Development of an Emergency Department-Based Intervention to Expand Access to Medications for Addiction Treatment for Opioid Use Disorder in Appalachia: Protocol for Engagement and Community Collaboration (Preprint)

BACKGROUND The opioid epidemic has disproportionately impacted the Appalachian region of the United States (US), a region characterized by higher poverty rates, healthcare access challenges, and higher opioid overdose death rates than other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over two times greater than the statewide average (48.8 versus 19.9 overdoses per 10,000 persons). Emergency Departments (EDs) have been recognized as a major source of healthcare for persons with Opioid Use Disorder (OUD). A program to initiate medications for addiction treatment (MAT) for OUD in the ED has been shown to be effective. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficacious and impactful for long-term treatment success. OBJECTIVE This protocol outlines a framework for ED-initiated MAT for OUD in a resource-limited region of the US, made possible through community partnerships with referral resources for definitive OUD care. METHODS When a patient presents to the ED with symptoms of opioid withdrawal, non-fatal opioid overdose, or requesting opioid detoxification, clinicians will screen for OUD using the Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis. All patients who screen positive for OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine/naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. RESULTS This project is currently ongoing. It was funded in February, 2019, and approved by the University of Alabama at Birmingham IRB in June, 2019. Data collection began on July 7th, 2019 with projected end date February, 2022. Seventy-nine subjects have been enrolled to date. Results to be published in summer 2022. CONCLUSIONS ED recognition of OUD accompanied by buprenorphine/naloxone induction and referral for subsequent long-term treatment engagement have been shown to be one component of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource limited areas such as Appalachia, are crucial for the continuity of addiction care and rehabilitation outcomes.

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Methadone for Opioid Use Disorder

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0008 ◽

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.

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Pharmacotherapy for substance use disorders within correctional facilities

10.1093/med/9780199360574.003.0046 ◽

2015 ◽

Author(s):

Sarah E. Wakeman ◽

Josiah D. Rich

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Behavioral Interventions ◽

Opioid Dependence ◽

Addiction Treatment ◽

Term Treatment ◽

Opiate Dependence ◽

Opioid Use ◽

Long Term Treatment

Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.

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Long-term treatment outcomes in a First Nations high school population with opioid use disorder

Canadian Family Physician ◽

10.46747/cfp.6612907 ◽

2020 ◽

Vol 66 (12) ◽

pp. 907-912

Author(s):

Anita Srivastava ◽

Meldon Mayer Kahan ◽

Mae Katt ◽

Tammy Patriquin ◽

Henry Becker ◽

...

Keyword(s):

High School ◽

Treatment Outcomes ◽

First Nations ◽

Opioid Use Disorder ◽

Term Treatment ◽

Opioid Use ◽

School Population ◽

Long Term Treatment

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Pharmacotherapy for substance use disorders within correctional facilities

10.1093/med/9780199360574.003.0046_update_001 ◽

2017 ◽

Author(s):

Sarah E. Wakeman ◽

Josiah D. Rich

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Behavioral Interventions ◽

Opioid Dependence ◽

Addiction Treatment ◽

Term Treatment ◽

Opiate Dependence ◽

Opioid Use ◽

Long Term Treatment

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Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

Journal of Drug Issues ◽

10.1177/00220426211006362 ◽

2021 ◽

pp. 002204262110063

Author(s):

Brian King ◽

Ruchi Patel ◽

Andrea Rishworth

Keyword(s):

Age Groups ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Policy Recommendations ◽

Opioid Use ◽

Fentanyl Analogs ◽

Measure Change ◽

Using Data ◽

At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

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Discovering Non-Invasive Biomarkers Predictive of Opioid Use Disorder Treatment Response

CNS Spectrums ◽

10.1017/s1092852920002825 ◽

2021 ◽

Vol 26 (2) ◽

pp. 173-173

Author(s):

Amir Levine ◽

Kelly Clemenza ◽

Shira Weiss ◽

Adam Bisaga ◽

Erez Eitan ◽

...

Keyword(s):

Treatment Response ◽

Mononuclear Cells ◽

Specific Treatment ◽

The United States ◽

Opioid Use Disorder ◽

Response To Treatment ◽

Post Translational Modification ◽

Opioid Use ◽

Peripheral Blood Mononuclear ◽

Long Term Treatment

AbstractBackgroundOpioid use disorder (OUD) continues to be the driving force behind drug overdoses in the United States, killing nearly 47,000 people in 2018 alone. The increasing presence of deadlier fentanyl analogues in the heroin drug supply are putting users at a greater risk for overdose than ever before. Admissions to treatment programs for OUD have also nearly doubled since 2006, yet relapse rates remain high. In response to these alarming statistics, developing approaches to reduce overdose deaths has become an area of high priority. As it is not yet known which patients are most likely to benefit from a specific treatment, there is a dire need to utilize new molecular tools to guide precision medicine approaches and improve treatment outcomes. Here we describe a proof-of-concept study evaluating plasma-derived extracellular vesicle (EV) signatures and how they differ in patients who responded to two pharmacologically contrasting treatments for OUD: the μOR agonist methadone, and the μOR antagonist naltrexone.MethodsWe obtained blood samples from patients with OUD who remained abstinent from illicit opioids for at least 3 months during treatment with methadone (n=5) and naltrexone (n=5), as well as matched healthy controls (n=5). EVs were isolated from plasma and histones were isolated from peripheral blood mononuclear cells (PBMCs). EVs were then analyzed for lipid and histone post-translational modification (PTM) content using liquid chromatography-mass spectrometry. EV miRNA cargo was determined by RNA sequencing.ResultsWe found one lipid class and six miRNAs that differed significantly between the naltrexone group and the methadone and control groups. We also found that histone H3acK9acK14 was increasingly acetylated in PMBCs from both the methadone and naltrexone groups compared to controls.DiscussionNaltrexone, which is used in treatment of OUD and other substance use disorders as well as disorders of impulse control, was found to have multiple potential corresponding molecular signatures that can be identified after long-term treatment. It remains to be seen if these markers can also be a good predictor for treatment response. In addition, significant gender differences in EV content are found between men and women with OUD, which supports the importance of examining changes in response to treatment in a gender informed way.

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What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041425 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1425

Author(s):

Morgane Guillou-Landreat ◽

Antoine Dany ◽

Gaëlle Challet-Bouju ◽

Edouard Laforgue ◽

Juliette Leboucher ◽

...

Keyword(s):

Clinical Practice ◽

Opioid Use Disorder ◽

Term Treatment ◽

Pharmacological Therapy ◽

Daily Clinical Practice ◽

Short Report ◽

Opioid Use ◽

Cross Sectional ◽

Long Term Treatment ◽

Social Profiles

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

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Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? (Preprint)

10.2196/preprints.23463 ◽

2020 ◽

Author(s):

Samuel W Stull ◽

Erin R McKnight ◽

Andrea E Bonny

Keyword(s):

The United States ◽

Opioid Use Disorder ◽

Drop Out ◽

Mobile Technologies ◽

Opioid Use ◽

The Face ◽

One Step ◽

Clinician Perspectives ◽

Receive Treatment

UNSTRUCTURED Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term.

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Abstract P44: Does Race Influence Disability and Hospital Disposition After Cerebral Hemorrhage? Results From a Community Wide Stroke Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap44 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Dilip K Pandey ◽

Venkatesh Aiyagari

Keyword(s):

Hospital Mortality ◽

Racial Differences ◽

The United States ◽

Term Treatment ◽

Severe Disability ◽

Stroke Registry ◽

Discharge Disposition ◽

Long Term Treatment ◽

Mortality Incidence

Background: Compared to Non-Hispanic whites (NHW), intracerebral hemorrhage (ICH) has a higher incidence among African Americans (AA) where it also occurs at a younger age. Previous studies have concluded that there are no racial differences in hospital mortality after ICH, but the influence of race on disability and discharge disposition after ICH has not been studied. Methods: The Illinois Capture-Stroke registry is a prospectively collected database of patients admitted with a stroke to 56 acute care hospitals in Illinois. We performed a retrospective analysis of the association between race, and in-hospital mortality, modified Rankin Scale (mRS) score at discharge and discharge disposition in 804 patients with ICH enrolled in the registry between 2005 and 2007. Results: We studied 530 NHW and 175 AA patients with radiologically proven ICH. Compared to NHW, AA patients were younger (mean age NHW: 73±14 vs AA: 58±12 yrs, p <0.001) and had a higher incidence of hypertension, smoking and coronary artery disease. Although there was no racial difference in hospital mortality, incidence of moderate to severe disability (mRS 4-5) was significantly higher in NHW (69%) compared to AA (55%). Among patients <65 years old, a trend (p=0.102) towards a higher disability in NHW was observed (60% in NHW vs. 45% in AA). In this age group, 41% of NHW and 33% of AA were discharged to rehabilitation facilities while 37% of NHW and 44% of AA were discharged home. Conclusion: A very large proportion of patients with ICH are discharged from hospitals with moderate or severe disability. Compared to NHW, a higher proportion of younger AA patients are discharged home after ICH. The long term outcomes of survivors after ICH in the United States is not well studied, and the influence of racial and socioeconomic factors on long-term treatment and outcome after ICH needs to be explored.

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Use of Buprenorphine for the Treatment of Opioid Use Disorder

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0009 ◽

2020 ◽

pp. 155-168

Author(s):

Paul J. Fudala ◽

Anne Cramer Andorn

Keyword(s):

Opioid Dependence ◽

Addiction Treatment ◽

Partial Agonist ◽

The United States ◽

Opioid Use Disorder ◽

Sublingual Administration ◽

Opioid Use ◽

The Us ◽

Monthly Administration ◽

Drug Addiction Treatment

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.

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