scholarly journals Implementing a Low-threshold Audio-only Telehealth Model for Medication-assisted Treatment of Opioid Use Disorder at a Community-based Non-profit Organization in Washington, D.C.

2021 ◽  
Author(s):  
Ellis Jaewon Yeo ◽  
Hannah Kralles ◽  
David Sternberg ◽  
Dana McCullough ◽  
Ajetha Nadanasabesan ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Treatment Access ◽  
Community Based ◽  
Medication Assisted Treatment ◽  
Low Threshold

Abstract BackgroundThe COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the United States, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Case PresentationThis case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. ConclusionsLow-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

scholarly journals Implementing a low-threshold audio-only telehealth model for medication-assisted treatment of opioid use disorder at a community-based non-profit organization in Washington, D.C.

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ellis Jaewon Yeo ◽  
Hannah Kralles ◽  
David Sternberg ◽  
Dana McCullough ◽  
Ajetha Nadanasabesan ◽  
...  
Keyword(s):  
Behavioral Health Care ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Retention Rates ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Treatment Access ◽  
Community Based ◽  
Medication Assisted Treatment ◽  
Low Threshold

Abstract Background The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Lessons learned have the potential to improve MAT delivery to people with OUD. Case presentation This case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. Patients were predominantly male (74.4%) and black (90.6%). The mean age was 53 years old with more than half of the clients aged 55 or older. Less than half (42.3%) of the patients lived in stable housing. Patients commonly had self-reported comorbid conditions such as hypertension (35.4%), hepatitis C (23.5%), diabetes (11.9%), human immunodeficiency virus (HIV) (7.2%). A majority of patients (68.6%) reported engagement with behavioral health care. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. In-person retention rates at 90- and 180-days were substantially higher than telehealth retention rates (93.9% vs 68.4% and 91.5% vs 51.9%, respectively). Conclusions Low-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

scholarly journals Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph Tay Wee Teck ◽  
Alexander Baldacchino ◽  
Lauren Gibson ◽  
Con Lafferty
Keyword(s):  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
High Dose ◽  
Opioid Use ◽  
Access To Treatment ◽  
Medication Assisted Treatment ◽  
Low Threshold ◽  
Healthcare Innovation ◽  
Long Acting

Healthcare innovation has never been more important as it is now when the world is facing up to the unprecedented challenges brought by the COVID-19 pandemic. Within addictions services in Scotland, the priority has been to tackle our rising drug related death rate by maintaining and improving access to treatment while protecting frontline workers and managing operational challenges as a result of the pandemic. We present here a case study of five patients with opioid use disorder whose treatment represents a confluence of three important Medication Assisted Treatment (MAT) service innovations. The first was a low threshold drop in and outreach MAT service to rapidly and safely initiate opiate replacement therapy (ORT). The second was the provision of a microdosing regimen to enable same day induction to oral buprenorphine while minimizing the risk of precipitated opioid withdrawals and/or treatment disengagement. The third was rapid transitioning to an injectable long-acting buprenorphine depot which reduced unnecessary face to face patient contact and treatment non-adherence. This case study of five patients highlights the valuable role that buprenorphine microdosing can play in making induction to long-acting buprenorphine depot feasible to a broader range of patients, including those on a high dose methadone treatment regime.

scholarly journals Hepatitis C Treatment Among People Who Use Drugs in an Office-Based Opioid Treatment Program Versus a Syringe Exchange Program: A Real-World Prospective Clinical Trial

2021 ◽  
Vol 21 (8) ◽  
Author(s):  
Andrew Seaman ◽  
Wren Ronan ◽  
Lauren Myers ◽  
Haven Wheelock ◽  
Melinda Butler ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Treatment Outcomes ◽  
Real World ◽  
Treatment Completion ◽  
Opioid Use Disorder ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Treatment Access ◽  
Open Label

Background: Hepatitis C Virus (HCV) treatment in people who inject drugs (PWID) is a key component of elimination models but PWID face substantial barriers to treatment access. Despite data showing treatment outcomes among PWID on medications for opioid use disorder (MOUD) are similar to non-PWID outcomes, few studies examine PWID treatment outcomes with only syringe services support. Objectives: To evaluate the effect of recruitment for HCV treatment with elbasvir/grazoprevir (E/G) in a syringe services program (SSP) as compared to an MOUD program for people with opioid use disorder. Methods: This real-world, multi-site prospective open-label pilot study compares treatment of PWID with aspartate aminotransferase to platelet ratio (APRI) < 0.7 and genotype 1a, 1b, and 4 HCV with E/G, engaged in MOUD (n = 25) or an SSP (n = 25). The MOUD arm was enrolled through a federally qualified community health center and SSP arm through a nearby SSP. Prospective arms were compared to an academic hepatology clinic group (n = 50). Sustained virologic response at 12 weeks (SVR12), medication adherence, and treatment discontinuation were evaluated. Results: In the MOUD vs SSP arms, substance use throughout treatment was found in 36% (9/25) vs 100% (25/25); good adherence (> 90% pills taken) in 100% (25/25) vs 68% (17/25); treatment completion 100% (25/25) vs 64% (16/25); and SVR12 rates were 96% (24/25) vs 60% (15/25). In the community standard comparison group, SVR12 was achieved in 94% (47/50). There were two virologic failures or re-infections in the SSP group; all other non-responders were due to missing SVR12 data. Conclusions: While recruitment and follow-up are challenging in SSPs, preliminary data suggests adherence, treatment completion, and SVR12 are high in PWID treated with E/G engaging in SSP or MOUD. All metrics are comparable to community standards for non-PWID for treatment of HCV with direct-antiviral drugs.

Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician's Perspective

2018 ◽  
Vol 46 (2) ◽  
pp. 268-271 ◽  
Author(s):  
Curtis Bone ◽  
Lindsay Eysenbach ◽  
Kristen Bell ◽  
Declan T. Barry
Keyword(s):  
Health Care Providers ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use ◽  
Ethical Obligation ◽  
Medication Assisted Treatment ◽  
Improved Outcomes ◽  
Poor Outcomes

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration.

scholarly journals Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice

2020 ◽  
Vol 11 ◽  
pp. 215013272093172
Author(s):  
Mark Deyo-Svendsen ◽  
Matthew Cabrera Svendsen ◽  
James Walker ◽  
Andrea Hodges ◽  
Rachel Oldfather ◽  
...  
Keyword(s):  
Family Medicine ◽  
The United States ◽  
Opioid Use Disorder ◽  
Number Needed To Treat ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Effect Change ◽  
Medication Assisted Treatment ◽  
Rural Family ◽  
Outpatient Practice

Opioid use disorder (OUD) is a cause of significant morbidity and mortality in the United States. Although efforts are being made to limit access to prescription opioids, the use of heroin and synthetic opioids as well as death due to opioid overdose has increased. Medication-assisted treatment (MAT) is the pairing of psychosocial intervention with a Food and Drug Administration (FDA)–approved medication (methadone, buprenorphine plus naltrexone) to treat OUD. MAT has resulted in reductions in overdose deaths, criminal activity, and infectious disease transmission. Access to MAT in rural areas is limited by shortages of addiction medicine-trained providers, lack of access to comprehensive addiction programs, transportation, and cost-related issues. Rural physicians express concern about lack of mentorship and drug diversion as reasons to avoid MAT. The prescribing of MAT with buprenorphine requires a Drug Enforcement Agency (DEA) waiver that can easily be obtained by Family Medicine providers. MAT can be incorporated into the outpatient practice, where patient follow-up rates and number needed to treat to effect change are similar to that of other chronic medical conditions. We describe a case of opioid overdose and a suggested protocol for the induction of MAT with buprenorphine/naloxone (Suboxone) for OUD in a rural family medicine outpatient practice. Treatment access is facilitated by utilizing the protocol, allowing office staff work to the extent allowed by their licensure, promoting teamwork and minimizing physician time commitment. We conclude that improved access to MAT can be accomplished in a rural family medicine outpatient clinic by staff that support and mentor one another through use of a MAT protocol.

scholarly journals The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

2020 ◽  
Author(s):  
Pengyue Zhang ◽  
Chien-Wei Chiang ◽  
Sara Quinney ◽  
Macarius Donneyong ◽  
Bo Lu ◽  
...  
Keyword(s):  
Large Scale ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
P Value ◽  
Opioid Use ◽  
Pain Medications ◽  
Real World Evidence ◽  
Opioid Medications ◽  
Buprenorphine Treatment

ABSTRACTIntroductionRetention in buprenorphine treatment for opioid use disorder (OUD) yields better opioid abstinence and reduces all-cause mortality for patients with OUD. Despite significant efforts have been made to expand the availability and use of buprenorphine in the United States, its retention rates remain on a low level. The current study examines discontinuation of buprenorphine with respect to concurrent initiation of other medications using real-world evidence.MethodsCase-crossover study was conducted to examine discontinuation of buprenorphine using a large-scale longitudinal health dataset including 148,306 commercially-insured individuals initiated on medications for opioid use disorder (MOUD). Odds ratios and Bonferroni adjusted p-values were calculated for medications and therapeutic classes of medications.ResultsClonidine was associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone (OR = 1.583 and adjusted p-value = 1.22 × 10−6) and using naltrexone as a comparison drug (OR = 2.706 and adjusted p-value = 4.11 × 10−5). Opioid medications (oxycodone, morphine and fentanyl) and methocarbamol were associated with increased discontinuation risk of buprenorphine using the buprenorphine dataset alone (adjusted p-value < 0.05), but not significant using naltrexone as a comparison drug. 6 drug therapeutic classes were associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone and using naltrexone as a comparison drug (adjusted p-value < 0.05).ConclusionConcurrent initiation of medications is associated with increased discontinuation risk of buprenorphine. Opioid medications are prescribed among patients on MOUD and associated with increased discontinuation risk of buprenorphine. Analgesics is associated with increased discontinuation risk of buprenorphine for patients without previous exposure of pain medications.

scholarly journals A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Marika Elise Waselewski ◽  
Tabor Elisabeth Flickinger ◽  
Chelsea Canan ◽  
William Harrington ◽  
Taylor Franklin ◽  
...  
Keyword(s):  
Pilot Study ◽  
The United States ◽  
Opioid Use Disorder ◽  
Mobile App ◽  
Evidence Based ◽  
Opioid Use ◽  
Self Monitoring ◽  
Health Crisis ◽  
Medication Assisted Treatment ◽  
System Usability

BACKGROUND Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. OBJECTIVE The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. METHODS Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers’ perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants’ input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. RESULTS Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. CONCLUSIONS The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program’s effect on clinical outcomes, patient linkage, and engagement in care.

Overcoming Barriers: Individual Experiences Obtaining Medication-Assisted Treatment for Opioid Use Disorder

2020 ◽  
Vol 30 (13) ◽  
pp. 2103-2117
Author(s):  
Krista L. Scorsone ◽  
Emily A. Haozous ◽  
Leslie Hayes ◽  
Kim J. Cox
Keyword(s):  
Urban Areas ◽  
Enhanced Recovery ◽  
The United States ◽  
Gender Disparity ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Intersectionality Theory ◽  
Recovery Capacity ◽  
Qualitative Descriptive

Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. Guided interviews were conducted with 20 participants. The frameworks of critical social theory, intersectionality theory, and the brain opioid theory of social attachment were used to guide data analysis and interpretation. Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural–urban MAT disparity, leading to enhanced recovery capacity and transformative policies.

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