scholarly journals Pharmacy Students’ Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 205
Author(s):  
Alina Cernasev ◽  
Michael P. Veve ◽  
Taylor Talbott ◽  
Elizabeth A. Hall ◽  
Kenneth C. Hohmeier
Keyword(s):  
Student Perceptions ◽  
Qualitative Interviews ◽  
Opioid Use Disorder ◽  
Pharmacy Students ◽  
Community Settings ◽  
Opioid Use ◽  
Difficult Patient ◽  
Electronic Survey ◽  
Mixed Methods Evaluation ◽  
Life Saving

Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.

scholarly journals Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists’ Perceptions and Attitudes

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 144
Author(s):  
Elizabeth A. Hall ◽  
Alina Cernasev ◽  
Umida Nasritdinova ◽  
Michael P. Veve ◽  
Kenneth C. Hohmeier
Keyword(s):  
Community Pharmacy ◽  
Student Perceptions ◽  
Opioid Use Disorder ◽  
Vital Role ◽  
Primary Objective ◽  
Community Resources ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Electronic Survey ◽  
Perceptions And Attitudes

Objectives: Pharmacists play a vital role in serving patients during the ongoing nationwide opioid epidemic, and so it is also critical to educate the next generation of pharmacists on opioids and opioid use disorder (OUD). The primary objective of this study was to quantitatively characterize student perceptions of opioid use and the stigma associated with OUD. Secondary aims were to determine whether differences in perceptions exist based upon the student’s year in the Doctor of Pharmacy program or employment in a community pharmacy. Methods: First-, second-, third-, and fourth-year student pharmacists voluntarily completed an electronic survey regarding perceptions of opioid use and stigma associated with OUD. Results: Of the 9 survey items, students were most uncomfortable referring patients to community resources for addiction support and/or treatment (25.3% comfortable or very comfortable). Students working in a community pharmacy were significantly more comfortable talking to patients attempting to refill opioids early and providing opioid counseling as compared to their peers not working in community pharmacy. Fourth-year students reported a higher level of comfort talking to a patient attempting to refill an opioid prescription early, counseling a patient on an opioid prescription, and providing information about alternatives to opioids. Third-year students responded most favorably to the items regarding how well the curriculum has prepared them to interact with patients taking opioids and those with OUD. Conclusions: These findings reveal that students are comfortable counseling on opioids and discussing alternative options. Differences in perceptions were observed based upon the student’s year in the program and whether or not they were employed in a community pharmacy setting.

scholarly journals MP11: Emergency physician attitudes on opioid use disorder and barriers to providing buprenorphine/naloxone

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S46-S46
Author(s):  
D. Webster ◽  
T. Meyer ◽  
C. Crain ◽  
J. Fraser ◽  
P. Atkinson
Keyword(s):  
Harm Reduction ◽  
Formal Education ◽  
Opioid Use Disorder ◽  
Physician Attitudes ◽  
Opioid Use ◽  
Medically Ill ◽  
Bridge Program ◽  
Narrow Scope ◽  
Life Saving ◽  
Systemic Health

Introduction: Buprenorphine/naloxone (buprenorphine) has proven to be a life-saving intervention amidst the ongoing opioid epidemic in Canada. Research has shown benefits to initiating buprenorphine from the emergency department (ED) including improved treatment retention, systemic health care savings and fewer drug-related visits to the ED. Despite this, there has been little to no uptake of this evidence-based practice in our department. This qualitative study aimed to determine the local barriers and potential solutions to initiating buprenorphine in the ED and gain an understanding of physician attitudes and behaviours regarding harm reduction care and opioid use disorder management. Methods: ED physicians at a midsize Atlantic hospital were recruited by convenience sampling to participate in semi-structured privately conducted interviews. Audio recordings were transcribed verbatim and de-identified transcripts were uploaded to NVivo 12 plus for concept driven and inductive coding and a hierarchy of open, axial and selective coding was employed. Transcripts were independently reviewed by a local qualitative research expert and themes were compared for similarity to limit bias. Interview saturation was reached after 7 interviews. Results: Emergent themes included a narrow scope of harm reduction care that primarily focused on abstinence-based therapies and a multitude of biases including feelings of deception, fear of diversion, feeling buprenorphine induction was too time consuming for the ED and differentiating patients with opioid use disorder from ‘medically ill’ patients. Several barriers and proposed solutions to initiating buprenorphine from the ED were elicited including lack of training and need for formal education, poor familiarity with buprenorphine, the need for an algorithm and community bridge program and formal supports such as an addictions consult team for the ED. Conclusion: This study elicited several opportunities for improved care for patients with addictions presenting to our ED. Future education will focus on harm reduction care, specifically strategies for managing patients desiring to continue to use substances. Education will focus on addressing the multitude of biases elicited and dispelling common myths. A locally informed buprenorphine pathway will be developed. In future, this study may be used to advocate for improved formal supports for our department including an addictions consult team.

scholarly journals Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Marcus Castillo ◽  
Brianna Conte ◽  
Sam Hinkes ◽  
Megan Mathew ◽  
C. J. Na ◽  
...  
Keyword(s):  
Medical Student ◽  
People Who Inject Drugs ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Use Disorder ◽  
Health Issues ◽  
Opioid Use ◽  
Academic Medical ◽  
Life Saving ◽  
Attending Physicians

Abstract Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

scholarly journals Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew Edsall ◽  
Kim A. Hoffman ◽  
Dinh Thanh Thuy ◽  
Pham Phuong Mai ◽  
Nguyen Thu Hang ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Social Life ◽  
Hiv Transmission ◽  
Qualitative Interviews ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Heroin Use ◽  
Methamphetamine Use ◽  
Polysubstance Use ◽  
History Of

Abstract Background Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. Methods We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. Results Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. Conclusions Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. Trial registration BRAVO - NCT01936857, September 2013.

scholarly journals Public perceptions of naloxone use in the outpatient setting

2019 ◽  
Vol 9 (4) ◽  
pp. 275-279 ◽  
Author(s):  
Jordan O. Smith ◽  
Scott S. Malinowski ◽  
Jordan M. Ballou
Keyword(s):  
The United States ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
Public Perceptions ◽  
Amazon Mechanical Turk ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Reversal Agent ◽  
Electronic Survey ◽  
Accidental Overdose

Abstract Introduction Naloxone has become an important component of preventing deaths from opioid overdose. Although studies have confirmed its cost-effectiveness, naloxone is rarely prescribed proactively in case of accidental overdose. The perception still exists that a reversal agent may enable patients with opioid use disorder to continue abusing opioids without fear of death from overdose. This study was designed to determine the general public's knowledge of naloxone and their perceptions about receiving a naloxone prescription with opioid use. Methods Participants were recruited through Amazon Mechanical Turk (MTurk), where a link directed participants to an electronic survey. Participants were included if they were 18 years of age or greater and currently living in the United States. Participants were paid $0.10 USD via Amazon MTurk upon completing the survey. Results Four hundred five participants successfully completed the survey, and 61% were aware that there is a medication available to treat opioid overdose. The majority of participants responded positively to the idea of acquiring naloxone. Responses were evenly split for agreeing and disagreeing with the statement “naloxone is only necessary for people who abuse opioids.” Although 51% of respondents believed that having naloxone available enables people who abuse opioids, 88% agreed that naloxone is beneficial for people who accidentally overdose on opioids. A majority believed that naloxone should be made available upon request to anyone concerned about opioid overdose. Discussion Participants were generally aware of the availability of an opioid reversal agent and responded positively to 3 different methods of acquiring naloxone through their prescriber or pharmacist.

scholarly journals Perspectives on extended-release naltrexone induction among patients living with HIV and opioid use disorder: a qualitative analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kim A. Hoffman ◽  
Robin Baker ◽  
Laura C. Fanucchi ◽  
Paula J. Lum ◽  
Lynn E. Kunkel ◽  
...  
Keyword(s):  
Extended Release ◽  
Qualitative Interviews ◽  
Opioid Use Disorder ◽  
Readiness For Change ◽  
Opioid Use ◽  
Convenience Sample ◽  
Treatment As Usual ◽  
Supportive Environment ◽  
Study Participants ◽  
Living With Hiv

Abstract Background The CHOICES study randomized participants with HIV and opioid use disorder (OUD) to HIV clinic-based extended-release naltrexone (XR-NTX), which requires complete cessation of opioid use, versus treatment-as-usual (i.e., buprenorphine, methadone). Study participants randomized to XR-NTX were interviewed to assess their experiences with successful and unsuccessful XR-NTX induction. Methods Semi-structured qualitative interviews were completed with a convenience sample of study participants with HIV and OUD (n = 37) randomized to XR-NTX in five HIV clinics between 2018 and 2019. All participants approached agreed to be interviewed. Interviews were digitally recorded, professionally transcribed, and analyzed using thematic analysis. Results Participants included women (43%), African Americans (62%) and Hispanics (16%), between 27 to 69 years of age. Individuals who completed XR-NTX induction (n = 20) reported experiencing (1) readiness for change, (2) a supportive environment during withdrawal including comfort medications, and (3) caring interactions with staff. Four contrasting themes emerged among participants (n = 17) who did not complete induction: (1) concern and anxiety about withdrawal including past negative experiences, (2) ambivalence about or reluctance to stop opioids, (3) concerns about XR-NTX effects, and (4) preferences for other medications. Conclusions The results highlight opportunities to improve initiation of XR-NTX in high-need groups. Addressing expectations regarding induction may enhance XR-NTX initiation rates. Trial Registration ClinicalTrials.gov: NCT03275350. Registered September 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03275350?term=extended+release+naltrexone&cond=Opioid+Use.

scholarly journals Expanding Contraception Access for Women With Opioid-Use Disorder: A Qualitative Study of Opportunities and Challenges

2020 ◽  
Vol 34 (8) ◽  
pp. 909-918 ◽  
Author(s):  
Emily A. Hurley ◽  
Alex Duello ◽  
Sarah Finocchario-Kessler ◽  
Kathy Goggin ◽  
Stephani Stancil ◽  
...  
Keyword(s):  
Qualitative Interviews ◽  
Unmet Need ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Patient Centered ◽  
Essential Components ◽  
Catchment Areas ◽  
Contraceptive Services ◽  
Access To Contraception

Purpose: As almost nine in ten pregnancies among women with opioid use disorder (OUD) are unintended, expanding access to contraception is an underutilized but potentially effective strategy in increasing reproductive agency and reducing the overall burden of neonatal abstinence syndrome. We aimed to identify where and how contraceptive services could be integrated into existing points-of-contact for women with OUD. Approach: In-depth qualitative interviews. Setting: Three diverse catchment areas in Missouri. Participants: Women with OUD (n = 15) and professional stakeholders (n = 16) representing five types of existing OUD service points: syringe exchange programs, recovery support programs, substance use treatment programs, emergency departments, and Federally Qualified Health Centers. Method: Interviews were audio-recorded, transcribed, and thematically coded using Dedoose software. Results: Six themes emerged as essential components for integrating contraceptive services into existing points-of-contact for women with OUD: (1) reach women with unmet need; (2) provide free or affordable contraception; (3) maximize service accessibility; (4) provide patient-centered care; (5) employ willing, qualified contraceptive providers; and (6) utilize peer educators. Participants affirmed the overall potential benefit of contraceptive service integration and illuminated various opportunities and challenges relevant to each type of existing service point. Conclusion: As health promotion initiatives look to increase access to contraception among women with OUD, these six’ participant-identified components offer essential guidance in selecting advantageous points-of-contact and addressing remaining gaps in services.

scholarly journals Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs

2018 ◽  
Vol 46 (2) ◽  
pp. 241-251 ◽  
Author(s):  
Stephen R. Baldassarri ◽  
Ike Lee ◽  
Stephen R. Latham ◽  
Gail D'Onofrio
Keyword(s):  
Critically Ill ◽  
Psychiatric Care ◽  
Holistic Approach ◽  
Opioid Use Disorder ◽  
Sustained Remission ◽  
Care Providers ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Injection Drugs ◽  
Life Saving

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal.

Medications for management of opioid use disorder

2019 ◽  
Vol 76 (15) ◽  
pp. 1097-1103 ◽  
Author(s):  
Jennifer L Koehl ◽  
David E Zimmerman ◽  
Patrick J Bridgeman
Keyword(s):  
Illicit Drugs ◽  
Symptom Control ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Life Saving ◽  
Fentanyl Analogs ◽  
Initiation Of Therapy ◽  
Long Acting ◽  
Illicit Opioid Use

Abstract Purpose The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. Summary The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. Conclusion Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.

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