Implementing a Methadone Delivery System in New York City in Response to COVID-19

2021 ◽  
Vol 111 (12) ◽  
pp. 2115-2117
Author(s):  
Alex Harocopos ◽  
Michelle L. Nolan ◽  
Gail P. Goldstein ◽  
Shivani Mantha ◽  
Madeleine O’Neill ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
First Line ◽  
Opioid Agonist ◽  
Fatal Overdose ◽  
First Line Treatment

Opioid agonist medication, including methadone, is considered the first-line treatment for opioid use disorder. Methadone, when taken daily, reduces the risk of fatal overdose; however, overdose risk increases following medication cessation. Amid an overdose epidemic accelerated by the proliferation of fentanyl, ensuring continuity of methadone treatment during the COVID-19 pandemic is a vital public health priority. (Am J Public Health. 2021;111(12):2115–2117. https://doi.org/10.2105/AJPH.2021.306523 )

scholarly journals Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services

Addiction ◽  
2020 ◽  
Vol 115 (9) ◽  
pp. 1683-1694 ◽  
Author(s):  
Noa Krawczyk ◽  
Ramin Mojtabai ◽  
Elizabeth A. Stuart ◽  
Michael Fingerhood ◽  
Deborah Agus ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose

CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017–2020

2021 ◽  
pp. 009145092110521
Author(s):  
Brandon del Pozo
Keyword(s):  
Public Health ◽  
New York ◽  
Performance Metrics ◽  
Public Health Intervention ◽  
Police Department ◽  
Opioid Use Disorder ◽  
Health Staff ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Overdose Deaths

From 2017 to early 2020, the US city of Burlington, Vermont led a county-wide effort to reduce opioid overdose deaths by concentrating on the widespread, low-barrier distribution of medications for opioid use disorder. As a small city without a public health staff, the initiative was led out of the police department—with an understanding that it would not be enforcement-oriented—and centered on a local adaptation of CompStat, a management and accountability program developed by the New York City Police Department that has been cited as both yielding improvements in public safety and overemphasizing counterproductive police performance metrics if not carefully directed. The initiative was instrumental to the implementation of several novel interventions: low-threshold buprenorphine prescribing at the city’s syringe service program, induction into buprenorphine-based treatment at the local hospital emergency department, elimination of the regional waiting list for medications for opioid use disorder (MOUD), and the de-facto decriminalization of diverted buprenorphine by the chief of police and county prosecutor. An effort by local legislators resulted in a state law requiring all inmates with opioid use disorder be provided with MOUD as well. By the end of 2018, these interventions were collectively associated with a 50% (17 vs. 34) reduction in the county’s fatal overdose deaths, while deaths increased 20% in the remainder of Vermont. The reduction was sustained through the end of 2019. This article describes the effort undertaken by officials in Burlington to implement these interventions. It provides an example that other municipalities can use to take an evidence-based approach to reducing opioid deaths, provided stakeholders assent to sustained collaboration in the furtherance of a commitment to save lives. In doing so, it highlights that police-led public health interventions are the exception, and addressing the overdose crisis will require reform that shifts away from criminalization as a community’s default framework for substance use.

Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach

2020 ◽  
Vol 13 (3) ◽  
pp. e233715 ◽  
Author(s):  
Mackenzie Duncan Gregory Caulfield ◽  
Rupinder Brar ◽  
Christy Sutherland ◽  
Seonaid Nolan
Keyword(s):  
Slow Release ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
First Line ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Evidence Based Treatment ◽  
Opioid Agonist Therapy

In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.

scholarly journals The Increasing Prevalence of Fentanyl: A Urinalysis‐Based Study Among Individuals With Opioid Use Disorder in New York City

2020 ◽  
Vol 30 (1) ◽  
pp. 65-71
Author(s):  
Suky Martinez ◽  
Jermaine D. Jones ◽  
Laura Brandt ◽  
Aimee N. C. Campbell ◽  
Rebecca Abbott ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Opioid Use Disorder ◽  
Opioid Use

Methadone for Opioid Use Disorder

2020 ◽  
pp. 139-154
Author(s):  
Dennis J. Hand
Keyword(s):  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Long Term Treatment ◽  
Long Acting ◽  
Practical Factors

Methadone is a long-acting full opioid agonist that has a long history in the treatment of opioid use disorder (OUD). It was the first opioid agonist with OUD as an indication for use. Methadone was developed for OUD during a time of prohibition and criminalization of both addiction and the use of opioid agonists for addiction treatment, which resulted in methadone being heavily regulated at multiple levels. Methadone is frequently used in short-term withdrawal management (i.e., detoxification) and in long-term treatment, with the latter producing better treatment outcomes. This chapter explores the basic pharmacology of methadone and the development of methadone for OUD and its accompanying regulations, discusses the place of methadone in treatment for OUD, reviews the effectiveness of methadone treatment, and visits some practical factors related to methadone as part of treatment for OUD.

scholarly journals Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255396
Author(s):  
Lexis R. Galarneau ◽  
Jesse Hilburt ◽  
Zoe R. O’Neill ◽  
Jane A. Buxton ◽  
Frank X. Scheuermeyer ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Mitigation ◽  
Community Outreach ◽  
Healthcare Services ◽  
Opioid Use Disorder ◽  
Mitigation Strategies ◽  
Outreach Program ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Health Measures

Aim To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. Design We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. Setting We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. Participants Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. Measurements We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants’ knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. Results One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. Conclusion COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.

scholarly journals Impact of Prerelease Methadone on Mortality Among People with HIV and Opioid Use Disorder After Prison Release: Results from a Randomized and Participant Choice Open-Label Trial in Malaysia

2021 ◽  
Author(s):  
Alexander R. Bazazi ◽  
Gabriel J. Culbert ◽  
Martin P. Wegman ◽  
Robert Heimer ◽  
Adeeba Kamarulzaman ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Controlled Trial ◽  
Methadone Treatment ◽  
Vital Statistics ◽  
Opioid Use Disorder ◽  
Cox Proportional Hazards ◽  
Opioid Use ◽  
Open Label ◽  
Opioid Agonist ◽  
The Impact

Abstract Introduction: Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Opioid agonist therapy (OAT) with methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison. Methods:This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n=291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n=64) and participant choice (n=246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival. Results: Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5–89.4). Most deaths were of infectious etiology. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6–3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5–2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0–1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1–3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7–1.0). Conclusions: Mortality after prison release in this sample of men with HIV and OUD was extraordinarily high and unaffected by prerelease methadone. Treatment of OUD alone may be insufficient to reduce mortality in settings where inadequately treated HIV is the main cause of death after prison release. Trial registration number: NCT02396979. Retrospectively registered 24/03/2015.

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