A Smartphone-Smartcard Platform for Implementing Contingency Management in Buprenorphine Maintenance Patients With Concurrent Stimulant Use Disorder

Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder.Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression.Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints.Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.

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Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

PLoS ONE ◽

10.1371/journal.pone.0244401 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244401

Author(s):

Danielle Rice ◽

Kimberly Corace ◽

Dianna Wolfe ◽

Leila Esmaeilisaraji ◽

Alan Michaud ◽

...

Keyword(s):

Contingency Management ◽

Psychosocial Interventions ◽

Opioid Use Disorder ◽

Treatment Retention ◽

Controlled Trials ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Meta Analyses

Background Guidelines recommend that individuals with opioid use disorder (OUD) receive pharmacological and psychosocial interventions; however, the most appropriate psychosocial intervention is not known. In collaboration with people with lived experience, clinicians, and policy makers, we sought to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy (OAT) among persons with OUD. Methods A review protocol was registered a priori (CRD42018090761), and a comprehensive search for randomized controlled trials (RCT) was conducted from database inception to June 2020 in MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Established methods for study selection and data extraction were used. Primary outcomes were treatment retention and opioid use (measured by urinalysis for opioid use and opioid abstinence outcomes). Odds ratios were estimated using network meta-analyses (NMA) as appropriate based on available evidence, and in remaining cases alternative approaches to synthesis were used. Results Seventy-two RCTs met the inclusion criteria. Risk of bias evaluations commonly identified study limitations and poor reporting with regard to methods used for allocation concealment and selective outcome reporting. Due to inconsistency in reporting of outcome measures, only 48 RCTs (20 unique interventions, 5,404 participants) were included for NMA of treatment retention, where statistically significant differences were found when psychosocial interventions were used as an adjunct to OAT as compared to OAT-only. The addition of rewards-based interventions such as contingency management (alone or with community reinforcement approach) to OAT was superior to OAT-only. Few statistically significant differences between psychosocial interventions were identified among any other pairwise comparisons. Heterogeneity in reporting formats precluded an NMA for opioid use. A structured synthesis was undertaken for the remaining outcomes which included opioid use (n = 18 studies) and opioid abstinence (n = 35 studies), where the majority of studies found no significant difference between OAT plus psychosocial interventions as compared to OAT-only. Conclusions This systematic review offers a comprehensive synthesis of the available evidence and the limitations of current trials of psychosocial interventions applied as an adjunct to OAT for OUD. Clinicians and health services may wish to consider integrating contingency management in addition to OAT for OUD in their settings to improve treatment retention. Aside from treatment retention, few differences were consistently found between psychosocial interventions adjunctive to OAT and OAT-only. There is a need for high-quality RCTs to establish more definitive conclusions. Trial registration PROSPERO registration CRD42018090761.

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Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa386 ◽

2020 ◽

Author(s):

Taylor Kirby ◽

Robert Connell ◽

Travis Linneman

Keyword(s):

Multivariate Analysis ◽

Hospital Admission ◽

Intervention Group ◽

Opioid Use Disorder ◽

Control Group ◽

Opioid Use ◽

Motivation To Change ◽

Heroin Use ◽

Ed Visits ◽

The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

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Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00399-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Heather Palis ◽

Kirsten Marchand ◽

Gerald “ Spike” Peachey ◽

Jordan Westfall ◽

Kurt Lock ◽

...

Keyword(s):

Controlled Trial ◽

Research Question ◽

Substitution Effect ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Stimulant Use ◽

Practice Elements ◽

Concurrent Use ◽

Wide Range

Abstract Background A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients. Methods Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n = 20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results Participants reported a range of stimulant use types, including cocaine (n = 8), methamphetamine (n = 8), or both (n = 4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic). Conclusion In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

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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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Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

10.21203/rs.3.rs-404459/v1 ◽

2021 ◽

Author(s):

Heather Palis ◽

Kirsten Marchand ◽

Gerald Spike Peachey ◽

Jordan Westfall ◽

Kurt Lock ◽

...

Keyword(s):

Controlled Trial ◽

Research Question ◽

Substitution Effect ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Stimulant Use ◽

Practice Elements ◽

Concurrent Use ◽

Wide Range

Abstract Background: A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients.Methods: Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n=20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results: Participants reported a range of stimulant use types, including cocaine (n=8), methamphetamine (n=8), or both (n=4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic).Conclusion: In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

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Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

PLoS ONE ◽

10.1371/journal.pone.0226349 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0226349 ◽

Cited By ~ 1

Author(s):

Justin C. Yang ◽

Andres Roman-Urrestarazu ◽

Carol Brayne

Keyword(s):

United States ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment

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Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽

10.1017/cem.2020.438 ◽

2020 ◽

Vol 22 (6) ◽

pp. 784-792 ◽

Cited By ~ 1

Author(s):

Patrick McLane ◽

Ken Scott ◽

Zainab Suleman ◽

Karen Yee ◽

Brian R. Holroyd ◽

...

Keyword(s):

Emergency Department ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Emergency Department Care ◽

Improvement Project ◽

Health Crisis ◽

Opioid Agonist Treatment ◽

Before And After ◽

Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

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