Substance use disorder—substance-induced disorder clinics for pain-medication addictions and addicted patients’ pains: Futuristic need for pain physicians sub-specializing in addiction-medicine

2018 ◽  
Vol 14 (1) ◽  
pp. 5
Author(s):  
DeepaK Gupta, MD ◽  
Shushovan Chakrabortty, MD, PhD
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Pain Medication ◽  
Addiction Medicine

no abstract

scholarly journals Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis

2019 ◽  
Vol 34 (12) ◽  
pp. 2796-2803 ◽  
Author(s):  
Honora Englander ◽  
Konrad Dobbertin ◽  
Bonnie K. Lind ◽  
Christina Nicolaidis ◽  
Peter Graven ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Treatment Engagement ◽  
Addiction Medicine ◽  
Substance Use Disorder Treatment ◽  
Disorder Treatment

scholarly journals 780. Inpatient Addiction Medicine Consultations at the Urban/Rural Frontier: Improving Quality of Care and Linkage to Outpatient Services for Patients with Substance Use Disorder in Central Kentucky

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S346
Author(s):  
Laura Fanucchi ◽  
Devin Oller
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Medical Advice ◽  
Outpatient Services ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Opioid Treatment ◽  
Rural Counties ◽  
Discharge Against Medical Advice ◽  
The University

Abstract Background When persons with opioid use disorder (OUD) are hospitalized with medical complications (e,g. endocarditis, viral hepatitis) they frequently do not receive medications for the underlying OUD. In recent years, a number of hospitals have implemented addiction medicine consultation (AMC) services to help address this treatment gap, though these are all in large urban centers. AMCs provide comprehensive substance use disorder (SUD) assessments, manage SUDs, initiate pharmacotherapy for OUD, and arrange linkage to ongoing treatment. The aim of this study was to describe the initial implementation and outcomes of a new AMC at the University of Kentucky Hospital, a 945-bed tertiary referral center with a large rural catchment. Methods The Addiction Consultation and Education Service(ACES) began October, 2018 and was comprised of several physicians and an APRN. A patient navigator assisted with prior authorizations and outpatient linkage. ACES referred to a new bridge clinic at the University for ongoing office-based opioid treatment as well as to community programs and licensed opioid treatment programs. Patient demographics, SUD diagnoses, and comorbidities (including details of the injection-related infections) are collected from the electronic health record, as well as key process metrics including: time-to-consultation and medication initiation, length of stay(LOS), discharge against medical advice(AMA), and details of linkage to outpatient services. Results From October-December, 91 patients were seen, 73 met DSM-5 criteria for OUD, 82 had a medical complication of SUD, and 53 lived in rural counties (Rural-Urban Continuum Codes 4–9). Average LOS was 19.5 days. Among OUD patients, 71% underwent buprenorphine/naloxone induction, 9% were started on methadone. Less than 6% of patients started on buprenorphine or methadone left against medical advice. Conclusion AMCs are a key part of providing comprehensive care for persons hospitalized with infectious complications of substance use. Initiating medication for OUD likely decreases rates of discharge against medical advice. Compared with other AMCs, a greater percentage of patients seen by ACES resided in rural counties. Establishing a bridge clinic prior to starting an AMC is critical to ensure ongoing care. Disclosures All authors: No reported disclosures.

scholarly journals Buprenorphine: Not a silver bullet, and still controversial

2021 ◽  
Vol 17 (7) ◽  
pp. 9-10
Author(s):  
Sudheer Potru, DO, FASAM ◽  
Michael Sprintz, DO, DFASAM ◽  
Antje M. Barreveld, MD ◽  
Lynn Kohan, MD
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Working Group ◽  
Ad Hoc ◽  
Hospital Setting ◽  
Outpatient Setting ◽  
Pain Medicine ◽  
Appropriate Use ◽  
Addiction Medicine ◽  
Silver Bullet

We are practitioners of pain medicine and addiction medicine and also four of the seven members of the Multi-Society Ad Hoc Substance Use Disorder (SUD) Working Group comprised of representatives from anesthesia, pain, pharmacy, and addiction medicine societies. We are finalizing “tip sheets” and a consensus-based manuscript to provide guidance on the appropriate use and initiation of buprenorphine in the hospital setting by anesthesiologists, and in the outpatient setting by pain clinicians.

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

2021 ◽  
pp. 104990912199978
Author(s):  
Katie Fitzgerald Jones ◽  
J. Janet Ho ◽  
Zachary Sager ◽  
Julie Childers ◽  
Jessica Merlin
Keyword(s):  
Palliative Care ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Care Quality ◽  
Addiction Medicine ◽  
Serious Illness ◽  
Disorder Treatment ◽  
Evidenced Based ◽  
The Impact

Background: The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. Objective: This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. Methods: A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. Results: There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. Conclusion: PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.

scholarly journals Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Erika L. Crable ◽  
Allyn Benintendi ◽  
David K. Jones ◽  
Alexander Y. Walley ◽  
Jacqueline Milton Hicks ◽  
...  
Keyword(s):  
Substance Use ◽  
Policy Implementation ◽  
Substance Use Disorder ◽  
Service Providers ◽  
Implementation Strategies ◽  
Local Context ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Addiction Medicine ◽  
Us States

Abstract Background Despite the important upstream impact policy has on population health outcomes, few studies in implementation science in health have examined implementation processes and strategies used to translate state and federal policies into accessible services in the community. This study examines the policy implementation strategies and experiences of Medicaid programs in three US states that responded to a federal prompt to improve access to evidence-based practice (EBP) substance use disorder (SUD) treatment. Methods Three US state Medicaid programs implementing American Society of Addiction Medicine (ASAM) Criteria-driven SUD services under Section 1115 waiver authority were used as cases. We conducted 44 semi-structured interviews with Medicaid staff, providers and health systems partners in California, Virginia, and West Virginia. Interviews were triangulated with document review of state readiness and implementation plans. The Exploration, Preparation, Implementation, Sustainment Framework (EPIS) guided qualitative theme analysis. The Expert Recommendations for Implementing Change and Specify It criteria were used to create a taxonomy of policy implementation strategies used by policymakers to promote providers’ uptake of statewide EBP SUD care continuums. Results Four themes describe states’ experiences and outcomes implementing a complex EBP SUD treatment policy directive: (1) Medicaid agencies adapted their inner/outer contexts to align with EBPs and adapted EBPs to fit their local context; (2) enhanced financial reimbursement arrangements were inadequate bridging factors to achieve statewide adoption of new SUD services; (3) despite trainings, service providers and managed care organizations demonstrated poor fidelity to the ASAM Criteria; and (4) successful policy adoption at the state level did not guarantee service providers’ uptake of EBPs. States used 29 implementation strategies to implement EBP SUD care continuums. Implementation strategies were used in the Exploration (n=6), Preparation (n=10), Implementation (n=19), and Sustainment (n=6) phases, and primarily focused on developing stakeholder interrelationships, evaluative and iterative approaches, and financing. Conclusions This study enhances our understanding of statewide policy implementation outcomes in low-resource, public healthcare settings. Themes highlight the need for additional pre-implementation and sustainment focused implementation strategies. The taxonomy of detailed policy implementation strategies employed by policymakers across states should be tested in future policy implementation research.

Sign in / Sign up

Export Citation Format

Share Document