A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings

Abstract Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

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Primary Care Patients with Opioid Use Disorder Have a High Prevalence of Pain and Mental Health and Other Substance Use Disorders

Journal of General Internal Medicine ◽

10.1007/s11606-020-05820-3 ◽

2020 ◽

Author(s):

Claire B. Simon ◽

Jared W. Klein ◽

Katharine A. Bradley ◽

Malia Oliver

Keyword(s):

Mental Health ◽

Primary Care ◽

Substance Use ◽

Substance Use Disorders ◽

Opioid Use Disorder ◽

Opioid Use ◽

High Prevalence ◽

Primary Care Patients ◽

Prevalence Of Pain

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Medication Management of Co-Occurring Opioid Use Disorder in Mental Health Settings: A Guide for Practitioners

10.7249/tla928-2 ◽

2021 ◽

Keyword(s):

Mental Health ◽

Medication Management ◽

Opioid Use Disorder ◽

Opioid Use ◽

Mental Health Settings

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Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic

Journal of Primary Care & Community Health ◽

10.1177/2150132720932017 ◽

2020 ◽

Vol 11 ◽

pp. 215013272093201 ◽

Cited By ~ 3

Author(s):

Stephanie A. Hooker ◽

Michelle D. Sherman ◽

Mary Lonergan-Cullum ◽

Adam Sattler ◽

Bruce S. Liese ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Substance Use ◽

Food Insecurity ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Treatment Retention ◽

Psychosocial Needs ◽

Opioid Use ◽

Psychosocial Concerns

Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment ( P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.

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Longitudinal assessment of mental health and well-being in patients being treated with medications for opioid use disorder in primary care

Addictive Behaviors Reports ◽

10.1016/j.abrep.2021.100348 ◽

2021 ◽

Vol 13 ◽

pp. 100348

Author(s):

Stephanie A. Hooker ◽

Mary Lonergan-Cullum ◽

Robert Levy ◽

Tanner Nissly ◽

Michelle D. Sherman

Keyword(s):

Mental Health ◽

Primary Care ◽

Well Being ◽

Opioid Use Disorder ◽

Longitudinal Assessment ◽

Opioid Use ◽

Health And Well Being

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Collaborative care in the treatment of opioid use disorder and mental health conditions in primary care: A clinical study protocol

Contemporary Clinical Trials ◽

10.1016/j.cct.2021.106325 ◽

2021 ◽

Vol 103 ◽

pp. 106325

Author(s):

Rebecca Arden Harris ◽

David S. Mandell ◽

Kyle M. Kampman ◽

Yuhua Bao ◽

Kristen Campbell ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Clinical Study ◽

Study Protocol ◽

Collaborative Care ◽

Opioid Use Disorder ◽

Health Conditions ◽

Opioid Use ◽

Mental Health Conditions

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3543 Translating the complex medical jargon of opioid use disorder and medication assisted treatment into locally relevant messages in rural Colorado using Boot Camp Translation

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.222 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 97-98

Author(s):

Mary Fisher ◽

Donald E. Nease ◽

Linda Zittleman ◽

Jack Westfall ◽

Jennifer Ancona

Keyword(s):

Primary Care ◽

Local Community ◽

Boot Camp ◽

Opioid Use Disorder ◽

Research Network ◽

High Plains ◽

Opioid Use ◽

Community Members ◽

Medication Assisted Treatment ◽

South Central

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

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Primary Care of Opioid use Disorder: The End of “the French Model”?

European Addiction Research ◽

10.1159/000506630 ◽

2020 ◽

Vol 26 (6) ◽

pp. 346-354 ◽

Cited By ~ 1

Author(s):

Julie Dupouy ◽

Sandy Maumus-Robert ◽

Yohann Mansiaux ◽

Antoine Pariente ◽

Maryse Lapeyre-Mestre

Keyword(s):

Primary Care ◽

Private Practice ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

Access To Treatment ◽

Cross Sectional ◽

Number Of Patients ◽

French Model

Background: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. Objectives: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. Materials and Methods: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. Results: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. Conclusions: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

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