Pain Conditions

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

Captagon use in a patient with iatrogenic opioid use disorder

2021 ◽  
Vol 10 ◽  
Author(s):  
Mohammed Hamdan ◽  
Samer El Hayek ◽  
Maya Bizri
Keyword(s):  
Middle Eastern ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Psychotic Symptoms ◽  
Patient Counseling ◽  
Opioid Use ◽  
Case Presentation ◽  
Recreational Use ◽  
Reducing Properties

Background: Captagon or Fenethylline is a synthetic theophylline derivative of amphetamine that is widely available for recreational use in the Middle East. It has pain-reducing properties and is known to induce restlessness, irritability, and psychotic symptoms. Case presentation: A middle-aged man with iatrogenic opioid use disorder was admitted for acute cholecystitis. A week following cholecystectomy, the patient used Captagon while hospitalized to manage opioid withdrawal pain. He experienced waxing and waning episodes of irritability, aggressiveness, disorganized behaviors, delusions, and hallucinations, all concurrent with his Captagon intake. These episodes were managed similarly to intoxication with other stimulant types. Conclusion: Careful patient counseling and close follow-up are essential when opioids are prescribed. Captagon’s pain-reducing properties make it an attractive and dangerous option for Middle Eastern patients suffering from opioid withdrawal. Captagon intoxication is currently managed similarly to other stimulant types, but more studies are needed to develop management guidelines specific to this substance.

scholarly journals Comparing Methadone and Tincture of Opium for the Management of Opioid Withdrawal among Subjects with an Opioid Use Disorder

2019 ◽  
pp. 1-11
Author(s):  
Mohammad Jamalian ◽  
Milad Nasrollahzadeh ◽  
Amir Mohammad Kazemifar ◽  
Hasan Solhi
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Fecal Excretion ◽  
Opiate Withdrawal ◽  
Opioid Use ◽  
Double Blind ◽  
Runny Nose ◽  
Group 2 ◽  
The Individual ◽  
Group 1

Introduction: Drug addiction is associated with complications such as mortality, monetary burden, and various socioeconomic problems at the individual to the community level. Methadone and Tincture of Opium (TOP) are the most commonly used drugs to help addicts maintain their drug withdrawal process and eventually permanent withdrawal. Desirable clinical experiences have been reported in the use of these two agents in the management of opioid withdrawal. The purpose of this study was to compare the efficacy of methadone and TOP using Khomree method for detoxification of drug abuse. Materials and Methods: This study was a randomized double-blind clinical trial among opium addicts (at least one year of use) referred to Arak University of Medical Sciences. Seventy subjects were enrolled in the study according to inclusion and exclusion criteria and then randomly divided into two groups (n = 35, treated with methadone) and group 2 (n = 35, treated with TOP). Furthermore, patients were evaluated for withdrawal symptoms on days 1, 3, 7, 14 and 28 after treatment. Finally, the results were analyzed using SPSS 18 software. Results: Severity of sweating (group 1: P = 0.0001, group 2: P =0. 005), runny nose (P = 0.001), lacrimation (P = 0.001), chord reflex (P = 001.0), fecal excretion (group 1: P = 0.001, group 2: P = 0.01, muscle twitches (P = 0.001), drooling (P = 0.001) warming sensation (P = 0.0001) and substance seeking (group 1: P = 0.0001, P = 0.008) in both groups were significantly improved during 28 days of treatment. Conclusion: Methadone and TOP detoxification are both effective in opioid withdrawal syndrome and the effect of methadone and TOP in opiate withdrawal are not preferable. However, further studies are recommended.

The opioid epidemic

2017 ◽  
Vol 52 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Nitin Chopra ◽  
Lauren H Marasa
Keyword(s):  
United States ◽  
Treatment Options ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Significant Family History ◽  
History Of ◽  
Number Of Treatment

Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.

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