San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

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A review of the evidence to explain pharmacological basis of injection (ab)use of buprenorphine–naloxone tablets

Journal of Opioid Management ◽

10.5055/jom.2021.0651 ◽

2021 ◽

Vol 17 (7) ◽

pp. 141-152

Author(s):

Tamoud Modak, MD, DM ◽

Siddharth Sarkar, MD, MRCPsych ◽

Yatan Pal Singh Balhara, MD

Keyword(s):

Public Health Problem ◽

Opioid Use Disorder ◽

Critical Examination ◽

Evidence Based ◽

Major Public Health Problem ◽

Opioid Use ◽

Evidence Based Treatment ◽

Opioid Replacement Therapy ◽

Pharmacological Basis

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

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Beyond Antibiotics: A Practical Guide for the Infectious Disease Physician to Treat Opioid Use Disorder in the Setting of Associated Infectious Diseases

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz539 ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 4

Author(s):

Nikhil Seval ◽

Ellen Eaton ◽

Sandra A Springer

Keyword(s):

Infectious Disease ◽

Extended Release ◽

Hospital Admissions ◽

Opioid Use Disorder ◽

Evidence Based ◽

Opioid Use ◽

Patient Centered ◽

Infectious Disease Physician ◽

Centered Care ◽

Acute Injection

Abstract Infections are a common cause of hospitalization for patients with opioid use disorder (OUD), and hospital admissions are rising in the context of the worsening US opioid crisis. Infectious disease (ID) physicians are frequently the first point of medical contact for these patients. In this article, we discuss the integration of evidence-based management of OUD and patient-centered care of hospitalized persons with acute injection-related infections. We describe the following components of a comprehensive approach for OUD with inpatient ID consultations: (1) how to screen for OUD; (2) how to initiate the 3 US Food and Drug Administration-approved medications for OUD (buprenorphine, methadone, and extended-release naltrexone); (3) how to manage acute pain and opioid-related conditions; and (4) how to link and integrate ID and OUD treatment after hospital discharge. These strategies reduce unplanned discharges and increase completion of recommended antimicrobial regimens.

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Harm Reduction

10.1093/med/9780190610999.003.0005 ◽

2017 ◽

Author(s):

Sonal Batra ◽

Noah Villegas ◽

Erin Zerbo

Keyword(s):

Harm Reduction ◽

Historical Context ◽

Opioid Use Disorder ◽

Economic Consequences ◽

Evidence Based ◽

Maladaptive Behaviors ◽

Negative Consequences ◽

Opioid Use ◽

Humanistic Approach ◽

Female Sex Work

Harm reduction is defined as a set of policies, programs, and practices aimed at reducing the negative health, social, and economic consequences associated with various behaviors. Although classically applied to the treatment of substance use disorders, its scope has broadened over time to include high-risk sexual activity, nonadherence to treatment, and other behaviors that may lead to negative consequences. In addition to providing relevant historical context for scenarios encountered, this chapter uses a case to demonstrate how a provider might take a nonjudgmental and humanistic approach to identifying maladaptive behaviors and apply evidence-based, realistic interventions to reduce associated harms. Specific topics discussed include opioid use disorder, tobacco use disorder, female sex work, and nonadherence to psychotropic medications.

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Opioid Use in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.1.72 ◽

2019 ◽

Vol 24 (1) ◽

pp. 72-75

Author(s):

Kelly L. Matson ◽

Peter N. Johnson ◽

Van Tran ◽

Evan R. Horton ◽

Jennifer Sterner-Allison ◽

...

Keyword(s):

Young Adults ◽

Pain Management ◽

Pediatric Population ◽

The United States ◽

Opioid Use Disorder ◽

Adolescents And Young Adults ◽

Evidence Based ◽

Opioid Misuse ◽

Opioid Use ◽

Electronic Prescription

Limited guidance on opioid use exists in the pediatric population, causing medication safety concerns for pain management in children and adolescents. Opioid misuse and use disorder continue to greatly affect adolescents and young adults in the United States, furthering the apprehension of their use. Pediatric Pharmacy Advocacy Group (PPAG) recommends pharmacists contribute their knowledge to pain management in children, including the discussion of appropriate use of non-opioid alternatives for pain and when to recommend coprescribing of naloxone. PPAG also supports the review of electronic prescription drug–monitoring programs prior to opioid prescribing and dispensing by both prescribers and pharmacists. Education by pharmacists of children and their families regarding proper administration, storage, and disposal, as well as the awareness of opioid misuse and use disorder among adolescents and young adults, is key to prevention. If opioid use disorder is diagnosed, PPAG encourages improved access among adolescents to evidence-based medications including methadone, buprenorphine, and naltrexone. Furthermore, pharmacists should assist in screening and referral to evidence-based treatment.

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What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals

Public Health Reports ◽

10.1177/0033354920968805 ◽

2020 ◽

pp. 003335492096880

Author(s):

Berkeley Franz ◽

Cory E. Cronin ◽

Jose A. Pagan

Keyword(s):

The United States ◽

National Sample ◽

Opioid Use Disorder ◽

Opioid Abuse ◽

Public Health Issue ◽

Evidence Based ◽

Opioid Epidemic ◽

Opioid Use ◽

Nonprofit Hospitals ◽

Community Benefit

Objectives Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.

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Using community engagement to implement evidence-based practices for opioid use disorder: A data-driven paradigm & systems science approach

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108675 ◽

2021 ◽

Vol 222 ◽

pp. 108675 ◽

Cited By ~ 1

Author(s):

Nabila El-Bassel ◽

Louisa Gilbert ◽

Tim Hunt ◽

Elwin Wu ◽

Emmanuel A. Oga ◽

...

Keyword(s):

Community Engagement ◽

Opioid Use Disorder ◽

Data Driven ◽

Systems Science ◽

Evidence Based ◽

Opioid Use ◽

Evidence Based Practices ◽

Science Approach

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Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach

BMJ Case Reports ◽

10.1136/bcr-2019-233715 ◽

2020 ◽

Vol 13 (3) ◽

pp. e233715 ◽

Cited By ~ 1

Author(s):

Mackenzie Duncan Gregory Caulfield ◽

Rupinder Brar ◽

Christy Sutherland ◽

Seonaid Nolan

Keyword(s):

Slow Release ◽

Oral Morphine ◽

Opioid Use Disorder ◽

Evidence Based ◽

Opioid Use ◽

First Line ◽

Agonist Therapy ◽

Opioid Agonist ◽

Evidence Based Treatment ◽

Opioid Agonist Therapy

In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.

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