scholarly journals Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis

2020 ◽  
Vol 110 (2) ◽  
pp. 244-250 ◽  
Author(s):  
Theodore J. Cicero ◽  
Matthew S. Ellis ◽  
Zachary A. Kasper
Keyword(s):  
Substance Use ◽  
Supply And Demand ◽  
The United States ◽  
National Sample ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Drug Classes ◽  
Global Nature ◽  
Illicit Opioid Use

Objectives. To understand important changes in co-occurring opioid and nonopioid drug use (i.e., polysubstance use) within the opioid epidemic in the United States. Methods. We analyzed survey data on the past month co-use of prescription and illicit opioids and 12 nonopioid psychoactive drug classes from a national sample of 15 741 persons entering treatment of opioid use disorder. Results. Past-month illicit opioid use increased from 44.8% in 2011 to 70.1% in 2018, while the use of prescription opioids alone dropped from 55.2% to 29.9%, yet overall remained high (94.5% to 85.2%). Past-month use of at least 1 nonopioid drug occurred in nearly all participants (> 90%), with significant increases in methamphetamine (+85%) and decreases across nonopioid prescription drug classes (range: −40% to –68%). Conclusions. Viewing opioid trends in a “silo” ignores the fact not only that polysubstance use is ubiquitous among those with opioid use disorder but also that significant changes in polysubstance use should be monitored alongside opioid trends. Public Health Implications. Treatment, prevention, and policymaking must address not only the supply and demand of a singular drug class but also the global nature of substance use overall.

scholarly journals Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

2021 ◽  
Author(s):  
Celia Stafford ◽  
Wesley Marrero ◽  
Rebecca B. Naumann ◽  
Kristen Hassmiller Lich ◽  
Sarah Wakeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Geographic Region ◽  
Influential Factors ◽  
Opioid Use ◽  
Living Situation ◽  
Data Set ◽  
Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

scholarly journals What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals

2020 ◽  
pp. 003335492096880
Author(s):  
Berkeley Franz ◽  
Cory E. Cronin ◽  
Jose A. Pagan
Keyword(s):  
The United States ◽  
National Sample ◽  
Opioid Use Disorder ◽  
Opioid Abuse ◽  
Public Health Issue ◽  
Evidence Based ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Nonprofit Hospitals ◽  
Community Benefit

Objectives Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.

NIOSH Responds to the U.S. Drug Overdose Epidemic

2021 ◽  
pp. 104829112110407
Author(s):  
Jamie C. Osborne ◽  
L. Casey Chosewood
Keyword(s):  
United States ◽  
Substance Use ◽  
Drug Overdose ◽  
Drug Users ◽  
Illicit Drugs ◽  
Occupational Safety ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery “capital.” The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

Psychopharmacology for Substance Use Disorders

2021 ◽  
Author(s):  
Olapeju Simoyan ◽  
Krista Ulisse
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Maintenance Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Duration Of Symptoms ◽  
Stimulant Use

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder. This review contains 3 tables, and 31 references. Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal

scholarly journals Relapse rates among veterans on maintenance doses of combination buprenorphine and naloxone for opioid use disorder

2020 ◽  
Vol 10 (3) ◽  
pp. 80-84
Author(s):  
Katie J. Binger ◽  
Elayne D. Ansara ◽  
Talia M. Miles ◽  
Samantha L. Schulte
Keyword(s):  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Difference ◽  
Time To Relapse ◽  
Recovery Program

Abstract Introduction Opioid use disorder (OUD) can cause significant morbidity and mortality with more than 115 people dying from an opioid overdose daily in the United States. Treatment with buprenorphine/naloxone (BUP/NAL) can be effective; however, there is conflicting evidence on the utility of higher doses in preventing relapse. This study was designed to assess BUP/NAL maintenance doses and the rate of relapse in veterans with OUD. Methods Patients diagnosed with OUD who received a prescription for BUP/NAL through the substance use disorder recovery program were retrospectively evaluated. Patients were categorized into 2 treatment groups: those prescribed ≤16 mg of BUP/NAL daily and those prescribed >16 mg of BUP/NAL daily. The primary outcome was to determine rates of relapse between maintenance doses of BUP/NAL. Secondary outcomes included evaluating the difference in rates of relapse between daily versus take-home dosing, tablets versus films, time to relapse, and use of illicit substances during treatment. Results Patients prescribed >16 mg of BUP/NAL daily had statistically significantly lower rates of relapse compared to patients prescribed ≤16 mg of BUP/NAL daily (P = .0018). Regarding secondary outcomes, there was a statistically significant difference in time to relapse (P = .036) and dosage form (P = .0124). Difference in administration of dose and illicit substance use during treatment were not statistically significant. Discussion This study identified that rate of relapse can be lowered and time to relapse can be lengthened when doses >16 mg of BUP/NAL are prescribed in the veteran population for OUD.

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.

scholarly journals 1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S717-S718
Author(s):  
Michael Lowry ◽  
Christina Fiske ◽  
Peter F Rebeiro
Keyword(s):  
United States ◽  
Substance Use ◽  
Bacterial Infections ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Discharge Data ◽  
Serious Infections ◽  
The Us

Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p< 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures

scholarly journals Persistence and Pervasiveness

2020 ◽  
pp. 003335492096917
Author(s):  
Joel E. Segel ◽  
Tyler N.A. Winkelman
Keyword(s):  
Linear Models ◽  
State Level ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Death Rates ◽  
Overdose Death ◽  
Polysubstance Use ◽  
Opioid Deaths

Objectives Although trends in opioid-related death rates in the United States have been described, the association between state-level opioid overdose death rates in early waves and substance-related overdose death rates in later waves has not been characterized. We examined the relationship between state-level opioid overdose death rates at the beginning of the crisis (1999-2004) and overdose death rates for opioids and other substances in later years. Methods Using 1999-2018 multiple cause of death data from the Centers for Disease Control and Prevention, we first categorized each state by quartile of baseline (1999-2004) opioid overdose death rates. By baseline opioid overdose death rates, we then compared states’ annual overdose death rates from any opioid, heroin, synthetic opioids, sedatives, stimulants/methamphetamine, and cocaine from 2005 through 2018. To test the association between baseline opioid overdose death rates and subsequent substance-related overdose death rates for all 6 substances, we estimated unadjusted and adjusted linear models controlling for annual state-level unemployment, median household income, age, sex, and race/ethnicity. Results Our results suggest 2 characteristics of the opioid crisis: persistence and pervasiveness. In adjusted analyses, we found that for each additional opioid overdose death per 100 000 population at baseline, states had 23.5 more opioid deaths, 4.4 more heroin deaths, 8.0 more synthetic opioid deaths, 9.2 more sedative deaths, 3.3 more stimulant deaths, and 4.6 more cocaine deaths per 100 000 population from 2005 to 2018. Conclusion These findings have important implications for continued surveillance to assist policy makers in deciding how to deploy resources to combat not just opioid use disorder but also polysubstance use disorder and broader problems of substance use disorder.

scholarly journals “The elephant in the room;” a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine Leiner ◽  
Tamara Cody ◽  
Nathan Mullins ◽  
Melinda Ramage ◽  
Bayla M. M. Ostrach
Keyword(s):  
United States ◽  
Substance Use ◽  
Focus Group ◽  
Social Services ◽  
The United States ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
Opioid Use ◽  
Treatment Access ◽  
Subset Analysis

Abstract Background Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. Patients and providers report obstacles to OUD treatment access. Difficulties include legal ambiguity related to Social Services notification requirements following a birth to people using opioids or in medication-assisted treatment for OUD. Methods Through semi-structured interviews, participant-observation, and a focus group conducted in a mostly rural, region of the Southern United States (where perinatal OUD is more prevalent), patients’ and providers’ perspectives about perinatal substance use treatment were initially sought for a larger study. The findings presented here are from a subset analysis of patients’ experiences and perspectives. Following ethics review and exemption determination, a total of 27 patient participants were opportunistically, convenience, and/or purposively sampled and recruited to participate in interviews and/or a focus group. Data were analyzed using modified Grounded Theory. Results When asked about overall experiences with and barriers to accessing perinatal substance use treatment, 11 of 27 participants reported concerns about Social Services involvement resulting from disclosure of their substance use during pregnancy. In the subset analysis, prevalent themes were Fears of Social Services Involvement, Preparation for Delivery, and Providers Addressing Fears. Conclusions Perinatal OUD patients may seek substance use treatment with existing fears of Social Services involvement. Patients appreciate providers’ efforts to prepare them for this potential reality. Providers should become aware of how their own hospital systems, counties, states, and countries interpret laws governing notification requirements. By becoming aware of patients’ fears, providers can be ready to discuss the implications of Social Services involvement, promote patient-centered decision-making, and increase trust.

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