scholarly journals Cross-Training Needs Among Community-Based Clinicians in HIV and Substance Use

2021 ◽  
Author(s):  
Kasey Claborn ◽  
Kelli Scott ◽  
Sara J Becker
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Scale Up ◽  
Opioid Use Disorder ◽  
Training Needs ◽  
Opioid Use ◽  
Double Burden ◽  
Individual Interviews ◽  
Cross Training ◽  
Training Need

Abstract Background: People with double burden of HIV and substance use have poorer treatment engagement and worse treatment outcomes. Cross-training of HIV and substance use disorder clinicians can potentially enhance the scale up and quality of integrated care. Research is needed on clinicians’ areas of greatest training need in order to inform training development. Methods: Data from semi-structured individual interviews with 16 HIV and 13 substance use disorder clinicians (N=29) examining clinician perspectives on their training needs were analyzed using thematic analysis. Results: Overall, three themes emerged in regards to the clinicians’ need for training: 1) past training experiences: both HIV and substance use clinicians reported they had received minimal formal cross-training; 2) gaps in training: sensitivity and anti-stigma training, the latest medications for opioid use disorder and HIV prevention/treatment and referral resources emerged as key areas of cross-training need; and 3) training and supervision format/structure: clinicians cited didactic workshops and ongoing supervision as appealing strategies. Conclusions: Results show that lack of formal and updated training for clinicians is an important gap in providing integrated HIV and substance use treatment. Didactic workshops and ongoing support strategies that address stigma, medications for HIV and substance use disorder, and referral resources are likely to be particularly valuable.

scholarly journals A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Megan A. O’Grady ◽  
Patricia Lincourt ◽  
Belinda Greenfield ◽  
Marc W. Manseau ◽  
Shazia Hussain ◽  
...  
Keyword(s):  
Substance Use ◽  
Quality Improvement ◽  
Substance Use Disorder ◽  
Controlled Trial ◽  
Opioid Use Disorder ◽  
Treatment Quality ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
Randomized Controlled ◽  
Disorder Treatment

Abstract Background The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder. Methods A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data. Discussion This study will provide the field with a strong test of a multicomponent intervention to improve providers’ capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system. Trial registration Trial #NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020

scholarly journals Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support

2021 ◽  
Vol 15 ◽  
pp. 117822182097698
Author(s):  
Milena Stanojlović ◽  
Larry Davidson
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Recovery Process ◽  
Continuum Of Care ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Care Continuum ◽  
Cascade Of Care ◽  
Recovery Support ◽  
The Continuum

Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

2020 ◽  
pp. 104973232097123
Author(s):  
Barbara Andraka-Christou ◽  
Olivia Randall-Kosich ◽  
Rachel Totaram
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorder ◽  
Professional Education ◽  
Opioid Use Disorder ◽  
Treatment Center ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
History Of ◽  
Disorder Treatment

Treatment preferences of people with opioid use disorder (OUD) have been underexplored, especially among those with a history of utilizing medications for opioid use disorder (MOUD). Therefore, we sought to understand preferred characteristics of substance use disorder treatment centers among people recovering from OUD with a history of MOUD utilization. We recruited 30 individuals from eight states through snowball sampling initiated at three syringe exchange programs. Telephone interviews were audio-recorded and transcribed in 2018–2019. Inductive thematic analysis in Dedoose software occurred iteratively with recruitment. The following were “ideal” treatment center themes: a menu of treatment options, including MOUD and nonspiritual peer support groups; an integrated system with multiple care levels (e.g., outpatient, residential); a harm reduction approach, including for goal setting and success measures; adjunctive support services (e.g., housing); and employees with recovery experience and professional education. Many preferences directly related to core principles of person-centered care and harm reduction.

scholarly journals LO91: Opioid poisoning and opioid use disorder in older trauma patients

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S40-S41
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
L. Moore ◽  
A. Cournoyer ◽  
M. Emond ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Proportional Hazards ◽  
Opioid Use Disorder ◽  
Cox Proportional Hazards ◽  
Trauma Patients ◽  
Opioid Use ◽  
Multicenter Cohort Study ◽  
Opioid Prescription ◽  
History Of

Introduction: Patients hospitalized following a trauma will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (< 3 months) opioid use after discharge and the risk of opioid poisoning (OP) or opioid use disorder (OUD) in older trauma patients Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients aged 65 years and older admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for OP and OUD from ICD-9 and ICD-10 code diagnosis that resulted in a hospitalization or a medical consultation after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not fill an opioid prescription during that period using Cox proportional hazards regressions. Results: A total of 70,314 participants were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3-months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.30%; 95%CI: 0.25%-0.35%) were hospitalized for OP and 73 (0.10%; 95%CI: 0.07%-0.13%) were diagnosed with OUD. Having filled an opioid prescription within 3-months of injury was associated with an increased hazard ratio of OP (2.6; 95%CI: 1.9-3.5) and OUD (4.0; 95%CI: 2.3-7.0). However, history of OP (2.7; 95%CI: 1.2-6.1), of substance use disorder (4.3; 95%CI: 2.4-7.9), or of opioid prescription filled (2.7; 95%CI: 2.1-3.5) before trauma were also related to OP or OUD. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with history of substance use disorder, opioid poisoning or opioid use during the past year.

Collaborating to Address Substance Use Disorder in Correctional Settings

2019 ◽  
pp. 123-134
Author(s):  
Rosemarie A. Martin ◽  
Nicole Alexander-Scott ◽  
Joseph Wendelken ◽  
Jennifer G. Clarke
Keyword(s):  
Substance Use ◽  
Rhode Island ◽  
Substance Use Disorder ◽  
Program Implementation ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
The Social ◽  
Correctional Settings ◽  
State Programs

For years, advocates in Rhode Island, including many individuals on staff at the Rhode Island Department of Corrections, envisioned a criminal justice system that did not perpetuate the crises of substance use disorder and overdose and instead helped address them thought treatment and recovery supports. In 2016, the state’s corrections department introduced the first statewide correctional system medication-assisted treatment program in the country to initiate a comprehensive program to screen for opioid use disorder. The program is demonstrating successful results. Continued public health and corrections collaboration lay the groundwork for additional innovations in program implementation, including the Rhode Island Department of Health’s focus on health equity and the social determinants of health. This chapter shares the Rhode Island experience as a potential model for other state programs.

Suicidology and Substance abuse in Adolescence

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Werner ◽  
J.-P. Kahn
Keyword(s):  
Substance Use ◽  
Childhood Abuse ◽  
Substance Use Disorder ◽  
Suicidal Behaviour ◽  
Treatment Protocol ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Opioid Use ◽  
Treatment And Prevention ◽  
History Of

Adolescence is a critical period for suicidal risk. Suicide currently ranks as the second or third leading cause of mortality among adolescents in developped countries. It has been shown that a history of suicidal act, of depressive disorder and of a substance use disorder (SUD), alcohol and drugs, are the most prominent risk factors for suicidal behaviour among adolescents.Data on alcohol and drug use disorders and suicide consisted primarily of reports on alcohol use disorders and, to a lesser extent, opioid use disorder. The magnitude of the association with other drugs is still unclear.The relationships between substance use disorder and suicidal behaviour are multiple: In the long term, SUD may be associated with increases in stress and co-occuring psychopathology (poor self esteem, feeling of worthlessness, isolation).These elements may reach a level where a suicide attempt is viewed as a means to cope with perceived unsolvable difficulties. During life crises, SUD can also be responsible for inhibiting adaptative coping and desinhibiting suicidal behaviour. Finally, SUD and suicidal behaviour share common vulnerability factors: history of childhood abuse, genetically determined dimensions such as impulsivity or psychiatric disorders, particularly unipolar depressive and bipolar disorder.Given the comorbidity between SUD and suicide, it is essential for treatment and prevention that all suicidal adolescents be screened for SUD and vice versa. Ideally, adolescents who receive diagnosis of SUD and co-occuring suicidality should follow an integrated treatment protocol that addresses both conditions.

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