TY - JOUR AB - DEA is amending its regulations to allow qualified practitioners not otherwise registered as a narcotic treatment program to dispense and prescribe to narcotic dependent persons Schedule III, IV, and V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in maintenance or detoxification treatment. This Final Rule is in response to amendments to the Controlled Substances Act by the Drug Addiction Treatment Act of 2000 (DATA) that are designed to expand and improve treatment of narcotic addiction. This Final Rule is intended to accomplish the goals of DATA while preventing the diversion of Schedule III, IV, and V narcotic controlled drugs approved by the Food and Drug Administration specifically for maintenance / detoxification treatment. DB - Medline KW - narcotic agent addiction article certification drug control drug detoxification drug legislation human legal aspect opiate addiction pharmacy (shop) physician attitude prescription United States LA - English M1 - 120 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2005 SN - 0097-6326 SP - 36338-36344 ST - Authority for practitioners to dispense or prescribe approved narcotic controlled substances for maintenance or detoxification treatment. Final rule T2 - Federal register TI - Authority for practitioners to dispense or prescribe approved narcotic controlled substances for maintenance or detoxification treatment. Final rule UR - https://www.embase.com/search/results?subaction=viewrecord&id=L40940331&from=export VL - 70 ID - 931220 ER - TY - JOUR AB - Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment. AN - 26679961 DA - Dec DO - 10.18553/jmcp.2015.21.12.1116 DP - NLM ET - 2015/12/19 J2 - Journal of managed care & specialty pharmacy KW - Analgesics, Opioid/adverse effects/*therapeutic use Delivery of Health Care, Integrated Education, Pharmacy, Continuing Humans Interdisciplinary Communication Opioid-Related Disorders/diagnosis/epidemiology/*prevention & control Pain/diagnosis/*prevention & control Pain Management/adverse effects/*methods/standards Pharmacists Prescription Drug Misuse/*prevention & control Professional Role Quality Improvement Quality Indicators, Health Care Risk Factors LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SP - 1116-22 ST - Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder T2 - J Manag Care Spec Pharm TI - Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder VL - 21 ID - 930991 ER - TY - JOUR AB - The proceedings contain 362 papers. The topics discussed include: modelling dose-concentration-response; epidemiology of fatal poisonings: national poison data system (NPDS) data 2000-2014; a simple prognostic model for predicting mortality in acute aluminium phosphide poisoning; clinical risk factors in emergency department (ED) patients with prescription opioid overdose; immunological cross-reactivity and pre-clinical neutralisation of European viper venoms with ViperaTAb antivenom; Australian elapid envenoming and intracranial haemorrhage; a national serum depot for antivenoms: the set-up and lessons learned; fomepizole versus ethanol in acute methanol poisoning: a quasi-case-control study; population pharmacokinetics of an Indian F(ab')2 snake antivenom in patients with Russell's viper bite; clinical findings in patients receiving physostigmine in a toxicologic ICU: a quality and safety assessment study; and the use of digoxin-specific antibodies in chronic digoxin poisoning. DB - Embase KW - poison aluminum phosphide digoxin opiate antibody alcohol 4 methylpyrazole viper venom physostigmine European human patient model intoxication brain hemorrhage epidemiology digitalis intoxication serum mortality information processing case control study cross reaction Australian Elapidae risk factor prescription methanol poisoning population pharmacokinetics Indian snake emergency ward risk assessment concentration response Daboia russellii LA - English M1 - 4 M3 - Conference Review N1 - Embase Elsevier literature search May 7, 2021 PY - 2015 SN - 1556-3650 ST - 35th International Congress of the European Association of Poisons Centres and Clinical Toxicologists, EAPCCT 2015 T2 - Clinical Toxicology TI - 35th International Congress of the European Association of Poisons Centres and Clinical Toxicologists, EAPCCT 2015 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71904389&from=export VL - 53 ID - 931187 ER - TY - JOUR AB - BACKGROUND: Historically, older people who inject drugs (PWID) have had the highest hepatitis C virus (HCV) burden; however, young PWID now account for recent increases. We assessed factors associated with past or present HCV infection (HCV antibody [anti-HCV] positive) among young (≤35 years) and older (>35 years) PWID. METHODS: We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to examine sociodemographic and past 12-month injection behaviors associated with HCV infection. RESULTS: Of 4094 PWID, 55.2% were anti-HCV positive. Among young PWID, anti-HCV prevalence was 42.1% and associated with ≤high school diploma/General Education Development diploma (GED) (aPR, 1.17 [95% CI, 1.03-1.33]), receptive syringe sharing (aPR, 1.37 [95% CI, 1.21-1.56]), sharing injection equipment (aPR, 1.16 [95% CI, 1.01-1.35]), arrest history (aPR, 1.14 [95% CI, 1.02-1.29]), and injecting speedball (aPR, 1.37 [95% CI, 1.16-1.61]). Among older PWID, anti-HCV prevalence was 62.2% and associated with ≤high school diploma/GED (aPR, 1.08 [95% CI, 1.02-1.15]), sharing injection equipment (aPR, 1.08 [95% CI, 1.02-1.15]), high injection frequency (aPR, 1.16 [95% CI, 1.01-1.34]), and injecting speedball (aPR, 1.09 [95% CI, 1.01-1.16]). CONCLUSIONS: Anti-HCV prevalence is high among PWID and varies with age. Scaling up direct-acting antiviral treatment, syringe service programs, and medication-assisted therapy is critical to mitigating transmission risk and infection burden. AD - Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington. Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado. STD/HIV Program, Louisiana Department of Health and LSU Health Sciences Center, School of Public Health, New Orleans, Louisiana. Chicago Department of Public Health, Chicago, Illinois. Los Angeles County Department of Public Health, Los Angeles, California. Bureau of HIV/AIDS Epidemiology, New York State Department of Health, Albany, New York. TB/HIV/STD Branch, Texas Department of State Health Services, Austin, Texas. Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York. AN - 30915477 AU - Abara, W. E. AU - Trujillo, L. AU - Broz, D. AU - Finlayson, T. AU - Teshale, E. AU - Paz-Bailey, G. AU - Glick, S. AU - Al-Tayyib, A. A. AU - Robinson, W. T. AU - Masiello-Schuette, S. AU - Sey, E. K. AU - Anderson, B. J. AU - Poe, J. AU - Braunstein, S. DA - Jul 2 DO - 10.1093/infdis/jiz142 DP - NLM ET - 2019/03/28 J2 - The Journal of infectious diseases KW - Adult Antiviral Agents/therapeutic use Cities/epidemiology Female HIV/drug effects/pathogenicity HIV Infections/*complications/drug therapy/virology Hepacivirus/drug effects/*pathogenicity Hepatitis C/drug therapy/*epidemiology/*virology Humans Male Prevalence Risk Factors Risk-Taking Substance Abuse, Intravenous/*complications *Hcv *direct-acting antiviral treatment *hepatitis C *heroin *medication-assisted treatment *opioid use *people who inject drugs *young people who inject drugs LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0022-1899 SP - 377-385 ST - Age-Related Differences in Past or Present Hepatitis C Virus Infection Among People Who Inject Drugs: National Human Immunodeficiency Virus Behavioral Surveillance, 8 US Cities, 2015 T2 - J Infect Dis TI - Age-Related Differences in Past or Present Hepatitis C Virus Infection Among People Who Inject Drugs: National Human Immunodeficiency Virus Behavioral Surveillance, 8 US Cities, 2015 VL - 220 ID - 930908 ER - TY - JOUR AB - Introduction: It is widely acknowledged that heroin dependence results in homelessness, family disruption, social instability and marginalization. Anecdotal reports indicate many members of society regard people who use drugs as sinners. Although 2011 UNODC Study Kenya revealed 55% of all PWID are Christian, 42% Muslim. Nairobi PWID comprise 16% versus 72% at Coast. Evidence regarding spiritual support for PWID is limited. Description: Following initiation of Medically Assisted Therapy (MAT) programme in Malindi, enrolled Muslim MAT clients expressed a desire to fast during Ramadhan 2015. From May 2015 they requested MAT clinic team to dispense methadone after sunset for Muslim clients or wean them off methadone 6 weeks before Ramadhan. Unfortunately national guidelines for MAT don't recommend take home doses, dispensing by non-pharmacists or beyond operational hours. International MAT experts restricted detox for incarcerated MAT clients and advised against shifting MAT Clinic operational hours to assure structured way of life for clients. Religious leaders recommended MAT clients adopt Islam's waiver from fasting for sick, pregnant or nursing women. Malindi hospital unwilling to dispense methadone at 24-hour main pharmacy due to security concerns. Mathari MAT Clinic in Nairobi rejected a similar plea as its Muslim MAT Clients were few (<10). Lessons learned: On 1st day of Ramadhan 2015, almost 40 clients missed daily methadone dose. By 3rd day, severe withdrawal drove a few Muslim clients to MAT pharmacy for daily dose. Clients who showed up on subsequent days required re-induction. However, by 7th Ramadhan, 29 clients still kept away. Rumours that some fasting clients were taking heroin after sunset and at pre-dawn to manage their withdrawal prompted Malindi MAT Clinic team to unanimously approve evening dispensing for fasting Muslim clients. Eligibility for evening doses for MAT defaulters: 3-days re-induction at daytime. Three (3) fasting clients refused to comply. On 12th Ramadhan, 26 fasting clients accessed evening services. All routinely reported immediately after prayers; within 40 minutes, all doses dispensed. This service was halted on Eid day. Conclusions/Next steps: Moonlight dispensing enabled Muslim clients to fast after years of drug use while improving client-provider relations. As Kenya scales up MAT programme, prioritize spiritual recovery for MAT Clients. AD - S. Abdallah, UNODC, Mombasa, Kenya AU - Abdallah, S. AU - Ibrahim, F. AU - Kirimo, M. AU - Mongi, A. AU - Baya, J. AU - Shossi, M. AU - Omar, A. DB - Embase DO - 10.7448/IAS.19.6.21264 KW - diamorphine methadone clergy diet restriction drug therapy family study heroin dependence homelessness human Islam Kenya nursing pharmacy (shop) practice guideline pregnancy relapse seashore spiritual care weaning LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2016 SN - 1758-2652 SP - 149-150 ST - Moonlight methadone for Muslims on medically assisted therapy curbing drug relapse in Malindi, Kenya T2 - Journal of the International AIDS Society TI - Moonlight methadone for Muslims on medically assisted therapy curbing drug relapse in Malindi, Kenya UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615728332&from=export http://dx.doi.org/10.7448/IAS.19.6.21264 VL - 19 ID - 931177 ER - TY - JOUR AB - OBJECTIVE: To identify geographic disparities in access to opioid use disorder (OUD) treatment medications and county demographic and economic characteristics associated with access to buprenorphine and oral naltrexone prescribers in Medicare Part D. DATA SOURCES/STUDY SETTING: We utilized data from the Medicare Part D Prescription Drug Event Standard Analytic File (2010-2015). STUDY DESIGN/DATA COLLECTION: We used logistic regression to examine county-level access to OUD medication prescribers. PRINCIPAL FINDINGS: There was a 5.6 percentage point increase in counties with access to an OUD prescriber over the study period. However, in 2015, 60 percent of US counties lacked access to a Medicare Part D buprenorphine prescriber and over 75 percent lacked access to an oral naltrexone prescriber. Increased access to OUD prescribers was largely concentrated in urban counties. Results of logistic regression indicate regional differences and potential racial disparities in access to OUD prescribers. CONCLUSIONS: To improve access to buprenorphine and naltrexone treatment for Medicare Part D enrollees, CMS may consider implementing educational and training initiatives focused on OUD treatment, offering training to obtain a buprenorphine waiver at no cost to providers, and sending targeted information to providers in low OUD treatment capacity areas. AD - Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, Georgia. Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia. School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana. AN - 30665272 AU - Abraham, A. J. AU - Adams, G. B. AU - Bradford, A. C. AU - Bradford, W. D. C2 - Pmc6407357 DA - Apr DO - 10.1111/1475-6773.13113 DP - NLM ET - 2019/01/22 J2 - Health services research KW - Buprenorphine/administration & dosage/*therapeutic use Health Services Accessibility/*statistics & numerical data Humans Logistic Models Medicare Part D/*statistics & numerical data Naltrexone/administration & dosage/*therapeutic use Opiate Substitution Treatment/methods/*statistics & numerical data Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians'/statistics & numerical data Residence Characteristics Socioeconomic Factors United States *access *buprenorphine *medicare *naltrexone *opioid use disorder LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0017-9124 (Print) 0017-9124 SP - 390-398 ST - County-level access to opioid use disorder medications in medicare Part D (2010-2015) T2 - Health Serv Res TI - County-level access to opioid use disorder medications in medicare Part D (2010-2015) VL - 54 ID - 930814 ER - TY - JOUR AB - Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder. AD - School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA, 30602, USA. aabraham@uga.edu. College of Social Work, University of South Carolina, 1512 Pendleton St., Room 309, Columbia, SC, 29208, USA. School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA, 30602, USA. University of Massachusetts Medical School Baystate, 280 Chestnut St., Springfield, MA, 01199, USA. AN - 31907876 AU - Abraham, A. J. AU - Andrews, C. M. AU - Harris, S. J. AU - Friedmann, P. D. C2 - Pmc7007488 DA - Jan DO - 10.1007/s13311-019-00814-4 DP - NLM ET - 2020/01/08 J2 - Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics KW - Alcoholism/*drug therapy Health Services Accessibility/*statistics & numerical data Humans Opioid-Related Disorders/*drug therapy United States *Alcohol use disorder *buprenorphine-waivered providers. *medication treatment *opioid use disorder *specialty treatment LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1933-7213 (Print) 1878-7479 SP - 55-69 ST - Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA T2 - Neurotherapeutics TI - Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA VL - 17 ID - 930813 ER - TY - JOUR AB - INTRODUCTION: Opioid use disorder (OUD) is a major and growing public health concern, and Medicare patients have nearly double the proportion of OUD prevalence compared with those with commercial insurance. This study examines provider-level characteristics to delineate the wide variation behind buprenorphine provision, which is the mainstay of medication-assisted treatment for OUD. METHODS: Using Medicare Part D Public Use Files claims data from 2013 to 2016 in all states, we assessed prescribing patterns of buprenorphine formulations for the specialties of family medicine, internal medicine, psychiatry, and general practice. We incorporated data from 2013 to 2016 American Medical Association Physician Masterfile to model various provider- and area-level characteristics as predictors of buprenorphine prescriber status. RESULTS: Family medicine and internal medicine comprise nearly two-thirds of the outpatient buprenorphine prescriber population for Medicare beneficiaries. Yet, both specialties also have the lowest proportion of active buprenorphine prescribers compared with psychiatrists and general practitioners. Additional characteristics associated with buprenorphine provision include male sex, osteopathic training, Northeast region, US undergraduate medical education, more years in practice, and a higher proportion of dual-eligible patients. CONCLUSIONS: Primary care specialties, such as family medicine and internal medicine, currently comprise a significant majority of the US buprenorphine prescriber population for Medicare beneficiaries. Future policies should target specific demographics to enable greater patient access from physicians who are characteristically less likely to prescribe buprenorphine to increase overall capacity. AD - From Boston University School of Medicine, Departments of Family Medicine and Psychiatry, Boston, MA (RA); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (EW, YJ, SP, AB). rohit.abraham@bmc.org. From Boston University School of Medicine, Departments of Family Medicine and Psychiatry, Boston, MA (RA); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (EW, YJ, SP, AB). AN - 31907241 AU - Abraham, R. AU - Wilkinson, E. AU - Jabbarpour, Y. AU - Petterson, S. AU - Bazemore, A. DA - Jan-Feb DO - 10.3122/jabfm.2020.01.190233 DP - NLM ET - 2020/01/08 J2 - Journal of the American Board of Family Medicine : JABFM KW - Buprenorphine/*therapeutic use Cross-Sectional Studies Family Practice Female General Practice/statistics & numerical data Humans Internal Medicine/statistics & numerical data Male Medicare Part D/statistics & numerical data Narcotic Antagonists/*therapeutic use Opiate Substitution Treatment/methods/statistics & numerical data Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians'/*statistics & numerical data Psychiatry/statistics & numerical data United States *American Medical Association *Buprenorphine *Medicare Part D *Opioid-Related Disorders *Primary Health Care *Public Health LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1557-2625 SP - 9-16 ST - Characteristics of Office-Based Buprenorphine Prescribers for Medicare Patients T2 - J Am Board Fam Med TI - Characteristics of Office-Based Buprenorphine Prescribers for Medicare Patients VL - 33 ID - 930816 ER - TY - JOUR AD - Institute for Research on Addictive Behavior, Indiana University, Bloomington, IN, USA. Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA. AN - 30397977 AU - Agley, J. AU - Adams, Z. W. AU - Hulvershorn, L. A. DA - Mar DO - 10.1111/add.14494 DP - NLM ET - 2018/11/07 J2 - Addiction (Abingdon, England) KW - Comorbidity Education, Medical, Continuing/*methods Health Workforce Humans Mental Disorders/epidemiology/therapy Opiate Substitution Treatment Opioid-Related Disorders/epidemiology/*therapy Physicians, Primary Care/*education Practice Guidelines as Topic *Continuing medical education *Echo *medication assisted treatment *opioid use disorder *practice change *psychiatry LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0965-2140 SP - 573-574 ST - Extension for Community Healthcare Outcomes (ECHO) as a tool for continuing medical education on opioid use disorder and comorbidities T2 - Addiction TI - Extension for Community Healthcare Outcomes (ECHO) as a tool for continuing medical education on opioid use disorder and comorbidities VL - 114 ID - 931012 ER - TY - JOUR AB - BACKGROUND: In order to streamline the emergency department (ED) referral process in a multi-network automated opioid treatment referral program, we performed a needs assessment of community providers for Medication for Opioid Use Disorder (MOUD) in the EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial network. METHODS: A needs assessment was conducted in two phases: (1) key stakeholder meetings and (2) a survey of community sites offering MOUD. Stakeholder meetings were conducted with five key stakeholder groups: 1) ED clinicians and staff, 2) community sites offering MOUD, 3) the investigative team, 4) health system IT staff, and 5) medical ethics experts. Meetings continued until each stakeholder group stated that their priorities and needs were understood. Major categories of needs were extracted pragmatically based on recurrence across stakeholder groups. Informed by needs expressed by IT and MOUD site stakeholders, nineteen MOUD sites were surveyed to better characterize information needs of community sites offering MOUD when receiving an ED referral. RESULTS: Three major categories of needs for referral system were identified: 1) The system to be automated, flexible and allow multiple channels of referral, 2) Referral metrics are retrievable in a HIPAA compliant manner, 3) Patients are scheduled into community sites offering MOUD as urgently as possible. Of the MOUD sites surveyed, 68.4% (13/19) responded. Based on the responses, specific patient identifiers were required for most MOUD site referrals, and encrypted emails and EHR were the preferred methods of communication for the handoff. 53.8% (7/13) of the sites were able to accept patients within 3 days with only 1 site requiring >7 days. CONCLUSION: These findings can inform IT solutions to address the discordant priorities of the ED (rapid and flexible referral process) and the community sites offering (referrals minimize variability and overbooking). To prevent drop-out in the referral cascade, our findings emphasize the need for increased availability and accessibility to MOUD on demand and protected communication channels between EDs and community providers of MOUD. AD - Yale University School of Medicine, New Haven, CT, USA. Eastern Virginia Medical School, Norfolk, VA, USA. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: edward.melnick@yale.edu. AN - 31202288 AU - Ahmed, O. M. AU - Mao, J. A. AU - Holt, S. R. AU - Hawk, K. AU - D'Onofrio, G. AU - Martel, S. AU - Melnick, E. R. C2 - Pmc6578846 C6 - Nihms1529179 DA - Jul DO - 10.1016/j.jsat.2019.05.006 DP - NLM ET - 2019/06/17 J2 - Journal of substance abuse treatment KW - Automation Buprenorphine/administration & dosage Communication Community Health Services/*organization & administration Emergency Service, Hospital/organization & administration Humans Needs Assessment Opiate Substitution Treatment/methods Opioid-Related Disorders/*rehabilitation Patient Handoff/*organization & administration Referral and Consultation/*organization & administration Surveys and Questionnaires *Medication assisted treatment *Medication for addiction treatment *Medication for opioid use disorder *Opioid use disorder *Referral LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0740-5472 (Print) 0740-5472 SP - 47-52 ST - A scalable, automated warm handoff from the emergency department to community sites offering continued medication for opioid use disorder: Lessons learned from the EMBED trial stakeholders T2 - J Subst Abuse Treat TI - A scalable, automated warm handoff from the emergency department to community sites offering continued medication for opioid use disorder: Lessons learned from the EMBED trial stakeholders VL - 102 ID - 930917 ER - TY - JOUR AB - Individuals with a history of heroin dependence are overrepresented in American correctional facilities and 75% of inmates with a drug use disorder do not receive treatment during incarceration or after release. Medication-assisted treatment (MAT) with opiate agonists, such as methadone or buprenorphine, constitutes standard of care; to guide planning for an expansion of drug treatment services in correctional facilities, a needs assessment was conducted at the Department of Correction and Rehabilitation (DCR) of Puerto Rico (PR). The authors report on the research process, the findings that informed their recommendations for the DCR to expand MAT for eligible inmates, and lessons learned. AD - Center for Evaluation and Sociomedical Research, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico. carmen.albizu@upr.edu AN - 22263714 AU - Albizu-García, C. E. AU - Caraballo, J. N. AU - Caraballo-Correa, G. AU - Hernández-Viver, A. AU - Román-Badenas, L. C2 - Pmc3372322 C6 - Nihms359081 DO - 10.1080/08897077.2011.620462 DP - NLM ET - 2012/01/24 J2 - Substance abuse KW - Adult Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Cross-Sectional Studies Female Health Services Needs and Demand Heroin Dependence/drug therapy/*rehabilitation Humans Male Methadone/*therapeutic use *Needs Assessment *Opiate Substitution Treatment *Prisoners Puerto Rico Young Adult LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2012 SN - 0889-7077 (Print) 0889-7077 SP - 60-9 ST - Assessing need for medication-assisted treatment for opiate-dependent prison inmates T2 - Subst Abus TI - Assessing need for medication-assisted treatment for opiate-dependent prison inmates VL - 33 ID - 930969 ER - TY - JOUR AB - OBJECTIVES: : Since 2003, a new form of treatment for opioid dependence (OD), called buprenorphine medication-assisted treatment (B-MAT), has become increasingly available in the United States. The purpose of this study was to measure self-reported psychiatrists' practice patterns, personal and professional characteristics, and psychiatrists' barriers to treating OD patients with office-based opioid therapy. METHODS: : Managed care network psychiatrists waivered to prescribe buprenorphine for treating OD were surveyed (N = 294) about specific skills and barriers to increasing the number of OD patients treated with B-MAT. Psychiatrists completed a self-administered survey about attitudes, beliefs, skills, experiences in general practice, and experience treating chronic disease, addiction, and OD. RESULTS: : Of the 11 barriers measured on the survey, the 5 that were endorsed by the greatest number of psychiatrists as affecting their decision to use B-MAT or increase the number of B-MAT patients were as follows: urine testing requirements and logistical issues, possibility of patients selling their buprenorphine or taking more than prescribed, attracting more OD patients to their practice, concern about drug enforcement agency intrusion, and belief of greater time commitment for treating B-MAT patients. CONCLUSION: : Barriers were perceived to exist, and the perception of the level of these barriers varied significantly between psychiatrists whose B-MAT practices were growing and those whose practices were not. The findings suggest that to increase the use of B-MAT by waivered psychiatrists, support services and medical education programs should focus on the barriers that are rated the most influential by psychiatrists whose patient sample was decreasing or remaining flat. AD - From the Department of Quality, Outcomes and Research (JA, AE), and Division of Behavior Health (RC), Magellan Health Services; and Department of Translational Sciences (JT, CR), Health Analytics, Columbia, MD. AN - 21769038 AU - Albright, J. AU - Ciaverelli, R. AU - Essex, A. AU - Tkacz, J. AU - Ruetsch, C. DA - Dec DO - 10.1097/ADM.0b013e3181c816f3 DP - NLM ET - 2011/07/20 J2 - Journal of addiction medicine LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2010 SN - 1932-0620 (Print) 1932-0620 SP - 197-203 ST - Psychiatrist characteristics that influence use of buprenorphine medication-assisted treatment T2 - J Addict Med TI - Psychiatrist characteristics that influence use of buprenorphine medication-assisted treatment VL - 4 ID - 930959 ER - TY - CHAP AB - Background: Opioid addiction is a serious concern in the United States that can be treated successfully through medication-assisted treatment (MAT). Methadone, buprenorphine, and extended-release, injectable naltrexone are three medications that have been approved by the FDA for treatment of opioid use disorder. Method: National Survey of Substance Abuse Treatment Services data for years 2003 through 2015 were used to assess the usage and trends of MAT in facilities with and without OTPs. Results: This analysis found that the numbers of facilities utilizing MAT for opioid use disorder and the numbers of clients receiving each of the three medications has increased from 2003 to 2015. Conclusion: The increases in numbers of facilities providing MAT services and the increase in numbers of clients receiving MAT is an indication that facilities are responding to the demand for effective treatment for opioid use disorder. However, without a leveling off in the trends, there is indication of unmet need. Public health resources and education could be used to further increase access to treatment and inform the public about treatment options. AN - 29200242 AU - Alderks, C. E. CY - Rockville (MD) LA - eng N1 - PubMed NLM literature search May 7, 2021 PB - Substance Abuse and Mental Health Services Administration (US) PY - 2013 SP - 1-8 ST - Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update) T2 - The CBHSQ Report TI - Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update) ID - 930966 ER - TY - JOUR AB - Background: Cumulative meta-analysis of 'Audit and Feedback' (A&F) trials have shown no improvement in effect sizes, suggesting a lack of learning on how to improve effectiveness. The Campaign to Reduce Opioid Prescribing (CROP) provided 316 practices in West Yorkshire with bimonthly evidence-based enhanced A&F reports on their opioid prescribing for one year. The CROP intervention reduced predicted opioid prescription spending by £900,000 in West Yorkshire. We are exploring feasibility and ethical challenges of scaling up the CROP intervention for a national primary care randomised controlled trial to reduce harmful opioid prescribing whilst adding significantly to the wider evidence base on A&F. Methods: A structured Delphi consensus panel of A&F experts, primary care medicines optimisation leads and members of our existing Patient and Public Involvement Panel will identify solutions to the ethical and feasibility issues of scaling up the CROP intervention, drawing upon a state-of-the-science summary of recommendations, on-going research and medicines optimisation expertise. Timing of potential results: We will present the findings of the consensus process, due to take place in May and June 2019 with results due in July 2019. Results will be presented by panellist type and overall results. Potential relevance and impact A key factor to the successful planning and delivery of a national primary care A&F intervention trial will be how well ethical and feasibility issues relating to consent (waive consent, practice or Clinical Commissioning Group consent), unit of randomisation (practices, Clinical Commissioning Groups or regional), and the source of primary care data (nationally gathered databases or electronic health records) are resolved. We will present the consensus process recommendations on how acceptable and ideal different core ethical and feasibility options are for a national trial of different modifications to A&F for primary care opioid prescribing that will add significantly to the wider evidence base on A&F. AD - S. Alderson, University of Leeds, Leeds, United Kingdom AU - Alderson, S. AU - Farrin, A. AU - Foy, R. DB - Embase DO - 10.1186/s13063-019-3688-6 KW - opiate adult conference abstract consensus controlled study drawing drug therapy effect size electronic health record feasibility study female human intervention study learning male meta analysis prescription primary medical care randomization randomized controlled trial (topic) scale up LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1745-6215 ST - How should we proceed from local to national evaluation of complex interventions: Overcoming challenges in scaling up a local primary care prescribing feedback intervention to a national trial-a consensus process T2 - Trials TI - How should we proceed from local to national evaluation of complex interventions: Overcoming challenges in scaling up a local primary care prescribing feedback intervention to a national trial-a consensus process UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629760126&from=export http://dx.doi.org/10.1186/s13063-019-3688-6 VL - 20 ID - 931112 ER - TY - JOUR AB - BACKGROUND: Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine's association with fewer withdrawal symptoms and lessened risk of abuse, compared with methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance. METHODS: Informed by diffusion theory, the current study examined perceptions of buprenorphine's and methadone's acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted 2 ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone. RESULTS: Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared with methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability. CONCLUSIONS: Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine's or methadone's effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors, and patients about the use of opioid agonist therapy. AD - a Owens Institute for Behavioral Research , University of Georgia , Athens , Georgia , USA. b Department of Sociology, Anthropology, Social Work, and Criminal Justice , Oakland University , Rochester , Michigan , USA. AN - 26168816 AU - Aletraris, L. AU - Edmond, M. B. AU - Paino, M. AU - Fields, D. AU - Roman, P. M. C2 - Pmc4879956 C6 - Nihms771313 DO - 10.1080/08897077.2015.1062457 DP - NLM ET - 2015/07/15 J2 - Substance abuse KW - Buprenorphine/therapeutic use Counselors/*education/*psychology Female *Health Knowledge, Attitudes, Practice Humans Information Dissemination Male Methadone/therapeutic use Narcotic Antagonists/therapeutic use Opioid-Related Disorders/*drug therapy Buprenorphine counselor attitudes medication-assisted treatment methadone opioid agonist therapy opioid use disorder substance abuse LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0889-7077 (Print) 0889-7077 SP - 47-53 ST - Counselor training and attitudes toward pharmacotherapies for opioid use disorder T2 - Subst Abus TI - Counselor training and attitudes toward pharmacotherapies for opioid use disorder VL - 37 ID - 930901 ER - TY - JOUR AB - BACKGROUND: Project Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence. The seven strategies include: community education, provider education, hospital emergency department policy change, diversion control, support programs for patients with pain, naloxone policies, and addiction treatment expansion. PL was originally developed in Wilkes County, NC. It was made available to all counties in North Carolina starting in March 2013 with funding of up to $34,400 per county per year. We examined the association between PL implementation and 1) overall dispensing rate of opioid analgesics, and 2) utilization of buprenorphine. Buprenorphine is often used in connection with medication assisted treatment (MAT) for opioid dependence. METHODS: Observational interrupted time series analysis of 100 counties over 2009-2014 (n = 7200 county-months) in North Carolina. The intervention period was March 2013-December 2014. 74 of 100 counties implemented the intervention. Exposure data sources comprised process surveys, training records, Prescription Drug Monitoring Program (PDMP) data, and methadone treatment program quality data. Outcomes were PDMP-derived counts of opioid prescriptions and buprenorphine patients. Incidence Rate Ratios were estimated with adjusted GEE Poisson regression models of all seven PL strategies. RESULTS: In adjusted models, diversion control efforts were positively associated with increased dispensing of opioid analgesics (IRR: 1.06; 95% CI: 1.03, 1.09). None of the other PL strategies were associated with reduced prescribing of opioid analgesics. Support programs for patients with pain were associated with a non-significant decrease in buprenorphine utilization (IRR: 0.93; 95% CI: 0.85, 1.02), but addiction treatment expansion efforts were associated with no change in buprenorphine utilization (IRR: 0.98; 95% CI: 0.91, 1.06). CONCLUSIONS: Implementation of PL strategies did not appreciably reduce opioid dispensing and did not increase buprenorphine utilization. These results are consistent with previous findings of limited impact of PL strategies on overdose morbidity and mortality. Future studies should analyze the uptake of MAT using a more expansive view of institutional barriers, treating community coalition activity around MAT as an effect modifier. AD - Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. aaa@unc.edu. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. aaa@unc.edu. Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. AN - 30663005 AU - Alexandridis, A. A. AU - Dasgupta, N. AU - McCort, A. D. AU - Ringwalt, C. L. AU - Rosamond, W. D. AU - Chelminski, P. R. AU - Marshall, S. W. C2 - Pmc6339867 DA - Jan 21 DO - 10.1186/s40621-018-0179-2 DP - NLM ET - 2019/01/22 J2 - Injury epidemiology KW - Buprenorphine Community coalitions Evaluation Interrupted time series Mat Opioids Overdose Pdmp Prevention Office of Human Reseach Ethics at the University of North Carolina at Chapel Hill (IRB 12–2570, 17–0889). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2197-1714 (Print) 2197-1714 SP - 2 ST - Associations between implementation of Project Lazarus and opioid analgesic dispensing and buprenorphine utilization in North Carolina, 2009-2014 T2 - Inj Epidemiol TI - Associations between implementation of Project Lazarus and opioid analgesic dispensing and buprenorphine utilization in North Carolina, 2009-2014 VL - 6 ID - 930874 ER - TY - JOUR AB - BACKGROUND: In the US, medication assisted treatment, particularly with office-based buprenorphine, has been an important component of opioid dependence treatment among patients with iatrogenic addiction to opioid analgesics. The predictors of initiating buprenorphine for addiction among opioid analgesic patients have not been well-described. METHODS: We conducted a time-to-event analysis using data from the North Carolina (NC) Prescription Drug Monitoring Program (PDMP). Our outcome of interest was time-to-initiation of sublingual buprenorphine. Our study population was a prospective cohort of all state residents receiving a full-agonist opioid analgesic between 2011 and 2015. Predictors of initiation of sublingual buprenorphine examined included: age, gender, cumulative pharmacies and prescribers utilized, cumulative opioid intensity (defined as cumulative opioid exposure divided by duration of opioid exposure), and benzodiazepine dispensing. FINDINGS: Of 4.3 million patients receiving opioid analgesics in NC between 2011 and 2015 (accumulated 8.30 million person-years of follow-up), and a total of 28,904 patients initiated buprenorphine formulations intended for addiction treatment (overall rate 3.48 per 1,000 person-years). In adjusted multivariate models, the utilization of 3 or more pharmacies (HR: 2.93; 95% CI: 2.82, 3.05) or 6 or more controlled substance prescribers (HR: 12.09; 95% CI: 10.76, 13.57) was associated with buprenorphine initiation. A dose-response relationship was observed for cumulative opioid intensity (HR in highest decile relative to lowest decile: 5.05; 95% CI: 4.70, 5.42). Benzodiazepine dispensing was negatively associated with buprenorphine initiation (HR: 0.63; 95% CI: 0.61, 0.65). CONCLUSIONS: Opioid analgesic patients utilizing multiple prescribers or pharmacies are more likely to initiate sublingual buprenorphine. This finding suggests that patients with multiple healthcare interactions are more likely to be treated for high-risk opioid use, or may be more likely to be identified and treated for addiction. Future research should utilize prescription monitoring program data linked to electronic health records to include diagnosis information in analytic models. AD - Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America. AN - 31923197 AU - Alexandridis, A. A. AU - Dasgupta, N. AU - Ringwalt, C. L. AU - Rosamond, W. D. AU - Chelminski, P. R. AU - Marshall, S. W. C2 - PMC6953786 following competing interests: AAA is currently a Postdoctoral Fellow at the US Food and Drug Administration (FDA). The research presented was completed while AAA was a student at the University of North Carolina at Chapel Hill. The results and conclusions do not necessarily represent FDA’s views or policies. ND has served as a temporary voting member on FDA’s Drug Safety and Risk Management Advisory Committee. ND is a part-time employee of the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, which had no knowledge of or involvement in this paper. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado (United States of America). The RADARS System is supported by subscriptions from pharmaceutical manufacturers, governmental and non-governmental agencies for data, research and reporting services. Employees are prohibited from personal financial relationships with any biopharmaceutical company. This does not alter our adherence to PLOS ONE policies on sharing data and materials. DO - 10.1371/journal.pone.0227350 DP - NLM ET - 2020/01/11 J2 - PloS one KW - Adult Analgesics, Opioid/*therapeutic use Benzodiazepines/therapeutic use Buprenorphine/*therapeutic use Humans Male Middle Aged North Carolina Opiate Substitution Treatment/*methods Opioid-Related Disorders/epidemiology *Prescription Drug Monitoring Programs LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1932-6203 SP - e0227350 ST - Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data T2 - PLoS One TI - Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data VL - 15 ID - 930883 ER - TY - JOUR AB - BACKGROUND: In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose. METHODS: Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009-2012) and intervention periods (2013-2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0-6 months). RESULTS: In adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models. CONCLUSIONS: Provider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality. AD - Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Injury and Violence Prevention Branch, Raleigh, North Carolina, USA. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. AN - 28835443 AU - Alexandridis, A. A. AU - McCort, A. AU - Ringwalt, C. L. AU - Sachdeva, N. AU - Sanford, C. AU - Marshall, S. W. AU - Mack, K. AU - Dasgupta, N. C2 - Pmc5795575 C6 - Nihms933912 DA - Feb DO - 10.1136/injuryprev-2017-042396 DP - NLM ET - 2017/08/25 J2 - Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention KW - Analgesics, Opioid/*poisoning Drug Overdose/*prevention & control Emergency Service, Hospital/legislation & jurisprudence/*statistics & numerical data *Guideline Adherence Harm Reduction Humans North Carolina/epidemiology Patient Education as Topic Practice Guidelines as Topic Practice Patterns, Physicians'/legislation & jurisprudence/*statistics & numerical data Prescription Drugs/*poisoning Program Evaluation *Epidemiology *Outcome Evaluation *Poisoning *Surveillance *Time Series Control and Prevention, which funded the evaluation of the study. LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1353-8047 (Print) 1353-8047 SP - 48-54 ST - A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina T2 - Inj Prev TI - A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina VL - 24 ID - 930949 ER - TY - JOUR AB - Purpose: Nine of every 10 people with addiction first used substances before age 18, and opioid overdose deaths among adolescents have risen nearly threefold since 1999. However, recent data on training in substance use and opioid misuse in pediatric residency programs are lacking. We sought to describe the educational landscape of training on substance use and opioid misuse in US pediatric residency programs. Methods: An electronic survey was distributed to pediatric associate program directors (APDs) from all 201 US pediatric residency programs through the Association of Pediatric Program Directors listserv. The survey assessed (1) whether programs are providing formal training in substance use and opioid misuse; (2) the content and format of training; and (3) interest in a shared curriculum. Surveys were completed by one APD from each program, or if the APD preferred, by a chief resident or rotation director with better knowledge of the educational content offered. Descriptive statistics were used to summarize results. Data collection is ongoing; here we report preliminary data from respondents to date (n=91; 45.3% of all pediatric residency programs). The study was approved by the Boston University School of Medicine Institutional Review Board. Results: Among programs surveyed, 77 (84.6%) reported having a curriculum on adolescent substance use. Topics covered included screening (94.8%), brief interventions (77.9%), and treatment (50.6%). Overall, 74 (81.3%) programs reported teaching about adolescent opioid misuse. Among these 74 programs, topics covered included: epidemiology of opioid misuse and related harms (72.9%), screening for opioid misuse (72.5%), use of medications such as buprenorphine or naltrexone to treat opioid use disorder (29.7%), emergence of high-potency opioids including fentanyl (25.7%), and how to prescribe the overdose reversal agent naloxone (21.6%). Among all residency programs, 23 (25.3%) reported that the buprenorphine waiver course was available to pediatric residents in their health system while 49 (53.9%) were unsure if the course was available. Twelve (11.4%) programs had ≥1 resident who had completed buprenorphine waiver training. Overall, 71.8% of APDs reported that their residents cared for adolescents with opioid use disorder “sometimes” or “frequently”, and 96.7% believed training about opioid misuse was “important” or “very important”. However, only 11.0% rated their overall education on opioid misuse as “good” or “very good.” Barriers to providing education about adolescent opioid misuse included insufficient faculty expertise (67.0%), curricular time (57.1%), curricular content (48.4%), and resident time (45.1%). All (100.0%) respondents reported interest in a shared, web-based curriculum on adolescent opioid misuse and related topics. Conclusions: Although most US pediatric residency programs provide some teaching about adolescent substance use—most commonly focused on screening and brief intervention—gaps in training remain, particularly with respect to opioid misuse, treating opioid use disorder, and preventing overdose. There is broad interest in a shared curriculum to address educational gaps. Given the onset of substance use disorders during adolescence and rising youth morbidity and mortality related to opioid misuse, addressing gaps in training for pediatricians should be a priority. Sources of Support: Allen: HRSA/MCHB LEAH training grant T71MC00009. Hadland: NIH/NIDA K23-DA045085 & L40-DA042434, Thrasher Research Fund Early Career Award. Bagley: NIH/NIDA 1K23-DA044324. AU - Allen, E. B. AU - Michelson, C. D. AU - O'Donnell, K. A. AU - Bagley, S. M. AU - Earlywine, J. AU - Hadland, S. DB - Embase DO - 10.1016/j.jadohealth.2019.11.021 KW - buprenorphine naloxone naltrexone opiate adolescence adolescent awards and prizes career child conference abstract controlled study curriculum drug dependence drug overdose drug therapy female human institutional review juvenile major clinical study male Massachusetts morbidity mortality pediatrician preliminary data prevention resident rotation teaching LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1879-1972 1054-139X SP - S10 ST - 18. Training in Adolescent Substance use and Opioid Misuse in US Pediatric Residency Programs: A National Survey T2 - Journal of Adolescent Health TI - 18. Training in Adolescent Substance use and Opioid Misuse in US Pediatric Residency Programs: A National Survey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004572653&from=export http://dx.doi.org/10.1016/j.jadohealth.2019.11.021 VL - 66 ID - 931090 ER - TY - JOUR AB - Background: The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.Objective: To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.Methods: The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client's home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.Results: Shorter distance from a client's residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.Conclusions: Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted. AD - Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. Spokane Regional Health District, Spokane, WA, USA. Program of Excellence in Addiction Research, Washington State University, Spokane, WA, USA. Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA. AN - 31237791 AU - Amiri, S. AU - Lutz, R. B. AU - McDonell, M. G. AU - Roll, J. M. AU - Amram, O. DO - 10.1080/00952990.2019.1620261 DP - NLM ET - 2019/06/27 J2 - The American journal of drug and alcohol abuse KW - Adult Alcoholic Beverages/economics Cannabis Commerce/economics Duration of Therapy Female *Health Services Accessibility Humans Linear Models Male Medication Adherence/*statistics & numerical data Methadone/*therapeutic use Middle Aged *Opiate Substitution Treatment Opioid-Related Disorders/*rehabilitation Residence Characteristics/*statistics & numerical data Spatial Analysis Washington/epidemiology *Gis *Medication-assisted treatment with methadone *alcohol outlets *area deprivation *cannabis outlets *methadone dose *opioid treatment program *spatial access LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0095-2990 SP - 78-87 ST - Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment T2 - Am J Drug Alcohol Abuse TI - Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment VL - 46 ID - 930878 ER - TY - JOUR AB - OBJECTIVES: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS: The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems. AD - Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. Electronic address: solmaz.amiri@wsu.edu. Behavioral Health Innovations, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA. Department of Sociology, Washington State University, Pullman, WA, USA. Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. AN - 33518025 AU - Amiri, S. AU - McDonell, M. G. AU - Denney, J. T. AU - Buchwald, D. AU - Amram, O. DA - Feb DO - 10.1016/j.jval.2020.08.2098 DP - NLM ET - 2021/02/02 J2 - Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research KW - Buprenorphine/administration & dosage/*therapeutic use Cross-Sectional Studies Health Services Accessibility/economics/*statistics & numerical data Humans Narcotic Antagonists/administration & dosage/*therapeutic use Opiate Substitution Treatment/*statistics & numerical data Opioid-Related Disorders/*drug therapy/epidemiology Residence Characteristics Rural Population/statistics & numerical data Small-Area Analysis Socioeconomic Factors United States Urban Population/statistics & numerical data *2-step floating catchment area *Area Deprivation Index *Gis *Integrated Nested Laplace Approximation *Ruca *medication-assisted treatment LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1098-3015 SP - 188-195 ST - Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis T2 - Value Health TI - Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis VL - 24 ID - 930937 ER - TY - JOUR AB - AIM: Our aim was to compare physician-reported barriers to sublingual buprenorphine (BUP) and extended-release naltrexone (XR-NLT) prescribing in U.S. office-based practices, and to identify potential policies for minimizing these barriers. Only one previous qualitative study has examined physician-reported barriers to prescribing XR-NLT and no qualitative study has compared physician-reported barriers between the two medications. METHODS: Researchers conducted individual semi-structured and in-depth interviews with 20 licensed physicians in four U.S. states between January 2016 and May 2017. Interview questions included general barriers to addiction treatment in office-based settings, barriers specific to BUP and XR-NLT prescribing, and potential government policies to decrease barriers. Researchers conducted thematic analysis of transcribed interviews. They developed and pilot tested a coding template based on a sample of transcripts, independently coded transcripts in Dedoose software, conducted consensus coding to eliminate coding discrepancies, and then assessed data for themes using research questions as a guide. RESULTS: General barriers to office-based OUD treatment included limited physician education, limited insurance reimbursement, stigma, and perceptions of "difficult" patients. Barriers specific to BUP prescribing included regulatory restrictions, liability fears, and restrictions imposed by the criminal justice system. Barriers specific to XR-NLT prescribing included limited access to medically-supervised opioid detoxification, lack of awareness of the medication, and patient fears or disinterest. Participants without experience prescribing either medication emphasized barriers to treating OUD in general. Participants with experience prescribing BUP and/or XR-NLT described barriers to treating OUD in general as well as barriers specific to each medication. Policy makers should increase access to addiction medicine education, mandate insurance coverage of both medications and inpatient detoxification, prohibit excessive insurance prior authorization requirements, increase insurance reimbursement for behavioral healthcare, and incentivize interdisciplinary collaboration. CONCLUSIONS: While overlap exists, some barriers to BUP prescribing differ from barriers to XR-NLT prescribing. AD - Department of Health Management & Informatics, College of Health & Public Affairs, University of Central Florida-Orlando, FL, United States. Electronic address: barbara.andraka@ucf.edu. Department of Biology, College of Arts & Sciences, Indiana University-Bloomington, IN, United States. AN - 29324253 AU - Andraka-Christou, B. AU - Capone, M. J. DA - Apr DO - 10.1016/j.drugpo.2017.11.021 DP - NLM ET - 2018/01/13 J2 - The International journal on drug policy KW - Buprenorphine/*therapeutic use Delayed-Action Preparations/therapeutic use *Facilities and Services Utilization Female *Health Services Accessibility Humans Male Naltrexone/administration & dosage/*therapeutic use Narcotic Antagonists/therapeutic use Opiate Substitution Treatment Physicians/*psychology Policy Making Qualitative Research *Buprenorphine *Extended-release naltrexone *Medication-assisted treatment *Opioid use disorder LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0955-3959 SP - 9-17 ST - A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices T2 - Int J Drug Policy TI - A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices VL - 54 ID - 930965 ER - TY - JOUR AB - BACKGROUND: Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system. METHODS: We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods. RESULTS: 231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications (p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone (p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone (p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications (p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone (p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes. CONCLUSION: As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel. AD - Department of Health Management & Informatics, University of Central Florida, United States of America. Electronic address: Barbara.andraka@ucf.edu. Department of Health Management & Informatics, University of Central Florida, United States of America. Maurer School of Law, Indiana University-Bloomington, United States of America. Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, United States of America. AN - 31370988 AU - Andraka-Christou, B. AU - Gabriel, M. AU - Madeira, J. AU - Silverman, R. D. DA - Sep DO - 10.1016/j.jsat.2019.06.011 DP - NLM ET - 2019/08/03 J2 - Journal of substance abuse treatment KW - Adult Case Management Counselors *Criminal Law Female *Health Knowledge, Attitudes, Practice Humans Indiana Male Middle Aged *Opiate Substitution Treatment Police *Attitudes *Beliefs *Buprenorphine *Courts *Criminal justice *Education *Medication-assisted treatment *Medications for opioid use disorder *Methadone *Naltrexone *Opioid use disorder *Survey *Training LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0740-5472 SP - 72-82 ST - Court personnel attitudes towards medication-assisted treatment: A state-wide survey T2 - J Subst Abuse Treat TI - Court personnel attitudes towards medication-assisted treatment: A state-wide survey VL - 104 ID - 930820 ER - TY - JOUR AB - In 2018, the Trump Administration took the unprecedented step of allowing states to impose work requirements as a condition of Medicaid eligibility. States can apply for a demonstration waiver to require Medicaid beneficiaries aged 19-64 who do not meet exemption criteria (e.g., disability, caring for a sick relative) to participate in "community engagement" activities, which include employment, volunteering, and enrollment in a qualifying education or job training program. Debate thus far has focused primarily around the important issue of whether such requirements are legal. Less attention has focused on another serious concern - namely, that work requirements could exacerbate the nation's most urgent public health crisis: the opioid epidemic. Many enrollees with opioid use disorder who are unable to meet states' community engagement criteria will not qualify for an exemption from the work requirements, and risk being dropped from Medicaid enrollment. Refusing health insurance to individuals who are unable to meet work requirements could result in significant losses in coverage among a highly vulnerable population. Implementing new barriers to Medicaid coverage will hinder the effectiveness of massive state and federal investments in improving access to evidence-based addiction treatment. AD - College of Social Work, University of South Carolina, Columbia, SC, USA. Senior Research Career Scientist, Center for Innovation to Implementation, U.S. Department of Veterans Affairs, Stanford University School of Medicine, Menlo Park, CA, USA. School of Social Service Administration, University of Chicago, Chicago, IL, USA. AN - 31800334 AU - Andrews, C. M. AU - Humphreys, K. AU - Grogan, C. M. DO - 10.1080/00952990.2019.1686760 DP - NLM ET - 2019/12/05 J2 - The American journal of drug and alcohol abuse KW - Adult Eligibility Determination/*legislation & jurisprudence Employment/*legislation & jurisprudence Humans Insurance Coverage/*legislation & jurisprudence Medicaid/*legislation & jurisprudence Middle Aged Opioid Epidemic/*prevention & control Opioid-Related Disorders/*prevention & control United States Volunteers/legislation & jurisprudence Work/legislation & jurisprudence *Medicaid *opioid use disorder *opioids *substance use disorder *work requirements LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0095-2990 SP - 1-3 ST - How Medicaid work requirements could exacerbate the opioid epidemic T2 - Am J Drug Alcohol Abuse TI - How Medicaid work requirements could exacerbate the opioid epidemic VL - 46 ID - 930812 ER - TY - JOUR AB - BACKGROUND: In 2016, the Comprehensive Addiction Recovery Act permitted nurse practitioners (NPs) and physician assistants (PAs) to obtain a waiver to prescribe buprenorphine to treat opioid use disorder (OUD), with the goal of increasing access to this treatment. This study's purpose was to describe the buprenorphine prescribing practices of NPs and PAs and compare the barriers rural and urban providers face delivering treatment. METHODS: From the October 2018 Drug Enforcement Administration list of providers with the waiver to prescribe buprenorphine, all rural NPs and PAs (1,057) and a random sample of 500 urban NPs and PAs were surveyed. The questionnaire queried respondents about demographics, prescribing practices, practice characteristics, reimbursement policies, and barriers to prescribing buprenorphine to treat OUD. RESULTS: Of the waivered NPs and PAs, 80.3% reported having prescribed buprenorphine and 71.1% said they were currently accepting new patients with OUD. Providers with the 30-patient waiver were treating, on average, 13.2 patients; 37.0% were not treating any patients. The most common barrier, cited by half of providers, was concerns about diversion/medication misuse. More rural providers indicated lack of specialty backup and mental health providers as a barrier than urban providers. Never-prescribers and former-prescribers reported 6 barriers at significantly higher rates than did current prescribers. More rural providers accepted Medicaid and cash reimbursement than urban providers. CONCLUSIONS: NPs and PAs face many of the same barriers to providing buprenorphine as physicians have reported. Interventions to address these barriers have the potential to benefit all providers with the waiver to prescribe buprenorphine. AD - WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. AN - 31650634 AU - Andrilla, C. H. A. AU - Jones, K. C. AU - Patterson, D. G. DA - Mar DO - 10.1111/jrh.12404 DP - NLM ET - 2019/10/28 J2 - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association KW - *buprenorphine *medication-based treatment *opiate dependent *opiate substitution treatment *rural health LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0890-765x SP - 187-195 ST - Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine T2 - J Rural Health TI - Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine VL - 36 ID - 930880 ER - TY - JOUR AB - PURPOSE: The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office-based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it. The study team interviewed rural physicians successfully prescribing buprenorphine to identify strategies for overcoming commonly cited barriers for providing this service. METHODS: Interview candidates were randomly selected from a list of rurally located physicians with a DEA waiver to prescribe buprenorphine who reported treating high numbers of patients on a 2016 survey. Forty-three rural physicians, who were prescribing buprenorphine to a high number of patients, were interviewed about how they overcame prescribing barriers previously identified in that survey. FINDINGS: Interviewed physicians reported numerous ways to overcome common barriers to providing buprenorphine treatment in rural areas. Key recommendations included ways to (1) get started and maintain medication-assisted treatment, (2) minimize DEA intrusion and medication diversion, and (3) address the lack of mental health providers and stigma surrounding opioid use disorder (OUD). Overall, physicians found providing this service to be very rewarding. CONCLUSIONS: Despite known barriers, rural physicians around the country have been successful in adding buprenorphine treatment to their practices. Nonprescribing providers can learn from the strategies used by successful prescribers to add this service. AD - WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. AN - 30339720 AU - Andrilla, C. H. A. AU - Moore, T. E. AU - Patterson, D. G. DA - Jan DO - 10.1111/jrh.12328 DP - NLM ET - 2018/10/20 J2 - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association KW - Adult Aged Buprenorphine/*therapeutic use Female Humans Male Middle Aged Opiate Substitution Treatment/*methods/statistics & numerical data Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians'/*classification/statistics & numerical data Rural Population/trends Surveys and Questionnaires United States *buprenorphine *medication-assisted treatment *opioid treatment *opioid use disorder *rural health LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0890-765x SP - 113-121 ST - Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians T2 - J Rural Health TI - Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians VL - 35 ID - 930903 ER - TY - JOUR AB - PURPOSE: Opioid use disorder (OUD) is a substantial public health problem. Buprenorphine is an effective medication-assisted treatment (MAT) for OUD, but access is difficult for patients, especially in rural locations. To improve access, the Comprehensive Addiction and Recovery Act of 2016 extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat OUD to nurse practitioners (NPs) and physician assistants (PAs). This study summarizes the geographic distribution of waivered physicians, NPs, and PAs at the end of 2017 and compares it to the distribution of waivered physicians 5 years earlier. METHODS: Using the DEA list of providers with a waiver to prescribe buprenorphine to treat OUD and the Area Health Resources File, we assigned waivered providers to counties in 1 of 4 geographic categories. We calculated the number of counties in each category that did not have a waivered provider and county provider to population ratios and then compared our results to the waivered workforce in 2012. FINDINGS: The availability of a physician with a DEA waiver to provide office-based MAT has increased across all geographic categories since 2012. More than half of all rural counties (56.3%) still lack a provider, down from 67.1% in 2012. Almost one-third (29.8%) of rural Americans compared to 2.2% of urban Americans live in a county without a buprenorphine provider. NPs and PAs add otherwise lacking treatment availability in 56 counties (43 rural). CONCLUSIONS: Overall, MAT access has improved, but rural communities still experience treatment disparities. AD - WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. AN - 29923637 AU - Andrilla, C. H. A. AU - Moore, T. E. AU - Patterson, D. G. AU - Larson, E. H. DA - Jan DO - 10.1111/jrh.12307 DP - NLM ET - 2018/06/21 J2 - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association KW - Buprenorphine/therapeutic use Drug Prescriptions/statistics & numerical data *Geographic Mapping Health Personnel/*classification/statistics & numerical data Humans Licensure/classification/*statistics & numerical data Opiate Substitution Treatment/*classification/trends Opioid-Related Disorders/*drug therapy United States *buprenorphine *medication-assisted treatment *opioid treatment programs *opioid use disorder *rural health LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0890-765x SP - 108-112 ST - Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update T2 - J Rural Health TI - Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update VL - 35 ID - 930801 ER - TY - JOUR AB - The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas. NPs and PAs are projected to increase the number of rural patients treated with buprenorphine by 10,777 (15.2%). Census Divisions varied substantially in the number of projected new treatment slots per 10,000 population (0.8-10.6). The New England and East South Central Census Divisions are projected to have the largest population-adjusted increase. NPs and PAs have considerable potential to reduce substantial MAT access disparities. AD - WWAMI Rural Health Research Center, University of Washington School of Medicine, Seattle, WA, USA. AN - 30089426 AU - Andrilla, C. H. A. AU - Patterson, D. G. AU - Moore, T. E. AU - Coulthard, C. AU - Larson, E. H. DA - Apr DO - 10.1177/1077558718793070 DP - NLM ET - 2018/08/10 J2 - Medical care research and review : MCRR KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Health Services Needs and Demand Humans New England Nurse Practitioners/*statistics & numerical data/supply & distribution Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Physician Assistants/*statistics & numerical data/supply & distribution Practice Patterns, Physicians'/statistics & numerical data Rural Health Services/*statistics & numerical data Surveys and Questionnaires United States *Cara 2016 *buprenorphine *medication-assisted treatment *opioid treatment *opioid use disorder *rural health LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1077-5587 SP - 208-216 ST - Projected Contributions of Nurse Practitioners and Physicians Assistant to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas T2 - Med Care Res Rev TI - Projected Contributions of Nurse Practitioners and Physicians Assistant to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas VL - 77 ID - 930939 ER - TY - JOUR AB - BACKGROUND: Buprenorphine is an effective pharmacotherapy for the treatment of opioid use disorder (OUD), but recent increases in the rate of OUD in the U.S. have outpaced the supply of clinicians waivered to prescribe buprenorphine. To increase the supply of buprenorphine prescribers, the Comprehensive Addiction and Recovery Act expanded buprenorphine prescribing waiver eligibility beyond physicians to nurse practitioners (NP) and physician assistants (PA) in 2017. Little is known about patterns of waiver uptake among NPs and PAs. This study examined associations between the existing supply of waivered prescribers and waiver uptake among NPs and PAs in U.S. states. METHODS: NP and PA waiver uptake was evaluated as the number of NPs or PAs obtaining an initial buprenorphine prescribing waiver per 10,000 state residents from January 2017 to December 2018 using data from the Buprenorphine Waiver Notification System. NP and PA waiver uptake was estimated as a function of existing waivered prescriber supply, OUD treatment capacity, and other state characteristics using generalized least squares (GLS) regression. RESULTS: 28,010 NPs and PAs have become waivered to prescribe buprenorphine since January 2017. GLS regressions indicated that waivered prescriber supply was significantly, positively associated with both NP (b = 0.101 p < 0.001) and PA (b = 0.030, p < 0.001) waiver uptake. Results suggest an addition of ten waivered prescribers to existing supply was associated with an increase of one waivered NP, and an addition of thirty-three waivered prescribers to existing supply was associated with an increase of one waivered PA. CONCLUSIONS: NP and PA waiver uptake is strongly associated with the existing supply of waivered prescribers in a state, suggesting NPs and PAs may be more likely to acquire waivers in states with a high existing supply of buprenorphine prescribers. Additional policy solutions are needed to scale up the supply of buprenorphine prescribers in underserved states. AD - Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA. Electronic address: sgauty@bu.edu. Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA. Electronic address: mdstein@bu.edu. Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 1 Medical Center Place, Boston, MA, 02118, USA. Electronic address: alexander.walley@bmc.org. Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA; Department of Infectious Disease, Boston University School of Medicine, 801 Massachusetts Ave Crosstown Center, Boston, MA, 02118, USA. Electronic address: drainoni@bu.edu. AN - 32600629 AU - Auty, S. G. AU - Stein, M. D. AU - Walley, A. Y. AU - Drainoni, M. L. DA - Aug DO - 10.1016/j.jsat.2020.108032 DP - NLM ET - 2020/07/01 J2 - Journal of substance abuse treatment KW - *Buprenorphine *Nurse practitioners *Opioid use disorder *Physician assistants *Treatment capacity disclose. LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 SP - 108032 ST - Buprenorphine waiver uptake among nurse practitioners and physician assistants: The role of existing waivered prescriber supply T2 - J Subst Abuse Treat TI - Buprenorphine waiver uptake among nurse practitioners and physician assistants: The role of existing waivered prescriber supply VL - 115 ID - 930836 ER - TY - JOUR AB - Background: Since 2004, Stanley Street Treatment and Resources Inc. (SSTAR) has offered buprenorphine in our PHS 330 Federally Qualified Health Center (FQHC). Medical care is provided by waivered, family practice physicians working closely with nurse care coordinators. We have developed nursing protocols for medication induction and maintenance. Manualized, evidence-based group therapy is required and delivered by mental health providers employed by the clinic. The clinic has transitioned from an abstinence-only focus to a harm-reduction model that increases support and substance abuse counseling when illicit use occurs. Behavioral health treatment has become more integrated by use of electronic medical records and regular team meetings. These analyses describe the patient demographics, enrollment process, treatment outcomes and profits. Methods: Medical records, state tracking reports and internal accounting records were reviewed. Results: Since 2004, we have treated 865 patients. The current patient population is male (60%), white (88%) and IV heroin abusers (75%).We maintain rapid access with 4.62 days between initial contact and enrollment vs. the state average of 16.6 days. 59% of our clients receive 20 mg or less of Suboxone. We demonstrate retention consistent with the national average and have a current length of stay of 892 days. ∼2400 group sessions are delivered annually. In 2010 and 2011, the total revenues generated by the medical component was $636,000 and $669,581, respectively; after expenses a $282,000 and $395,037 profits were demonstrated, respectively. Mental health services were billed separately and generated $73,000 in 2010. Conclusions: Buprenorphine can be successfully provided in a primary care setting. Care is best delivered in a team model with integrated electronic medical records. Such programs can be financially viable. AD - G.L. Bailey, Warren Alpert Medical School, Brown University, United States AU - Bailey, G. L. DB - Embase DO - 10.1111/j.1521-0391.2013.12069.x KW - buprenorphine diamorphine buprenorphine plus naloxone primary medical care hospital addiction psychiatry substance abuse human patient profit electronic medical record model general practice mental health evidence based practice drug therapy group therapy abstinence harm reduction nursing protocol medical care medical record treatment outcome nurse population male health counseling physician length of stay mental health service health center LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2013 SN - 1055-0496 SP - 306 ST - Integrated substance abuse treatment: Buprenorphine in a primary care clinic T2 - American Journal on Addictions TI - Integrated substance abuse treatment: Buprenorphine in a primary care clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71061669&from=export http://dx.doi.org/10.1111/j.1521-0391.2013.12069.x VL - 22 ID - 931202 ER - TY - JOUR AB - Objectives: Substantial reduction in mortality for Opioid Use Disorder (OUD) treatment with buprenorphine has been established. Providers waivered under the Drug Addiction Treatment Act of 2000 (DATA 2000) have the ability to prescribe buprenorphine in outpatient settings. Despite a national effort to increase waivered providers, the utilization of buprenorphine has been low. This systematic literature review was conducted to describe the influence of provider attitudes, intention and behavior on the low uptake of buprenorphine. Methods: We searched the PubMed, Medline, and PsycINFO databases for studies published up to February 24, 2019. The eligibility criteria used for the searches were: (1) studies which discussed treatment of patients with OUD (2) includes providers attitude/intention and/or behavior (3) describes treatment with buprenorphine (4) setting is outpatient/office based and (5) should be US only. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 354 non-duplicate citations screened, 36 articles comprising of 26 cross-sectional studies and 10 qualitative studies met the inclusion criteria for the systematic review. Overall, a high percentage of the studies (39%) have highlighted negative or neutral attitudes and intentions of providers towards treating opioid dependent patients. Some of the main barriers identified in most of the studies were insurance and prior authorization, stigma towards patients with addiction, time constraints, buprenorphine availability and lack of psycho-social services. Generalizability of the findings is often difficult as most studies are limited to specific states, organizations or specialty of providers. Conclusions: The findings suggest that more efforts are required to study the influence of provider attitudes, intention and behavior at the national level and in varied settings and practice types. Future research should focus on developing provider training resources during residency and after the DATA waiver is obtained. AU - Bapat, S. AU - Varisco, T. AU - Thornton, J. D. DB - Embase DO - 10.1016/j.jval.2020.04.824 KW - buprenorphine opiate addiction adult attitude conference abstract coronavirus disease 2019 cross-sectional study drug therapy female human male Medline meta analysis organization outpatient Preferred Reporting Items for Systematic Reviews and Meta-Analyses prior authorization PsycINFO qualitative research social work stigma systematic review LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1524-4733 1098-3015 SP - S242 ST - PMU51 PROVIDER ATTITUDE'S, INTENTION, AND BEHAVIOR TO PRESCRIBE BUPRENORPHINE FOR THE TREATMENT OF OPIOID USE DISORDER: A SYSTEMATIC REVIEW T2 - Value in Health TI - PMU51 PROVIDER ATTITUDE'S, INTENTION, AND BEHAVIOR TO PRESCRIBE BUPRENORPHINE FOR THE TREATMENT OF OPIOID USE DISORDER: A SYSTEMATIC REVIEW UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005868033&from=export http://dx.doi.org/10.1016/j.jval.2020.04.824 VL - 23 ID - 931079 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: Outcome intervention data from Medicare, veteran, prison, and United States' public populations can identify best practices to decrease opioid misuse. Prescription policies for treating pain in the United States and other countries are relevant to preventing overdose. METHODS: Three strategies are considered: (1) Demand Reduction counsels and educates patients and current or potential opioid users about risks and treatment options to reduce motivation to consume opioids. (2) Supply Reduction limits access and dosage of opioids and co-drugs such as benzodiazepines. It encourages use of safest prescribing practices for treating pain. (3) Harm Reduction reduces opioid deaths through medication-assisted treatment (MAT) combining opioid substitution therapy (OST), provision of opioid antagonists like Naltrexone, and behavioral health services. RESULTS: Demand Reduction is often inadequate to treat severe pain or in the presence of major psychopathology like opioid abuse disorder (OUD). Among veterans, lower opioid doses for pain treatment were associated with diminished death rates. Supply Reduction interventions have disadvantages. Banning drugs has poor long-term success with prison inmates, because abstinence is difficult to enforce after discharge. Limiting opioid supplies does not increase survival rates for Medicare patients. DISCUSSION AND CONCLUSIONS: Sharp opioid dose restriction in outpatient treatment increases heroin and fentanyl use, explaining why recent years' decrease in United States opioid prescriptions has not reduced national mortality rates. Although Harm Reduction is the safest, most effective single approach, combining three interventions while improving pain and addiction prescribing practices is optimal. SCIENTIFIC SIGNIFICANCE: Scientific research needs to inform choice of opioid overuse interventions. (Am J Addict 2018;XX:1-3). AD - Former Professor of Psychiatry, Northwestern Medical School, Chicago, Illinois. Former Professor in Residence and Chief of Addiction Medicine, UC Davis Medical School, Sacramento, California. AN - 30311993 AU - Barglow, P. DA - Dec DO - 10.1111/ajad.12823 DP - NLM ET - 2018/10/13 J2 - The American journal on addictions KW - *Ambulatory Care/methods/standards *Analgesics, Opioid/classification/pharmacology *Behavior, Addictive/epidemiology/psychology/therapy Drug Overdose/prevention & control Evidence-Based Medicine Humans Opiate Substitution Treatment/*methods *Opioid-Related Disorders/epidemiology/prevention & control/psychology/therapy Pain Management/methods Quality Improvement United States/epidemiology LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1055-0496 SP - 605-607 ST - Commentary: The opioid overdose epidemic: Evidence-based interventions T2 - Am J Addict TI - Commentary: The opioid overdose epidemic: Evidence-based interventions VL - 27 ID - 930795 ER - TY - JOUR AB - Background: There are large segments of the country where access to evidence-based treatment for opioid use disorder (OUD) is limited by the lack of clinician supply. To help address the limits of OUD treatment capacity, the Comprehensive Addiction and Recovery Act (CARA) passed in July 2016 enabled nurse practitioners and physicians' assistants (NP/PA) to obtain federal waivers to prescribe buprenorphine, an effective medication for treating OUD, after 24 hours of training. We examined the take-up and use of these waivers by NPs and PAs and their association with scope of practice laws. Methods: We obtained the date and county of buprenorphine waiver approval for all clinicians including NP/PAs from 2005-2017 from the Substance Abuse and Mental Health Services Administration, merged with publicly available county demographic characteristics and 2016 opioid mortality data. We captured buprenorphine prescribing from the publicly available Drug Enforcement Agency databases. Using linear regression, we estimated the associations in characteristics of counties with the highest vs. lowest quartiles of waivered NP/PAs per capita by the end of 2017. Next, we estimated a county-or 3-digit ZIP-quarter level linear regression with geographic fixed effects to quantify changes post-CARA in buprenorphine prescribing per capita. We compared growth in these outcomes between states with fully independent vs. restricted scope of practice laws for NP/PAs as of 2016. Results: By the end of 2017, 3,682 NPs and PAs in 812 counties representing 75% of the US population obtained buprenorphine waivers, including 39 counties with no buprenorphine-waivered providers before 2017. Among counties with any waivered NP/PAs, there were 6.2 vs. 0.6 waivered NP/PAs per 100,000 in counties in the top vs. bottom quartiles of NP/PA waiver adoption. Top quartile counties had significantly higher opioid-related mortality per 100,00 in 2016 than bottom quartile counties (18.4 vs. 13.2, adjusted p< 0.001). By the end of 2017, counties in states with full vs. restricted scope of practice had over twice as many waivered NP/PAs per 100,000 (2.2 vs. 0.9, p< 0.001). Annual buprenorphine prescribing per capita grew faster in 2017 after CARA passage than from 2005-2016 (15.2% faster annual growth vs. national average, p< 0.001), but there was no difference in growth between states with full vs. restricted scope of practice regulations (p=0.27). Conclusions: One year after CARA passage, thousands of NP/PAs obtained buprenorphine waivers despite the 24-hour training requirement, many of whom were in counties with no prior buprenorphine providers. There was greater adoption in states where NP/PAs could practice independently, though buprenorphine prescribing did not grow faster in states with full scope of practice laws in 2017. The growth of NP/PAs as buprenorphine providers suggests that they could serve a crucial role in expanding access to OUD treatment nationally. AD - M.L. Barnett, Harvard T.H. Chan School of Public Health, Boston, MA, United States AU - Barnett, M. L. AU - Lee, D. AU - Frank, R. DB - Embase DO - 10.1007/11606.1525-1497 KW - buprenorphine opiate addiction adoption advanced practice provider conference abstract controlled study human linear regression analysis mortality nurse practitioner outcome assessment physician assistant prescription quantitative analysis remission scope of practice LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1525-1497 SP - S218 ST - Expanding supply of medication assisted treatment to underserved areas: Buprenorphine waivers for advanced practice providers T2 - Journal of General Internal Medicine TI - Expanding supply of medication assisted treatment to underserved areas: Buprenorphine waivers for advanced practice providers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629003309&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 931127 ER - TY - JOUR AB - Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 285 rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas. AD - Michael L. Barnett ( mbarnett@hsph. harvard. edu ) is an assistant professor of health policy and management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and a primary care physician at Brigham and Women's Hospital, both in Boston, Massachusetts. Dennis Lee is a research assistant in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health. Richard G. Frank is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy, Harvard Medical School, in Boston. AN - 31794302 AU - Barnett, M. L. AU - Lee, D. AU - Frank, R. G. C2 - Pmc6938159 C6 - Nihms1064458 DA - Dec DO - 10.1377/hlthaff.2019.00859 DP - NLM ET - 2019/12/04 J2 - Health affairs (Project Hope) KW - Buprenorphine/*therapeutic use Databases, Factual *Drug Prescriptions Humans Nurse Practitioners/*statistics & numerical data/supply & distribution Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Physician Assistants/*statistics & numerical data/supply & distribution Physicians/statistics & numerical data/supply & distribution Rural Health Services/*statistics & numerical data Rural Population Scope of Practice/legislation & jurisprudence *Access to care *Buprenorphine *Health policy *Nurse practitioner *Opioid use disorder *Physician assistant *Physicians *Populations *Primary care *Regulation *Rural health care *Substance abuse LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0278-2715 (Print) 0278-2715 SP - 2048-2056 ST - In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants T2 - Health Aff (Millwood) TI - In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants VL - 38 ID - 930840 ER - TY - JOUR AD - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, US bicket@jhmi.edu. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, US. AN - 31387971 AU - Bicket, M. C. AU - Durbhakula, S. DA - Aug 5 DO - 10.1136/rapm-2019-100743 DP - NLM ET - 2019/08/08 J2 - Regional anesthesia and pain medicine KW - chronic pain graduate medical education opioid misuse opioids, adverse effects pain medicine Healthcare and Alosa and has stock options in Axial Healthcare. He serves on the board of directors for the Association of Pain Program Directors. These arrangements have been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1098-7339 ST - One prescription for the opioid crisis: require buprenorphine waivers for pain medicine fellows T2 - Reg Anesth Pain Med TI - One prescription for the opioid crisis: require buprenorphine waivers for pain medicine fellows ID - 930982 ER - TY - JOUR AB - Acollaborative care model features four essential elements. It must be team-driven, i.e. a multidisciplinary group of healthcare delivery professionals providing care in a coordinated fashion. It must be population-focused, i.e. the team is responsible for the provision of care and health outcomes of a defined population. It must be measurement-guided, i.e. the team uses systematic, disease-specific, patient-reported outcome measures to drive clinical decision making. Finally, it must be evidence-based, i.e. the team adapts scientifically proven treatments within an individual clinical context to achieve improved health outcomes. The framework of Medication Assisted Treatment (MAT) in primary care consists of pharmacological treatment (such as buprenorphine and naltrexone), psychosocial services, integration of care, and education and outreach. The Vermont Hub and Spoke system is a statewide attempt to integrate MAT. Vermont opened its first Outpatient Treatment Program (OTP) (methadone) in 2002 and adopted Office Based Opioid Treatment (OBOT) (buprenorphine) in 2003, quickly expanding to become first in the United States for waivered physicians and doses prescribed per capita. Due to high demand, OTPs became Hubs (specialty center responsible for coordinating complex cases) and most of OBOTs became Spokes (ongoing care systems including a physician and collaborating addiction professionals). The established relationships between the hub and spokes promote integration of care and collaboration, including consultation with the hubs. The Vermont Hub and Spoke system developed a sustainable reimbursement model, implemented MAT and best practices as a standard of care, and engaged and supported community health center providers in treating substance use disorders with reduced stigma. One of the main challenges faced by the system is that the demand for treatment exceeds available slots. Additionally, changing the culture of treatment requires significant investment and clinical support, and the need for new clinical, administrative and billing protocols. Insurance rules such as prior authorization requirements pose further barriers. Integrating MATinto systems based practice needs a strong model of financial stability, comparative effectiveness studies, and expanding provision for all treatments including XRnaltrexone (e.g. Alkermes Vivitrol) and XR-buprenorphine (e.g. Titan's injectable buprenorphine). Ongoing education of providers is essential, and PCSS is the best model for provider clinical support and mentoring. Increased efforts need to be directed towards reaching patients in rural and underserved areas through telemedicine and XR formulations. AD - A. Bisaga AU - Bisaga, A. DB - Embase DO - 10.1111/ajad.12545 KW - buprenorphine methadone naltrexone opiate clinical decision making clinical study clinical trial comparative effectiveness consultation drug dependence drug therapy health center human investment mentoring outpatient patient-reported outcome primary medical care reimbursement stigma telemedicine Vermont LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2017 SN - 1055-0496 SP - 235 ST - Integrating MAT into systems based practice and innovative collaborative care models, emphasizing data from vermont hub and Spoke System T2 - American Journal on Addictions TI - Integrating MAT into systems based practice and innovative collaborative care models, emphasizing data from vermont hub and Spoke System UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615220906&from=export http://dx.doi.org/10.1111/ajad.12545 VL - 26 ID - 931170 ER - TY - JOUR AB - BACKGROUND: There is need for better treatments of addictive behaviors, both substance and non-substance related, termed Reward Deficiency Syndrome (RDS). While the FDA has approved pharmaceuticals under the umbrella term Medication Assisted Treatment (MAT), these drugs are not optimal. OBJECTIVES: It is our contention that these drugs work well in the short-term by blocking dopamine function leading to psychological extinction. However, use of buprenorphine/Naloxone over a long period of time results in unwanted addiction liability, reduced emotional affect, and mood changes including suicidal ideation. METHODS: We are thus proposing a paradigm shift in addiction treatment, with the long-term goal of achieving "Dopamine Homeostasis." While this may be a laudable goal, it is very difficult to achieve. Nevertheless, this commentary briefly reviews past history of developing and subsequently, utilizing a glutaminergic-dopaminergic optimization complex [Kb220Z] shown to be beneficial in at least 20 human clinical trials and in a number of published and unpublished studies. RESULTS: It is our opinion that, while additional required studies could confirm these findings to date, the cited studies are indicative of achieving enhanced resting state functional connectivity, connectivity volume, and possibly, neuroplasticity. Conclusions/Importance: We are proposing a Reward Deficiency Solution System (RDSS) that includes: Genetic Addiction Risk Score (GARS); Comprehensive Analysis of Reported Drugs (CARD); and a glutaminergic-dopaminergic optimization complex (Kb220Z). Continued investigation of this novel strategy may lead to a better-targeted approach in the long-term, causing dopamine regulation by balancing the glutaminergic-dopaminergic pathways. This may potentially change the landscape of treating all addictions leading us to the promised land. AD - a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA. b Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA. c Department of Clinical Neurology , PATH Foundation NY , New York , New York , USA. d Human Integrated Services Unit , University of Vermont Centre for Clinical & Translational Science , Burlington , Vermont , USA. e Division of Addiction Services , Dominion Diagnostics, LLC , North Kingstown , Rhode Island , USA. f Division of Neuroscience-Based Therapy , Summit Estate Recovery Center , Los Gatos , California , USA. g Division of Neuroscience Research and Addiction Therapy , The Shores Treatment and Recovery Center , Port Saint Lucie , Florida , USA. h Institute of Psychology , Eötvös Loránd University , Budapest , Hungary. i Department of Psychiatry , Wright State University Boonshoft School of Medicine , Dayton , Ohio, USA. j Center for Psychiatric Medicine , North Andover , Massachusetts , USA. k Department of Psychology , Curry College , Milton , Massachusetts , USA. AN - 28033474 AU - Blum, K. AU - Febo, M. AU - Fried, L. AU - Li, M. AU - Dushaj, K. AU - Braverman, E. R. AU - McLaughlin, T. AU - Steinberg, B. AU - Badgaiyan, R. D. C2 - Pmc5589271 C6 - Nihms900306 DA - Mar 21 DO - 10.1080/10826084.2016.1244551 DP - NLM ET - 2016/12/30 J2 - Substance use & misuse KW - Behavior, Addictive/metabolism/*physiopathology Brain/diagnostic imaging/metabolism/physiopathology Catecholamines/*physiology Dopamine/*metabolism *Homeostasis/physiology Humans Monoamine Oxidase/*physiology Neprilysin/*physiology Neuroimaging/methods Neuropharmacology/methods *Reward Substance-Related Disorders/metabolism/physiopathology Syndrome *Dopamine homeostasis *Kb220z *Reward Deficiency Syndrome (RDS) *neuroimaging *neuropharmaco-logical Synaptamine, which holds patents on KB220Z. Drs. Marcelo Febo and Rajendra D. Badgaiyan are on the Scientific Advisory Board of LaVita RDS. There are no other conflicts to reports. LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1082-6084 (Print) 1082-6084 SP - 535-547 ST - Hypothesizing That Neuropharmacological and Neuroimaging Studies of Glutaminergic-Dopaminergic Optimization Complex (KB220Z) Are Associated With "Dopamine Homeostasis" in Reward Deficiency Syndrome (RDS) T2 - Subst Use Misuse TI - Hypothesizing That Neuropharmacological and Neuroimaging Studies of Glutaminergic-Dopaminergic Optimization Complex (KB220Z) Are Associated With "Dopamine Homeostasis" in Reward Deficiency Syndrome (RDS) VL - 52 ID - 930999 ER - TY - JOUR AB - OBJECTIVE: To present an analysis of the Drug Addiction Treatment Act of 2000 (DATA) and its impact on the practice of pharmacy. DATA SOURCES: Statutes, codes, regulations, newspaper articles, journal articles; search of articles posted on MEDLINE identified using the search terms methadone, buprenorphine, treatment, opioid abuse, and opioid addiction. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: DATA and Food and Drug Administration approval of sublingual tablets of buprenorphine and buprenorphine with naloxone (Reckitt and Benckiser) will dramatically expand opioid addicts' access to treatment and increase the number of opioid addicts receiving prescriptions for buprenorphine and buprenorphine with naloxone. The availability of buprenorphine will pose unique challenges to pharmacists and suggests the need for education on addiction and greater awareness of the unique needs of patients recovering from addiction. CONCLUSION: The stage is being set to expand access to treatment and reach more untreated opioid addicts in the United States. Professional organizations such as the American Pharmaceutical Association should work with the U.S. Department of Health and Human Services and its Substance Abuse and Mental Health Services Administration to develop training materials, curricula, and guidelines for pharmacists on substance abuse with a special focus on outpatient opioid treatment. Such materials could be used in continuing education programs and materials and in pharmacy schools. AD - D.E. Boatwright, San Francisco Veterans Affairs Medical Center, Calif, USA. AU - Boatwright, D. E. DB - Medline DO - 10.1331/108658002763316860 KW - buprenorphine naloxone narcotic analgesic agent narcotic antagonist article counseling drug legislation human opiate addiction pharmacist United States LA - English M1 - 3 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2002 SN - 1086-5802 SP - 432-438 ST - Buprenorphine and addiction: challenges for the pharmacist T2 - Journal of the American Pharmaceutical Association (Washington,D.C. : 1996) TI - Buprenorphine and addiction: challenges for the pharmacist UR - https://www.embase.com/search/results?subaction=viewrecord&id=L35599669&from=export http://dx.doi.org/10.1331/108658002763316860 VL - 42 ID - 931224 ER - TY - JOUR AB - BACKGROUND: Family medicine residency programs vary in the extent of training offered on opioid use disorder (OUD) in their curricula. The purpose of this study was to determine the impact of OUD education and buprenorphine waiver provision on postresidency buprenorphine prescribing patterns. METHODS: Three North Carolina family medicine residency programs differed in the extent to which they taught OUD, including buprenorphine waiver provision. Program A required OUD education and assisted residents in obtaining a waiver; Program B offered OUD education and did not assist with obtaining a waiver; and Program C did not offer OUD education. In November 2019, graduates from these 3 programs were surveyed regarding the extent to which they engaged in treatment of OUD. Descriptive statistics were used to characterize the survey participants and their responses. RESULTS: Of the 62 graduates invited to participate, 49 (79.0%) responded. Across the 3 programs, the percentage of graduates with a waiver varied significantly (P < .0001): Program A (84.2%), Program B (33.3%), and Program C (0.0%). Of those who were not waivered, Program B had a larger percentage that desired to prescribe buprenorphine products (70.0%) as compared with Program C (9.1%) (P = .009). CONCLUSIONS: Family medicine residency graduates from programs with more integrated OUD education were more likely to obtain and use a waiver to prescribe buprenorphine-containing medications postgraduation. AD - From the Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill (VB, CGW, EBF, KBF); UNC Health Sciences at MAHEC, Asheville, NC (CGW, EBF, CRT); Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill (CGW); Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC (JK); Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC (CRT). From the Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill (VB, CGW, EBF, KBF); UNC Health Sciences at MAHEC, Asheville, NC (CGW, EBF, CRT); Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill (CGW); Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC (JK); Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC (CRT) courtenay.wilson@mahec.net. AN - 33219079 AU - Boggiano, V. AU - Gilmore Wilson, C. AU - Fagan, E. B. AU - Kirk, J. AU - Bossenbroek-Fedoriw, K. AU - Tak, C. R. DA - Nov-Dec DO - 10.3122/jabfm.2020.06.200127 DP - NLM ET - 2020/11/22 J2 - Journal of the American Board of Family Medicine : JABFM KW - *Buprenorphine *Family Medicine *Health Services Accessibility *Health Workforce *Opioid-Related Disorders *Primary Health Care *Residency *Surveys and Questionnaires LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1557-2625 SP - 998-1003 ST - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency T2 - J Am Board Fam Med TI - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency VL - 33 ID - 930832 ER - TY - JOUR AB - Background: Family medicine residency programs vary in the extent of training offered on opioid use disorder (OUD) in their curricula. The purpose of this study was to determine the impact of OUD education and buprenorphine waiver provision on postresidency buprenorphine prescribing patterns. Methods: Three North Carolina family medicine residency programs differed in the extent to which they taught OUD, including buprenorphine waiver provision. Program A required OUD education and assisted residents in obtaining a waiver; Program B offered OUD education and did not assist with obtaining a waiver; and Program C did not offer OUD education. In November 2019, graduates from these 3 programs were surveyed regarding the extent to which they engaged in treatment of OUD. Descriptive statistics were used to characterize the survey participants and their responses. Results: Of the 62 graduates invited to participate, 49 (79.0%) responded. Across the 3 programs, the percentage of graduates with a waiver varied significantly (P < .0001): Program A (84.2%), Program B (33.3%), and Program C (0.0%). Of those who were not waivered, Program B had a larger percentage that desired to prescribe buprenorphine products (70.0%) as compared with Program C (9.1%) (P = .009). Conclusions: Family medicine residency graduates from programs with more integrated OUD education were more likely to obtain and use a waiver to prescribe buprenorphine-containing medications postgraduation. AD - C.G. Wilson, 123 Hendersonville Rd, Asheville, NC, United States AU - Boggiano, V. AU - Wilson, C. G. AU - Blake Fagan, E. AU - Kirk, J. AU - Bossenbroek-Fedoriw, K. AU - Tak, C. R. DB - Embase Medline DO - 10.3122/jabfm.2020.06.200127 KW - buprenorphine adult article education program family medicine female health care access health survey health workforce human male normal human opiate addiction prescription primary health care questionnaire residency education resident LA - English M1 - 6 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1558-7118 1557-2625 SP - 998-1003 ST - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision during Residency T2 - Journal of the American Board of Family Medicine TI - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision during Residency UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2010279270&from=export http://dx.doi.org/10.3122/jabfm.2020.06.200127 VL - 33 ID - 931049 ER - TY - JOUR AB - Background: Family medicine residency programs vary in the extent of training offered on opioid use disorder (DUD) in their curricula. The purpose of this study was to determine the impact of OUD education and buprenorphine waiver provision on postresidency buprenorphine prescribing patterns. Methods: Three North Carolina family medicine residency programs differed in the extent to which they taught DUD. including buprenorphine waiver provision. Program A required OUD education and assisted residents in obtaining a waiver; Program B offered OUD education and did not assist with obtaining a waiver; and Program C did not offer OUD education. In November 2019, graduates from these 3 programs were surveyed regarding the extent to which they engaged in treatment of OUD. Descriptive statistics were used to characterize the survey participants and their responses. Results: Of the 62 graduates invited to participate, 49 (79.0%) responded. Across the 3 programs, the percentage of graduates with a waiver varied significantly (P < .0001): Program A (84.2%), Program B (33.3%), and Program C (0.0%). Of those who were not waivered, Program B had a larger percentage that desired to prescribe buprenorphine products (70.0%) as compared with Program C (9.1%) (P = .009). Conclusions: Family medicine residency graduates from programs with more integrated OUD education were more likely to obtain and use a waiver to prescribe buprenorphine-containing medications postgraduation. AD - [Boggiano, Victoria; Wilson, Courtenay Gilmore; Fagan, E. Blake; Bossenbroek-Fedoriw, Kelly] Univ N Carolina, Dept Family Med, Sch Med, Chapel Hill, NC 27515 USA. [Wilson, Courtenay Gilmore; Fagan, E. Blake; Tak, Casey R.] MAHEC, UNC Hlth Sci, Asheville, NC USA. [Wilson, Courtenay Gilmore] Univ N Carolina, Div Practice Adv & Clin Educ, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA. [Kirk, Julienne] Wake Forest Sch Med, Dept Family & Community Med, Winston Salem, NC 27101 USA. [Tak, Casey R.] Univ N Carolina, Div Pharmaceut Outcomes & Policy, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA. Wilson, CG (corresponding author), 123 Hendersonville Rd, Asheville, NC 28803 USA. courtenay.wilson@mahec.net AN - WOS:000592692300020 AU - Boggiano, V. AU - Wilson, C. G. AU - Fagan, E. B. AU - Kirk, J. AU - Bossenbroek-Fedoriw, K. AU - Tak, C. R. DA - Nov-Dec DO - 10.3122/jabfm.2020.06.200127 J2 - J. Am. Board Fam. Med. KW - Buprenorphine Family Medicine Health Services Accessibility Health Workforce Opioid-Related Disorders Primary Health Care Residency Surveys and Questionnaires EARLY-CAREER BUPRENORPHINE PHYSICIANS MANAGEMENT BARRIERS Primary Health Care Medicine, General & Internal LA - English M1 - 6 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2020 SN - 1557-2625 SP - 998-1003 ST - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency T2 - Journal of the American Board of Family Medicine TI - The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency UR - ://WOS:000592692300020 VL - 33 ID - 931235 ER - TY - JOUR AB - Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200 000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care. AD - J. Bonhomme, Bldg. B, 1513 E Cleveland Ave, East Point, GA 30344, United States AU - Bonhomme, J. AU - Shim, R. S. AU - Gooden, R. AU - Tyus, D. AU - Rust, G. DB - Embase Medline DO - 10.1016/S0027-9684(15)30175-9 KW - buprenorphine diamorphine illicit drug methadone naloxone African American analgesia chronic pain clinical practice constipation drug efficacy drug megadose drug misuse drug safety drug tolerability dysphoria ethnicity health disparity human low drug dose medical education mental health care meta analysis (topic) opiate addiction penis erection physician pregnancy prevalence primary medical care priority journal respiration depression review screening sexual dysfunction side effect substance abuse sweat United States withdrawal syndrome L1 - http://www.nmanet.org/index.php?option=com_content&view=article&id=262&Itemid=389 LA - English M1 - 7-8 M3 - Review N1 - Embase Elsevier literature search May 7, 2021 PY - 2012 SN - 0027-9684 SP - 342-350 ST - Opioid addiction and abuse in primary care practice: A comparison of methadone and buprenorphine as treatment options T2 - Journal of the National Medical Association TI - Opioid addiction and abuse in primary care practice: A comparison of methadone and buprenorphine as treatment options UR - https://www.embase.com/search/results?subaction=viewrecord&id=L365739576&from=export http://dx.doi.org/10.1016/S0027-9684(15)30175-9 VL - 104 ID - 931205 ER - TY - JOUR AB - Dependence on opioids and the number of opioid overdose deaths are serious and escalating public health problems, but medication-assisted treatments for opioid addiction remain inadequate for many patients. Glucagon-like pepide-1 (GLP-1) is a gut hormone and neuropeptide with actions in peripheral tissues and in the brain, including regulation of blood glucose and food intake. GLP-1 analogs, which are approved diabetes medications, can reduce the reinforcing and rewarding effects of alcohol, cocaine, amphetamine, and nicotine in rodents. Investigations on effects of GLP-1 analogs on opioid reward and reinforcement have not been reported. We assessed the effects of the GLP-1 receptor agonist Exendin-4 (Ex4) on opioid-related behaviors in male mice, i.e., morphine-conditioned place preference (CPP), intravenous self-administration (IVSA) of the short-acting synthetic opioid remifentanil, naltrexone-precipitated morphine withdrawal, morphine analgesia (male and female mice), and locomotor activity. Ex4 treatment had no effect on morphine-induced CPP, withdrawal, or hyperlocomotion. Ex4 failed to decrease remifentanil self-administration, if anything reinforcing effects of remifentanil appeared increased in Ex4-treated mice relative to saline. Ex4 did not significantly affect analgesia. In contrast, Ex4 dose dependently decreased oral alcohol self-administration, and suppressed spontaneous locomotor activity. Taken together, Ex4 did not attenuate the addiction-related behavioral effects of opioids, indicating that GLP-1 analogs would not be useful medications in the treatment of opioid addiction. This difference between opioids and other drug classes investigated to date may shed light on the mechanism of action of GLP-1 receptor treatment in the addictive effects of alcohol, central stimulants, and nicotine. AD - Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen 2100, Denmark and University Hospital of Copenhagen, Copenhagen DK2100, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark. Department of Surgery, University of Michigan, Ann Arbor, MI 48109. AN - 31058214 AU - Bornebusch, A. B. AU - Fink-Jensen, A. AU - Wörtwein, G. AU - Seeley, R. J. AU - Thomsen, M. C2 - Pmc6498420 DA - Mar-Apr DO - 10.1523/eneuro.0443-18.2019 DP - NLM ET - 2019/05/07 J2 - eNeuro KW - Alcoholism/drug therapy Animals Behavior, Animal/*drug effects Conditioning, Operant/*drug effects Exenatide/*pharmacology Glucagon-Like Peptide-1 Receptor/*agonists/analysis Hypoglycemic Agents/*pharmacology Male Mice Mice, Inbred C57BL Mice, Knockout Motor Activity/*drug effects Opioid-Related Disorders/*drug therapy *abuse *gut-brain axis *neuropeptides *operant behavior *opioid *substance use disorder LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2373-2822 ST - Glucagon-Like Peptide-1 Receptor Agonist Treatment Does Not Reduce Abuse-Related Effects of Opioid Drugs T2 - eNeuro TI - Glucagon-Like Peptide-1 Receptor Agonist Treatment Does Not Reduce Abuse-Related Effects of Opioid Drugs VL - 6 ID - 930869 ER - TY - JOUR AB - INTRODUCTION: Among people with opioid use disorder (OUD), stigma is a known barrier to accessing treatment and has negative impacts on physical and mental health. The purpose of this study was to understand the factors associated with self-stigma and perceived stigma severity among people with OUD entering an inpatient detoxification program. METHODS: Between December 2015 and August 2016, consecutive persons seeking inpatient opioid detoxification were asked to complete a survey that included sociodemographic, drug use, treatment variables, an 8-item General Self-Stigma scale, and a 3-item Treatment Stigma scale. Correlates of stigma severity were estimated using ordinary least squares regression. RESULTS: The 407 participants had an average age of 32.4 (±8.79) years, with 72.2% male and 84.5% non-Hispanic White. Two-thirds had ever received medication-assisted treatment for OUD and 323 (79.4%) had ever been admitted to a detoxification program. Adjusted mean General Self-Stigma scores were positively and significantly associated with recent injection drug use (b = 0.262, P = 0.032), and having previously entered detoxification programs (b = 0.330, P = 0.016). Adjusted mean Treatment Stigma scores were positively and significantly associated with years of education (b = 0.142, P = 0.002), having ever been prescribed naltrexone (b = 0.277, P = 0.025) and having previously entered detoxification programs (b = 0.389, P = 0.007). CONCLUSION: People with OUD presenting for inpatient detoxification struggle with experiences of self and perceived stigma. Strikingly, people with previous detoxification program admission had higher levels of stigma on both scales. Our findings suggest an opportunity for targeted intervention in this group. AD - Department of Family and Community Medicine, University of Toronto, ON, Canada (NB); Centre for Addiction and Mental Health, Toronto, ON, Canada (NB); Behavioral Medicine Department, Butler Hospital, Providence, RI (BJA, MDS); Warren Alpert Medical School of Brown University, Providence, RI (GLB); Stanley Street Treatment and Resources, Inc., Fall River, MA (GLB); and Boston University School of Public Health, Boston, MA (MDS). AN - 28885299 AU - Bozinoff, N. AU - Anderson, B. J. AU - Bailey, G. L. AU - Stein, M. D. C2 - Pmc5786480 C6 - Nihms901631 DA - Jan/Feb DO - 10.1097/adm.0000000000000355 DP - NLM ET - 2017/09/09 J2 - Journal of addiction medicine KW - Adult Behavior Rating Scale Behavior Therapy Female Humans Inpatients/statistics & numerical data Male Multivariate Analysis Naltrexone/therapeutic use Narcotic Antagonists/therapeutic use Opioid-Related Disorders/*psychology/rehabilitation Program Evaluation Regression Analysis Self Report *Social Stigma Young Adult LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1932-0620 (Print) 1932-0620 SP - 19-23 ST - Correlates of Stigma Severity Among Persons Seeking Opioid Detoxification T2 - J Addict Med TI - Correlates of Stigma Severity Among Persons Seeking Opioid Detoxification VL - 12 ID - 930850 ER - TY - JOUR AB - STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): Our primary goal was to add treatment of opioid use disorder with buprenorphine to an ongoing project implementing the Collaborative Care Model of behavioral health integration into primary care at several clinic sites. We sought to improve access to treatment, and to address psychiatric and physical co-morbidities in a holistic, efficient, and non-stigmatizing way. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS) : The collaborative care model, which traditionally has focused on depression and anxiety, adds a behavioral health clinician (BHC, LICSW), supervised by a consulting psychiatrist, to the primary care team and utilizes a registry to proactively track patients. Workflows were developed to include care of patients with OUD by alternating visits between the waivered primary care provider (PCP) and the BHC. These visits are supported by a medical assistant, who collects urine for drug screening, queries the Prescription Drug Monitoring Program, administers the Brief Addiction Monitor questionnaire, and cues buprenorphine prescription refills. An infrastructure of necessary documents, note templates, electronic health record (EHR) tools was developed. Implementation teams are supported by regular meetings with core project staff, and clinician decision making is supported by a locally developed guideline, EHR based e-consults, and a monthly learning collaborative. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Our main measure of reach was number of patients initiated on buprenorphine per month, and our main measure of quality was 90 day treatment retention. A preimplementation staff questionnaire was done to assess attitudes and barriers, and will be followed by a post-implementation questionnaire. We tracked number of PCPs waivered to prescribe, and number of PCPs prescribing buprenorphine to one or more and five or more patients. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): At the beginning of the intervention, <20% of PCPs were waivered. The majority of those had not prescribed yet, and were unwilling to do so without the availability of in-clinic behavioral support. Over the implementation period, the number of waivered PCPs quadrupled (11 to 46). The number of PCPs prescribing buprenorphine for 5 or more patients in the past year rose from 2 to 18. The number of patients initiated on buprenorphine rose to 8-11/month. 90 day treatment retention was 65% in the most recent quarter. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Both OUD and buprenorphine are associated with stigma and misunderstanding that must be overcome at the all-staff level; this takes time, and can be done explicitly through training and implicitly through positive experiences of early adopters. Other barriers to primary care based treatment include limited clinician access and under recognition of OUD. Although medical treatment of OUD is relatively straightforward, the behavioral and monitoring needs are best met by a team approach. Medical and psychiatric comorbidities are common, and are best addressed through an integrated approach. AD - C.D. Brackett, GIM, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States AU - Brackett, C. D. DB - Embase DO - 10.1007/s11606-020-05890-3 KW - buprenorphine opiate addiction adult anxiety attitude clinical article comorbidity conference abstract controlled study decision making drug screening drug therapy electronic health record female hospital patient human human tissue learning male medical assistant outpatient prescription drug monitoring program primary medical care psychiatrist quantitative analysis questionnaire stigma workflow LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1525-1497 SP - S660-S661 ST - Implementation of primary care based treatment of opioid use disorder using the collaborative care model T2 - Journal of General Internal Medicine TI - Implementation of primary care based treatment of opioid use disorder using the collaborative care model UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633956365&from=export http://dx.doi.org/10.1007/s11606-020-05890-3 VL - 35 ID - 931076 ER - TY - JOUR AB - Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement. AD - Department of Social Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA. Center for Health Equity Research, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA. Rollins School of Public Health, Emory University , Atlanta, Georgia, USA. Vera Institute of Justice , Substance Use and Mental Health Program, New York City, New York, USA. Department of Health Behavior and Health Sciences, University of Arkansas for Medical Sciences , Fayetteville, Arkansas, USA. Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, Rhode Island, USA. AN - 28299971 AU - Brinkley-Rubinstein, L. AU - Cloud, D. H. AU - Davis, C. AU - Zaller, N. AU - Delany-Brumsey, A. AU - Pope, L. AU - Martino, S. AU - Bouvier, B. AU - Rich, J. DA - Mar 13 DO - 10.1108/ijph-08-2016-0039 DP - NLM ET - 2017/03/17 J2 - International journal of prisoner health KW - Cooperative Behavior Criminals/statistics & numerical data Drug Overdose/epidemiology/*prevention & control Female *Harm Reduction Humans Male Prisoners/*statistics & numerical data Risk Factors Substance-Related Disorders/epidemiology/*prevention & control United States Vulnerable Populations/statistics & numerical data *Criminal justice system *Drug addiction *Illicit drugs *Opioid substitution therapy *Prisoners LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1744-9200 SP - 25-31 ST - Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings T2 - Int J Prison Health TI - Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings VL - 13 ID - 931000 ER - TY - JOUR AB -: Medication-assisted treatment for opioid use disorder (OUD), which incorporates methadone, buprenorphine, or naltrexone, has been shown to reduce all-cause mortality rates in patients with this disease-and the numbers of patients receiving such treatment is substantial. In 2016, among U.S. patients with OUD, nearly 350,000 were treated with methadone, more than 60,000 were treated with buprenorphine, and more than 10,000 were treated with naltrexone. Managing acute pain in patients receiving this treatment can be a significant nursing challenge. The authors discuss the attributes of the three medications used to treat OUD and, through a composite patient case, review how to manage acute pain effectively in patients receiving this type of treatment.This article is one in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (https://advancingexpertcare.org), which offers education, certification, advocacy, leadership, and research on palliative care. AD - Kathleen Broglio is an NP in the Section of Palliative Medicine and an assistant professor of medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Marianne Matzo is director of research for the Hospice and Palliative Nurses Association, Pittsburgh, PA. She is an AJN contributing editor and coordinates Perspectives on Palliative Nursing. Contact author: Marianne Matzo, mariannem@hpna.org. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. AN - 30211703 AU - Broglio, K. AU - Matzo, M. DA - Oct DO - 10.1097/01.naj.0000546378.81550.84 DP - NLM ET - 2018/09/14 J2 - The American journal of nursing KW - Analgesics, Opioid/pharmacology/therapeutic use Buprenorphine/pharmacology/therapeutic use Female Humans Methadone/pharmacology/therapeutic use Middle Aged Naltrexone/pharmacology/therapeutic use Narcotic Antagonists/pharmacology/therapeutic use Nurse's Role Opiate Substitution Treatment/*methods Opioid-Related Disorders/drug therapy/*nursing Pain Management/methods/*nursing Palliative Care Substance Withdrawal Syndrome/*nursing/prevention & control LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0002-936x SP - 30-38 ST - CE: Acute Pain Management for People with Opioid Use Disorder T2 - Am J Nurs TI - CE: Acute Pain Management for People with Opioid Use Disorder VL - 118 ID - 930898 ER - TY - JOUR AB - BACKGROUND: Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999-2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. METHODS: This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. DISCUSSION: This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov. AD - Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA. aryana.bryan@utah.edu. Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Division of Maternal Fetal Medicine, Salt Lake City, UT, 84132, USA. Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste. A, Salt Lake City, UT, 84108, USA. Department of Pediatrics, University of Utah School of Medicine, Division of General Pediatrics, 295 Chipeta Way, Salt Lake City, UT, 84108, USA. Eastern Utah Women's Health, LLC, 77 S 600 E, Price, UT, 84501, USA. Greater Intermountain Node (GIN), NIH NIDA Clinical Trials Network, University of Utah, Salt Lake City, UT, USA. Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. AN - 33129355 AU - Bryan, M. A. AU - Smid, M. C. AU - Cheng, M. AU - Fortenberry, K. T. AU - Kenney, A. AU - Muniyappa, B. AU - Pendergrass, D. AU - Gordon, A. J. AU - Cochran, G. C2 - Pmc7603672 DA - Oct 31 DO - 10.1186/s13722-020-00206-6 DP - NLM ET - 2020/11/02 J2 - Addiction science & clinical practice KW - *Medication for opioid use disorder *Medication-assisted treatment *Opioid use disorder *Perinatal addiction *Provider education *Rural LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1940-0632 (Print) 1940-0632 SP - 33 ST - Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol T2 - Addict Sci Clin Pract TI - Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol VL - 15 ID - 930829 ER - TY - JOUR AB - INTRODUCTION: Esophagogastroduodenoscopic (EGD) procedures require deeper levels of sedation or general anesthesia than colonoscopies. EGDs may also predispose patients to increase risk of aspiration and airway complications due to esophageal and/or gastric diseases. A higher risk of for cardiorespiratory complications has been reported in patients who received propofol for EGDs 1. Anesthesiologists have increasingly been requested to provide deep sedation and/or general anesthesia for patients undergoing EDGs 2. We sought to determine the incidence of airway complications using various anesthetic techniques in patients undergoing EGDs in a rural community hospital. METHODS: After obtaining IRB approval and waiver of consent a retrospective chart review for patients undergoing colonoscopies at Lexington Medical Center- Wake Forest Baptist Health (WFBH) from September 2015 to June 2017 was performed. Inclusion criteria included patients 18 years of age and older scheduled for colonoscopies which were performed by seven different endoscopists. Different anesthesiologists and nurse anesthetists from WFBH were involved. No patients were excluded from analysis. All the cases and anesthetic techniques used were at the discretions of the anesthesiology-based team consisting of anesthesiologists and nurse anesthetists. Data collected included demographics (age, weight, height, BMI, gender, ASA classification, and diagnosis/reason for endoscopies), medications used (propofol, sedatives-midazolam, and narcotics-fentanyl, others-ketamine, glycopyrrolate, lidocaine). Types of airway complications including levels of desaturations; moderate (SpO2- 80-90%) and severe (SpO2 < 80%) and/or to assist with ventilation and/or intubate. The times for endoscopies were as follows; total time spent in the endoscopy suite, total anesthesia time, and time of the actual endoscopic procedure. RESULTS: See table 1 for demographics and diagnoses. 10/91 (11 %) patients desaturated with 4/10 (40%) and 6/10 (60%) severe and moderate, respectively. 4/91 were intubated (4.4%) with 4/4 intubated patients being planned intubations due to emergent EGD for food bolus and/or bleeding. None of these desaturated. The mean dose of propofol used was 111.5 mcg/kg/min ± 59.8 (0.0- 290.3). See table 2 for anesthetic techniques. See table 3 for different times involved with EGDs. CONCLUSIONS: We found a higher incidence of desaturations in patients undergoing EGDs than reported when non-anesthesiologists used propofol. The incidence of desaturations and other related airway complications have been reported to be lower when anesthesiologists were not used for EGDs with the most common type of complication of hypoxemia 3. The reason for this discrepancy may be due to anesthesiologists being involved with more ill patients and/or using higher levels of anesthetic agents. Though our study was retrospective, the number of higher ASA level III and IV may explain our higher incidence of desaturations. Further studies are required to develop specific anesthetic protocol for all patients undergoing EGDs. (Table Presented). AD - Y.F. Bryan, Wake Forest University, School of Medicine, Winston-Salem, NC, United States AU - Bryan, Y. F. AU - McLaughlin, D. H. AU - Johnson, K. AU - Hasanaj, E. AU - Sundararajan, S. DB - Embase KW - fentanyl glycopyrronium ketamine lidocaine midazolam propofol adult adverse drug reaction airway Baptist bleeding body mass case report clinical article colonoscopy complication conference abstract deep sedation drug therapy endoscopist female forest gender general anesthesia height human hypoxemia incidence intubation male medical record review nurse anesthetist retrospective study rural population side effect stomach disease young adult LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1526-7598 SP - 464-465 ST - Airway complications using different anesthetic techniques in patients undergoing esophagogastroduodenoscopic procedures in a rural community hospital T2 - Anesthesia and Analgesia TI - Airway complications using different anesthetic techniques in patients undergoing esophagogastroduodenoscopic procedures in a rural community hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626089094&from=export VL - 126 ID - 931155 ER - TY - JOUR AB - INTRODUCTION: Deep sedation or general anesthesia have been used by different medical specialties in patients undergoing colonoscopies. Propofol in varying doses has been safely administered by nonanesthesiologists for colonoscopies1. The risk of airway complications using propofol for colonoscopies when administered by non-anesthesiologists has been low2. The incidence of moderate to severe desaturations range from 0.5 to 2.6 % but depended on the doses of propofol used by the non-anesthesiologists 3. We sought to determine the types of airway complications and desaturations when anesthesiologist based teams used propofol in patients undergoing colonoscopies in a rural community hospital. METHODS: After obtaining IRB approval and waiver of consent a retrospective chart review for patients undergoing colonoscopies at Lexington Medical Center a part of Wake Forest Baptist Health (WFBH) from September 2015 to June 2017 was performed. Inclusion criteria included patients 18 years of age and older scheduled for colonoscopies which were performed by seven different endoscopists and with different anesthesiologists and nurse anesthetists. No patients were excluded from analysis. For all cases, the anesthetic techniques used were at the discretion of the anesthesiology-based team consisting of anesthesiologists and nurse anesthetists. Data collected included demographics (age, weight, height, BMI, gender, ASA classification, and diagnoses/reasons for endoscopies), medications used (propofol, sedativesmidazolam, and narcotics-fentanyl, others-ketamine, glycopyrrolate, lidocaine). Types of airway complications including levels of desaturations; moderate (SpO2- 80- 90%) and severe (SpO2 < 80%) and/or to assist with ventilation and/or intubate. The times for endoscopies were as follows; total time spent in the endoscopy suite, total time under anesthesia, and the actual time of the colonoscopy procedure. RESULTS: See table 1 for demographics and diagnoses. 7/94 (87.4%) patients experienced moderate desaturations and 1/94 experienced a severe desaturation. 1/ 94 (1.1%) required placement of an oral airway to assist with ventilation. None of the patients were intubated. The mean dose of propofol was 118.9 mcg/kg/min ± 43.7 (19.5 - 239.6). See table 2. See table 3 for different times involved in colonoscopies. CONCLUSIONS: We found a low incidence of airway problems, specifically desaturations, when anesthesiologist based teams administered propofol during colonoscopies in a rural hospital. However, this was higher than reported by non-anesthesiologists who performed colonoscopies with propofol (2,4). This may have been due several factors such as higher levels of ASA 3-4 patients seen in our study and/or the selection of healthier patients by non-anesthesiologist based teams and the studies being performed in large medical and specialized academic centers1. We also found a wide range in the doses of propofol required for colonoscopies. The limitations of our study were that it was retrospective chart review with a small sample size and performed in one rural community hospital. Further studies are required on the doses of propofol-based anesthetic techniques and associated airway complications in all patients undergoing colonoscopies in rural hospitals. (Table Presented). AD - Y.F. Bryan, Wake Forest University, School of Medicine, Winston-Salem, NC, United States AU - Bryan, Y. F. AU - McLaughlin, D. H. AU - Johnson, K. AU - Hasanaj, E. AU - Sundararajan, S. DB - Embase KW - fentanyl glycopyrronium ketamine lidocaine propofol adult anesthesia artificial ventilation Baptist body mass case report clinical article colonoscopy complication conference abstract drug therapy endoscopist female forest gender height human incidence male medical record review nurse anesthetist oropharynx airway retrospective study rural population sample size young adult LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1526-7598 SP - 479-480 ST - Development and initial experience of an anesthesiology based team using propofol for gastrointestinal endoscopies at a rural community hospital: Airway complications during colonoscopies T2 - Anesthesia and Analgesia TI - Development and initial experience of an anesthesiology based team using propofol for gastrointestinal endoscopies at a rural community hospital: Airway complications during colonoscopies UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626089363&from=export VL - 126 ID - 931156 ER - TY - JOUR AB - Introduction: People with opioid use disorder (OUD) are increasing hospitalized for complications related to opioid use. While their acute medical issue is treated in the hospital, often their OUD is not addressed, resulting in a missed opportunity to engage high-risk patients inOUD treatment. Hospitalist physicians care for many hospitalized patients in the United States and are leaders of innovation in hospital medicine. We aimed to expand addiction treatment for hospitalized patients by: 1) training an existing hospital-based workforce in addiction medicine to provide evidence-based addiction treatment in the hospital setting, 2) implementing universal screening to identify hospitalized patients with OUD and offer life saving treatment, including medications for OUD (buprenorphine or methadone enrollment) and naloxone for overdose reversal, and 3) providing patients with linkage to addiction treatment following hospital discharge. Methods: In year one, eleven hospitalists were recruited from an academic hospital who participated in a comprehensive addiction medicine training program which included: 1) a 15-part lecture series covering topics such as addiction in pregnancy, medications for OUD, 12-step programs, trauma and addiction, interpretation of drug testing, among others, 2) online addiction American Society of Addiction Medicine (ASAM) training modules with textbook, 3) membership to ASAM for increased participation in the field of addiction medicine, and 4) 10-1/2 day shadowing shifts with an addiction medicine physician. All participating hospitalists have committed to taking the Addiction Medicine board exam by 2021. In year two, hospitalist will attend on a Monday through Friday inpatient addiction medicine consult service. The program also supports a dedicated social worker and peer recovery coach who, in year one, outreached to local addiction treatment centers to identify community partners, and in year two, continue to work to link patients to treatment post hospital discharge. Year one metrics for hospitalist include: 100% buprenorphine certification, 100% online module completion, and 100% completion of shadowing shifts. Year two service goals include: initiation of Monday through Friday hospitalist-supported addiction consult service with buprenorphine or methadone and linkage to treatment for patients OUD, and community partnerships. Year two metrics include: number of addiction medicine consults seen pre/post program implementation; buprenorphine prescriptions initiated during hospitalization and at discharge, naloxone prescriptions at discharge, in hospital methadone use for prevention of opioid withdrawal, hospital-based methadone enrollment; 30-day readmissions for patients with OUD, billing for addiction services, and addiction medicine board certification. Results: Since program inception in October 2018, 11 hospitalists have been buprenorphine waivered, hospitalists have completed online training and >70 shadow shifts. All hospitalists have participated in the 15-part lecture series. In August 2019, we hired a social worker and peer recovery coach who have visited with local treatment sites, including two methadone clinics. On October 1, 2019, we began our hospitalist-supported addiction consult service. Year two metrics will be measured in October 2020. Conclusion: Program success requires a motivated champion with addiction medicine expertise to support the hospitalists, Hospital Medicine leadership support, and hospital support for a dedicated addiction medicine social worker. AD - S.L. Calcaterra AU - Calcaterra, S. L. AU - McBeth, L. DB - Embase KW - buprenorphine methadone naloxone opiate addiction medicine adult certification conference abstract drug overdose drug screening drug therapy evidence based practice center female hospital discharge hospital medicine hospital patient hospital readmission hospitalization human injury internet addiction leadership local therapy medical staff multicenter study physician pregnancy prescription remission social worker training university hospital workforce LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1935-3227 SP - e396 ST - Expanding Access to Addiction Treatment for Inpatients Utilizing Existing Resources T2 - Journal of Addiction Medicine TI - Expanding Access to Addiction Treatment for Inpatients Utilizing Existing Resources UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634656493&from=export VL - 14 ID - 931053 ER - TY - JOUR AB - STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): People with opioid use disorder are increasing hospitalized, yet little is being done to engage patients in addiction treatment during hospitalization. Hospitalists are uniquely positioned to be trained to provide this life-saving care. OBJECTIVES OF PROGRAM/ INTERVENTION (NO MORE THAN THREE OBJECTIVES): In 2018, we obtained funding to build a hospitalist driven addiction consult service in partnership with an addiction medicine trained hospital medicine physician. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS) : In year one, eleven hospitalists were recruited from an academic hospital who participated in a comprehensive addiction medicine training program which included: 1) a 13-part lecture series covering medications for opioid and alcohol use disorder, trauma and addiction, interpretation of drug testing, among others, 2) online addiction training modules with textbook, 3) American Society of Addiction Medicine membership, and 4) 10 - day shadowing shifts with an addiction medicine physician. In year two, hospitalists will attend on a Monday through Friday addiction consult service. The program also supports a dedicated social worker and peer recovery coach. All participating hospitalists committed to taking the Addiction Medicine board exam by 2021. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): First year metrics are: 100% buprenorphine certification, 100% online module completion, and 100% completion of shadowing shifts, and to hire a dedicated addiction social worker and recovery coach. Year two metrics are: initiation of Monday through Friday hospitalist-supported addiction consult service with buprenorphine or methadone initiation and linkage to treatment with expansion of community partnerships. Year two quantitative measures include: monthly addiction consults completed; buprenorphine prescriptions initiated, naloxone prescriptions at discharge across all specialties, hospital-based methadone enrollment; billing for addiction services, and addiction medicine board certification. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): In year one, all hospitalists were buprenorphine waivered, completed the online training, and completed 85% of the shadow shifts. We hired a dedicated addiction social worker and peer recovery coach who visited six community treatment partners and three methadone clinics in year one and two. In year two, we began our Monday through Friday addiction consult service. From October to December 2019, we initaited and prescribed buprenorphine 15 times at discharge with linkage to treatment, enrolled 21 patients into a methadone program, and billed over $100,500 for addiction services provided. Across all hospital services, naloxone was prescribed 138 times at discharge. Hospitalists will take the Addiction Medicine board exam in 2021 through the practice pathway. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): Program success requires 1) a motivated addiction medicine expert to support hospitalists, 2) hospital leadership support, and 3) hospital support for a dedicated addiction medicine social worker. AD - S.L. Calcaterra, Medicine, University of Colorado, Denver, CO, United States AU - Calcaterra, S. L. AU - McBeth, L. AU - Keniston, A. AU - Burden, M. DB - Embase DO - 10.1007/s11606-020-05890-3 KW - buprenorphine methadone naloxone opiate addiction medicine adult alcoholism certification clinical article conference abstract controlled study drug screening drug therapy female funding group therapy hospital medicine hospital patient hospital service hospitalization human injury internet addiction leadership male medical staff multicenter study outpatient physician prescription quantitative analysis social worker training university hospital LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1525-1497 SP - S627-S628 ST - Addicton treatment for hospitalized patients with linkage to care: A novel intervention to scale addiction medicine expertise to hospitalists T2 - Journal of General Internal Medicine TI - Addicton treatment for hospitalized patients with linkage to care: A novel intervention to scale addiction medicine expertise to hospitalists UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633956257&from=export http://dx.doi.org/10.1007/s11606-020-05890-3 VL - 35 ID - 931075 ER - TY - JOUR AB - BACKGROUND: Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use Disorders treatment (PROUD) trial tests whether implementation of a collaborative care model (Massachusetts Model) using a nurse care manager (NCM) to support medication treatment of OUD in primary care increases OUD treatment and improves outcomes. Specifically, it tests whether implementation of collaborative care, compared to usual primary care, increases the number of days of medication for OUD (implementation objective) and reduces acute health care utilization (effectiveness objective). The protocol for the PROUD trial is presented here. METHODS: PROUD is a hybrid type III cluster-randomized implementation trial in six health care systems. The intervention consists of three implementation strategies: salary for a full-time NCM, training and technical assistance for the NCM, and requiring that three primary care providers have DEA waivers to prescribe buprenorphine. Within each health system, two primary care clinics are randomized: one to the intervention and one to Usual Primary Care. The sample includes all patients age 16-90 who visited the randomized primary care clinics from 3 years before to 2 years after randomization (anticipated to be > 170,000). Quantitative data are derived from existing health system administrative data, electronic medical records, and/or health insurance claims ("electronic health records," [EHRs]). Anonymous staff surveys, stakeholder debriefs, and observations from site visits, trainings and technical assistance provide qualitative data to assess barriers and facilitators to implementation. The outcome for the implementation objective (primary outcome) is a clinic-level measure of the number of patient days of medication treatment of OUD over the 2 years post-randomization. The patient-level outcome for the effectiveness objective (secondary outcome) is days of acute care utilization [e.g. urgent care, emergency department (ED) and/or hospitalizations] over 2 years post-randomization among patients with documented OUD prior to randomization. DISCUSSION: The PROUD trial provides information for clinical leaders and policy makers regarding potential benefits for patients and health systems of a collaborative care model for management of OUD in primary care, tested in real-world diverse primary care settings. Trial registration # NCT03407638 (February 28, 2018); CTN-0074 https://clinicaltrials.gov/ct2/show/NCT03407638?term=CTN-0074&draw=2&rank=1. AD - Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA. cynthia.i.campbell@kp.org. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA. The Emmes Company, 401 N Washington St # 700, Rockville, MD, 20850, USA. National Institute on Drug Abuse Center for Clinical Trials Network, Three White Flint North, 11601 Landsdown Street, North Bethesda, MD, 20852, USA. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA. Boston Medical Center/Boston University School of Medicine: Clinical Addiction Research & Education (CARE) Unit Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA. Albert Einstein College of Medicine, Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA. Kaiser Permanente Washington, 9800 4th Ave. N.E., Seattle, WA, 98115, USA. Kootenai Clinic Family Medicine, 1919 Lincoln Way, Suite 315, Coeur d Alene, ID, 83814, USA. Department of Family & Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston School, 7000 Fannin Street, Houston, TX, 77030, USA. Department of Psychiatry, Center for Health Policy and Health Services Research, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA. Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor, Miami, FL, 33136, USA. University of Minnesota/Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA. NYU Grossman School of Medicine, 180 Madison Ave., New York, NY, 10016, USA. Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, 933West, Pittsburgh, PA, 15213, USA. University of Washington/Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA. Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA. Clinical Addiction Research & Education (CARE) Unit, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA. Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA. AN - 33517894 AU - Campbell, C. I. AU - Saxon, A. J. AU - Boudreau, D. M. AU - Wartko, P. D. AU - Bobb, J. F. AU - Lee, A. K. AU - Matthews, A. G. AU - McCormack, J. AU - Liu, D. S. AU - Addis, M. AU - Altschuler, A. AU - Samet, J. H. AU - LaBelle, C. T. AU - Arnsten, J. AU - Caldeiro, R. M. AU - Borst, D. T. AU - Stotts, A. L. AU - Braciszewski, J. M. AU - Szapocznik, J. AU - Bart, G. AU - Schwartz, R. P. AU - McNeely, J. AU - Liebschutz, J. M. AU - Tsui, J. I. AU - Merrill, J. O. AU - Glass, J. E. AU - Lapham, G. T. AU - Murphy, S. M. AU - Weinstein, Z. M. AU - Yarborough, B. J. H. AU - Bradley, K. A. C2 - Pmc7849121 DA - Jan 31 DO - 10.1186/s13722-021-00218-w DP - NLM ET - 2021/02/02 J2 - Addiction science & clinical practice KW - *Buprenorphine *Collaborative care *Medication *Nurse care manager *Opioid use disorder *Pragmatic trial *Primary care on Drug Abuse (UG1DA040314, R01DA047405), the Food and Drug Administration, and has support managed through her institution from a consortium of pharmaceutical companies to conduct Food and Drug Administration-mandated studies on opioids. Gavin Bart is supported by grants from NIDA and NIDDK. Robert P. Schwartz has provided consultant to Verily Life Sciences, and is the principal investigator of a NIDA-funded study that will be receiving free medication from Alkermes and Indivior. Andrew J. Saxon has royalties as Section Editor, Drug Use Disorders, UpToDate, Inc. has travel support from Alkermes, Inc. research support from Medicasafe, Inc. and consulting fees from Indivior, Inc. Paige D. Wartko, Denise M. Boudreau, and Bobbi Jo H. Yarborough receive funding from a research contract through their institutions from a consortium of pharmaceutical companies (Allergan, BioDelivery Sciences, Collegium, Daiichi Sankyo, Depomed, Egalet, Endo, Janssen, Mallinckrodt, Pernix, Pfizer, Purdue, and West-Ward) to conduct Food and Drug Administration-mandated studies on opioids. LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1940-0632 (Print) 1940-0632 SP - 9 ST - PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment T2 - Addict Sci Clin Pract TI - PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment VL - 16 ID - 931019 ER - TY - JOUR AB - Background: A growing subset of medical toxicologists (MT) are making addiction medicine (AM) a key part of their clinical practice. Approximately 8% of currently board-certifiedMT hold dual certification in AM, most via an AM "practice pathway." The American Board of Emergency Medicine (ABEM) and the American Board of PreventiveMedicine (ABPM) recently approved a 30-month fellowship track combining MT and AM. In a 2015 survey of USMT fellowship directors, none reported having an AM-boarded facultymember, three had anX-waivered faculty member, three offered anXwaiver course as part of the fellowship, and only one had a faculty member that prescribed buprenorphine. We sought to determine current AM-related faculty credentials and educational opportunities in US MT fellowships. Methods:We sent a 25-question survey to all 29 USMTfellowship directors via the ACMT fellowship listserv in October 2019 and sent two reminder emails over the following month. The survey was hosted on REDCap and used a combination of multiple-choice and free-response questions. Results: Seventeen of 29 (59%) fellowships responded, representing 60%of active MT fellows. Six programs reported there is a separate AM fellowship at their institution, and one offers a combined fellowship in MT and AM. Compared to 2015, the number of programs with at least one AM-boarded faculty member increased from three to eight, those with an X-waivered faculty member increased from three to 17, and those offering an X-waiver course during the fellowship increased from three to 17. Seven require fellows to complete an X-waiver course. The number of programs with physicians prescribing buprenorphine also increased from one to 14. Conclusion: An increasing number of US MT fellowship programs have faculty members with specialized certification in AM and offer AMrelated educational opportunities. Several appear well-positioned to form combined fellowships in MT and AM. AD - J.E. Carpenter, Emory University, Atlanta, GA, United States AU - Carpenter, J. E. AU - Lang, N. AU - Morgan, B. W. AU - Wiegand, T. J. DB - Embase DO - 10.1007/s13181-020-00759-7 KW - buprenorphine addiction medicine certification conference abstract controlled study e-mail human physician prescription toxicology LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1937-6995 SP - 143 ST - Addiction medicine training in US medical toxicology fellowships T2 - Journal of Medical Toxicology TI - Addiction medicine training in US medical toxicology fellowships UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631722835&from=export http://dx.doi.org/10.1007/s13181-020-00759-7 VL - 16 ID - 931098 ER - TY - JOUR AB - BACKGROUND: Buprenorphine-based medication-assisted treatment (B-MAT) is a powerful, concrete intervention that can be provided by nurse practitioners (NPs) to reduce opioid-related overdoses in patients with opioid use disorder (OUD). However, multiple barriers exist to provide and access this therapy. LOCAL PROBLEM: A rural Midwestern county struggled with increasing OUD and scant access to B-MAT. A nurse-led, community clinic had the potential to expand access to treatment but no support structure to provide it. METHODS: In this quality improvement project, a one-group posttest-only design was used to assess treatment access, care quality, and patient characteristics. INTERVENTIONS: An evidence-based, nurse led weekly B-MAT clinic using a low-threshold, chronic-care model for treatment of OUD. RESULTS: The B-MAT clinic expanded county-wide access by 34% over seven months. A total of 23 patients were seen with 21 eligible for treatment with B-MAT. All nine patients with at least 90-day continuous treatment were retained in the program. Three quarters of patients had at least 30 days of active buprenorphine-naloxone coverage and 17% of all patients were lost to follow up. There were no induction-related adverse events, no fatalities, and one nonfatal overdose. In a chart review, 85% of patients met at least six of eight quality criteria. CONCLUSIONS: This low-barrier approach to OUD expanded access to treatment and demonstrated a model stable enough to continue delivering care throughout the first 5 months of the novel coronavirus (COVID-19) pandemic. NPs in primary care settings can effectively provide B-MAT in a low-threshold, office-based setting. AD - Director of Clinical Care, HealthFinders Collaborative; Nursing Simulation Coordinator, Saint Olaf College Department of Nursing, Northfield, Minnesota. AN - 33767120 AU - Carroll, E. DA - Mar 19 DO - 10.1097/jxx.0000000000000588 DP - NLM ET - 2021/03/27 J2 - Journal of the American Association of Nurse Practitioners LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 2327-6886 ST - Implementation of office-based buprenorphine treatment for opioid use disorder T2 - J Am Assoc Nurse Pract TI - Implementation of office-based buprenorphine treatment for opioid use disorder ID - 930979 ER - TY - JOUR AB - BACKGROUND: Evidence-based therapies for opioid use disorder (OUD) and chronic pain such as medication-assisted treatment (MAT) and complementary and integrative health (CIH; e.g., acupuncture and meditation) therapies exist. However, their adoption has been slow, particularly in primary care, due to numerous implementation challenges.We sought to expand the use of MAT and CIH by using an evidence- based quality improvement (EBQI) implementation strategy. We aimed to pilot how effectively EBQI could engage primary care in facilitatingMAT and CIH delivery to patients with OUD. METHODS: We used EBQI to engage two sites from June 2018-September 2019. EBQI included top-down and bottom-up multi-level stakeholder engagement, with external facilitators providing technical support, practice facilitation, and routine data feedback. We conducted preimplementation key stakeholder interviews (14 providers, 5 Veterans) to understand OUD, MAT and CIH experiences at baseline.We established a local QI team at each site with diverse stakeholders (e.g., primary care, pain, nursing, addiction, pharmacy), meeting virtually twice monthly.We met monthly with regional stakeholders to review formative data on our progress and discuss methods to address implementation barriers. We twice convened a national-level advisory board to ensure alignment with national priorities. We conducted exit interviews with 8 key providers to assess their experiences with the implementation pilot. RESULTS: Pre-implementation interviews indicated facility-level and provider-level barriers to prescribing buprenorphine, including strong provider resistance. Stakeholders indicated acceptance and utilization of CIH therapies. Both sites conducted educational meetings (e.g., Grand Rounds) and educational outreach visits (i.e., X-waiver trainings). Site A also offered clinical preceptorships for newly X-waivered primary care prescribers. Site B also used mass media and mailings to educate patients about MAT and CIH options and dashboards to identify potential candidates for MAT. After fifteen months, both sites increased their OUD treatment rates to >90th percentile of VHA medical centers nationally. Exit interviews indicated an attitudinal shift in MAT delivery in primary care. Stakeholders valued the EBQI process, particularly cross-site collaboration. CONCLUSIONS: Despite initial implementation barriers, we effectively engaged stakeholders using EBQI strategies to overcome these challenges. QI teams used an assortment of implementation strategies, ultimately transforming their facilities to among the highest performers in VHA OUD treatment. EBQI may be an effective strategy to engage stakeholders to implement MAT and CIH therapies to treat OUD. AD - E.T. Chang, General Internal Medicine, VA- Greater Los Angeles, Los Angeles, CA, United States AU - Chang, E. T. AU - Oberman, R. AU - Cohen, A. N. AU - Taylor, S. L. AU - Gumm, E. AU - Mardian, A. AU - Toy, S. AU - Revote, A. AU - Lewkowitz, B. AU - Yano, E. M. DB - Embase DO - 10.1007/s11606-020-05890-3 KW - buprenorphine opiate addiction adoption adult body weight conference abstract controlled study drug therapy education facilitation human interview mass medium nursing pain prescription primary medical care stakeholder engagement total quality management veteran LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1525-1497 SP - S176 ST - Increasing access to medication-assisted treatment and complementary and integrative health therapies for opioid use disorder in primary care T2 - Journal of General Internal Medicine TI - Increasing access to medication-assisted treatment and complementary and integrative health therapies for opioid use disorder in primary care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633957809&from=export http://dx.doi.org/10.1007/s11606-020-05890-3 VL - 35 ID - 931078 ER - TY - JOUR AB - OBJECTIVES: Evidence-based therapies for opioid use disorder (OUD) and chronic pain, such as medications for OUD (MOUD) and complementary and integrative health (CIH; e.g., acupuncture and meditation) therapies, exist. However, their adoption has been slow, particularly in primary care, due to numerous implementation challenges. We sought to expand the use of MOUD and CIH within primary care by using an evidence-based quality improvement (EBQI) implementation strategy. METHODS: We used EBQI to engage two facilities in the Veterans Health Administration (VHA) from June 2018 to September 2019. EBQI included multilevel stakeholder engagement, with external facilitators providing technical support, practice facilitation, and routine data feedback. We established a quality improvement (QI) team at each facility with diverse stakeholders (e.g., primary care, addiction, pain, nursing, pharmacy). We met monthly with regional stakeholders to address implementation barriers. We also convened an advisory board to ensure alignment with national priorities. RESULTS: Pre-implementation interviews indicated facility-level and provider-level barriers to prescribing buprenorphine, including strong primary care provider resistance. Both facilities developed action plans. They both conducted educational meetings (e.g., Grand Rounds, MOUD waiver trainings). Facility A also offered clinical preceptorships for newly trained primary care prescribers. Facility B used mass media and mailings to educate patients about MOUD and CIH options and dashboards to identify potential candidates for MOUD. After 15 months, both facilities increased their OUD treatment rates to the ≥ 90th percentile of VHA medical centers nationally. Exit interviews indicated an attitudinal shift in MOUD delivery in primary care. Stakeholders valued the EBQI process, particularly cross-site collaboration. IMPLICATIONS: Despite initial implementation barriers, we effectively engaged stakeholders using EBQI strategies. Local QI teams used an assortment of QI interventions and developed tools to catapult their facilities to among the highest performers in VHA OUD treatment. IMPACTS: EBQI is an effective strategy to partner with stakeholders to implement MOUD and CIH therapies. AD - VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Evelyn.Chang@va.gov. Department of General Internal Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Evelyn.Chang@va.gov. Division of General Internal Medicine, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. Evelyn.Chang@va.gov. VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA. Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. Division of General Internal Medicine, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. Department of Health Policy & Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA. Southern Arizona VA Health Care System, Tucson, AZ, USA. Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, USA. Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. Primary Care, South Texas Veterans Healthcare System, San Antonio, TX, USA. AN - 33145686 AU - Chang, E. T. AU - Oberman, R. S. AU - Cohen, A. N. AU - Taylor, S. L. AU - Gumm, E. AU - Mardian, A. S. AU - Toy, S. AU - Revote, A. AU - Lewkowitz, B. AU - Yano, E. M. C2 - Pmc7728925 DA - Dec DO - 10.1007/s11606-020-06255-6 DP - NLM ET - 2020/11/05 J2 - Journal of general internal medicine KW - *X-waiver *buprenorphine *complementary and integrative health *medications for opioid use disorder *opioid use disorder LA - eng M1 - Suppl 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0884-8734 (Print) 0884-8734 SP - 918-926 ST - Increasing Access to Medications for Opioid Use Disorder and Complementary and Integrative Health Services in Primary Care T2 - J Gen Intern Med TI - Increasing Access to Medications for Opioid Use Disorder and Complementary and Integrative Health Services in Primary Care VL - 35 ID - 930849 ER - TY - JOUR AB - INTRODUCTION: The height of the opioid epidemic in the USA has led to an increasing call for access to medication assisted treatment for opioid use disorder, including buprenorphine initiation from the emergency department (ED). However, only a small percentage of emergency physicians feel prepared or have the necessary training to prescribe buprenorphine. Twitter has increasingly been used as a tool for medical education, and there is growing interest in using this forum to actively engage medical providers and the public. This study examined the views regarding ED initiation of buprenorphine treatment among contributors to the quarterly American College of Medical Toxicology (ACMT) tweetchat, #firesidetox, and the demographics of the participants. METHODS: A mixed methods descriptive study was conducted to analyze individual responses and self-identified demographics among Twitter users participating in the #firesidetox tweetchat regarding the ACMT position statement about ED initiation of buprenorphine treatment. RESULTS: This tweetchat included 86 participants, the majority of whom were clinicians in the USA. Physicians accounted for 46% of participants primarily emergency medicine physician toxicologists and authored 75% of the tweets. It consisted of 317 tweets which most frequently described clinical vignettes or experience (46%) or medical education (25%) related to buprenorphine and had themes related to treatment initiation location (ED vs outpatient vs home) (8.6%) and challenges and solutions to buprenorphine administration (8.6%). CONCLUSIONS: A tweetchat can be used to disseminate and discuss the adoption of buprenorphine in the ED. Importantly, the tweetchat provides a forum for experts to share narratives and expertise on implementation and barriers and successes in operationalizing buprenorphine administration in emergency departments. AD - Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Meganchenworth@gmail.com. Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Department of Emergency Medicine, Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA. Division of Medical Toxicology, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA. Division of Medical Toxicology, Department of Emergency Medicine, SBH Health Systems, Bronx, NY, USA. Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA. The Fenway Institute, Boston, MA, USA. The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA. AN - 31898154 AU - Chenworth, M. AU - Perrone, J. AU - Love, J. S. AU - Greller, H. A. AU - Sarker, A. AU - Chai, P. R. C2 - Pmc7320102 DA - Jul DO - 10.1007/s13181-019-00754-7 DP - NLM ET - 2020/01/04 J2 - Journal of medical toxicology : official journal of the American College of Medical Toxicology KW - *Buprenorphine *Medication assisted treatment *Opioid use disorder *Social media *Twitter LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1556-9039 (Print) 1556-9039 SP - 262-268 ST - Buprenorphine Initiation in the Emergency Department: a Thematic Content Analysis of a #firesidetox Tweetchat T2 - J Med Toxicol TI - Buprenorphine Initiation in the Emergency Department: a Thematic Content Analysis of a #firesidetox Tweetchat VL - 16 ID - 930873 ER - TY - JOUR AB - Objectives: •Describe the principles of buprenorphine (Suboxone) prescribing for opioid use disorder.•Identify different strategies that outpatient palliative care practices can use to incorporate buprenorphine treatment of addiction into their setting.•Discuss how to overcome barriers to implementing buprenorphine prescribing within their palliative care practices. Patients with serious illness are not exempt from opioid use disorders raging through our communities. Outpatient palliative care clinicians are increasingly challenged to manage patients with both serious illness and active opioid use disorders. In this population, the use of opioids for pain is particularly complicated, and we struggle to provide safe, rational, and appropriate care. Buprenorphine (brand names include Suboxone, Zubsolv, and Bunavail) is a partial opioid agonist that can be used for maintenance treatment of opioid use disorders in the outpatient setting. In addition to providing analgesia, buprenorphine stabilizes the cycle of craving and withdrawal experienced by individuals with addiction. To prescribe buprenorphine for addiction in an office setting, clinicians of all specialties can complete 8 to 24 hours of online and/or in-person training and apply to the DEA for an ‘X’ waiver. Individuals with serious illness often have difficulty attending a typical addiction treatment program due to their poor health and the need to continue treatments such as chemotherapy. A few palliative care clinicians across the United States have begun including addiction treatment with buprenorphine into their outpatient palliative care practice to provide care to this underserved and stigmatized population. This session will inform participants of different models of using buprenorphine for addiction within palliative care, and discuss common issues that arise when undertaking care of patients with addiction. Participants will be able to differentiate its use for addiction versus pain. After a brief review of the pharmacology of buprenorphine, we will describe patient selection, buprenorphine prescribing and monitoring in the treatment of addiction among patients with serious illness. Four palliative care clinicians from different medical centers, including two physicians, a nurse practitioner, and a psychiatrist, will discuss challenges and successes developing a buprenorphine program within their outpatient practices. AU - Childers, J. AU - Horowitz, R. AU - Broglio, K. AU - Jangro, W. DB - Embase DO - 10.1016/j.jpainsymman.2018.12.048 KW - buprenorphine buprenorphine plus naloxone opiate addiction adult analgesia cancer chemotherapy cancer patient clinician conference abstract controlled study craving drug therapy human maintenance therapy monitoring nomenclature nurse practitioner outpatient palliative therapy patient selection prescription psychiatrist United States LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1873-6513 0885-3924 SP - 372-373 ST - No Patient Left Behind: Integrating Addiction Treatment with Buprenorphine into Your Outpatient Palliative Care Practice (TH316) T2 - Journal of Pain and Symptom Management TI - No Patient Left Behind: Integrating Addiction Treatment with Buprenorphine into Your Outpatient Palliative Care Practice (TH316) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001484792&from=export http://dx.doi.org/10.1016/j.jpainsymman.2018.12.048 VL - 57 ID - 931135 ER - TY - JOUR AB - Objective: The study aims to: (1) identify areas in need of medication-assisted treatment (MAT) of opioid use disorders; (2) characterize expansion of buprenorphine prescribers by geographical area; and (3) evaluate trends in buprenorphine use. Methods: This national retrospective analysis characterizes the relationships between potential expanded access to buprenorphine and actual use. Three data sets, spanning January 1, 2012, to December 31, 2015, will be used. DATA 2000, a Substance Abuse and Mental Health Services Administration-sponsored registry of all practitioners authorized to prescribe buprenorphine, includes prescriber information, maximum allowed number of buprenorphine patients, and geographical area. IMS National Prescription Audit (NPA) is a proprietary database that contains pharmacy retail transactions of opioids and buprenorphine. Automation of Reports and Consolidated Orders System data, available from the Drug Enforcement Administration, provide insight on its distribution at the dispensing or retail level in hospitals, pharmacies, practitioners, and teaching institutions. These data will be analyzed with geospatial analytic techniques using ArcGIS 10.4.1. Analyses will be conducted at 6-month cross-sections to examine adoption and utilization trends over time. Using this technique, study investigators will be able to identify "cold spots," where buprenorphine prescribers and use are low, and "hot spots," where prescribers and use suggest optimal saturation. Results: Research in progress. Conclusions: Preliminary analyses suggest a rising number of buprenorphine prescribers per year and an increase in buprenorphine use. Findings from this study will provide a national snapshot of buprenorphine dissemination and adoption. Policy makers at the state and federal level will be able to utilize information regarding geographical variation to plan for prevention and treatment resources to maximize utilization of buprenorphine, a potentially life-saving MAT. AD - M. Choi, University of Maryland, United States AU - Choi, M. AU - Simoni-Wastila, L. DB - Embase DO - 10.1016/j.japh.2017.04.011 KW - buprenorphine opiate adoption adult automation cold stress conference abstract female government human male pharmacy (shop) physician prescription register retrospective study teaching LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2017 SN - 1544-3450 ST - Buprenorphine prescribing: Has expansion of physician capacity led to addressing the need for medication-assisted treatment of opioid use disorders? T2 - Journal of the American Pharmacists Association TI - Buprenorphine prescribing: Has expansion of physician capacity led to addressing the need for medication-assisted treatment of opioid use disorders? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621976146&from=export http://dx.doi.org/10.1016/j.japh.2017.04.011 VL - 57 ID - 931168 ER - TY - CHAP AB - BACKGROUND: The majority of medication treatment for opioid use disorder (OUD) is provided in primary care settings. Effective and innovative models of care for medication-assisted treatment (MAT) in primary care settings (including rural or other underserved settings) could facilitate implementation and enhance provision and uptake of agonist and antagonist pharmacotherapy in conjunction with psychosocial services for more effective treatment of OUDs. PURPOSE: The purpose of this Technical Brief is to describe promising and innovative MAT models of care in primary care settings, describe barriers to MAT implementation, summarize the evidence available on MAT models of care in primary care settings, identify gaps in the evidence base, and guide future research. METHODS: We performed searches in electronic databases from 1995 to mid-June 2016, reviewed reference lists, searched grey literature sources, and interviewed Key Informants. We summarized representative MAT models of care in primary care settings and qualitatively summarized the evidence on MAT models of care in primary care settings and identified areas of future research needs. FINDINGS: We summarized 12 representative MAT models of care in primary care settings, using a framework describing the pharmacological component, the psychosocial services component, the integration/coordination component, and the educational/outreach component. Innovations in MAT models of care include the use of designated nonphysician staff to perform the key integration/coordination role; tiered care models with centralized intake and stabilization of patients with ongoing management in community settings; screening and induction performed in emergency department, inpatient, or prenatal settings with subsequent referral to community settings; community-based stakeholder engagement to develop practice standards and improve quality of care; and use of Internet-based learning networks. Most trials of MAT in primary care settings focus on comparisons of one pharmacological therapy versus another, or on the effectiveness of different intensities or types of psychosocial interventions, rather than on effectiveness of different MAT models of care per se. Key barriers to implementation of MAT models of care include stigma, lack of institutional support, lack of prescribing physicians, lack of expertise, and inadequate reimbursement. CONCLUSIONS: A number of MAT models of care have been developed and implemented in primary care settings. Research is needed to clarify optimal MAT models of care and to understand effective strategies for overcoming barriers to implementation. The models of care presented in this technical brief may help inform the individualized implementation or MAT models of care in different primary care settings. AD - Pacific Northwest Evidence-based Practice Center AN - 28045474 AU - Chou, R. AU - Korthuis, P. T. AU - Weimer, M. AU - Bougatsos, C. AU - Blazina, I. AU - Zakher, B. AU - Grusing, S. AU - Devine, B. AU - McCarty, D. CY - Rockville (MD) LA - eng N1 - PubMed NLM literature search May 7, 2021 PB - Agency for Healthcare Research and Quality (US) PY - 2016 ST - AHRQ Comparative Effectiveness Technical Briefs T2 - Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings TI - AHRQ Comparative Effectiveness Technical Briefs ID - 930867 ER - TY - JOUR AB - Statement Of Problem Or Question (One Sentence): Despite the national opioid epidemic, there are a dearth of U.S. healthcare providers willing and able to treat opioid use disorders with effective medication-assisted treatment. Objectives Of Program/Intervention (No More Than Three Objectives): To engage, educate, and increase the number of primary care providers trained and willing to treat patients with opioid use disorders with buprenorphine. Description Of Program/Intervention, Including Organizational Context (E.G. Inpatient Vs. Outpatient, Practice Or Community Characteristics): Providence Medical Group (PMG) is a large primary care network within a multi-state integrated healthcare system. Our project targeted PMG primary care providers within the greater Portland Service Area of Oregon and Southwest Washington. Project team members include two physician champions, a clinical phar-macist, a behavioral psychologist, and a project manager. Starting in early 2016, the project focused on educational initiatives aimed at PMG primary care physicians. A 12 minute educational video highlighted our physician champions' experience in treating opioid use disorders. The team created a buprenorphine toolkit that includes information such as training resources, office visit templates, office workflows, and frequently asked questions. The team presented at large regional medical director meetings and primary care clinics during their designated provider meetings. A monthly conference call fielded questions about training and current cases. The grant provided reimbursement for the training required for the buprenorphine DATAwaiver aswell as an additional CME day. Measures Of Success (Discuss Qualitative And/Or Quantitative Metrics Which Will Be Used To Evaluate Program/Intervention): A baseline and follow-up survey assessed provider knowledge, attitude and interest in medication-assisted treatment with buprenorphine. We track the number of PMG primary care providers with DATA waivers and the number of buprenorphine inductions performed. A cohort study is measuring the effect of the “uptake” clinics onER use, hospitalizations, and overall costs of care for patients with opioid use disorders. Findings To Date (It Is Not Sufficient To State Findings Will Be Discussed): The initial survey identified that 77% of responding physicians think that buprenorphine treatment should be provided in primary care settings but only 24% were somewhat to very likely to prescribe buprenorphine. At the start of our project, there were 5 primary care providers with waivers to prescribe buprenorphine in 3 PMG clinics. Currently, there are 44 providers in 17 PMG clinics with buprenorphine waivers. 169 buprenorphine inductions have been performed in PMG clinics, and 83% of providers with waivers are treating patients with buprenorphine. KEY LESSONS FOR DISSEMINATION (WHAT CANOTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COM-MUNITY?): Our project has been successful in engaging a significant number of providers in treating opioid use disorders. We sought to understand potential barriers and mitigate them with the development of a toolkit and clinical pathways involving clinical pharmacy and behavioral health. Face-to-face discussions at provider meetings with the physician champions emphasized feasibility of treatment within primary care, including conceptualization of addiction treatment within the chronic-disease model of care. AD - B. Clark, Providence Portland Medical Center, Portland, OR, United States AU - Clark, B. AU - Kai, M. AU - Dix, R. AU - White, J. DB - Embase KW - buprenorphine opiate addiction adult animal experiment animal model chronic disease clinical pharmacy cohort analysis conference abstract controlled study drug therapy feasibility study female follow up general practitioner hospitalization male medical director nonhuman Oregon psychologist quantitative analysis reimbursement videorecording Washington workflow LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1525-1497 SP - 799-800 ST - Improving access to treatment of opioid use disorders in primary care T2 - Journal of General Internal Medicine TI - Improving access to treatment of opioid use disorders in primary care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622329896&from=export VL - 33 ID - 931158 ER - TY - JOUR AB - IMPORTANCE: Opioid use disorder (OUD) is a public health crisis in the United States, but only 5% of US physicians have obtained a Drug Addiction Treatment Act (DATA) waiver to prescribe buprenorphine to treat OUD. Increasing the number of primary care physicians (PCPs) who have obtained the waiver and are able to treat patients with OUD is of utmost importance. OBJECTIVE: To determine whether a multimodal educational intervention of PCPs is associated with an increase in the number of buprenorphine waivers obtained and patients initiated into treatment in a primary care setting. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted in primary health care clinics within a large, integrated health care system. Patients included those who had received a diagnosis of OUD, and had Providence Health Plan Medicare or Medicaid insurance. Included PCPs were divided into 2 groups: those who obtained a DATA waiver after an education intervention (uptake PCPs) vs those who did not obtain a DATA waiver (nonuptake PCPs). The study took place between January 1, 2016, and December 31, 2017. Data analyses were conducted from December 2017 to August 2019. EXPOSURES: Multimodal educational intervention including video, in-person visits to clinical practitioner meetings by physician champions, and a primary care toolkit with training resources and clinic protocols. MAIN OUTCOMES AND MEASURES: The number of new uptake clinics where at least 1 PCP obtained a DATA waiver, the number of new PCPs with DATA waivers, the number of patients receiving a buprenorphine prescription, and the number of patients who received 12 or more weeks of treatment. RESULTS: Twenty-seven of 41 invited clinics implemented the intervention, and 620 PCPs were included. The number of PCPs with DATA waivers increased from 5 PCPs (0.8%) to 44 PCPs (7.1%), and the number of clinics with at least 1 buprenorphine prescriber increased from 3 clinics (7.3%) to 17 clinics (41.5%). In total, 213 patients underwent buprenorphine treatment, and 140 patients received 12 or more weeks of treatment. A total of 646 patients had Providence Health Plan Medicare or Medicaid insurance and were eligible for the study (mean [SD] age, 61.7 [16.5] years; 410 [63.5%] women). There was a statistically significant difference in treatment with buprenorphine between patients with uptake PCPs vs patients with nonuptake PCPs (23 patients [16.4%] vs 18 patients [3.5%]; odds ratio, 4.61 [95% CI, 2.32-10.51]; P = .01) after the intervention. CONCLUSIONS AND RELEVANCE: In this quality improvement study, an educational intervention was associated with an increase in the number of PCPs and clinics that could provide buprenorphine treatment for OUD and with an increase in the patients who were able to access care with medications for OUD. AD - Department of Medical Education, Providence Portland Medical Center, Portland, Oregon. Providence Medical Group, Portland, Oregon. Froedtert & Medical College of Wisconsin, Milwaukee. Providence St Joseph Health, Portland, Oregon. AN - 31642929 AU - Clark, B. AU - Kai, M. AU - Dix, R. AU - White, J. AU - Rozenfeld, Y. AU - Levy, S. AU - Engstrom, K. C2 - Pmc6820030 DA - Oct 2 DO - 10.1001/jamanetworkopen.2019.13818 DP - NLM ET - 2019/10/24 J2 - JAMA network open KW - Buprenorphine/*therapeutic use Humans Narcotic Antagonists/*therapeutic use Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy Oregon Physicians, Primary Care/*education Quality Improvement LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2574-3805 SP - e1913818 ST - Association of a Multimodal Educational Intervention for Primary Care Physicians With Prescriptions of Buprenorphine for Opioid Use Disorders T2 - JAMA Netw Open TI - Association of a Multimodal Educational Intervention for Primary Care Physicians With Prescriptions of Buprenorphine for Opioid Use Disorders VL - 2 ID - 930881 ER - TY - JOUR AB - Introduction: Substance use disorders have reached epidemic proportions and many physicians feel unprepared to intervene. In response, the Brown Internal Medicine Residency has developed a substance use curriculum. Our goal is to evaluate the content and standardize the individual components into a sustainable the three-year curriculum. Methods: In 2015-2016, we began to train all internal medicine residents during our pre-clinic conferences in the USPSTF-recommended SBIRT and motivational interviewing. Additionally we offered certain residents a 1.5-hour workshop in their ambulatory block curricula to practice these skills. We also identified noon conferences and morning reports as additional pre-existing avenues to focus on addiction topics. For residents seeking additional training, a 1-month long addiction elective was created. Evaluation methods to date have mostly consisted of written qualitative feedback. Starting in 2017-2018 we aimed to have all general internal medicine (GIM) residents complete the FDA-required 8-hour addiction training known as DATA 2000. We also held a 4-hour addiction summit for 9 PGY3 GIM residents where we reviewed the material covered and had lunch with a patient in recovery. Residents then completed a questionnaire focusing on knowledge, attitudes, and self-reported practices regarding substance use, and strengths and weakness of the curriculum. Results: 100% of internal medicine residents have been exposed to certain aspects of the curriculum and approximately 70% of internal medicine residents have participated in the majority of the components. Specific substances addressed include alcohol, opiates, tobacco, marijuana, and stimulants. After completing the 3-year substance use curriculum, 100% of surveyed residents (n = 9) agreed that the curriculum content impacted the care they provided to their patients. Additionally, 89% agreed that the curriculum influenced the way they viewed their patients with substance use disorders. On the knowledge portion of the survey residents were able to correctly identify recommended treatment modalities (MAT, brief intervention), appropriate screening techniques, and label stages of change. 89% of residents feel comfortable assessing for risking drinking, however only 44% are comfortable with the single-item screen for illicit/prescription drug misuse. 11% stated that they did not have a good understanding of pharmacologic options for substance use disorder, coinciding with 11% that reported inadequate substance use disorder training during residency. Assessing the utility of the curriculum, the residents found each component to have varying degrees of usefulness. Small groups were the preferred venue for education (44%), and group discussion and case-based lectures were the preferred teaching modalities (44%, 33% respectively). Constructive feedback included more opiate training, using the residents' actual patients for teaching, increased access to educational resources. Conclusions: Current resident training fails to adequately prepare providers to address substance use in our community. Standardization of this 3-year substance use curriculum will help solidify the content as an integral component of resident training. Survey results confirm that the curriculum is both necessary and effective. Additionally the responses have provided valuable information for content adjustments and areas needing additional focus. Moving forward we will focus on improving content, expanding exposure, and augmenting the evaluation process for our substance use curriculum. AD - S.A. Clark AU - Clark, S. A. DB - Embase DO - 10.1097/ADM.0000000000000417 KW - alcohol cannabis opiate adult clinical article conference abstract constructive feedback controlled study curriculum drinking drug dependence epidemic female human internal medicine male motivational interviewing prescription drug misuse questionnaire remission residency education risk assessment skill standardization teaching tobacco weakness LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1935-3227 SP - E8 ST - Evaluation & standardization of a substance use curriculum for internal medicine residents T2 - Journal of Addiction Medicine TI - Evaluation & standardization of a substance use curriculum for internal medicine residents UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627852179&from=export http://dx.doi.org/10.1097/ADM.0000000000000417 VL - 12 ID - 931153 ER - TY - JOUR AB - Introduction: Rhode Island has responded to the opioid epidemic by intervening on multiple fronts. Increasing buprenorphine-waiver training has been central to this effort. However, despite an increase in prescription capacity, the number of patients receiving treatment has not seen a proportional rise, resulting in a persistent treatment gap. This is in part because of insufficient provider training, prominently among residents. In an effort to increase the number of active prescribers, we incorporated buprenorphine treatment in the resident clinic of an academic health center and developed a warm line for local consultation. Methods: A literature search was performed to identify best practices regarding office-based opioid treatment in general and specific to academic health centers. Local buprenorphine providers and other stakeholders were contacted for guidance in implementing a unique clinic in the electronicmedical record in compliance with 42 CFR Part 2 confidentiality requirements. A protocol was developed with a focus on harm reduction. The clinic was awarded a Rhode Island Department of Health grant that funded a program coordinator, patient transportation, and a phone for warm-line local consultation. Results: The Center for Primary Care Recovery Clinic (CPC-RC) began in July 2018. It is located at Rhode Island Hospital's Internal Medicine residency clinic and staffed by an interdisciplinary team consisting of 2 attending physicians, 1 program coordinator, 1 pharmacist, 1 addiction medicine fellow, 1 Internal Medicine resident, licensed clinical social worker support, and rotating students. The clinic works closely with local nonprofit organizations that support people with a history of incarceration and experiencing homelessness and addiction. As of October 2018, we have completed 17 new patient evaluations and 13 were deemed appropriate for buprenorphine treatment at CPC-RC. All 13 patients remain in active treatment (average length 7.4 weeks). Eighty-five percentage of our patients have never provided an opioid positive urine after establishing care. Fifty-four percentage was inducted on buprenorphine in the inpatient setting immediately before enrollment. Eighty-five percentage of our patients have history of incarceration, 46% with unstable housing on initiation, 38% HCV positive, 77% unemployed, and 92% are medicaid patients. Additionally, this clinic has provided the opportunity to discuss inpatient and outpatient OUD management with providers via multiple avenues including grand rounds, morning reports, and rounding on the wards, as well as create a warm-line available for provider education and care coordination. Discussion: Using the common barometers of treatment retention and opioid negative toxicology screens, the early months of the CPC-RC have been a success. Altough the direct impact on the treatment gap has been modest, the clinic's effect on our patients and learners is evident. Anecdotally, our learners are more comfortable addressing OUD as evident by the number of inductions performed in the inpatient setting. The promising start has us poised to open an additional session to increase treatment capacity and have the potential to provide outpatient inductions. Moving forward our goals include streamlining the referral process with inpatient services and EDs, provide long-acting naltrexone and buprenorphine injections, and ultimately participate in community outreach and enhance Rhode Island's harm reduction efforts. AD - S.A. Clark AU - Clark, S. A. AU - Vanjani, R. AU - Geary, M. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - buprenorphine naltrexone opiate addiction medicine adult clinical evaluation conference abstract confidentiality coordination drug therapy epidemic female harm reduction health center homelessness housing human human tissue injection internal medicine male medicaid non profit organization outpatient patient referral pharmacist primary medical care remission resident Rhode Island social worker student systematic review teaching toxicology unemployment urine LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E8-E9 ST - Implementation of a buprenorphine clinic at an internal medicine resident teaching PCMH T2 - Journal of Addiction Medicine TI - Implementation of a buprenorphine clinic at an internal medicine resident teaching PCMH UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628536395&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931120 ER - TY - JOUR AB - BACKGROUND: Cannabis has been linked to reduced opioid use, although reasons for cannabis use among adults prescribed opioids are unclear. AIMS: The purpose of this study was to determine whether motivations for cannabis use differ between adults prescribed opioids for persistent pain versus those receiving opioids as medication-assisted treatment for opioid use disorder. DESIGN: A cross-sectional survey design was used. PARTICIPANTS: Adults prescribed opioids for persistent pain (n = 104) or opioid use disorder (n = 139) were recruited from outpatient settings. METHODS: Data were collected on surveys asking about cannabis use and compared the two populations. A series of regression models examined population characteristics and cannabis use motivations using validated measures of the Marijuana Motives Measure scale. RESULTS: More than half the sample (n = 122) reported current, daily cannabis use and 63% reported pain as a motivation for use. Adults with persistent pain were more likely to be older, female, and have higher levels of education (p < .05). Adults with opioid use disorder were more likely to report "enhancement" (p < .01) and relief of drug withdrawal symptoms (p < .001) as motivations for cannabis use. The most common reasons for cannabis use in both populations were social and recreational use and pain relief. CONCLUSIONS: Both studied populations have unmet health needs motivating them to use cannabis and commonly use cannabis for pain. Persistent pain participants were less likely to use cannabis for euphoric effects or withdrawal purposes. Nurses should assess for cannabis use, provide education on known risks and benefits, and offer options for holistic symptom management. AD - College of Nursing, Washington State University, Spokane, Washington. College of Nursing, Washington State University, Spokane, Washington. Electronic address: marian.wilson@wsu.edu. AN - 31375419 AU - Clem, S. N. AU - Bigand, T. L. AU - Wilson, M. DA - Feb DO - 10.1016/j.pmn.2019.06.009 DP - NLM ET - 2019/08/04 J2 - Pain management nursing : official journal of the American Society of Pain Management Nurses KW - Adult Analgesics, Opioid/adverse effects/therapeutic use Chronic Pain/drug therapy/epidemiology Cross-Sectional Studies Female Humans Male Marijuana Abuse/epidemiology/*psychology Middle Aged *Motivation Opioid-Related Disorders/*complications/epidemiology/psychology Pain Management/methods/psychology/standards Surveys and Questionnaires LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1524-9042 SP - 43-47 ST - Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction T2 - Pain Manag Nurs TI - Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction VL - 21 ID - 930826 ER - TY - JOUR AB - Physician behaviors are difficult to change, but academic detailing has been shown to improve guideline implementation [1]. This report examines the possible effect of academic detailing on reducing opioid-related deaths. Materials and Methods: Between August 2008 and June 2009, 581 medical providers and 136 additional participants attended learning sessions. Six practices for safer opioid prescribing comprised the core educational component: 1) start low, go slow (methadone 5 mg bid for most patients); 2) obtain sleep studies for patients on >100 mg/day morphine equivalent or >50 mg methadone; 3) obtain EKGs for patients on methadone >50 mg/day or when combining with other QT prolonging drugs; 4) avoid opioids in combination with benzodiazepines and sleep aids; 5) avoid long-acting opioid for acute pain; and 6) educate patients and families. Session participants completed a self-reported survey querying changes in behaviors regarding the six practices at 0, 1, and 6 months. Results: Of eligible participants, 37% completed the 1-month survey and 25% completed the 6 month survey. Results are interim as data collection is ongoing. By the 6-month survey, the percentage of respondents who had fully adopted the six practices were: 1) 52%; 2) 32%; 3) 53.3%; 4) 72%; 5) 84%; and 6) 48%. Uniquely, our state showed the largest one-year drop in deaths from nonillicit drug overdose in 18 years, from 317 deaths in 2007 to 277 in 2008. IRB approved/waived. Conclusions: Academic detailing, although only part of a state campaign to combat overdose deaths, appears effective in accomplishing desired physician behavior changes and reducing deaths. AD - S. Cochella, University of Utah, Salt Lake City, UT, United States AU - Cochella, S. AU - Rolfs, R. AU - Johnson, E. AU - Bateman, K. AU - Webster, L. R. DB - Embase DO - 10.1111/j1526-4637.2009.00781.x KW - opiate methadone morphine benzodiazepine derivative death pain United States patient physician sleep intoxication behavior change information processing drug overdose learning LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2010 SN - 1526-2375 SP - 326 ST - The effect of academic detailing on curbing opioid-related deaths in Utah T2 - Pain Medicine TI - The effect of academic detailing on curbing opioid-related deaths in Utah UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70212102&from=export http://dx.doi.org/10.1111/j1526-4637.2009.00781.x VL - 11 ID - 931214 ER - TY - JOUR AB - BACKGROUND: The opioid epidemic has disproportionately affected rural areas, where a limited number of health care providers offer medication-assisted treatment (MAT), the mainstay of treatment for opioid use disorder (OUD). Rural residents with OUD may face multiple barriers to engagement in MAT including long travel distances. OBJECTIVE: To examine the degree to which rural residents with OUD are engaged with primary care providers (PCPs), describe the role of rural PCPs in MAT delivery, and estimate the association between enrollee distance to MAT prescribers and MAT utilization. DESIGN: Retrospective cohort study. PARTICIPANTS: Medicaid-enrolled adults diagnosed with OUD in 23 rural Pennsylvania counties. MAIN MEASURES: Primary care utilization, MAT utilization, distance to nearest possible MAT prescriber, mean distance traveled to actual MAT prescribers, and continuity of pharmacotherapy. KEY RESULTS: Of the 7930 Medicaid enrollees with a diagnosis of OUD, a minority (18.6%) received their diagnosis during a PCP visit even though enrollees with OUD had 4.1 visits to PCPs per person-year in 2015. Among enrollees with an OUD diagnosis recorded during a PCP visit, about half (751, 50.8%) received MAT, most of whom (508, 67.6%) received MAT from a PCP. Enrollees with OUD with at least one PCP visit were more likely than those without a PCP visit to receive MAT (32.7% vs. 25%; p < 0.001), and filled more buprenorphine and naltrexone prescriptions (mean = 11.1 vs. 9.3; p < 0.001). The median of the distances traveled to actual MAT prescribers was 48.8 miles, compared to a median of 4.2 miles to the nearest available MAT prescriber. Enrollees traveling a mean distance greater than 45 miles to MAT prescribers were less likely to receive continuity of pharmacotherapy (OR = 0.71, 95% CI = 0.56-0.91, p = 0.007). CONCLUSIONS: PCP utilization among rural Medicaid enrollees diagnosed with OUD is high, presenting a potential intervention point to treat OUD, particularly if the enrollee's PCP is located nearer than their MAT prescriber. AD - Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. evancole@pitt.edu. Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA, USA. Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Pennsylvania Department of Human Services, Harrisburg, PA, USA. AN - 30887440 AU - Cole, E. S. AU - DiDomenico, E. AU - Cochran, G. AU - Gordon, A. J. AU - Gellad, W. F. AU - Pringle, J. AU - Warwick, J. AU - Chang, C. H. AU - Kim, J. Y. AU - Kmiec, J. AU - Kelley, D. AU - Donohue, J. M. C2 - Pmc6544707 DA - Jun DO - 10.1007/s11606-019-04943-6 DP - NLM ET - 2019/03/20 J2 - Journal of general internal medicine KW - Adolescent Adult Cohort Studies Female Health Personnel/trends *Health Services Accessibility/trends Humans Male *Medicaid/trends Middle Aged Opiate Substitution Treatment/*methods/trends Opioid-Related Disorders/*drug therapy/epidemiology Primary Health Care/*methods/trends Retrospective Studies *Rural Population/trends United States/epidemiology Young Adult *medication-assisted treatment *opioid use disorder *primary care *rural LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0884-8734 (Print) 0884-8734 SP - 936-943 ST - The Role of Primary Care in Improving Access to Medication-Assisted Treatment for Rural Medicaid Enrollees with Opioid Use Disorder T2 - J Gen Intern Med TI - The Role of Primary Care in Improving Access to Medication-Assisted Treatment for Rural Medicaid Enrollees with Opioid Use Disorder VL - 34 ID - 930896 ER - TY - JOUR AB - Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8-24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America. AD - [Cole, Evan S.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA. [DiDomenico, Ellen] Pen Dept Drug & Alcohol Programs, Harrisburg, PA USA. [Green, Sherri] Univ North Carolina Chapel Hill, Gillings Sch Global Publ Hlth, Dept Maternal & Child Hlth, Chapel Hill, NC USA. [Heil, Susan K. R.; Hilliard, Tandrea; Mossburg, Sarah E.] Amer Inst Res, Washington, DC USA. [Sussman, Andrew L.; Salvador, Julie G.] Univ New Mexico, Dept Psychiat & Behav Sci, Albuquerque, NM 87131 USA. [Warwick, Jack] Univ Pittsburgh, Sch Pharm, Program Evaluat & Res Unit, Pittsburgh, PA USA. [Westfall, John M.; Zittleman, Linda] Univ Colorado, Dept Family Med, Aurora, CO USA. Cole, ES (corresponding author), Univ Pittsburgh, Dept Hlth Policy & Management, A616 Crabtree Hall,130 DeSoto St, Pittsburgh, PA 15261 USA. evancole@pitt.edu AN - WOS:000627016200001 AU - Cole, E. S. AU - DiDomenico, E. AU - Green, S. AU - Heil, S. K. R. AU - Hilliard, T. AU - Mossburg, S. E. AU - Sussman, A. L. AU - Warwick, J. AU - Westfall, J. M. AU - Zittleman, L. AU - Salvador, J. G. DO - 10.1080/08897077.2021.1891492 J2 - Subst. Abus. KW - Primary care rural opioid use disorder COLLABORATIVE CARE BUPRENORPHINE Substance Abuse LA - English M3 - Editorial Material; Early Access N1 - Web of Science Clarivate Analytics literature search May 7, 2021 SN - 0889-7077 SP - 7 ST - The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America COMMENT T2 - Substance Abuse TI - The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America COMMENT UR - ://WOS:000627016200001 ID - 931228 ER - TY - JOUR AB - Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8-24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America. AD - Graduate School of Public Health, Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA. The Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA, USA. Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA. American Institutes for Research, Washington, DC, USA. Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA. Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA. Department of Family Medicine, University of Colorado, Aurora, CO, USA. AN - 33689594 AU - Cole, E. S. AU - DiDomenico, E. AU - Green, S. AU - Heil, S. K. R. AU - Hilliard, T. AU - Mossburg, S. E. AU - Sussman, A. L. AU - Warwick, J. AU - Westfall, J. M. AU - Zittleman, L. AU - Salvador, J. G. DA - Mar 9 DO - 10.1080/08897077.2021.1891492 DP - NLM ET - 2021/03/11 J2 - Substance abuse KW - Primary care opioid use disorder rural LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0889-7077 SP - 1-7 ST - The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America T2 - Subst Abus TI - The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America ID - 931008 ER - TY - JOUR AD - Brandi Parker Cotton is an assistant professor at the University of Rhode Island, College of Nursing, Providence, R.I. Ginette G. Ferszt is a professor at the University of Rhode Island, College of Nursing, Providence, R.I. AN - 29668514 AU - Cotton, B. P. AU - Ferszt, G. G. DA - May 17 DO - 10.1097/01.npr.0000531074.42053.50 DP - NLM ET - 2018/04/19 J2 - The Nurse practitioner KW - Buprenorphine/therapeutic use Drug Prescriptions/*nursing Humans Legislation, Nursing Narcotic Antagonists/therapeutic use *Nurse Practitioners *Nurse's Role *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Physicians/supply & distribution United States LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0361-1817 SP - 8 ST - The role of NPs in medication-assisted treatment for opioid use disorder T2 - Nurse Pract TI - The role of NPs in medication-assisted treatment for opioid use disorder VL - 43 ID - 930953 ER - TY - JOUR AB - BACKGROUND: More than 130 Americans die from opioid overdose each day. To address the opioid epidemic, opioid treatment programs are in place to treat substance use disorder. These programs have seen an influx of patients and are not able to accommodate the number of patients. Primary care practices can help with the crisis by providing an office-based opioid treatment (OBOT) program. OBJECTIVE: To describe the necessary steps and considerations to put in place for implementing a telehealth OBOT program. Establishing a telehealth program for patients controlled on medication-assisted treatment can improve access to care, improve patient compliance, and redirect the workflow of the family practice. METHODOS: After a literature review of established OBOT programs, state and federal laws, Medicare and reimbursement policies, a telehealth opioid treatment program was designed for private primary care practice. CONCLUSIONS: Primary care practices can should implement an office based opioid treatment program via telehealth to improve workflow and accessibility to care. IMPLICATIONS FOR NURSING: To offer improved access to care for patients with opioid addiction and seamless workflow in the office-based setting, primary care practices should consider establishing their telehealth OBOT program based on the following recommendations. AD - Northern Illinois University, DeKalb, Illinois katherinecoulter@niu.edu. Northern Illinois University, DeKalb, Illinois. AN - 33334926 AU - Coulter, K. J. AU - Hintzsche, M. F. DA - Nov 1 DO - 10.1891/jdnp-d-19-00068 DP - NLM ET - 2020/12/19 J2 - Journal of doctoral nursing practice KW - *addiction treatment *primary care *substance abuse *telehealth LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2380-9418 SP - 207-215 ST - Establishing a Telehealth Program in Primary Care for the Treatment of Opioid Use Disorder T2 - J Dr Nurs Pract TI - Establishing a Telehealth Program in Primary Care for the Treatment of Opioid Use Disorder VL - 13 ID - 930911 ER - TY - JOUR AB - Extended-release naltrexone (XR-NTX) is a medication-assisted treatment (MAT) that is used in conjunction with psychosocial treatment for substance use disorder. It is associated with a reduction in the number of days that patients use alcohol or opioids, in cravings and drug-seeking behaviors, and in healthcare utilization costs, as well as improved medication adherence rates for patients in substance use disorder (SUD) treatment programs and improved quality of life. Despite the clinical effectiveness of XR-NTX, its clinical use has been slow to develop. There is little research describing the utilization of XR-NTX over time at the treatment-system level and few documented attempts to promote MAT by creating a system to explicitly promote and sustain MAT use. This study examines changes between April 1, 2010, and March 30, 2015, in the utilization patterns of XR-NTX for SUDs as promoted and delivered in a system of "medication hubs," comprised of community providers and a medication coordinating center, and training efforts. This system was implemented as part of a large demonstration project that was designed to provide access to XR-NTX in Los Angeles County. Our findings indicated an increase in the initiation of XR-NTX (59% increase) and subsequent doses (89% increase) from Year 1 to Year 5 of the project (p<0.001). These findings suggest that it is possible to improve MAT utilization (in this case XR-NTX) through the use of a system of care that minimizes MAT payment issues for providers and patients, provides an infrastructure (medication hubs and SUD treatment providers), promotes system coordination, and educates providers. AD - University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA. Electronic address: SarahJCousins@ucla.edu. University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA. Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, 1000 S Fremont Avenue, A-9 East, 3rd Floor Alhambra, CA 91803, USA. AN - 28291571 AU - Cousins, S. J. AU - Crèvecoeur-MacPhail, D. AU - Kim, T. AU - Rawson, R. A. DA - Feb DO - 10.1016/j.jsat.2017.02.011 DP - NLM ET - 2017/03/16 J2 - Journal of substance abuse treatment KW - Adult Delayed-Action Preparations Female Health Services Accessibility Humans Los Angeles Male Medication Adherence Naltrexone/*therapeutic use Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy Program Development Quality of Life Substance-Related Disorders/drug therapy *Alcohol use disorder *Extended-release naltrexone *Injectable naltrexone *Medication-assisted treatment *Opioid use disorder *SUD treatment system development LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0740-5472 SP - 78-83 ST - The Los Angeles County hub-and-provider network for promoting the sustained use of extended-release naltrexone (XR-NTX) in Los Angeles County (2010-2015) T2 - J Subst Abuse Treat TI - The Los Angeles County hub-and-provider network for promoting the sustained use of extended-release naltrexone (XR-NTX) in Los Angeles County (2010-2015) VL - 85 ID - 930975 ER - TY - JOUR AB - A collaborative led by state health and human service agencies, academic leaders, and stakeholders tested interventions to expand use of medication assisted treatment (MAT) through a maternal medical home (MMH) model that coordinated behavioral health and prenatal care with social supports for pregnant women with opioid use disorder (OUD) enrolled in Medicaid. The program was anchored in four clinical organizations with distinct models of care: community behavioral health, residential behavioral health, hospital-based obstetrical practice, and co-located obstetrical and behavioral health. A modified version of the Institute for Healthcare Improvement Breakthrough Series Model for Improvement was implemented using monthly performance data feedback to conduct small tests of change and improve care. Administrative data from the state's Medicaid, vital statistics, and child welfare systems were linked to evaluate the impact of MOMS on 252 mother-infant dyads compared to a sample of 846 Medicaid beneficiaries with OUD in the third trimester of pregnancy. MOMS participation was associated with increased likelihood of MAT in trimesters one, two and three (AOR = 2.30, 4.40, 2.75, respectively), behavioral health counseling during trimesters two and three (AOR = 3.75 and 2.07, respectively), retention in MAT during postpartum months one through three and four through six (AOR = 2.86, 2.40, respectively), and marginally lower out-of-home placement of infants born to mothers with OUD (AOR = 0.66). Within the MOMS program, greater participation in behavioral health treatment and MAT (χ(2)(3) ≥ 12.09) was observed in the co-located behavioral health/obstetrical care practice site compared to behavioral health-led and obstetrical provider-led sites. AD - Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America. Electronic address: Dushka.Crane@osumc.edu. Tri-State Maternal-Fetal Medicine Associates, United States of America. Electronic address: Michael_Marcotte@trihealth.com. FACP - NASHP, Ohio Department of Medicaid, United States of America. Electronic address: Mary.Applegate@Medicaid.ohio.gov. Ohio Department of Mental Health and Addiction Services, United States of America. Electronic address: Richard.Massatti@mha.ohio.gov. Ohio Department of Mental Health and Addiction Services, United States of America. Electronic address: mark.hurst@mha.ohio.gov. Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America. Electronic address: Michelle.Menegay@osumc.edu. Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America. Electronic address: Rachel.Mauk@osumc.edu. Ohio Department of Job and Family Services, United States of America. Electronic address: Susan.Williams@jfs.ohio.gov. AN - 31202289 AU - Crane, D. AU - Marcotte, M. AU - Applegate, M. AU - Massatti, R. AU - Hurst, M. AU - Menegay, M. AU - Mauk, R. AU - Williams, S. DA - Jul DO - 10.1016/j.jsat.2019.04.010 DP - NLM ET - 2019/06/17 J2 - Journal of substance abuse treatment KW - Adult Female Humans Infant Infant, Newborn Medicaid Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy Patient-Centered Care Postpartum Period Pregnancy Pregnancy Complications/*drug therapy Prenatal Care/methods *Quality Improvement Social Support United States Young Adult LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0740-5472 SP - 53-59 ST - A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants T2 - J Subst Abuse Treat TI - A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants VL - 102 ID - 930811 ER - TY - JOUR AB - Background and Aims: The 23-bed tertiary-referral Paediatric Intensive Care Unit (PICU) in Our Lady's Children's Hospital (OLCHC) admits 1100 infants and children per year, many of whom are postoperative. Over the past 5 years, insertion ofwound catheters at the end of major general, thoracic, orthopaedic and cardiothoracic procedures has become routine practice. Children admitted to PICU receive continuous infusions of local anaesthetic medication for their postoperative pain relief.We wished to study this change in practice to describe current practice and identify areas for improvement and future practice development. Methods: We used our existing patient data management system (ICIP Phillips) to identify patients who received analgesia via a wound catheter. We identified the last 50 cases as a recent unselected sample and interrogated the data management system for 15 variables, relating to nursing care of the catheter, quality of analgesia, requirement for additional opiate analgesia and complications or problems relating to the use of the catheters. Our institutional ethics committee waived approval as it is an audit of current practice. Results: Fifty patientswere retrieved with complete data, admitted over the past 15 months. All patients had the catheter inserted under direct vision, in the operating room, before the completion of surgery. Post-thoracic surgery was the most frequent admitting diagnosis (32/50), with decortication the most frequent. The mean length of continuous local anaesthetic infusion was 60 hours and 46 patients received additional opiate medication. Conclusions: Our audit suggests that wound catheter-based infusions contribute to postoperative analgesia in the PICU, and are well-tolerated by children in PICU. AD - S. Crowe, Our Lady's Children's Hospital- Crumlin., Division of Paediatric Intensive Care, Dublin, Ireland AU - Crowe, S. AU - Delaney, P. DB - Embase KW - local anesthetic agent opiate catheter child complication conference abstract controlled study decortication diagnosis drug therapy female human infusion institutional ethics major clinical study male nursing care operating room patient monitor pediatric intensive care unit postoperative analgesia postoperative pain surgery thorax surgery vision wound LA - English M1 - 7 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1532-8651 SP - e185 ST - Wound catheters and infusions in the paediatric critical care setting: An audit of the last 50 consecutive cases T2 - Regional Anesthesia and Pain Medicine TI - Wound catheters and infusions in the paediatric critical care setting: An audit of the last 50 consecutive cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624140279&from=export VL - 43 ID - 931147 ER - TY - JOUR AB - BACKGROUND: Illicit drug use is common among HIV-infected individuals. Buprenorphine enables physicians to simultaneously treat HIV and opioid dependence, offering opportunities to improve health outcomes. Despite this, few physicians prescribe buprenorphine. OBJECTIVE: To examine barriers to obtaining waivers to prescribe buprenorphine. DESIGN: Cross-sectional survey study. PARTICIPANTS: 375 physicians attending HIV educational conferences in six cities in 2006. APPROACH: Anonymous questionnaires were distributed and analyzed to test whether confidence addressing drug problems and perceived barriers to prescribing buprenorphine were associated with having a buprenorphine waiver, using chi-square, t tests, and logistic regression. RESULTS: 25.1% of HIV physicians had waivers to prescribe buprenorphine. In bivariate analyses, physicians with waivers versus those without waivers were less likely to be male (51.1 vs 63.7%, p < .05), more likely to be in New York (51.1 vs 29.5%, p < .01), less likely to be infectious disease specialists (25.5 vs 41.6%, p < .05), and more likely to be general internists (43.6 vs 33.5%, p < .05). Adjusting for physician characteristics, confidence addressing drug problems (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [95% CI] = 1.08-3.88) and concern about lack of access to addiction experts (AOR = 0.56, 95% CI = 0.32-0.97) were significantly associated with having a buprenorphine waiver. CONCLUSIONS: Among HIV physicians attending educational conferences, confidence addressing drug problems was positively associated with having a buprenorphine waiver, and concern about lack of access to addiction experts was negatively associated with it. HIV physicians are uniquely positioned to provide opioid addiction treatment in the HIV primary care setting. Understanding and remediating barriers HIV physicians face may lead to new opportunities to improve outcomes for opioid-dependent HIV-infected patients. AD - Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. ccunning@montefiore.org AN - 17619934 AU - Cunningham, C. O. AU - Kunins, H. V. AU - Roose, R. J. AU - Elam, R. T. AU - Sohler, N. L. C2 - Pmc2219773 DA - Sep DO - 10.1007/s11606-007-0264-7 DP - NLM ET - 2007/07/11 J2 - Journal of general internal medicine KW - Adult Buprenorphine/*therapeutic use Cross-Sectional Studies *Drug Prescriptions *Drug and Narcotic Control Female HIV Infections/complications/*drug therapy Humans Male Middle Aged Opioid-Related Disorders/complications/*drug therapy LA - eng M1 - 9 N1 - PubMed NLM literature search May 7, 2021 PY - 2007 SN - 0884-8734 (Print) 0884-8734 SP - 1325-9 ST - Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians T2 - J Gen Intern Med TI - Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians VL - 22 ID - 930986 ER - TY - JOUR AB - OBJECTIVES: The study aim was to characterize the Indiana community-based pharmacist preceptors' knowledge and perceptions of medication-assisted treatment (MAT) for opioid use disorder (OUD). The secondary objectives were to explore the desired resources, dispensing concerns, and preceptors' involvement in precepting students. DESIGN: A 38-item survey was used to collect respondent demographics, knowledge, and perceptions of MAT for OUD. Perception questions were developed using the social cognitive theory and were adapted from previously published surveys with investigators' permission. SETTING: Community-based Indiana pharmacist preceptors were eligible to complete an electronic survey in February and March 2019. OUTCOME MEASURES: Descriptive statistics were used to characterize preceptor knowledge and perceptions of MAT for OUD. Desired MAT resources, dispensing concerns, and level of involvement in precepting students were collected. Respondent demographics were collected to characterize the study sample. RESULTS: Of the 116 survey responses, 104 were eligible, and 79 community-based pharmacist preceptors completed the survey, yielding a response rate of 76.0%. For knowledge questions, the overall correct score was 56.2%. Respondents had high correct scores on questions related to medication access. However, respondents either self-identified or performed poorly on the following knowledge items: Food and Drug Administration-approved MAT products for OUD, the need to provide an opioid-free interval before initiating treatment with buprenorphine and naltrexone, pregnancy recommendations, and treatment of severe OUD. Respondents reported positive perceptions on MAT for OUD, but identified concerns regarding diversion and misuse of MAT. Most respondents reported a desire for additional education on different aspects of MAT for OUD. Dispensing concerns and preceptors' involvement with students in MAT ranged from no concern and lack of involvement to many different concerns and full student involvement. CONCLUSION: Opportunities exist to fill identified gaps in knowledge, enhance perceptions, and provide desired continuing education for community-based pharmacist preceptors on MAT for OUD. AN - 32094038 AU - Davenport, E. S. AU - Arnett, S. J. AU - Nichols, M. A. AU - Miller, M. L. DA - May-Jun DO - 10.1016/j.japh.2020.01.001 DP - NLM ET - 2020/02/26 J2 - Journal of the American Pharmacists Association : JAPhA LA - eng M1 - 3s N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1086-5802 SP - S20-S28.e4 ST - Indiana community pharmacist preceptors' knowledge and perceptions of medication-assisted treatment T2 - J Am Pharm Assoc (2003) TI - Indiana community pharmacist preceptors' knowledge and perceptions of medication-assisted treatment VL - 60 ID - 930819 ER - TY - JOUR AB - INTRODUCTION: Post operative nausea and vomiting (PONV) remains a vexing clinical concern despite multimodal prophylaxis1. Aprepitant, a neurokinin 1 receptor antagonist, inhibits emetic effects of substance P in the gastrointestinal tract and central nervous system2. It is approved for prevention of both chemotherapy induced nausea and vomiting (CINV)3 and orally for PONV. There are reports of efficacy in PONV in IV form, with a longer half-life (9 - 12 hrs) than many currently available agents1,4,5. As part of an institution quality evaluation for a novel agent, we evaluated our practice with immediate postoperative IV aprepitant use. METHODS: Since IV aprepitant is expensive, in consultation with OR pharmacy, initial recommendations for PACU use included high-risk patients, failure of multimodal prophylaxis/treatment or contraindication of usual agents. After IRB approval with waiver of consent due to deidentified records, anesthetic and perioperative data were retrospectively collected for Apfel score6, use of antiemetic agents intraoperatively (ondansetron (O), dexamethasone, scopolamine patch) and in the PACU (promethazine (P), diphenhydramine, metoclopramide or repeat O). After anecdotal success, a Likert score of clinical effect for N/V was subsequently assessed in a small cohort before and after aprepitant administration (0 = none, 3 = persistent). Data was collated and analyzed via Stata 12.1 (College Station, TX) for descriptive statistics and Wilcoxon signed rank test as appropriate. RESULTS: Over 34 discontinuous months (when a research student was available), 131 patients who received IV aprepitant in PACU and with complete data availability were captured. A high-risk patient cohort was confirmed with female majority (75.6 %), all receiving a general anesthetic with intraoperative opioids and the majority receiving postoperative intravenous opioids (51%). Anticipated higher risk surgical groups included neuro (28.2%), bariatric and upper abdominal (16%), gynecologic (8.4%), ENT (7.6%) and spine (6.9%) surgical patients. Mean Apfel score (2.5 + 0.8) predicted a PONV incidence of 39-61% (6). Multimodal PONV prophylaxis was used routinely (1.9 + 0.8 agents/patient) as well as active management in PACU prior to aprepitant use (1.8 + 1.0 agents/patient) (Table 1). In the cohort (29) where efficacy was assessed in the latter stages of the study, a dramatic effect of aprepitant was found (p < 0.001, Table 2), confirming subjective opinion that aprepitant was extremely effective. CONCLUSIONS: Given the proven efficacy of IV aprepitant in CINV and PO aprepitant in PONV, we examined initial data of use of IV aprepitant in the PACU after introduction as a potential option for rescue therapy. We confirmed that use was appropriate, focused on high-risk patients, after failure of prophylactic therapy and active management in PACU, with almost universal subjective success. This data is reassuring given concerns about the cost and will form the basis for subsequent prospective investigations of cost analysis, efficacy and patient satisfaction, a metric which aligns with future ASA mandates. AD - J.B. De Haan, University of Texas, Health McGovern Medical School, Houston, TX, United States AU - De Haan, J. B. AU - Poi, T. J. AU - Ruggles, P. H. AU - Michael, A. K. AU - Water, A. P. K. AU - Cooke, J. M. AU - Pivalizza, E. G. DB - Embase KW - anesthetic agent aprepitant dexamethasone diphenhydramine metoclopramide ondansetron opiate promethazine scopolamine adult anonymised data chemotherapy induced nausea and vomiting cohort analysis college conference abstract consultation contraindication controlled study cost benefit analysis drug therapy female half life time high risk patient human incidence Likert scale major clinical study patient satisfaction postoperative nausea and vomiting prophylaxis prospective study research student retrospective study risk assessment spine statistics surgical patient treatment failure Wilcoxon signed ranks test LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1526-7598 SP - 618-619 ST - Evaluation of initial aprepitant use as a rescue anti-emetic in PACU T2 - Anesthesia and Analgesia TI - Evaluation of initial aprepitant use as a rescue anti-emetic in PACU UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626090535&from=export VL - 126 ID - 931157 ER - TY - JOUR AB - Background: Many people living with HIV (PLWH) suffering from chronic pain are treated with chronic opioid therapy (COT). It is unknown if system improvements to increase guideline concordant care impact satisfaction, confidence, or trust among patients and providers. Methods: The Targeting Effective Analgesia in Clinics for HIV (TEACH) study was a two arm cluster RCT to assess whether a collaborative care intervention improved COT prescribing practices and satisfaction with care compared to standard practice. From 2015 to 5016 we recruited COT care providers and their patients from two hospital-based HIV clinics. We randomized 41 providers, in a 1:1 ratio, to receive either the TEACH intervention (i.e., an IT-enabled nurse care manager; opioid education and academic detailing, access to addiction specialists) or a brochure on safe opioid prescribing (control). The primary outcome of this analysis was provider satisfaction at 12 months and three secondary outcomes were: 1 provider confidence prescribing COT; 2 patient satisfaction with COT; and 3 patient trust in provider (latter two outcomes dichotomized based on top vs. lower three quartiles). Intention-to-treat analyses were conducted using linear and logistic regression models. Results: Providers (n = 41) were 34% male; mean age 46 years; 63% white; 78% MDs; and 12% buprenorphine-waivered. Patients (n = 187) were 72% male; mean age 54 years; 28% white; 91% undetectable HIV viral load; and 15% history of injection drug use. Twentyone providers with 87 patients were randomized to the intervention. At 12 months, the adjusted mean satisfaction with COT was 1.11 points higher among intervention providers (Scale 1 to 10; 95% confidence interval (CI): -0.04 to 4.26, p = 0.06). The adjusted mean confidence with prescribing COT was 1.01 points higher among intervention providers (Scale 1 to 10; 95% CI: 0.05 to 5.96, p = 0.04). No significant differences were detected in patient satisfaction with COT (adjusted odds ratio (AOR) 1.17, 95% CI: 0.50 to 0.76, p = 0.72) or trust in provider (AOR 1.63, 95% CI: 0.65 to 5.09, p = 0.30). Conclusions: In the TEACH RCT, intervention providers had higher satisfaction and confidence than controls in prescribing COT, with the confidence outcome reaching statistical significance. TEACH did not decrease patient satisfaction or trust in providers. TEACH is a promising strategy to improve prescribing COT for PLWH. AD - C. Del Rio, Emory School of Public Health, Atlanta, United States AU - Del Rio, C. AU - Tsui, J. AU - Cheng, D. AU - Colasanti, J. AU - Liebschutz, J. AU - Lira, M. AU - Forman, L. AU - Shanahan, C. AU - Root, C. AU - Bridden, C. AU - Outlaw, K. AU - Abrams, C. AU - Carroll, J. AU - Walley, A. AU - Samet, J. DB - Embase DO - 10.1002/jia2.25327 KW - buprenorphine opiate addiction adult analgesia chronic pain conference abstract controlled study drug therapy education female human Human immunodeficiency virus infected patient injection major clinical study male middle aged multicenter study nurse manager patient satisfaction prescription randomized controlled trial statistical significance trust virus load LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1758-2652 ST - Targeting effective analgesia in clinics for HIV (TEACH): A randomized controlled trial (RCT) to improve satisfaction, confidence, and trust around chronic opioid therapy in HIV care T2 - Journal of the International AIDS Society TI - Targeting effective analgesia in clinics for HIV (TEACH): A randomized controlled trial (RCT) to improve satisfaction, confidence, and trust around chronic opioid therapy in HIV care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629011314&from=export http://dx.doi.org/10.1002/jia2.25327 VL - 22 ID - 931114 ER - TY - JOUR AB - OBJECTIVES: Although unhealthy substance use and addiction contribute to 1 in 4 deaths and are estimated to cost the US more than $740 billion annually, fewer than 12 hours of physician education over the 7 years of medical school and primary residency training specifically address alcohol and other drug-related issues. Addiction Medicine was formally recognized as a medical subspecialty in 2016 to address the need for physicians trained in prevention, treatment, and management of substance use. This study examines the characteristics of the Addiction Medicine fellowships in operation during this critical period in the subspecialty's development to identify needs and potential. METHODS: This study is a cross-sectional survey of Addiction Medicine Fellowship Directors from 46 fellowships accredited as of 2017 (43 in the United States and 3 in Canada). The response rate was 100%. RESULTS: Directors estimated significant growth in available fellowship slots between 2016 to 2017 and 2017 to 2018 (F = 49.584, P < .001). The majority of Directors reported that demand for their graduates was high (79.5%). Fellow training in screening, brief intervention, and referral to treatment spanned many substances and age groups, although fewer programs focused on nicotine and on adolescent populations. Notably, most directors reported that graduates completed waiver training to prescribe buprenorphine-naloxone (77.5%) and gained clinical experience in an opioid treatment setting (89.1%). Funding was the #1 need among 56.8% of Directors. CONCLUSIONS: Despite significant growth in Addiction Medicine fellowships over the past 6 years, meeting future workforce demands for Addiction Medicine specialists depends on access to funding to support fellowships. AD - Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (KJD); Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI (RB); Department of Family Medicine, University at Buffalo, State University of New York, Buffalo, NY (AD); American College of Academic Addiction Medicine, Chevy Chase, MD (AD, SF, TB, KK); Icahn School of Medicine, Mount Sinai, New York, NY (TB); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (SH). AN - 32032207 AU - Derefinko, K. J. AU - Brown, R. AU - Danzo, A. AU - Foster, S. AU - Brennan, T. AU - Hand, S. AU - Kunz, K. DA - Jul/Aug DO - 10.1097/adm.0000000000000595 DP - NLM ET - 2020/02/08 J2 - Journal of addiction medicine LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1932-0620 SP - e103-e109 ST - Addiction Medicine Training Fellowships in North America: A Recent Assessment of Progress and Needs T2 - J Addict Med TI - Addiction Medicine Training Fellowships in North America: A Recent Assessment of Progress and Needs VL - 14 ID - 930893 ER - TY - JOUR AB - Links between HIV and substance use were identified early in the U.S. HIV epidemic. People who use drugs are at risk of HIV infection through shared injection equipment and risky sexual behaviors. In addition, substance use has negative health consequences for people living with HIV. The prescription opioid misuse epidemic, linked to injection drug use, hepatitis C infection, and HIV, poses a new threat to declining HIV rates. We reviewed evidence-based interventions that decrease HIV risk in people who use drugs (needle/syringe programs, medication-assisted treatment, engagement in HIV care, and preexposure prophylaxis/postexposure prophylaxis). The critical roles of nurses in HIV prevention/care for this population are described, including applying the principles of harm reduction, screening for substance use, and undertaking implementation and research efforts. As the nation's largest health care profession, nurses are positioned to contribute to the quality of HIV-related prevention/care for people who use drugs and to lead practice initiatives. AN - 28456473 AU - Deren, S. AU - Naegle, M. AU - Hagan, H. AU - Ompad, D. C. C2 - Pmc5485853 C6 - Nihms862807 DA - Jul-Aug DO - 10.1016/j.jana.2017.03.005 DP - NLM ET - 2017/05/01 J2 - The Journal of the Association of Nurses in AIDS Care : JANAC KW - Adult *Evidence-Based Medicine HIV Infections/*prevention & control Harm Reduction Humans Needle Sharing/*adverse effects Needle-Exchange Programs *Nurse's Role Opioid-Related Disorders/*psychology Prescription Drug Misuse Risk-Taking Substance Abuse, Intravenous/*psychology Hiv interventions nursing roles substance use this article that could be construed as a conflict of interest. LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1055-3290 (Print) 1055-3290 SP - 622-632 ST - Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles T2 - J Assoc Nurses AIDS Care TI - Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles VL - 28 ID - 930919 ER - TY - JOUR AB - Aims: The overall number of physicians waivered to prescribe buprenorphine has been increasing. However, there is little information about their location and whether their distribution increases access to opioid agonist treatment in communities where opioid treatment programs are scarce. We sought to examine the extent to which geographic distribution of buprenorphine-waivered physicians has enhanced access to opioid treatment. Methods: Using data from the Buprenorphine Waiver Notification System, NSSATS, the Area Resource File, the DEA's System to Retrieve Information from Drug Evidence, and the National Vital Statistics System, we adopted a standardized approach used in identifying communities with health professional shortages, and identified counties that had a shortage of waivered physicians, opioid treatment programs, and opioid treatment over all. Results: The percentage of counties with a shortage of opioid treatment programs changed from 90% in 2002 to 87% in 2009. However, the percentage of counties with a shortage of waivered physicians fell from 99% of counties in 2002 to 51% in 2009. The percentage of the population living in counties with a shortage of opioid treatment programs fell modestly. However, the percentage of counties with a shortage of waivered physicians decreased so that only 13% of the population resided in a treatment shortage county in 2009. Conclusions: The expansion of waivered physicians has the potential to substantially expand access to opioid agonist treatment. There are large parts of the county in which access to opioid agonist treatment remains limited. Policies aimed at increasing the number of physicians waivered for prescribing buprenorphine in communities without methadone clinics might be an effective strategy for increasing treatment capacity, particularly in areas with limited access to opioid treatment programs. AD - A. Dick, RAND Corporation, Pittsburgh, PA, United States AU - Dick, A. AU - Pacula, R. AU - Gordon, A. J. AU - Sorbero, M. AU - Burns, R. M. AU - Farmer, C. AU - Leslie, D. AU - Stein, B. D. DB - Embase DO - 10.1016/j.drugalcdep.2014.09.189 KW - opiate agonist opiate buprenorphine methadone United States college drug dependence human physician community population policy health practitioner vital statistics geographic distribution hospital LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2015 SN - 0376-8716 SP - e266 ST - Increasing access to opioid agonist treatment in U.S. Treatment shortage areas T2 - Drug and Alcohol Dependence TI - Increasing access to opioid agonist treatment in U.S. Treatment shortage areas UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71802619&from=export http://dx.doi.org/10.1016/j.drugalcdep.2014.09.189 VL - 146 ID - 931193 ER - TY - JOUR AB - Opioid use disorders are a significant public health problem, affecting two million people in the United States. Treatment with buprenorphine, methadone, or both is predominantly offered in methadone clinics, yet many people do not receive the treatment they need. In 2002 the Food and Drug Administration approved buprenorphine for prescription by physicians who completed a course and received a waiver from the Drug Enforcement Administration, exempting them from requirements in the Controlled Substances Act. To determine the waiver program's impact on the availability of opioid agonist treatment, we analyzed data for the period 2002-11 to identify counties with opioid treatment shortages. We found that the percentage of counties with a shortage of waivered physicians fell sharply, from 98.9 percent in 2002 to 46.8 percent in 2011. As a result, the percentage of the US population residing in what we classified as opioid treatment shortage counties declined from 48.6 percent in 2002 to 10.4 percent in 2011. These findings suggest that the increase in waivered physicians has dramatically increased potential access to opioid agonist treatment. Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing. AU - Dick, A. W. AU - Pacula, R. L. AU - Gordon, A. J. AU - Sorbero, M. AU - Burns, R. M. AU - Leslie, D. AU - Stein, B. D. DB - Embase Medline DO - 10.1377/hlthaff.2014.1205 KW - buprenorphine article certification clinical practice drug control drug misuse Food and Drug Administration geographic distribution government health care access health care policy human opiate addiction physician prescription public health problem rural area United States urban population urban rural difference LA - English M1 - 6 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2015 SN - 1544-5208 0278-2715 SP - 1028-1034 ST - Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002-11 T2 - Health Affairs TI - Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002-11 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L604853914&from=export http://dx.doi.org/10.1377/hlthaff.2014.1205 VL - 34 ID - 931189 ER - TY - JOUR AB - Background: As a result of the Drug Addiction Treatment Act (DATA) 2000, physicians with a waiver may treat opioid-dependent patients outside of a licensed substance abuse treatment program. However, many primary care clinics are not properly structured to meet the ongoing needs of this patient population. The legal implications, unique medication properties, risk for diversion, drug-drug interactions, and comorbid diagnoses, allow for a novel role for pharmacists in the management of buprenorphine-maintained patients. Description of Innovative Service: Faculty from the University of Maryland School of Pharmacy developed a collaborative practice with a community health center to provide medication management for buprenorphine-maintained, opioid-dependent patients. In order to establish the practice, the pharmacists assisted in the design of the interdisciplinary structure, protocols, and documentation. Once per week for 3 hours, pharmacists routinely provided disease-state monitoring, medication management, consults, and patient education for the buprenorphine patients who had completed induction. Referrals were routinely evaluated for treatment adherence, efficacy, adverse effects, and drug diversion. The pharmacists assisted in approving and refilling prescriptions and ordering and monitoring laboratory tests, including toxicology screens. Impact on Patient Care: From July 2009 to December 2010, a board-certified psychiatric pharmacist and 3 PGY2 residents provided medication management services for 67 unique patients over 191 appointments. Sixty percent of the patients had at least 1 comorbid psychiatric diagnosis. A total of 634 interventions were made. The most common included assistance in refilling buprenorphine prescriptions, ordering toxicology screens, and educating patients. The pharmacists made an average of 3.3 types of interventions per patient. Patient encounter sheets were completed for tracking and billing purposes. While the facility did not routinely submit the billing, they were reimbursed $130 per patient visit using the 99211 code when they did. The projected potential revenue generated by pharmacist visits was $24,830. Conclusion: Pharmacists offer unique expertise which can complement a treatment team and allow for successful management of a large number of buprenorphine-maintained patients in a primary care setting. The majority of our patients had comorbid psychiatric diagnoses. Specialized training in psychiatric pharmacy was important in developing a niche and, ultimately, this practice. AD - B.A. DiPaula, University of Maryland, School of Pharmacy, Baltimore, MD, United States AU - DiPaula, B. A. AU - Park, D. DB - Embase DO - 10.1177/0897190011403437 KW - buprenorphine opiate human patient medication therapy management pharmacist college drug therapy monitoring primary medical care psychiatric diagnosis pharmacy (shop) toxicology prescription adverse drug reaction laboratory test patient care drug dependence physician substance abuse hospital population risk diagnosis university United States school health center documentation patient education drug interaction LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2011 SN - 0897-1900 SP - 280-281 ST - Collaborative drug therapy management for buprenorphine-maintained patients T2 - Journal of Pharmacy Practice TI - Collaborative drug therapy management for buprenorphine-maintained patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70692649&from=export http://dx.doi.org/10.1177/0897190011403437 VL - 24 ID - 931212 ER - TY - JOUR AB - Introduction: In response to an outbreak of 129 new HIV infections from 2015 to 2018 in persons who inject drugs (PWIDs) in Lawrence and Lowell, Massachusetts, and a related need for expanded community access to Opioid Use Disorder (OUD) treatment, the Greater Lawrence Family Health Center (GLFHC) initiated a mobile buprenorphine clinic through an existing Health Care for the Homeless Program (HCHP). Mobile Medical Units (MMUs) have been previously demonstrated to more effectively reach patients from racial and ethnic minorities, those experiencing homelessness, current PWIDs, uninsured patients, and those with less treatment experience than fixed site treatment centers. Methods: GLFHC's HCHP, equipped with a MMU, pharmacy support, and a multidisciplinary team, initiated an innovative buprenorphine clinic offering ondemand and same-day buprenorphine induction 5 days per week. TheMMU is equipped with phlebotomy, restroom, nursing capacity for medication and vaccine administration, a driver trained in syringe exchange and naloxone distribution, a medical assistant to assist in insurance application, and a family physician or nurse practitioner. Patients are seen without regard to insurance status or ability to pay, with medication fees waived for uninsured patients. Following an induction interview, buprenorphine is prescribed by a clinician, if appropriate, after which a pharmacy courier transports the medication from a fixed site pharmacy to the MMU, and an addiction-trained RN administers induction doses and ensures follow-up for buprenorphine refills. Additional services provided include: harm reduction counseling, HIV pre-exposure prophylaxis (PrEP), and general primary care including Hepatitis A, Hepatitis B,Tdap, and influenza vaccinations.Apeer support group was also initiated.We analyzed patient descriptors, retention in treatment, and primary care services during the period from program initiation on July 3, 2019 to January 20, 2019. Results: Forty-six patients were induced on buprenorphine during the study period. Thirty-seven out of 46 were experiencing homelessness, 3 of whom obtained housing during the study period. Two out of 46 (3%) patients were HIV positive, 25/46 (54%) had hepatitis C infection, and 40/46 (87%) had a documented psychiatric diagnosis. Twenty-five out of 46 (54%) patients maintained an active buprenorphine prescription in our program, 28/46 (60%) continued buprenorphine at any area program including our own, and 3/46 (7%) transitioned to methadone treatment, for an overall OUD treatment retention rate of 67%. Eleven out of 25 (44%) active patients had no opioids aside from buprenorphine present on their most recent toxicology screen, and 18/25 (72%) demonstrated reduction in use by negative drug testing for opioids. Twenty-eight out of 46 (61%) patients had documentation of PrEP eligibility during buprenorphine induction and 5/28 (18%) initiated PrEP, 1 of whom continued for longer than 1 month. Eighteen out of 46 (39%) individuals received at least 1 vaccine, 12 receiving Hepatitis A vaccine. Conclusions: GLFHC's mobile clinic has given a highly vulnerable population access to OUD treatment, harm reduction and primary care services, and retention rates thus far appear comparable with those reported in traditional primary care settings. Alhough continued efforts are needed to expand PrEP uptake and vaccination coverage, this model shows great promise for lowering the overall burden of addiction and its infectious comorbidities in our community. AD - R. Dono AU - Dono, R. AU - Younkin, M. AU - Lee, R. AU - Bositis, A. AU - Bositis, C. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - buprenorphine hepatitis A vaccine naloxone opiate addiction adult case report clinical article clinician comorbidity conference abstract counseling documentation driver drug screening drug therapy ethnic group family health female follow up general practitioner harm reduction health center hepatitis A hepatitis B hepatitis C homelessness housing human Human immunodeficiency virus infection influenza vaccination injection drug user insurance interview male Massachusetts medical assistant medically uninsured methadone treatment multidisciplinary team nurse practitioner pharmacokinetics phlebotomy pre-exposure prophylaxis prescription psychiatric diagnosis support group syringe toxicology vaccination coverage vulnerable population LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E9 ST - Implementation of a mobile buprenorphine clinic T2 - Journal of Addiction Medicine TI - Implementation of a mobile buprenorphine clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628536421&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931121 ER - TY - JOUR AB - The current policy environment provides the opportunity for federal and state agencies to work with private and nonprofit sectors to transform the American health care system through development of a comprehensive set of community-based, recovery-oriented, and evidence-based services for people with mental and substance use disorders. This Assessing the Evidence Base Series (AEB Series) provides science-supported information about selected mental health and substance abuse services for health care leaders. Series authors conducted reviews of research on 14 behavioral health services: behavioral management for children and adolescents, trauma-focused cognitive-behavioral therapy for children and adolescents, recovery housing, residential treatment for individuals with substance use disorders, peer support services for individuals with serious mental illnesses, peer recovery support for individuals with substance use disorders, permanent supportive housing, supported employment, substance abuse intensive outpatient programs, skill building, intensive case management, consumer and family psychoeducation, medication-assisted treatment with methadone, and medication-assisted treatment with buprenorphine. The goal of the AEB Series is to provide a framework for decision makers to build a modern addictions and mental health service system for the people who use these services and the people who provide them. The framework is intended to support decisions about the services that are likely to be most effective. This introduction to the AEB Series explains the methods used to conduct the reviews, rate the research evidence, and describe the effectiveness of the services. The rationale underlying recommendations for implementation of the services is also discussed, and suggestions are offered for future research. AN - 24141894 AU - Dougherty, R. H. AU - Lyman, D. R. AU - George, P. AU - Ghose, S. S. AU - Daniels, A. S. AU - Delphin-Rittmon, M. E. DA - Jan 1 DO - 10.1176/appi.ps.201300214 DP - NLM ET - 2013/10/22 J2 - Psychiatric services (Washington, D.C.) KW - Evidence-Based Practice/legislation & jurisprudence/methods/*standards Humans Mental Health Services/legislation & jurisprudence/*standards Process Assessment, Health Care/legislation & jurisprudence/methods/*standards LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2014 SN - 1075-2730 SP - 11-5 ST - Assessing the evidence base for behavioral health services: introduction to the series T2 - Psychiatr Serv TI - Assessing the evidence base for behavioral health services: introduction to the series VL - 65 ID - 930952 ER - TY - JOUR AB - Background: Buprenorphine is an alternative to methadone for the out-patient management of opiate dependence. When used for this indication, methadone prescribing is limited to opioid addition clinics; usually in single doses and take-home weekend doses. The Drug Addiction Treatment Act of 2000 allowed practitioners not affiliated with FDA approved opioid addiction clinics the ability to prescribe buprenorphine and to allow retail pharmacies to dispense multiple day quantities. Since the Treatment Act was signed into law, the number of providers in WV that can prescribe buprenorphine has been increasing. In WV, 81 private physicians and 18 treatment centers can now prescribe this drug. The purpose of this study was to determine if the change in prescription practices for buprenorphine increased the number of pediatric exposures reported to the WV poison center. For comparison, as methadone laws were unchanged, the number of methadone-related exposures was reviewed. Methods: A retrospective review of the number of reported exposures to buprenorphine and methadone in children ≤5 years between 2001 and 2009. Results: In 2008 and 2009, approx. 50 vs. <10% of unintentional ingestions in children ≤5 years were to burprenorphine and methadone respectively. Conclusions: Pediatric buprenorphine exposures rose during the period the number of physicians in WV that (Table presented) could prescribe buprenorphine increased. Poison prevention education should accompany information provided when buprenorphine is dispensed. AD - L.F. Durbac-Morris, West Virginia University, Charleston, WV, United States AU - Durbac-Morris, L. F. AU - Scharman, E. J. DB - Embase DO - 10.3109/15563650.2010.493290 KW - buprenorphine methadone opiate poison child toxicology victim exposure physician hospital ingestion prevention opiate addiction patient care education single drug dose drug dependence outpatient addiction pharmacy (shop) prescription poison center Food and Drug Administration LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2010 SN - 1556-3650 SP - 616 ST - Are children the unintended victims of changes in buprenorphine prescribing practices? T2 - Clinical Toxicology TI - Are children the unintended victims of changes in buprenorphine prescribing practices? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70273089&from=export http://dx.doi.org/10.3109/15563650.2010.493290 VL - 48 ID - 931213 ER - TY - JOUR AB - OBJECTIVE: To develop effective pharmacy-based interventions to mitigate harm from opioid use disorders. Programs include responsible opioid prescribing, expanded access to medication-assisted treatment (MAT), naloxone, and community interventions. SETTING: Clinical pharmacists practicing at Indian Health Service (IHS) locations in the Southwest, Midwest, and Great Lakes regions. These pharmacists serve culturally diverse American Indian populations throughout the United States and interface with tribal and federal programs to impact the opioid epidemic in Indian Country. PRACTICE DESCRIPTION: Pharmacists have reduced barriers to care by expanding clinical practices to include novel approaches in pain management clinics and MAT programs. PRACTICE INNOVATION: As part of a multidisciplinary team, IHS pharmacists provide comprehensive patient care while focusing on the prevention of opioid dependence and opioid overdose death. EVALUATION: Pharmacists have also expanded professional competencies to include coprescribing naloxone and training first responders on naloxone use. RESULTS: Pharmacists within IHS have proactively completed advanced training on responsible opioid prescribing, augmented services to increase access to MAT for American Indians and Alaska Natives, and increased access to naloxone for opioid overdose reversal. Pharmacists have also developed a comprehensive training program and program measurement tools for law enforcement officers serving in tribal communities. These materials were used to train 350 officers in 6 districts and conduct a mass naloxone dispensing initiative across Indian Country. Pharmacists have consequently developed successful community coalitions that are focused on saving lives. CONCLUSIONS: Pharmacist involvement in key initiatives including responsible opioid prescribing, expanded access to MAT, and expanded access to naloxone for trained first responders, coupled with an emphasis on enhanced education, illustrates pharmacists' impact with the opioid epidemic. AN - 28292501 AU - Duvivier, H. AU - Gustafson, S. AU - Greutman, M. AU - Jangchup, T. AU - Harden, A. K. AU - Reinhard, A. AU - Warshany, K. DA - Mar-Apr DO - 10.1016/j.japh.2017.01.005 DP - NLM ET - 2017/03/16 J2 - Journal of the American Pharmacists Association : JAPhA KW - Analgesics, Opioid/administration & dosage/*adverse effects Clinical Competence Drug Overdose/*drug therapy Health Services Accessibility Humans Naloxone/*administration & dosage/supply & distribution Narcotic Antagonists/administration & dosage/supply & distribution Opioid-Related Disorders/complications/prevention & control Pain Management/methods Patient Care Team/organization & administration Pharmaceutical Services/organization & administration Pharmacists/*organization & administration Practice Patterns, Physicians' United States United States Indian Health Service LA - eng M1 - 2s N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1086-5802 SP - S135-s140 ST - Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone T2 - J Am Pharm Assoc (2003) TI - Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone VL - 57 ID - 930976 ER - TY - JOUR AB - Opioid use disorder (OUD) is a mounting public health problem with substantial morbidity and mortality. Stress involvement in the course of OUD is generally accepted, but little is understood about the underlying neurobiological mechanisms in part due to a lack of laboratory-based models for chronic stress exposure. Post-traumatic stress disorder (PTSD) may be construed as a psychopathological prototype of chronic stress owing to the essential diagnostic criteria of experiencing and reliving a stressful event(s). Literature search on OUD and PTSD neurobiology was undertaken and the relevant data were integrated within four key areas: (1) OUD and PTSD comorbidity; (2) neurobiological overlap between OUD and PTSD; (3) chronic opioids- and stress-induced alterations of the reward-, stress- (i.e., "anti-reward") and related circuits and (4) mechanistically informed treatments of OUD and/or PTSD. Our findings suggest that even in the absence of prior opioid exposure PTSD patients may be susceptible for the development of OUD by the reason of similar (to those induced by opioids) reward alterations that may be targeted for therapeutic interventions. AD - Department of Psychiatry, Cooper Medical School, Rowan University, Camden, NJ, United States. Electronic address: elman-igor@CooperHealth.edu. Center for Pain and the Brain, Boston Children's Hospital, Massachusetts General Hospital and McLean Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston MA, United States. AN - 31063739 AU - Elman, I. AU - Borsook, D. DA - Aug DO - 10.1016/j.neubiorev.2019.04.023 DP - NLM ET - 2019/05/08 J2 - Neuroscience and biobehavioral reviews KW - Brain/metabolism/*physiopathology *Comorbidity Humans Opioid-Related Disorders/epidemiology/*physiopathology *Reward Stress Disorders, Post-Traumatic/epidemiology/*physiopathology *Aberrant learning *Addiction *Anti-reward *Buprenorphine *Conditioned stimulus *Corticotropin-releasing factor *Craving *Dopamine *Dynorphin *Gender *Glutamate *Homeostasis *Medication-assisted treatment *Norepinephrine *Reinforcement *Sensitization LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0149-7634 SP - 374-383 ST - The failing cascade: Comorbid post traumatic stress- and opioid use disorders T2 - Neurosci Biobehav Rev TI - The failing cascade: Comorbid post traumatic stress- and opioid use disorders VL - 103 ID - 930858 ER - TY - JOUR AB - OBJECTIVE: The aim of this study was the following. When the different dynamics of agonist or antagonist treatments considered it is assumed that the eligible treatment to the individual may be maintained with high efficacy. Thus, we aimed to examine the difference between treatment methods, considering sociodemographics and positive perception for treatment success. METHODS: The number of 136 individuals which their ages range between 19-50 and have been getting agonist (buprenorphine/naloxone) or antagonist (naltrexone) treatment because of opioid use disorder while resting in clinics have been evaluated to reveal the factors that may alter their perception about treatment and have been compared with sociodemographic variables and characteristics such as sociotropic and autonomic. Therefore, "Sociodemographic Data Evaluation Form," "Predictive Factors for The Addiction Treatment Success Scale," and "Sociotropy-Autonomy Scale" were used to assess the sociodemographic data, the perception towards factors which have been affected to the treatment and characteristics. The data of the individuals have been collected by the researcher via face-to-face interviews while patients were residential in the clinic. RESULTS: According to results of our study, it has been detected that there are some differences in the perception of treatment success between individuals who have been getting agonist or antagonist treatments such as treatment method (p<0.05), treatment frequency (p<0.01) and parents' vital statuses (p<0.05). CONCLUSION: At the end of the study it has been understood that medical and social benefits after the selection of eligible treatment methods which is suitable for individual's perception and characteristics have to be considered. AD - Çukurova University, Addiction and Forensic Sciences Institue, Adana, Turkey. AN - 33301668 AU - Erk, M. A. AU - Firat, S. DA - Dec 11 DO - 10.30773/pi.2020.0307 DP - NLM ET - 2020/12/11 J2 - Psychiatry investigation KW - Agonist Antagonist Implant Opioid use disorder Perception Success of treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1738-3684 (Print) 1738-3684 ST - Types of Medication-Assisted Treatment for Opioid Use Disorder in Turkey: The Perceptions of Inpatients about Treatment Success T2 - Psychiatry Investig TI - Types of Medication-Assisted Treatment for Opioid Use Disorder in Turkey: The Perceptions of Inpatients about Treatment Success ID - 930861 ER - TY - JOUR AB - As opioid use disorder (OUD) reaches epidemic levels in the United States, medication-assisted treatment (MAT) plays a central role in its treatment. Methadone, a long-acting mu-opioid receptor agonist has been shown to be effective in managing OUD. It is also known that chronic opioid therapy may have the paradoxical effect of increased sensitivity to pain, a phenomenon called opioid-induced hyperalgesia (OIH). This presents a conundrum when a patient such as ours, on MAT presents with acute pain and OIH. This case report illustrates the current challenges health care providers encounter when treating patients on chronic MAT for non-opioid-related conditions. As this patient population ages, these encounters will become more common. These patients will need appropriate health care screening and chronic care management. This case serves two purposes; to highlight the difficulty in treating acute pain in patients on long-term high-dose methadone coupled with the missed opportunity for primary care for OUD patient population, and proposes that education reforms in this area be implemented now. AD - Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA. AN - 33520540 AU - Ezeh, E. AU - Singh, D. AU - Dobariya, V. AU - Akhigbe, E. J. AU - Gilkerson, C. C2 - Pmc7837638 DA - Dec 28 DO - 10.7759/cureus.12345 DP - NLM ET - 2021/02/02 J2 - Cureus KW - high-dose methadone maintenance therapy opioid use disorder opioid-induced hyperalgesia LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2168-8184 (Print) 2168-8184 SP - e12345 ST - Opioid-Induced Hyperalgesia in a Cancer Patient on High-Dose Methadone Maintenance Therapy: A Case for Subspecialty Opioid Use Disorder Primary Care T2 - Cureus TI - Opioid-Induced Hyperalgesia in a Cancer Patient on High-Dose Methadone Maintenance Therapy: A Case for Subspecialty Opioid Use Disorder Primary Care VL - 12 ID - 931004 ER - TY - JOUR AB - IMPORTANCE: Opioid use disorder (OUD) is a significant cause of morbidity and mortality in the US, yet many individuals with OUD do not receive treatment. OBJECTIVE: To assess the cost-effectiveness of OUD treatments and association of these treatments with outcomes in the US. DESIGN AND SETTING: This model-based cost-effectiveness analysis included a US population with OUD. INTERVENTIONS: Medication-assisted treatment (MAT) with buprenorphine, methadone, or injectable extended-release naltrexone; psychotherapy (beyond standard counseling); overdose education and naloxone distribution (OEND); and contingency management (CM). MAIN OUTCOMES AND MEASURES: Fatal and nonfatal overdoses and deaths throughout 5 years, discounted lifetime quality-adjusted life-years (QALYs), and costs. RESULTS: In the base case, in the absence of treatment, 42 717 overdoses (4132 fatal, 38 585 nonfatal) and 12 660 deaths were estimated to occur in a cohort of 100 000 patients over 5 years, and 11.58 discounted lifetime QALYs were estimated to be experienced per person. An estimated reduction in overdoses was associated with MAT with methadone (10.7%), MAT with buprenorphine or naltrexone (22.0%), and when combined with CM and psychotherapy (range, 21.0%-31.4%). Estimated deceased deaths were associated with MAT with methadone (6%), MAT with buprenorphine or naltrexone (13.9%), and when combined with CM, OEND, and psychotherapy (16.9%). MAT yielded discounted gains of 1.02 to 1.07 QALYs per person. Including only health care sector costs, methadone cost $16 000/QALY gained compared with no treatment, followed by methadone with OEND ($22 000/QALY gained), then by buprenorphine with OEND and CM ($42 000/QALY gained), and then by buprenorphine with OEND, CM, and psychotherapy ($250 000/QALY gained). MAT with naltrexone was dominated by other treatment alternatives. When criminal justice costs were included, all forms of MAT (with buprenorphine, methadone, and naltrexone) were associated with cost savings compared with no treatment, yielding savings of $25 000 to $105 000 in lifetime costs per person. The largest cost savings were associated with methadone plus CM. Results were qualitatively unchanged over a wide range of sensitivity analyses. An analysis using demographic and cost data for Veterans Health Administration patients yielded similar findings. CONCLUSIONS AND RELEVANCE: In this cost-effectiveness analysis, expanded access to MAT, combined with OEND and CM, was associated with cost-saving reductions in morbidity and mortality from OUD. Lack of widespread MAT availability limits access to a cost-saving medical intervention that reduces morbidity and mortality from OUD. Opioid overdoses in the US likely reached a record high in 2020 because of COVID-19 increasing substance use, exacerbating stress and social isolation, and interfering with opioid treatment. It is essential to understand the cost-effectiveness of alternative forms of MAT to treat OUD. AD - Department of Management Science and Engineering, Stanford University, Stanford, California. Center for Innovation to Implementation, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Veterans Affairs Health Services Research and Development Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California. Veterans Affairs Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, VA Central Office, US Department of Veterans Affairs, Palo Alto, California. Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California. Department of Medicine, Stanford University, Stanford, California. AN - 33787832 AU - Fairley, M. AU - Humphreys, K. AU - Joyce, V. R. AU - Bounthavong, M. AU - Trafton, J. AU - Combs, A. AU - Oliva, E. M. AU - Goldhaber-Fiebert, J. D. AU - Asch, S. M. AU - Brandeau, M. L. AU - Owens, D. K. C2 - PMC8014209 Graduate Fellowship from Stanford University. Dr Humphreys was supported by Veterans Affairs Research and Development Service (grant RCS 04-141-3) and National Institute on Drug Abuse (grant 2UG1DA015815-19). Dr Trafton serves on the board of directors of Institute for Brain Potential outside the submitted work. Dr Asch reports grants from Facebook during the conduct of the study. Dr Owens reports grants from National Institutes of Health and Veterans Health Administration during the conduct of the study. No other disclosures were reported. DA - Mar 31 DO - 10.1001/jamapsychiatry.2021.0247 DP - NLM ET - 2021/04/01 J2 - JAMA psychiatry LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 2168-622X (Print) 2168-622x ST - Cost-effectiveness of Treatments for Opioid Use Disorder T2 - JAMA Psychiatry TI - Cost-effectiveness of Treatments for Opioid Use Disorder ID - 930988 ER - TY - JOUR AB - INTRODUCTION: Smoking during pregnancy is a major public health issue, contributing to adverse health outcomes. The vast majority of women with substance use disorders smoke during the perinatal period. Medication Assisted Treatment (MAT) is the standard of care for women using opioids during pregnancy. The majority of women engaged in MAT (88%-95%) report smoking. The purposes of this study were to describe: (1) facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT; and (2) strategies to tailor tobacco treatment interventions with this population. METHODS: Two semi-structured focus groups lasting approximately 45 minutes each were conducted with 22 women engaged in MAT. Focus groups were recorded, transcribed and analyzed in MAXQDA using content analysis. RESULTS: Participants reported: (1) desire to quit smoking for themselves and their children; (2) aversion to smoking; (3) a turning point in their lives from being pregnant and entering MAT; (4) nicotine dependence; (5) smoking as a way to cope with stress; (6) coping with dual dependencies; (7) past experiences with stopping smoking due to smoking restrictions; (8) perceived lack of success with nicotine replacement therapy or other tobacco treatment medications; and (9) the need for intensive environmental support for quit attempts. CONCLUSIONS: Participants were motivated to quit smoking, but faced multiple complex barriers. Integrating tobacco treatment into the psychosocial services offered in conjunction with MAT would allow a healthcare provider to offer tailored tobacco treatment in a supportive environment. IMPLICATIONS: Results of this qualitative study include facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT, as well as strategies to tailor tobacco treatment interventions for this population. In-depth knowledge of the complex barriers facing this patient population can be used to inform tailored tobacco treatment services that can be integrated into clinics providing MAT. AD - College of Nursing, University of Kentucky, Lexington, KY Amanda.fallin@uky.edu. College of Nursing, University of Kentucky, Lexington, KY. AN - 26817489 AU - Fallin, A. AU - Miller, A. AU - Ashford, K. C2 - Pmc4941599 DA - Aug DO - 10.1093/ntr/ntw023 DP - NLM ET - 2016/01/29 J2 - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco KW - Adult Female Focus Groups Humans Opioid-Related Disorders/*complications/prevention & control Outpatients Pregnancy Pregnancy Complications/prevention & control/*psychology *Pregnant Women *Prenatal Care Smoking/*psychology Smoking Cessation/methods Smoking Prevention Young Adult LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 1462-2203 (Print) 1462-2203 SP - 1727-32 ST - Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry T2 - Nicotine Tob Res TI - Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry VL - 18 ID - 930940 ER - TY - JOUR AB - Background: Emergency Departments (EDs) are uniquely positioned to identify patients at risk for opioid-related complications, but have not historically offered medication assisted treatment (MAT). Recently, several studies suggest that ED-initiated programs that include brief interventions and buprenorphine/naloxone initiation have increased engagement with addiction treatment programs and reduced self-reported illicit drug use. In August 2018, the Massachusetts legislature introduced an act that requires EDs to offer MAT. In response, a multidisciplinary workgroup was formed to lead a quality improvement project aimed at increasing MAT in the ED at our institution. Methods: At a 500 bed teaching hospital, a multidisciplinary workgroup comprised of representatives from the departments of addiction, emergency medicine, and pharmacy collaborated to increase ED-initiated MAT. The workgroup developed and implemented a MAT treatment pathway which started on 9/1/2018. Throughout the project, several interventions were implemented in response to newly identified areas for improvement including but not limited to healthcare staff MAT education, stocking MAT in the automated dispensing cabinets, and obtaining DEA X-waivers. Outcome measures included the monthly number of methadone or buprenorphine/naloxone doses administered in the ED, rescue naloxone administration following MAT in the ED, and number of discharge prescriptions for buprenorphine/ naloxone. Statistical significance was determined using Shewhart process control charts. Results: During the 12 months pre-intervention and 6 months post-intervention, 669 doses of methadone or buprenorphine/naloxone were administered in the ED. In the same time period, the median number of doses significantly increased from 24 to 87 per month. Administration of methadone and buprenorphine/naloxone were similar. Few patients received more than one dose of methadone or buprenorphine/naloxone. The median number of buprenorphine/naloxone discharge prescriptions increased from 0 to 2 per month. No patients received rescue naloxone following MAT administration. All patients receiving MAT were offered the opportunity to meet with the licensed substance abuse counselors and/or addiction medicine specialists for assistance with treatment referrals. Conclusions: Implementation of a multidisciplinary, ED-initiated treatment pathway for opioid dependence increased the number of patients receiving MAT in the ED. AD - N. Farrell, Boston Medical Center AU - Farrell, N. AU - Lookabill, S. AU - Fett, D. AU - Nentwich, L. DB - Embase DO - 10.1080/15563650.2019.1636569 KW - buprenorphine plus naloxone methadone naloxone opiate addiction medicine adult adverse drug reaction complication conference abstract controlled study counselor drug combination drug therapy education emergency medicine emergency ward human opiate addiction outcome assessment prescription process control side effect staff statistical significance substance abuse teaching hospital total quality management LA - English M1 - 10 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1556-9519 SP - 1003 ST - Implementation of an emergency department-initiated opioid dependence treatment pathway T2 - Clinical Toxicology TI - Implementation of an emergency department-initiated opioid dependence treatment pathway UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628977102&from=export http://dx.doi.org/10.1080/15563650.2019.1636569 VL - 57 ID - 931143 ER - TY - JOUR AB - BACKGROUND: Opioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release. RESULTS: All four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release. CONCLUSIONS: Adoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs. AD - Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. warren.ferguson@umassmemorial.org. St. Vincent Hospital, Worcester, MA, 01608, USA. Rhode Island Department of Corrections, 40 Howard Ave, Cranston, RI, 02920, USA. Sheriff, Middlesex County, 400 Mystic Ave, 4th Fl., Medford, MA, 02155, USA. Connecticut Department of Correction, 24 Wolcott Hill Rd., Wethersfield, CT, 06109, USA. Health and Addiction Services, Connecticut Department of Correction, 24 Wolcott Hill Rd, Wethersfield, CT, 06109, USA. University Correctional health Care, Bates Bldg, 2nd Fl, New Jersey Department of Corrections, Trenton, NJ, 08625-0863, USA. Health and Criminal Justice Program, University of Massachusetts Medical School, 333 South St., Shrewsbury, MA, 01545, USA. Center for Advancing Correctional Excellence, 4087 University Drive, 4100, MSN6D3, Fairfax, VA, 22030, USA. AN - 31832801 AU - Ferguson, W. J. AU - Johnston, J. AU - Clarke, J. G. AU - Koutoujian, P. J. AU - Maurer, K. AU - Gallagher, C. AU - White, J. AU - Nickl, D. AU - Taxman, F. S. C2 - Pmc6908545 DA - Dec 12 DO - 10.1186/s40352-019-0100-2 DP - NLM ET - 2019/12/14 J2 - Health & justice KW - Criminal justice Implementation science Mat Opioid Uptake LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2194-7899 (Print) 2194-7899 SP - 19 ST - Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails T2 - Health Justice TI - Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails VL - 7 ID - 930892 ER - TY - JOUR AB - Opioid dependence is a chronic relapsing medical condition with substantial health and societal complications. Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a process for federal exemptions to allow for pharmacologic treatment in office settings, waivers for the use of new medications, and new rules governing the oversight and distribution of opioid agonist medications for maintenance treatment. This perspective describes these initiatives and their implications for internists. AD - Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025, USA. david.fiellin@yale.edu AN - 12379070 AU - Fiellin, D. A. AU - O'Connor, P. G. DA - Oct 15 DO - 10.7326/0003-4819-137-8-200210150-00014 DP - NLM ET - 2002/10/16 J2 - Annals of internal medicine KW - Ambulatory Care Drug Prescriptions Education, Medical, Continuing *Government Programs Humans *Legislation, Drug Narcotics/agonists Opioid-Related Disorders/*therapy Research United States United States Food and Drug Administration LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2002 SN - 0003-4819 SP - 688-92 ST - New federal initiatives to enhance the medical treatment of opioid dependence T2 - Ann Intern Med TI - New federal initiatives to enhance the medical treatment of opioid dependence VL - 137 ID - 931024 ER - TY - JOUR AB - OBJECTIVE: Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt. METHOD: VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis. RESULTS: Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership. CONCLUSIONS: Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD. AD - Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California. National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, California. Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California. Kidney Health Research Collaborative, University of California San Francisco and VA San Francisco Health Care System, San Francisco, California. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Department of Veterans Affairs, Veterans Health Administration, Salem, Virginia. Department of Surgery, Stanford University School of Medicine, Stanford, California. AN - 30573022 AU - Finlay, A. K. AU - Wong, J. J. AU - Ellerbe, L. S. AU - Rubinsky, A. AU - Gupta, S. AU - Bowe, T. R. AU - Schmidt, E. M. AU - Timko, C. AU - Burden, J. L. AU - Harris, A. H. S. C2 - Pmc6308173 C6 - Nihms988731 DA - Nov DO - 10.15288/jsad.2018.79.909 DP - NLM ET - 2018/12/24 J2 - Journal of studies on alcohol and drugs KW - Analgesics, Opioid/therapeutic use Buprenorphine/*therapeutic use Cohort Studies Female *Hospitals, Veterans/trends Humans Male Methadone/therapeutic use Naltrexone/therapeutic use Opioid-Related Disorders/diagnosis/*drug therapy/epidemiology Residential Treatment/*methods/trends United States/epidemiology *United States Department of Veterans Affairs/trends *Veterans/psychology LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1937-1888 (Print) 1937-1888 SP - 909-917 ST - Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs T2 - J Stud Alcohol Drugs TI - Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs VL - 79 ID - 930902 ER - TY - JOUR AB - It has taken the tragedy of swelling opioid overdoses to raise addictions to national attention. This past year, a new law called the Comprehensive Addictions Recovery Act has helped to open doors for nurse practitioners and physician assistants to prescribe buprenorphine. Although this medication can assist those dependent on opioids in finding needed stability, medication-assisted treatment is only the beginning. Addiction and psychiatric nurses must play a larger role in providing various therapies that coincide with medication-assisted treatment to support ongoing recovery. One treatment option is group therapy, which is effective for individuals with substance use as well as other co-occurring disorders to develop needed skills to remain in recovery. The purpose of this review is to explore the nursing role in group therapy for substance use as well as encourage addictions and psychiatric nurse practitioners to offer recovery-focused group therapy to this population. AD - Susanne A. Fogger, DNP, CRNP, PMHNP-BC, CARN-AP, FAANP, VA Nursing Academic Partnership-Graduate Education for Psychiatric Nurse Practitioners, School of Nursing, University of Alabama at Birmingham. Kathleen Lehmann, EdD(c), RN-BC, PMHN, CCTP, Edith Nourse Rogers VAMC, Bedford, MA. AN - 28863059 AU - Fogger, S. A. AU - Lehmann, K. DA - Jul/Sep DO - 10.1097/jan.0000000000000180 DP - NLM ET - 2017/09/02 J2 - Journal of addictions nursing KW - Buprenorphine/administration & dosage/*therapeutic use Humans Narcotic Antagonists/administration & dosage/*therapeutic use *Nurse's Role Opiate Substitution Treatment Opioid-Related Disorders/drug therapy/*nursing/rehabilitation *Practice Patterns, Nurses' United States LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1088-4602 SP - 152-156 ST - Recovery Beyond Buprenorphine: Nurse-Led Group Therapy T2 - J Addict Nurs TI - Recovery Beyond Buprenorphine: Nurse-Led Group Therapy VL - 28 ID - 930815 ER - TY - JOUR AB - The Drug Addiction Treatment Act of 2000 (DATA 2000) changed addiction treatment in the United States by enabling physicians to treat opioid addiction in settings that do not require specific Federal/State licensure (i.e., physician offices). The legislation (U.S. Dept. of HHS, 2000) requires physicians to complete certification training and obtain a waiver from the Drug Enforcement Agency in order to prescribe and dispense approved opioid medications. In 2002, buprenorphine products (Suboxone (R) and Subutex (R)) became the first medications to be approved by the Food and Drug Administration (FDA) for use in office-based opioid treatment. Office-based opioid treatment (OBOT) is intended to address several needs in accordance with public health objectives, by increasing access to treatment for opioid addiction, offering treatment to patients outside the traditional methadone clinic system, and "mainstreaming" the treatment of opioid addiction by coordinating it with treatment of other medical conditions (Substance Abuse and Mental Health Services Administration-Center for Substance Abuse Treatment [SAMHSA-CSAT], 2001). Physicians have been slow to adopt OBOT. They are specifically prohibited from delegating buprenorphine prescribing functions to non-physicians. Advanced practice nurses (APNs), nurse practitioners (NPs) and physician assistants (PAs) are not permitted to prescribe buprenorphine, even if they have prescriptive authority in the states in which they practice, despite their interests in prescribing it. This limits the uptake of buprenorphine as a new treatmentmodality, inhibits the expansion of opioid treatment, and restricts access to buprenorphine by individuals with opioid addiction (Fornili & Burda-Cohee, 2006; Roose, Kunins, Sohler, Elam & Cunningham, 2008). The Geelhoed-Schouwstra framework is useful in determining whether policy outcomes are likely to be attributed to the policy( ies) of interest, or rather to other exogenous factors that may somehow have influenced those outcomes (Schouwstra & Ellman, 2006). In a previous issue of the Journal of Addictions Nursing, the model was used to explore how extraneous influences may affect implementation of policies and programs that promote treatment integration for individuals with co-occurring psychiatric and addiction problems (Fornili, 2008). In this column, we examine policies related to the implementation of buprenorphine therapy, and explore various exogenous influences (barriers) that contribute to its underperformance. In particular, we attempt to answer two important questions: Why is it that more waivered physicians are not prescribing buprenorphine? And why is it that nurse prescribers cannot prescribe it? Exploring these questions from their conceptual, institutional and historical perspectives may promote greater understanding, discussion, and collaboration among clinicians to further enhance access to care for patients in need of treatment for opioid addiction. AD - [Fornili, Katherine; Burda, Charon] Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Fornili, K (corresponding author), Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. AN - WOS:000208627600009 AU - Fornili, K. AU - Burda, C. DA - Dec DO - 10.3109/10884600903290424 J2 - J. Addict. Nurs. KW - Advanced practice nurses (APNs) Buprenorphine access Buprenorphine prescribing Explanatory model for policy analysis Geelhoed-schouwstra framework Nurse practitioners (NPs) Nurse prescribers Prescriptive authority Opioid addiction Policy analysis ADDICTION TREATMENT MANAGEMENT BARRIERS POLICY CARE Substance Abuse Nursing LA - English M1 - 4 M3 - Editorial Material N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2009 SN - 1088-4602 SP - 218-226 ST - Buprenorphine Prescribing: Why Physicians Aren't and Nurse Prescribers Can't T2 - Journal of Addictions Nursing TI - Buprenorphine Prescribing: Why Physicians Aren't and Nurse Prescribers Can't UR - ://WOS:000208627600009 VL - 20 ID - 931300 ER - TY - JOUR AB - The aim of this Policy Watch column is to provide an update on a much anticipated legislation, enacted in 2016, which enabled office-based opioid treatment (OBOT) with buprenorphine prescribing for the treatment of opioid addiction by nurse practitioners (as well as physician assistants). First, an overview of the Drug Addiction Treatment Act of 2000, which only permitted OBOT prescribing by physicians, will be described. It will be followed by a summary of the Recovery Enhancement for Addiction Treatment Act of 2015-2016. Finally, a review of the Comprehensive Addiction Recovery Act of 2016 will be provided, which includes information about important changes to OBOT regulations that enable NP prescribing of buprenorphine for the treatment of opioid addiction. AU - Fornili, K. S. AU - Fogger, S. A. DB - Medline DO - 10.1097/JAN.0000000000000160 KW - buprenorphine narcotic antagonist drug legislation human nurse practitioner opiate addiction prescription LA - English M1 - 1 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2017 SN - 1548-7148 SP - 43-48 ST - Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016 T2 - Journal of addictions nursing TI - Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617206784&from=export http://dx.doi.org/10.1097/JAN.0000000000000160 VL - 28 ID - 931173 ER - TY - JOUR AB - STUDY OBJECTIVE: Emergency department (ED) initiation of buprenorphine for patients with opioid use disorder increases treatment engagement but remains an uncommon practice. One important barrier to ED-initiated buprenorphine is the additional training requirement (X waiver). Our objective is to evaluate the influence of a financial incentive program on emergency physician completion of X-waiver training. Secondary objectives are to evaluate the program's effect on buprenorphine prescribing and to explore physician attitudes toward the incentive. METHODS: We conducted a prospective, observational cohort study set in 3 urban academic EDs before and after implementation of a financial incentive program providing $750 for completion of X-waiver training. We describe program participation as well as rates of buprenorphine prescribing per opioid use disorder-related encounter before and after the intervention period, using electronic health record data. We also completed a postintervention physician survey assessing attitudes about the incentive program. RESULTS: Overall, 89% of eligible emergency physicians (56/63) completed the X-waiver training during the 6-week incentive period. In the 5 months after the incentive, buprenorphine prescribing per opioid use disorder-related encounter increased from 0.5% to 16% (Δ 15%; 95% confidence interval 10.6% to 19.9%), with substantial variability across sites (range 8% to 22% of opioid use disorder-related encounters). In a postintervention survey, 67% of participating physicians indicated that they would have completed the training for a lower amount. CONCLUSION: A financial incentive paying approximately half the clinical rate was effective in promoting emergency physician X-waiver training. The effect on ED-based buprenorphine prescribing was positive but variable across sites, and likely dependent on the availability of additional supports. AD - Department of Emergency Medicine,University of Pennsylvania, Philadelphia, PA. Electronic address: sean.foster@pennmedicine.upenn.edu. Department of Emergency Medicine,University of Pennsylvania, Philadelphia, PA; Center for Digital Health at the Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA. Department of Emergency Medicine,University of Pennsylvania, Philadelphia, PA. Center for Digital Health at the Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA. Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA. AN - 32376089 AU - Foster, S. D. AU - Lee, K. AU - Edwards, C. AU - Pelullo, A. P. AU - Khatri, U. G. AU - Lowenstein, M. AU - Perrone, J. DA - Aug DO - 10.1016/j.annemergmed.2020.02.020 DP - NLM ET - 2020/05/08 J2 - Annals of emergency medicine KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Certification Emergency Medicine/*education Humans *Motivation Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Prospective Studies LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0196-0644 SP - 206-214 ST - Providing Incentive for Emergency Physician X-Waiver Training: An Evaluation of Program Success and Postintervention Buprenorphine Prescribing T2 - Ann Emerg Med TI - Providing Incentive for Emergency Physician X-Waiver Training: An Evaluation of Program Success and Postintervention Buprenorphine Prescribing VL - 76 ID - 930839 ER - TY - JOUR AB - BACKGROUND: The United States has the highest rate of incarceration in the world (937 per 100,000 adults). Approximately one-third of heroin users pass through correctional facilities annually. Few receive medication assisted treatment (MAT; either methadone or buprenorphine) for opioid use disorder during incarceration, and nearly three-quarters relapse to heroin use within 3 months of release. This qualitative study investigated barriers to and facilitators of buprenorphine maintenance treatment (BMT) following release from incarceration ("re-entry"). METHODS: We conducted 21 semistructured interviews of former inmates with opioid use disorder recruited from addiction treatment settings. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team. RESULTS: Participants reported adverse re-entry conditions, including persistent exposure to drug use and stressful life events, which were perceived to contribute to opioid relapse and affected addiction treatment decisions during re-entry. Themes that emerged relating to BMT included: 1) reliance on willpower; 2) fear of dependency on medications; 3) variable exposure to buprenorphine; and 4) acceptability of BMT following relapse. Willpower was perceived to be more important for recovery than medications. Many participants experienced painful withdrawal from methadone during incarceration and were fearful that using MAT would lead to opioid tolerance and painful withdrawal again in the future. Participants reported both positive and negative experiences taking illicit buprenorphine, which affected interest in BMT. Overall, BMT was perceived to be a good treatment option for opioid use disorder that could reduce the risk of re-incarceration. CONCLUSIONS: BMT was perceived to be acceptable, but former inmates with opioid use disorder may be reluctant to utilize BMT upon re-entry. Factors limiting utilization of BMT could be mitigated though policy change or interventions. Policies of the criminal justice system (e.g., forced detoxification) may be dissuading former inmates from utilizing effective treatments for opioid use disorder. Interventions that improve education and access to BMT for former inmates with opioid use disorder could facilitate entrance into treatment. Both policy changes and interventions are urgently needed to reduce the negative consequences of opioid relapse following re-entry. AD - Albert Einstein College of Medicine, Bronx, NY, 10461, USA. adfox@montefiore.org. Montefiore Medical Center, Bronx, NY, 10467, USA. adfox@montefiore.org. Albert Einstein College of Medicine, Bronx, NY, 10461, USA. jmaradia@montefiore.org. New York Academy of Medicine, New York, NY, 10029, USA. Lweiss@nyam.org. Montefiore Medical Center, Bronx, NY, 10467, USA. jennsanc@montefiore.org. Albert Einstein College of Medicine, Bronx, NY, 10461, USA. jostarre@montefiore.org. Montefiore Medical Center, Bronx, NY, 10467, USA. jostarre@montefiore.org. Albert Einstein College of Medicine, Bronx, NY, 10461, USA. ccunning@montefiore.org. Montefiore Medical Center, Bronx, NY, 10467, USA. ccunning@montefiore.org. AN - 25592182 AU - Fox, A. D. AU - Maradiaga, J. AU - Weiss, L. AU - Sanchez, J. AU - Starrels, J. L. AU - Cunningham, C. O. C2 - Pmc4410477 DA - Jan 16 DO - 10.1186/s13722-014-0023-0 DP - NLM ET - 2015/01/17 J2 - Addiction science & clinical practice KW - Buprenorphine/*therapeutic use Continental Population Groups Female Goals Heroin Dependence/drug therapy/psychology Humans Interviews as Topic Male Middle Aged Opiate Substitution Treatment/*methods/*psychology Opioid-Related Disorders/*drug therapy/*psychology Prisoners/*psychology Qualitative Research Recurrence Self Efficacy United States LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 1940-0632 (Print) 1940-0632 SP - 2 ST - Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder T2 - Addict Sci Clin Pract TI - Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder VL - 10 ID - 930993 ER - TY - JOUR AB - BACKGROUND: With the Canadian government legalizing cannabis in the year 2018, the potential harms to certain populations-including those with opioid use disorder-must be investigated. Cannabis is one of the most commonly used substances by patients who are engaged in medication-assisted treatment for opioid use disorder, the effects of which are largely unknown. In this study, we examine the impact of baseline and ongoing cannabis use, and whether these are impacted differentially by gender. METHODS: We conducted a retrospective cohort study using anonymized electronic medical records from 58 clinics offering opioid agonist therapy in Ontario, Canada. One-year treatment retention was the primary outcome of interest and was measured for patients who did and did not have a cannabis positive urine sample in their first month of treatment, and as a function of the proportion of cannabis-positive urine samples throughout treatment. RESULTS: Our cohort consisted of 644 patients, 328 of which were considered baseline cannabis users and 256 considered heavy users. Patients with baseline cannabis use and heavy cannabis use were at increased risk of dropout (38.9% and 48.1%, respectively). When evaluating these trends by gender, only female baseline users and male heavy users are at increased risk of premature dropout. INTERPRETATION: Both baseline and heavy cannabis use are predictive of decreased treatment retention, and differences do exist between genders. With cannabis being legalized in the near future, physicians should closely monitor cannabis-using patients and provide education surrounding the potential harms of using cannabis while receiving treatment for opioid use disorder. AD - Northern Ontario School of Medicine, Sudbury, Ontario, Canada. Canadian Addiction Treatment Centers, Richmond Hill, Ontario, Canada. AN - 29117267 AU - Franklyn, A. M. AU - Eibl, J. K. AU - Gauthier, G. J. AU - Marsh, D. C. C2 - PMC5678697 maintains the following roles: Chief Medical Director at CATC, opioid agonist therapy provider, and Associate Dean of Community Engagement and Deputy Dean of the Northern Ontario School of Medicine. Dr. Marsh has no ownership stake in the CATC as a stipendiary employee. We do not foresee any conflict of interest as data will be made freely available to the public and the CATC, and the Universities have no ability to prevent publication and dissemination of knowledge. This does not alter our adherence to PLOS ONE policies on sharing data and materials. DO - 10.1371/journal.pone.0187633 DP - NLM ET - 2017/11/09 J2 - PloS one KW - Adult Analgesics, Opioid/*agonists Cannabis/*adverse effects Demography Female Humans Male Marijuana Abuse/*drug therapy Ontario Patient Dropouts Sex Characteristics LA - eng M1 - 11 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1932-6203 SP - e0187633 ST - The impact of cannabis use on patients enrolled in opioid agonist therapy in Ontario, Canada T2 - PLoS One TI - The impact of cannabis use on patients enrolled in opioid agonist therapy in Ontario, Canada VL - 12 ID - 930943 ER - TY - JOUR AD - a Department of Psychiatry , New York University School of Medicine , New York , New York , USA. b Hazelden/Betty Ford Foundation , Center City , Minnesota , USA. AN - 27163907 AU - Galanter, M. AU - Seppala, M. AU - Klein, A. DA - Jul-Sep DO - 10.1080/08897077.2016.1187241 DP - NLM ET - 2016/05/11 J2 - Substance abuse KW - Humans Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy/rehabilitation Residential Treatment/*methods *Self-Help Groups LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0889-7077 SP - 381-383 ST - Medication-assisted treatment for opioid dependence in Twelve Step-oriented residential rehabilitation settings T2 - Subst Abus TI - Medication-assisted treatment for opioid dependence in Twelve Step-oriented residential rehabilitation settings VL - 37 ID - 930897 ER - TY - JOUR AD - [Gardenier, Donald] Eisenhower Hlth, Palms Springs, CA 92270 USA. Gardenier, D (corresponding author), Eisenhower Hlth, Palms Springs, CA 92270 USA. dgardenier@gmail.com AN - WOS:000518818600016 AU - Gardenier, D. AU - Moore, D. J. AU - Patrick, S. R. DA - Mar DO - 10.1016/j.nurpra.2019.12.001 J2 - JNP-J. Nurse Pract. KW - Nursing LA - English M1 - 3 M3 - Editorial Material N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2020 SN - 1555-4155 SP - 174-175 ST - Have Waivers Allowing Nurse Practitioners to Treat Opioid Use Disorder Made a Difference in the Opioid Epidemic? T2 - Jnp-Journal for Nurse Practitioners TI - Have Waivers Allowing Nurse Practitioners to Treat Opioid Use Disorder Made a Difference in the Opioid Epidemic? UR - ://WOS:000518818600016 VL - 16 ID - 931247 ER - TY - JOUR AB - BACKGROUND: Healthcare providers can receive waivers to prescribe buprenorphine for opioid use disorder, an evidence-based medication. The United States federal government has undertaken numerous recent efforts to expand access to waivers. This study describes national trends in the U.S. in 2016 and 2018, geospatial characteristics of waivered providers, and the association of county characteristics with patient treatment capacity. METHODS: Administrative data were drawn for all U.S. counties in 2016 and 2018 for waivered providers, as well as characteristics of counties that may indicate disparities in provider availability. Descriptive statistics were estimated to identify changes across the two years, and how community characteristics correlated with treatment capacity. Measures of geospatial heterogeneity were used to identify spatial clustering. RESULTS: Nationally the number of waivered providers increased by 175% between 2016 and 2018, and patient capacity increased by 211%. In 2018, 65% of counties had at least one provider, an increase from 54.9% in 2016. Rural counties continued to have relatively fewer providers than metropolitan counties. In both years, counties with higher indicators of the opioid crisis had greater treatment capacity on average. Certain disparities continued to persist in 2018 in terms of patient capacity, as counties in metropolitan areas, those with lower poverty rates and those more physicians per capita had higher capacity on average. CONCLUSIONS: The availability of waivered providers to prescribe buprenorphine increased from 2016 to 2018, while disparities persisted. More research is needed to understand how changes in availability of waivered prescribers impact population health. AD - Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 200 Independence Ave, SW, Washington, DC, 20201, United States. Electronic address: robin.ghertner@hhs.gov. AN - 31525570 AU - Ghertner, R. DA - Nov 1 DO - 10.1016/j.drugalcdep.2019.06.029 DP - NLM ET - 2019/09/17 J2 - Drug and alcohol dependence KW - Buprenorphine/therapeutic use Drug Prescriptions/standards Female Health Services Accessibility/*statistics & numerical data Humans Opiate Substitution Treatment/statistics & numerical data/trends Opioid-Related Disorders/drug therapy Physicians/statistics & numerical data/*supply & distribution/trends Residence Characteristics/statistics & numerical data Rural Health Services/statistics & numerical data United States Urban Health Services/statistics & numerical data *Buprenorphine *Medication assisted treatment *Opioid agonist therapy *Opioid use disorder LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0376-8716 SP - 107527 ST - U.S. trends in the supply of providers with a waiver to prescribe buprenorphine for opioid use disorder in 2016 and 2018 T2 - Drug Alcohol Depend TI - U.S. trends in the supply of providers with a waiver to prescribe buprenorphine for opioid use disorder in 2016 and 2018 VL - 204 ID - 930894 ER - TY - JOUR AD - R. Ghertner, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC, United States AU - Ghertner, R. AU - Ali, M. M. DB - Embase Medline DO - 10.1176/appi.ps.201900635 KW - buprenorphine health care access health care personnel human note nurse practitioner opiate addiction physician physician assistant prescription United States LA - English M1 - 9 M3 - Note N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1557-9700 1075-2730 SP - 971 ST - Increases in providers with buprenorphine waivers in the United States from 2016 to 2019 T2 - Psychiatric Services TI - Increases in providers with buprenorphine waivers in the United States from 2016 to 2019 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2010700487&from=export http://dx.doi.org/10.1176/appi.ps.201900635 VL - 71 ID - 931068 ER - TY - JOUR AB - Despite the high numbers of veterans with opioid dependence, few receive pharmacologic treatment for this disorder. The adoption of buprenorphine treatment within the Veterans Health Administration (VHA) has been slow. To expand capacity for buprenorphine treatment, the VHA sponsored two eight-hour credentialing courses for the Drug Addiction Treatment Act of 2000. We sought to describe the outcomes of such training. Following the training sessions, 29 participants (18 physicians) were highly satisfied with course content and affirmed their intention to prescribe buprenorphine; after nine-month follow-up, two physicians were prescribing. We conclude that providing credentialing courses, while popular, did not markedly promote the prescription of buprenorphine. Copyright © American Academy of Addiction Psychiatry. AD - A. J. Gordon, Mental Illness Research, Education, and Clinical Center, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, United States AU - Gordon, A. J. AU - Liberto, J. AU - Granda, S. AU - Salmon-Cox, S. AU - Andrée, T. AU - McNicholas, L. DB - Embase Medline DO - 10.1080/10550490802408613 KW - buprenorphine accreditation article certification follow up government human narcotic dependence outcome assessment physician prescription training LA - English M1 - 6 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2008 SN - 1055-0496 1521-0391 SP - 459-462 ST - Outcomes of DATA 2000 certification trainings for the provision of buprenorphine treatment in the veterans health administration T2 - American Journal on Addictions TI - Outcomes of DATA 2000 certification trainings for the provision of buprenorphine treatment in the veterans health administration UR - https://www.embase.com/search/results?subaction=viewrecord&id=L352766187&from=export http://dx.doi.org/10.1080/10550490802408613 VL - 17 ID - 931217 ER - TY - JOUR AB - Over the past decade, Maryland and the rest of the country have seen a significant increase in misuse of prescription opioids and heroin. Even more troubling, the last few years have seen the emergence of an epidemic of very potent, synthetic opioids like carfentanil. All of these have led to record numbers of fatal and nonfatal overdoses (well over 1000 fatalities in 2016). Rural areas are disproportionately affected by this epidemic. This session presents an innovative approach to increasing access to care by supporting prescribers across Maryland through access to telephone consultation. Medications such as buprenorphine and methadone have been shown to be extremely effective treatments for opioid use disorder but the availability of both are limited by federal regulations and lessthan-optimal acceptance by the general public and medical community. Many health practitioners are not certain how to best identify or manage individuals with opioid use disorders. To increase prescriber willingness to initiate and continue medication assisted therapy for patients with opioid use disorder, the State of Maryland Behavioral Health Administration funded the University of Maryland School of Medicine to operate the Maryland Addiction Consultation Service (MACS). The service supports primary care and mental health providers across Maryland in the identification and treatment of Opioid Use Disorders; with special focus on MDs, NPs, and PAs with a buprenorphine waiver. Phone consultation, training and education, and assistance with resource identification for their patients are available free of charge and regardless of patient's insurance status. We will present the data from the first year of MACS operation with regards to provider enrollment, consultation topics, and lessons learned. AD - A. Greenblatt, School of Medicine, University of Maryland, Baltimore, Maryland, United States AU - Greenblatt, A. DB - Embase KW - buprenorphine carfentanil diamorphine methadone opiate addiction adult comfort conference abstract drug overdose drug therapy education epidemic fatality health care management health practitioner human insurance Maryland mental health prescription primary medical care rest rural area teleconsultation LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 2531-4122 SP - 28 ST - Increasing primary care providers' comfort with buprenorphine prescribing via telephone consultation T2 - Heroin Addiction and Related Clinical Problems TI - Increasing primary care providers' comfort with buprenorphine prescribing via telephone consultation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623782750&from=export VL - 20 ID - 931152 ER - TY - JOUR AB - IMPORTANCE: Inadequate treatment of opioid use disorder (OUD) in pregnant women increases the risk of life-threatening consequences on maternal and fetal outcomes. Untreated OUD during pregnancy is associated with higher rates of adverse outcomes among newborns. OBJECTIVE: To examine the variation in the prevalence of OUD and the use of medication-assisted treatment among commercially insured pregnant women according to region and state legislature. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in which the patient cohort used was derived from a 10% random sample of enrollees within the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015. The database consists of a 10% random sample of private health insurance recipients in the United States and contains claims and enrollment data that are representative of the commercially insured US population. The cohort comprised women (n = 110 285) between 18 and 45 years of age with a code indicating a delivery and continuous insurance enrollment 9 months before and 12 months after delivery. Data analysis was performed from December 2017 to May 2018. EXPOSURES: Based on their state of residence, the women were classified into 4 different regions: South, Midwest, West, and Northeast. Those residing in states with statutes that imposed civil or criminal penalties for OUD diagnosis during pregnancy were placed in a separate population from those residing in states without these statutes. MAIN OUTCOMES AND MEASURES: Diagnosis of OUD in the 9 months before delivery and the receipt of medication-assisted treatment in the 9 months before or 12 months after delivery. RESULTS: The 110 285 pregnant women included in the analysis had a mean (SD) age of 30.26 (5.59) years, with most (67 771 [61.5%]) falling within the 26- to 35-year age range. Of this cohort, 277 women (0.25%) had a diagnosis of OUD and 312 (0.28%) received treatment. Among the 277 women with OUD, 127 (45.9%) received treatment. The prevalence of an OUD diagnosis and receipt of treatment within regions was statistically significant (OUD diagnosis by region: Midwest, 0.05%; North, 0.09%; South, 0.06%; West, 0.06%; χ23 = 45.1148 [P < .001]; OUD treatment by region: Midwest, 0.05%; North, 0.08%; South, 0.10%; West, 0.05%; χ23 = 26.5654 [P < .001]). The prevalence of OUD diagnosis was also statistically significant when comparing women residing in states with statutes with those in states without statutes (OUD diagnosis by criminal statutes: criminalization, 0.07%; no criminalization, 0.18%; χ21 = 14.6456 [P < .001]; OUD treatment by criminal statutes: criminalization, 0.12%; no criminalization, 0.17%; χ21 = 0.0895); the receipt of treatment was not statistically significant (P = .76). CONCLUSIONS AND RELEVANCE: These results appeared to show significant variations in the patterns of OUD diagnosis and receipt of medication-assisted treatment among pregnant women, suggesting the need to further explore the source of these variations. AD - Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. AN - 30848807 AU - Gressler, L. E. AU - Shah, S. AU - Shaya, F. T. C2 - Pmc6484651 DA - Mar 1 DO - 10.1001/jamanetworkopen.2019.0338 DP - NLM ET - 2019/03/09 J2 - JAMA network open KW - Adult Cohort Studies Criminal Behavior Criminals/*statistics & numerical data Female Humans Insurance, Health/statistics & numerical data *Opiate Substitution Treatment/methods/statistics & numerical data *Opioid-Related Disorders/complications/diagnosis/drug therapy/epidemiology Outcome Assessment, Health Care Patient Compliance/*statistics & numerical data Pregnancy *Pregnancy Complications/epidemiology/etiology/prevention & control/psychology Pregnant Women/*psychology Prevalence United States/epidemiology LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2574-3805 SP - e190338 ST - Association of Criminal Statutes for Opioid Use Disorder With Prevalence and Treatment Among Pregnant Women With Commercial Insurance in the United States T2 - JAMA Netw Open TI - Association of Criminal Statutes for Opioid Use Disorder With Prevalence and Treatment Among Pregnant Women With Commercial Insurance in the United States VL - 2 ID - 930868 ER - TY - JOUR AB - Many communities in the United States are struggling to deal with the negative consequences of illicit opioid use. Effectively addressing this epidemic requires the coordination and support of community stakeholders in a change process with common goals and objectives, continuous engagement with individuals with opioid use disorder (OUD) through their treatment and recovery journeys, application of systems engineering principles to drive process change and sustain it, and use of a formal evaluation process to support a learning community that continuously adapts. This review presents strategies to improve OUD treatment and recovery with a focus on engineering approaches grounded in systems thinking. AD - Regenstrief Center for Healthcare Engineering and Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA; email: paulgriffin@purdue.edu. AN - 32255677 AU - Griffin, P. M. DA - Jun 4 DO - 10.1146/annurev-bioeng-082719-040832 DP - NLM ET - 2020/04/08 J2 - Annual review of biomedical engineering KW - *capacity building *medication-assisted treatment *opioid use disorder *systems engineering LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1523-9829 SP - 207-229 ST - Engineering Approaches for Addressing Opioid Use Disorder in the Community T2 - Annu Rev Biomed Eng TI - Engineering Approaches for Addressing Opioid Use Disorder in the Community VL - 22 ID - 930833 ER - TY - JOUR AB - BACKGROUND: Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS: We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS: We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS: Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation. AD - I-LEAD Institute - Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, Santa Monica, CA, USA. Electronic address: erickguerrero454@gmail.com. Rand Corporation, Santa Monica, CA, USA. Electronic address: ober@rand.org. Texas A&M University, Public Policy Research Institute, College Station, TX, USA. Electronic address: dhoward@ppri.tamu.edu. University of Chicago, IL, USA. Electronic address: tenie@uchicago.edu. Mihaylo College of Business and Economics, California State University, Fullerton, CA, USA. Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, CA, USA. Electronic address: welmoed.vandeen@cshs.org. School of Social Work, University of Southern California, Los Angeles, CA, USA. Electronic address: avelarv@usc.edu. Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA. Electronic address: rtrotzky-sirr@dhs.lacounty.gov. Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA. Electronic address: menchine@usc.edu. AN - 31862684 AU - Guerrero, E. AU - Ober, A. J. AU - Howard, D. L. AU - Khachikian, T. AU - Kong, Y. AU - van Deen, W. K. AU - Valdez, A. AU - Trotzky-Sirr, R. AU - Menchine, M. C2 - Pmc7547528 C6 - NIHMS1547082 declared Tenie Khachikian: No conflict declared Welmoed Van Deen: No conflict declared Yinfei Kong: No conflict declared Avelardo Valdez: No conflict declared Daniel L. Howard: No conflict declared Rebecca Trotzky-Sirr: No conflict declared Michael Menchine: No conflict declared DA - Mar DO - 10.1016/j.addbeh.2019.106197 DP - NLM ET - 2019/12/22 J2 - Addictive behaviors KW - Adult *Attitude of Health Personnel Emergency Service, Hospital/*organization & administration Evidence-Based Practice Female Humans Male Middle Aged *Nurses *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Optimism *Organizational Culture Organizational Innovation *Physicians Practice Guidelines as Topic Self Efficacy Social Workers Stereotyping Transtheoretical Model LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0306-4603 (Print) 0306-4603 SP - 106197 ST - Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department T2 - Addict Behav TI - Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department VL - 102 ID - 930834 ER - TY - JOUR AB - BACKGROUND: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications. AD - From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI, USA. RAND Corporation, Boston, MA, USA. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MA, USA. Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Department of Health Management & Informatics, University of Central Florida, Orlando, FL, USA. barbara.andraka@ucf.edu. Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA. barbara.andraka@ucf.edu. the National Council for Behavioral Health, Washington, D.C, USA. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA. AN - 32928272 AU - Haffajee, R. L. AU - Andraka-Christou, B. AU - Attermann, J. AU - Cupito, A. AU - Buche, J. AU - Beck, A. J. C2 - Pmc7491096 DA - Sep 14 DO - 10.1186/s13011-020-00312-3 DP - NLM ET - 2020/09/16 J2 - Substance abuse treatment, prevention, and policy KW - *Barriers *Buprenorphine *Comparison *Dual diagnosis *Methadone *Naltrexone *Physicians *Pregnant *Referral *Survey LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1747-597x SP - 69 ST - A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder T2 - Subst Abuse Treat Prev Policy TI - A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder VL - 15 ID - 930895 ER - TY - JOUR AB - At least 2.3 million people in the U.S. have an opioid use disorder, less than 40% of whom receive evidence-based treatment. Buprenorphine used as part of medication-assisted treatment has high potential to address this gap because of its approval for use in non-specialty outpatient settings, effectiveness at promoting abstinence, and cost effectiveness. However, less than 4% of licensed physicians are approved to prescribe buprenorphine for opioid use disorder, and approximately 47% of counties lack a buprenorphine-waivered physician. Existing policies contribute to workforce barriers to buprenorphine provision and access. Providers are reticent to prescribe buprenorphine because of workforce barriers, such as (1) insufficient training and education on opioid use disorder treatment, (2) lack of institutional and clinician peer support, (3) poor care coordination, (4) provider stigma, (5) inadequate reimbursement from private and public insurers, and (6) regulatory hurdles to obtain the waiver needed to prescribe buprenorphine in non-addiction specialty treatment settings. Policy pathways to addressing these provider workforce barriers going forward include providing free and easy-to-access education for providers about opioid use disorders and medication-assisted treatment, eliminating buprenorphine waiver requirements for those licensed to prescribe controlled substances, enforcing insurance parity requirements, requiring coverage of evidence-based medication-assisted treatment as essential health benefits, and providing financial incentives for care coordination across healthcare professional types-including behavioral health counselors and other non-physicians in specialty and non-specialty settings. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. AD - Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan. Electronic address: haffajee@umich.edu. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan. Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan; Division of General Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. AN - 29779547 AU - Haffajee, R. L. AU - Bohnert, A. S. B. AU - Lagisetty, P. A. C2 - Pmc6330240 C6 - Nihms1004715 DA - Jun DO - 10.1016/j.amepre.2017.12.022 DP - NLM ET - 2018/05/22 J2 - American journal of preventive medicine KW - Buprenorphine/*administration & dosage *Health Policy Health Services Accessibility Health Workforce/organization & administration Humans Opioid-Related Disorders/*drug therapy Physicians/organization & administration Practice Patterns, Physicians'/*legislation & jurisprudence United States LA - eng M1 - 6 Suppl 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0749-3797 (Print) 0749-3797 SP - S230-s242 ST - Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment T2 - Am J Prev Med TI - Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment VL - 54 ID - 930946 ER - TY - JOUR AB - IMPORTANCE: Opioid overdose deaths in the United States continue to increase, reflecting a growing need to treat those with opioid use disorder (OUD). Little is known about counties with high rates of opioid overdose mortality but low availability of OUD treatment. OBJECTIVE: To identify characteristics of US counties with persistently high rates of opioid overdose mortality and low capacity to deliver OUD medications. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of data from 3142 US counties from January 1, 2015, to December 31, 2017, rates of opioid overdose mortality were compared with availability in 2017 of OUD medication providers (24 851 buprenorphine-waivered clinicians [physicians, nurse practitioners, and physician assistants], 1517 opioid treatment programs [providing methadone], and 5222 health care professionals who could prescribe extended-release naltrexone). Statistical analysis was performed from April 20, 2018, to May 8, 2019. EXPOSURES: Demographic, workforce, lack of insurance, road density, urbanicity, opioid prescribing, and regional division county-level characteristics. MAIN OUTCOME AND MEASURES: The outcome variable, "opioid high-risk county," was a binary indicator of a high (above national) rate of opioid overdose mortality with a low (below national) rate of provider availability to deliver OUD medication. Spatial logistic regression models were used to determine associations with being an opioid high-risk county. RESULTS: Of 3142 counties, 751 (23.9%) had high rates of opioid overdose mortality. A total of 1457 counties (46.4%), and 946 of 1328 rural counties (71.2%), lacked a publicly available OUD medication provider in 2017. In adjusted models, compared with the West North Central division, counties in the East North Central, Mountain, and South Atlantic divisions had increased odds of being opioid high-risk counties (East North Central: odds ratio [OR], 2.21; 95% CI, 1.19-4.12; Mountain: OR, 4.15; 95% CI, 1.34-12.89; and South Atlantic: OR, 2.99; 95% CI, 1.26-7.11). A 1% increase in unemployment was associated with increased odds (OR, 1.09; 95% CI, 1.03-1.15) of a county being an opioid high-risk county. Counties with an additional 10 primary care clinicians per 100 000 population had a reduced risk of being opioid high-risk counties (OR, 0.89; 95% CI, 0.85-0.93), as did counties that were micropolitan (vs metropolitan) (OR, 0.67; 95% CI, 0.50-0.90) and those that had an additional 1% of the population younger than 25 years (OR, 0.95; 95% CI, 0.92-0.98). CONCLUSIONS AND RELEVANCE: Counties with low availability of OUD medication providers and high rates of opioid overdose mortality were less likely to be micropolitan and have lower primary care clinician density, but were more likely to be in the East North Central, South Atlantic, or Mountain division and have higher rates of unemployment. Strategies to increase medication treatment must account for these factors. AD - Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor. Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. AN - 31251376 AU - Haffajee, R. L. AU - Lin, L. A. AU - Bohnert, A. S. B. AU - Goldstick, J. E. C2 - Pmc6604101 DA - Jun 5 DO - 10.1001/jamanetworkopen.2019.6373 DP - NLM ET - 2019/06/30 J2 - JAMA network open KW - Adult Analgesics, Opioid/*adverse effects Cross-Sectional Studies Female Health Services Accessibility/*statistics & numerical data Humans Male Middle Aged Opiate Substitution Treatment/*statistics & numerical data Opioid-Related Disorders/*drug therapy/epidemiology Policy Making Practice Patterns, Physicians'/*statistics & numerical data United States/epidemiology LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2574-3805 SP - e196373 ST - Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder T2 - JAMA Netw Open TI - Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder VL - 2 ID - 930886 ER - TY - JOUR AB - BACKGROUND: In the US, emergency room visits and overdoses related to prescription opioids have soared and the rates of illicit opioid use, including heroin and fentanyl, are increasing. Opioid use disorder (OUD) is associated with higher morbidity and mortality, higher HIV and HCV infection rates, and criminal behavior. Opioid agonist therapy (OAT; methadone and buprenorphine) is proven to be effective in treating OUD and decreasing its negative consequences. While the efficacy of OAT has been established, too few providers prescribe OAT to patients with OUD due to patient, provider, or system factors. While the Veterans Health Administration (VHA) has made great strides in OAT implementation, national treatment rates remain low (35% of patients with OUD) and several facilities continue to have much lower prescribing rates. METHODS: Eight VA sites with low baseline prescribing rates (lowest quartile, < 21%) were randomly selected from the 35 low prescribing sites to receive an intensive external facilitation implementation intervention to increase OAT prescribing rates. The intervention includes a site-specific developmental evaluation, a kick-off site visit, and 12 months of ongoing facilitation. The developmental evaluation includes qualitative interviews with patients, substance use disorders clinic staff, and primary care and general mental health leadership to assess site-level barriers. The site visit includes: (1) a review of site-specific barriers and potential implementation strategies; (2) instruction on using available dashboards to track prescribing rates and identify actionable patients; and (3) education on OAT, including, if requested, buprenorphine certification training for prescribers. On-going facilitation consists of monthly conference calls with individual site teams and expert clinical consultation. The primary outcomes is the proportion of Veterans with OUD initiating and sustaining OAT, with intervention sites expected to have larger increases in prescribing compared to control sites. Final qualitative interviews and a cost assessment will inform future implementation efforts. DISCUSSION: This project will examine and respond to barriers encountered in low prescribing VHA clinics allowing refinement of an intervention to enhance access to medication treatment for OUD in additional facilities. AD - Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code#152, Minneapolis, MN, 55417, USA. hildi.hagedorn@va.gov. Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, USA. hildi.hagedorn@va.gov. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code#152, Minneapolis, MN, 55417, USA. Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA. Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, South. Bldg. 9 Rm#316, Mail Code#152, Minneapolis, MN, 55417, USA. Department of Medicine, University of Minnesota, Minneapolis, USA. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, South. Bldg. 9 Rm#219, Mail Code#152, Minneapolis, MN, 55417, USA. Health Economics Research Center, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA. Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, USA. Center for Innovation to Implementation, Palo Alto Health Care System, 795 Willow Rd, MC152, Palo Alto, CA, 94304, USA. Department of Surgery, Stanford University, Stanford, USA. AN - 30545409 AU - Hagedorn, H. AU - Kenny, M. AU - Gordon, A. J. AU - Ackland, P. E. AU - Noorbaloochi, S. AU - Yu, W. AU - Harris, A. H. S. C2 - Pmc6293521 DA - Dec 13 DO - 10.1186/s13722-018-0127-z DP - NLM ET - 2018/12/14 J2 - Addiction science & clinical practice KW - Buprenorphine/*therapeutic use Humans Inservice Training/organization & administration Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians' Program Development Quality of Health Care United States United States Department of Veterans Affairs/*organization & administration/standards Veterans *Implementation science *Opioid agonist therapy *Substance use disorder LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1940-0632 (Print) 1940-0632 SP - 25 ST - Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities T2 - Addict Sci Clin Pract TI - Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities VL - 13 ID - 930882 ER - TY - JOUR AB - Parents who use opioids and are involved in the child welfare system are less likely to retain custody of their children than parents who use other drugs. No previous studies have described medication-assisted treatment (MAT) utilization and child permanency outcomes for this population. The Sobriety Treatment and Recovery Team (START) model is a child welfare-based intervention focused on families with co-occurring substance use and child abuse / neglect issues. This study examined the prevalence and correlates of MAT utilization among parents in the START program with a history of opioid use, and compared child outcomes for families who received MAT services to those who did not. Of the 596 individuals with a history of opioid use in the START program, 55 (9.2%) received MAT. Receipt of MAT services did not differ by gender, age, county of residence, or drug use, though individuals who identified as White were more likely to participate in MAT. In a multiple logistic regression model, additional months of MAT increased the odds of parents retaining custody of their children. To address barriers to MAT, results-focused educational interventions may be needed for the child welfare workforce, as well as programs to improve collaboration and decision-making between the child welfare workforce, court personnel, and drug addiction treatment providers. AD - Kent School of Social Work, University of Louisville, Louisville, KY. Electronic address: martin.hall@louisville.edu. Kent School of Social Work, University of Louisville, Louisville, KY. Eastern Kentucky University and Graduate Faculty, University of Kentucky, Lexington, KY. Sobriety Treatment and Recovery Teams, Kentucky Department for Community Based Services, Frankfort, KY. AN - 27776680 AU - Hall, M. T. AU - Wilfong, J. AU - Huebner, R. A. AU - Posze, L. AU - Willauer, T. DA - Dec DO - 10.1016/j.jsat.2016.09.006 DP - NLM ET - 2016/10/26 J2 - Journal of substance abuse treatment KW - Adolescent Adult Child Child Abuse/*statistics & numerical data Child Custody/statistics & numerical data Child Welfare/*statistics & numerical data Child of Impaired Parents/*statistics & numerical data Child, Preschool Female Humans Infant Kentucky Male Opiate Substitution Treatment/*statistics & numerical data Opioid-Related Disorders/*drug therapy Outcome Assessment, Health Care/*statistics & numerical data Young Adult *Child welfare *Medication-assisted treatment *Opioids LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0740-5472 SP - 63-67 ST - Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System T2 - J Subst Abuse Treat TI - Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System VL - 71 ID - 930942 ER - TY - JOUR AB - Opioid use disorder (OUD) among pregnant women increased substantially between 1992 and 2012 across the United States, with the greatest increases occurring in the southern states. We analyzed the 2013 Treatment Episodes Database-Admissions to determine how substances used, characteristics of treatment, and demographics of pregnant women entering treatment for opioid use disorder vary between geographical regions. Analyses were restricted to cases where women reported being pregnant at the time of admission and reported opioids as the primary substance problem leading to the treatment admission. Characteristics were compared between U.S. census regions using Chi-square tests and logistic regression with the South census region as the reference group. Compared to the South, pregnant women admitted for OUD treatment in other regions were 33-79% less likely to use benzodiazepines, twice as likely to be admitted to medication assisted treatment (MAT), 2-3 times more likely to use heroin, and up to 1.5 times more likely to inject drugs. Fewer women in the South reported having medical insurance, education beyond high school, and being married. There is a need in the southern U.S. for policies and treatment programs to target reducing concomitant opioid and benzodiazepine use, increasing access to, and utilization of, MAT, and increasing access to medical insurance. AD - Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA. Electronic address: Dennis.hand@jefferson.edu. Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA. Electronic address: Vanessa.short@jefferson.edu. Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, USA. Electronic address: Diane.abatemarco@jefferson.edu. AN - 28161143 AU - Hand, D. J. AU - Short, V. L. AU - Abatemarco, D. J. DA - May DO - 10.1016/j.jsat.2017.01.011 DP - NLM ET - 2017/02/06 J2 - Journal of substance abuse treatment KW - Adult Benzodiazepines Female Geography Humans Insurance Coverage Opiate Substitution Treatment/statistics & numerical data Opioid-Related Disorders/*epidemiology/*therapy Pregnancy Pregnancy Complications/drug therapy Prevalence Socioeconomic Factors Southeastern United States/epidemiology Substance Abuse, Intravenous/epidemiology Substance-Related Disorders/*epidemiology/*therapy United States/epidemiology Young Adult *Benzodiazepine *Buprenorphine *Medication assisted treatment *Methadone *Opioid use disorder *Pregnancy LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0740-5472 SP - 58-63 ST - Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region T2 - J Subst Abuse Treat TI - Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region VL - 76 ID - 930978 ER - TY - JOUR AB - STUDY OBJECTIVE: To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder. DESIGN: Retrospective chart review. SETTING: Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults. PARTICIPANTS: Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N = 123). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prescription contraceptive use at baseline and initiation of a new method within 90 days. RESULTS: Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69). CONCLUSION: Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions. AD - The Ohio State University College of Medicine, Columbus, Ohio. The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Electronic address: hannah.lange@nationwidechildrens.org. The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. The Ohio State University College of Medicine, Columbus, Ohio; Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio. The Ohio State University College of Medicine, Columbus, Ohio; The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio. AN - 29162530 AU - Handy, C. J. AU - Lange, H. L. H. AU - Manos, B. E. AU - Berlan, E. D. AU - Bonny, A. E. C2 - Pmc5866180 C6 - Nihms921816 DA - Apr DO - 10.1016/j.jpag.2017.11.002 DP - NLM ET - 2017/11/23 J2 - Journal of pediatric and adolescent gynecology KW - Adolescent Adult Contraception/*methods/statistics & numerical data Contraception Behavior/*statistics & numerical data Contraceptive Agents Family Planning Services Female Humans Opioid-Related Disorders/*epidemiology Pregnancy Retrospective Studies Sexual Behavior/*statistics & numerical data Young Adult Adolescent medicine Contraception Opioid use disorder Reproductive health & Co for being a Nexplanon trainer. There are no other potential conflicts of interest to report. The content of this manuscript is solely the responsibility of the authors. This work received support from Research Data & Computing (RDC) Services at Nationwide Children’s Hospital, the Center for Clinical and Translational Science at The Ohio State University (CTSA UL1TR001070), and the Ohio State University College of Medicine Bennett Research Scholarship awarded to Ms. Handy. No funding source had any influence on the design of the study or the content of the manuscript. LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1083-3188 (Print) 1083-3188 SP - 122-127 ST - A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder T2 - J Pediatr Adolesc Gynecol TI - A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder VL - 31 ID - 930921 ER - TY - JOUR AB - Overdose deaths from heroin and prescription opioids have reached epidemic proportions in recent years. Deaths specifically involving heroin have more than tripled since 2011, and for the first time, drug overdose deaths have exceeded deaths resulting from motor vehicle accidents. This epidemic has been receiving attention among policymakers and the media which has resulted in efforts to provide training and education on prescribing practices, increase the use of naloxone, and expand the availability and use of Medication-Assisted Treatment (MAT). What is not being talked about is the relationship between early initiation of less harmful substances such as alcohol and marijuana and subsequent use of prescription opioids and heroin. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a model which shows promise for preventing initiation and reducing risky substance use among adolescents before it progresses to use of harder drugs such as heroin. Unfortunately, though recommended by the American Academy of Pediatrics, health care providers are not even screening their adolescent patients for substance use. The heroin and prescription opioid epidemic and the dissemination of information regarding federal, state, and local efforts to combat the epidemic provide a platform for increasing awareness of SBIRT, garnering support for more research, and facilitating uptake and integration into practice. It is time to add SBIRT to the conversation. AD - Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, One University Place, Rensselaer, NY 12144, United States. Electronic address: bharris@albany.edu. AN - 27544318 AU - Harris, B. R. DA - Oct DO - 10.1016/j.ypmed.2016.08.022 DP - NLM ET - 2016/08/22 J2 - Preventive medicine KW - Adolescent Adolescent Health Services Analgesics, Opioid/*adverse effects Drug Overdose/drug therapy/*epidemiology *Epidemics Heroin/*adverse effects Humans Pediatrics *Referral and Consultation Substance-Related Disorders/diagnosis/therapy *Adolescents *Drug overdose *Heroin *Prescription opioids *Sbirt *Screening, brief intervention, and referral to treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0091-7435 SP - 397-399 ST - Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic T2 - Prev Med TI - Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic VL - 91 ID - 930973 ER - TY - JOUR AB - Deaths from overdose have risen dramatically over the past decade, driven mainly by opioids. In response, the Centers for Disease Control and Prevention released guidance on safe prescribing, safe storage of medications, Medication-Assisted Treatment (MAT), and the use of Naloxone to reverse an overdose. Even with this guidance, overdose deaths continue to rise. Suicide prevention is a strategy that may help address this problem. Suicide rose 32.4% between 1999 and 2019, from 10.5 to 13.9 per 100,000. Closely linked to overdose, the suicide rate among those with opioid use disorder is 87 per 100,000 population, six times that of the general US population. With multiple shared individual-level risk factors, strict standards for case ascertainment, and high potential for misclassification of opioid suicides, the distinction between overdose and suicide is often unclear, and the number of suicides is likely underestimated. The Surgeon General recently released a call to action for a public health approach to suicide prevention. Primary care and emergency departments have a major role to play. This commentary describes suicide as a hidden contributor to the opioid crisis; the rationale for integration of suicide prevention in primary care and emergency departments; and screening, education, brief intervention, and follow up and monitoring techniques that these settings can employ. Done effectively, this strategy has the potential to save countless lives. AD - University at Albany School of Public Health, Rensselaer, NY, United States. Electronic address: bharris@albany.edu. AN - 33894231 AU - Harris, B. R. DA - Apr 22 DO - 10.1016/j.ypmed.2021.106572 DP - NLM ET - 2021/04/25 J2 - Preventive medicine KW - Emergency medicine Opioid crisis Overdose Primary care Suicide prevention LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0091-7435 SP - 106572 ST - Suicide as a hidden contributor to the opioid crisis and the role that primary care and emergency medicine play in addressing it T2 - Prev Med TI - Suicide as a hidden contributor to the opioid crisis and the role that primary care and emergency medicine play in addressing it VL - 148 ID - 931029 ER - TY - JOUR AB - BACKGROUND/OBJECTIVE: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status. METHODS: This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services. RESULTS: Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating. CONCLUSION: Drawing on Agamben's theory of "bare life," and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment. AD - a Drug Policy Alliance , New York , New York , USA. c Departments of Psychiatry and Anthropology , New York University , New York , New York , USA. b Columbia University, Mailman School of Public Health, Sociomedical Sciences , New York , New York , USA. d Nathan Kline Institute , Orangeburg, New York , USA. AN - 29161171 AU - Hatcher, A. E. AU - Mendoza, S. AU - Hansen, H. C2 - Pmc5901978 C6 - Nihms953821 DA - Jan 28 DO - 10.1080/10826084.2017.1385633 DP - NLM ET - 2017/11/22 J2 - Substance use & misuse KW - Adult Buprenorphine/therapeutic use Ethnic Groups/psychology Female Humans Male Middle Aged Opiate Substitution Treatment/*psychology Opioid-Related Disorders/drug therapy Outpatients/*psychology Qualitative Research Social Class *Social Stigma Social Support *Medication assisted treatment *addiction *intersectionality *multiple oppressions *race *socioeconomic status *stigma *structural violence alone are responsible for the content and writing of the article. LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1082-6084 (Print) 1082-6084 SP - 301-310 ST - At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care" T2 - Subst Use Misuse TI - At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care" VL - 53 ID - 930997 ER - TY - JOUR AB - Background and Objectives: Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (ED) are an important setting for buprenorphine initiation for patients with untreated OUD, yet provider readiness varies. Our objective was to characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and to identify opportunities to promote readiness across multiple provider types Methods: In preparation for an implementation study on OUD treatment in the ED, we conducted a mixed-methods formative evaluation grounded in the Promoting Action on Research Implementation in Health Services framework (PARiHS) framework in four geographically diverse academic EDs. Attending physicians (n=113), residents (n=107) and advance practice providers (APPs) (n=48) completed surveys. A subset of these participants (n=74) also participated in 11 focus groups. Provider readiness to initiate buprenorphine for ED patients with OUD was assessed using a visual analog scale. Responders were dichotomized as not ready (answers 0-6) or ready (answers 7-10). An ED-adapted Organizational Readiness to Change Assessment (ORCA) was used and 11 focus groups to assess perspectives on evidence, context, and facilitation needs to promote ED-initiated buprenorphine were conducted Results: Amongst survey respondents (N=268), 56/268 (21%) indicated readiness to initiate buprenorphine and provide referral for ongoing treatment for ED patients with OUD, and 9/268 (3%) reported DATA 2000 waiver training completion. Providers who were ready to initiate buprenorphine scored higher across multiple evidence subscales and on the resources context subscale of the ORCA. Based on focus groups findings, barriers to ED-initiated buprenorphine included lack of training and experience in treating OUD with buprenorphine, concerns about ability to link to ongoing care, and competing needs and priorities for ED time and resources. Key facilitators to ED-initiated buprenorphine included receiving education and training, development of local departmental protocols, and receiving feedback on patient experiences and gaps in quality of care Conclusion: Most ED providers are not yet ready to initiate buprenorphine in the ED. Efforts to promote adoption of ED-initiated buprenorphine will require both clinician and system-level changes. AD - K. Hawk, Yale University AU - Hawk, K. AU - D'Onofrio, G. AU - Chawarski, M. C. AU - O'Connor, P. G. AU - Cowan, E. AU - Lyons, M. S. AU - Richardson, L. D. AU - Rothman, R. AU - Whiteside, L. AU - Owens, P. AU - Martel, S. AU - Coupet, E. AU - Pantalon, M. V. AU - Curry, L. AU - Fiellin, D. A. AU - Edelman, E. J. DB - Embase DO - 10.1111/acem.13961 KW - buprenorphine opiate adoption adult conference abstract controlled study drug combination drug therapy education emergency ward facilitation female human major clinical study male patient referral resident visual analog scale LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1553-2712 SP - S189 ST - Readiness to initiate buprenorphine in the emergency department: A multisite mixed-methods formative evaluation T2 - Academic Emergency Medicine TI - Readiness to initiate buprenorphine in the emergency department: A multisite mixed-methods formative evaluation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632418183&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 931082 ER - TY - JOUR AB - Importance: Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (EDs) are an important setting for buprenorphine initiation for patients with untreated OUD; however, readiness varies among ED clinicians. Objective: To characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and identify opportunities to promote readiness across multiple clinician types. Design, Setting, and Participants: Using data collected from April 1, 2018, to January 11, 2019, this mixed-methods formative evaluation grounded in the Promoting Action on Research Implementation in Health Services framework included 4 geographically diverse academic EDs. Attending physicians (n = 113), residents (n = 107), and advanced practice clinicians (APCs) (n = 48) completed surveys electronically distributed to all ED clinicians (n = 396). A subset of participants (n = 74) also participated in 1 of 11 focus group discussions. Data were analyzed from June 1, 2018, to February 22, 2020. Main Outcomes and Measures: Clinician readiness to initiate buprenorphine and provide referral for ongoing treatment for patients with OUD treated in the ED was assessed using a visual analog scale. Responders (268 of 396 [67.7%]) were dichotomized as less ready (scores 0-6) or most ready (scores 7-10). An ED-adapted Organizational Readiness to Change Assessment (ORCA) and 11 focus groups were used to assess ratings and perspectives on evidence and context-related factors to promote ED-initiated buprenorphine with referral for ongoing treatment, respectively. Results: Among the 268 survey respondents (153 of 260 were men [58.8%], with a mean [SD] of 7.1 [9.8] years since completing formal training), 56 (20.9%) indicated readiness to initiate buprenorphine for ED patients with OUD. Nine of 258 (3.5%) reported Drug Addiction Treatment Act of 2000 training completion. Compared with those who were less ready, clinicians who were most ready to initiate buprenorphine had higher mean scores across all ORCA Evidence subscales (3.50 [95% CI, 3.35-3.65] to 4.33 [95% CI, 4.13-4.53] vs 3.11 [95% CI, 3.03-3.20] to 3.60 [95% CI, 3.49-3.70]; P <.001) and on the Slack Resources of the ORCA Context subscales (3.32 [95% CI, 3.08-3.55] vs 3.0 [95% CI, 2.87-3.12]; P =.02). Barriers to ED-initiated buprenorphine included lack of training and experience in treating OUD with buprenorphine, concerns about ability to link to ongoing care, and competing needs and priorities for ED time and resources. Facilitators to ED-initiated buprenorphine included receiving education and training, development of local departmental protocols, and receiving feedback on patient experiences and gaps in quality of care. Conclusions and Relevance: Only a few ED clinicians had a high level of readiness to initiate buprenorphine; however, many expressed a willingness to learn with sufficient supports. Efforts to promote adoption of ED-initiated buprenorphine will require clinician and system-level changes. AD - K.F. Hawk, Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave, Ste 260, New Haven, CT, United States AU - Hawk, K. F. AU - D'Onofrio, G. AU - Chawarski, M. C. AU - O'Connor, P. G. AU - Cowan, E. AU - Lyons, M. S. AU - Richardson, L. AU - Rothman, R. E. AU - Whiteside, L. K. AU - Owens, P. H. AU - Martel, S. H. AU - Coupet, E. AU - Pantalon, M. AU - Curry, L. AU - Fiellin, D. A. AU - Edelman, E. J. DB - Embase Medline DO - 10.1001/jamanetworkopen.2020.4561 KW - adoption adult advanced practice provider article controlled study drug dependence drug therapy education emergency ward human major clinical study male patient referral resident visual analog scale buprenorphine opiate LA - English M3 - Article in Press N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 2574-3805 ST - Barriers and Facilitators to Clinician Readiness to Provide Emergency Department-Initiated Buprenorphine T2 - JAMA Network Open TI - Barriers and Facilitators to Clinician Readiness to Provide Emergency Department-Initiated Buprenorphine UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631783628&from=export http://dx.doi.org/10.1001/jamanetworkopen.2020.4561 ID - 931099 ER - TY - JOUR AB - Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed. A stigma-free approach, substance use disorder screening, medication-assisted treatment, screening and treatment of mental health disorders, and an after-birth environment that promotes maternal-child bonding are recommended. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 19-23.]. AN - 29505087 AU - Haycraft, A. L. DA - Mar 1 DO - 10.3928/02793695-20180219-03 DP - NLM ET - 2018/03/06 J2 - Journal of psychosocial nursing and mental health services KW - Analgesics, Opioid/adverse effects/*therapeutic use *Epidemics Female Humans Infant, Newborn Methadone/*therapeutic use Neonatal Abstinence Syndrome/*drug therapy Opiate Substitution Treatment/methods Opioid-Related Disorders/*epidemiology Pregnancy Pregnancy Complications/*drug therapy Pregnancy Outcome Psychiatric Nursing LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0279-3695 (Print) 0279-3695 SP - 19-23 ST - Pregnancy and the Opioid Epidemic T2 - J Psychosoc Nurs Ment Health Serv TI - Pregnancy and the Opioid Epidemic VL - 56 ID - 930794 ER - TY - JOUR AB - Background: Despite efforts by policy makers and physicians, the death toll attributed to the opioid epidemic continues to rise. These deaths represent only a fraction of the 2 million of Americans struggling with opioid use disorders. Opioid agonist medication assisted treatment with methadone or buprenorphine is the most effective treatment for opioid use disorder. Only 3% of primary care physicians (PCPs) have received waivers to prescribe buprenorphine. Primary Care (PC) residency practices care for vulnerable populations with a high prevalence of substance use. Thus PC residency is an opportune time to build treatment capacity. Understanding residents' knowledge and attitudes will help inform curriculua design on this important new competency for our future PC workforce. Methods: As a needs assessment for our PC Residency program, we incorporated a case in our annual 11 station performance based assessment (OSCE). The case involved a young woman with shoulder pain who exhibits many signs of opioid use disorder. The patient's hidden agenda was to obtain help for her addiction. Standardized patients (SPs) evaluated residents using a 35 item checklist. Item response options were: not done, partly done and well done, each with descriptive behavioral anchors to enhance rating reliability. Analyses include frequencies for specific checklist items summed into domain scores as well as a post-OSCE survey that included self-assessment of performance and questions about how prepared they felt for the case, with both qualitative and quantitative responses gathered. Results: 25 residents participated. All of the residents discussed treat-ment modalities, but almost half (44%) did not give detailed treatment options. Some residents (60%) were able to give specific information about starting buprenorphine. Very few (17% of SPs) reported they felt that they understood all of the medical options available and only a third (35% of SPs) felt very confident that they could stop using opiates after the encounter. About half (56%) of residents reported they did not feel prepared for this case. Most residents (80%) indicated that the most challenging aspect of the case was not feeling comfortable with treatment options; more than half (63%) specifically indicated they felt their knowledge of buprenorphine was lacking. Conclusions: Residents generally were able to identify the problem of opioid use disorder in a patient but lacked information and/or skills to counsel the patient on treatment options. As a result of these findings, we have revised our addiction medicine curricula to include waiver training to prescribe buprenorphine and have increased clinical experiences in managing opioid use disorder so that our residents are able to treat and manage patients with this increasingly common and devastating disorder.We will reassess their skills and attitudes at this year's annual OSCE and further adjust curricula based on resident performance. AD - R.W. Hayes, NYU, New York, NY, United States AU - Hayes, R. W. AU - Hanley, K. AU - Calvo-Friedman, A. AU - Adams, J. AU - Altshuler, L. AU - Gillespie, C. C. AU - Zabar, S. DB - Embase KW - buprenorphine buprenorphine plus naloxone opiate addiction medicine adult checklist conference abstract drug therapy female general practitioner human needs assessment opiate addiction prevalence quantitative analysis reliability resident self evaluation shoulder pain skill substance use vulnerable population LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1525-1497 SP - 349 ST - Suboxone and me: An osce-based assessment of medical residents' knowledge of medical treatment of opioid addiction T2 - Journal of General Internal Medicine TI - Suboxone and me: An osce-based assessment of medical residents' knowledge of medical treatment of opioid addiction UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622330272&from=export VL - 33 ID - 931159 ER - TY - JOUR AB - CONTEXT: Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state. PROGRAM: The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions. IMPLEMENTATION: Four OHA projects highlight the integration: (1) a Medicaid Coordinated Care Organization Performance Improvement Project focused on decreasing risky opioid prescribing; (2) Health Evidence Review Commission guidelines that set coverage standards for opioid and nonopioid back pain treatments for Medicaid recipients; (3) statewide opioid prescribing guidelines; and (4) an opioid data dashboard. Each project involves a partnership between governmental public health, public and private health care systems, and external stakeholders. PROGRESS: From 2015 to 2017, the number of Oregonians on 90 or more Morphine Equivalent Doses (MEDs) decreased by 37%, from 11.1 per 1000 residents quarterly to 7.0 per 1000 residents quarterly. Prescription opioid overdose deaths decreased 20% from 4.5 per 100 000 in 2015 to 3.6 per 100 000 in 2016. Within the Medicaid population, the percentage of clients on 120 or more MEDs for 30 consecutive days decreased 27%, from 2.3% in December 2015 to 1.6% in September 2017. DISCUSSION: Oregon's integrated approach to address the opioid crisis spans public health and health care systems, engages key stakeholders, and uses data and evidence to inform policies. The progress to date is promising and may assist other states seeking to identify effective strategies to decrease opioid prescribing, misuse, and overdose. AD - Public Health Division (Dr Hedberg, Ms Shields, and Mr Van Otterloo) and Health Policy and Analytics (Ms Bui and Dr Livingston), Oregon Health Authority, Portland, Oregon. AN - 30048336 AU - Hedberg, K. AU - Bui, L. T. AU - Livingston, C. AU - Shields, L. M. AU - Van Otterloo, J. DA - May/Jun DO - 10.1097/phh.0000000000000849 DP - NLM ET - 2018/07/27 J2 - Journal of public health management and practice : JPHMP KW - Analgesics, Non-Narcotic/therapeutic use Drug Prescriptions/standards/statistics & numerical data Humans Opioid Epidemic/*trends Oregon Practice Patterns, Physicians'/standards/statistics & numerical data Prescription Drug Misuse/adverse effects/prevention & control Program Development/methods Public Health/*methods/trends *State Government LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1078-4659 SP - 214-220 ST - Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority's Opioid Initiative T2 - J Public Health Manag Pract TI - Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority's Opioid Initiative VL - 25 ID - 930923 ER - TY - JOUR AB - Objective: Healthcare providers in the Emergency Department (ED) are on the front lines of the opioid crisis. ED visits present a unique opportunity to approach patients with opioid use disorder (OUD), and to initiate medication-assisted treatment (MAT) therapy. Buprenorphine MAT has been shown to increase treatment success and compliance, as well as to decrease the number of ED visits and hospitalizations for opioid-related complaints. Under the Drug Addiction Treatment Act of 2000, providers may obtain an “X waiver” to prescribe and dispense buprenorphine after completing an eight-hour training course. In addition, treatment may now be initiated in the ED by any licensed provider with a DEA number. The purpose of this study was to characterize provider knowledge and opinions about buprenorphine initiation in the ED, and to gauge interest for a MAT protocol in the ED of an urban academic tertiary hospital. Methods: A survey of 21 questions, including 6 demographic questions, was sent to 98 providers, including ED attending and resident physicians, physician assistants and nurse practitioners. The questions focused on MAT therapy induction with buprenorphine in the ED and various provider attitudes toward MAT, as well as perceived gaps in knowledge about the treatment options and process. Descriptive statistics were performed. Results: Results are based on a participation rate of 39%. Of the responses, 50% were from attending physicians, 34% were from resident physicians, and 16% were physician assistants. Seventy-seven percent of respondents stated that they were interested in obtaining an X waiver, already had a waiver, or stated that they were unsure about a waiver and needed more information. In terms of the perceived importance of MAT, 87% indicated that it was important to the management of the opioid epidemic, and 76% of respondents believe that it is in their scope of practice as emergency medicine providers to induce buprenorphine in the ED. Areas identified for further education include the specifics of buprenorphine dosing and pharmacology, efficacy of treatment, patient outcomes information, and legal issues associated with buprenorphine. Providers also indicated through structured survey answers and free text that downstream resources such as counseling and clinics were a critical piece of the ED buprenorphine induction process. Conclusion: Among Emergency Medicine providers in a large academic metropolitan ED, there is clear awareness of the opioid crisis as well as near-consensus that MAT is important in the management of the epidemic. While some providers are willing and eager to participate in a program for buprenorphine induction in the ED, others indicate gaps in their knowledge base and understanding of the process. Through this survey, providers have identified topics of critical importance to cover in buprenorphine training and the X waiver process to ensure the consistency and success of MAT therapy initiated in the ED, as well as gaps in existing processes and infrastructure that are critical to the success of such a program. AD - A. Zosel, Froedtert and the Medical, College of Wisconsin AU - Hernandez-Meier, J. AU - Good, S. AU - Zosel, A. DB - Embase DO - 10.1080/15563650.2019.1636569 KW - buprenorphine opiate adult awareness clinical protocol conference abstract consensus counseling drug dependence drug therapy education emergency medicine emergency ward epidemic gauge human knowledge base nurse practitioner physician assistant prescription resident scope of practice statistics tertiary care center LA - English M1 - 10 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1556-9519 SP - 1041-1042 ST - Emergency medicine provider attitudes toward and experiences with prescribing buprenorphine in the ED of a large academic metropolitan hospital T2 - Clinical Toxicology TI - Emergency medicine provider attitudes toward and experiences with prescribing buprenorphine in the ED of a large academic metropolitan hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628976703&from=export http://dx.doi.org/10.1080/15563650.2019.1636569 VL - 57 ID - 931142 ER - TY - JOUR AB - BACKGROUND: Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use disorder therapy. PURPOSE: Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. METHODS: The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18-64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. RESULTS: The number of OAT clinics in a region per 10,000 ZIP-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 ZIP-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). CONCLUSIONS: It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians. AD - Department of Human Development, Prevention Science Program, Washington State University, Pullman, Washington. Health Sciences Spokane, Washington State University, Spokane, Washington. Department of Health Policy and Administration, Spokane, Washington. AN - 26987797 AU - Hirchak, K. A. AU - Murphy, S. M. C2 - Pmc5568536 C6 - Nihms893811 DA - Jan DO - 10.1111/jrh.12178 DP - NLM ET - 2016/03/19 J2 - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association KW - Addiction Medicine/statistics & numerical data/trends Adolescent Adult Female *Geographic Mapping Health Services Accessibility/*standards Humans Indians, North American/*statistics & numerical data Male Middle Aged Opioid-Related Disorders Poisson Distribution Rural Population/statistics & numerical data Substance Abuse Treatment Centers/*statistics & numerical data Substance-Related Disorders/*therapy Urban Population/statistics & numerical data Washington *American Indians *opioid abuse *opioid agonist therapy *rural treatment *treatment access this research. LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0890-765X (Print) 0890-765x SP - 102-109 ST - Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation T2 - J Rural Health TI - Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation VL - 33 ID - 930995 ER - TY - JOUR AB - Poverty is common among people who have substance use disorder. The therapeutic workplace addresses some of the interrelated and chronic problems of poverty, such as unemployment, lack of education and job skills, and drug use. A prior controlled trial showed that the therapeutic workplace was effective in promoting drug abstinence and self-reported community employment in unemployed adults in medication-assisted treatment for opioid use disorder. The current study extends this research by providing a detailed and objective analysis of employment outcomes using objective data abstracted from participants' pay stubs. Secondary analyses examined the types and patterns of employment that participants (N = 44) obtained during the trial, and the extent to which participants gained and maintained financially sufficient employment. Although most participants had relatively long histories of unemployment and underemployment, many participants (n = 26; 59%) obtained employment at some point during the intervention. Most participants worked part time and were employed in low-wage jobs, however. The mean number of hours worked per week was 20.6 h (range 5.5 to 41.3 h per week) and the mean hourly pay was $11.00 per hour (range $9.00 to $15.50 per hour). The most common type of employment was in food preparation and serving-related occupations (e.g., waiters and waitresses, restaurant cooks, and fast food counter workers). Many participants (n = 17; 65%) maintained employment in these jobs over several weeks, while others (n = 9; 35%) were employed sporadically for short durations. Additional supports may be needed for some chronically unemployed adults with substance use disorder to promote consistent employment in well-paying jobs. AD - Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA. Electronic address: aholtyn1@jhmi.edu. Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Center for Learning and Health, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA. AN - 33298300 AU - Holtyn, A. F. AU - Toegel, F. AU - Arellano, M. AU - Subramaniam, S. AU - Silverman, K. C2 - Pmc7733028 C6 - Nihms1636693 DA - Jan DO - 10.1016/j.jsat.2020.108160 DP - NLM ET - 2020/12/11 J2 - Journal of substance abuse treatment KW - *Employment *Poverty *Substance use disorder *Therapeutic workplace LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0740-5472 (Print) 0740-5472 SP - 108160 ST - Employment outcomes of substance use disorder patients enrolled in a therapeutic workplace intervention for drug abstinence and employment T2 - J Subst Abuse Treat TI - Employment outcomes of substance use disorder patients enrolled in a therapeutic workplace intervention for drug abstinence and employment VL - 120 ID - 930950 ER - TY - JOUR AB - Objective: To identify, factors associated with obstetricians' treatment recommendations for pregnant women with an opioid use disorder (PWOUD), and to determine the prevalence of physicians waivered for buprenorphine as a medication-assisted treatment (MAT).Methods: We conducted a structured online survey of a nationally representative sample of 565 obstetrical physicians, with a response rate of 38%. Logistic regression models were derived to identify factors that influence treatment recommendations for PWOUD. The Clopper-Pearson method was used to derive the confidence interval (CI) for the number of physicians waivered for buprenorphine.Results: Approximately 77% of respondents had provided care for a PWOUD within the last year. Physicians reported that at least 75% of their PWOUD received Medicaid for prenatal care. The most common opioids used at patient presentation were prescription opioids, with the second most common being methadone. A total of 14.0% had buprenorphine waivers (95% CI: 11.6-16.7%), and among those waivered, 47% prescribed buprenorphine to PWOUD. Factors associated with buprenorphine waiver encompass referrals to community support services. The three most prominent factors associated with adherence to standard of care were: type of opioid at presentation, patient's choice, and physician's experience. Type of opioid was associated with methadone presentation, socioeconomic status, shared decision making and practice setting. Patient's choice was associated with physician preparedness and practice duration. Physician's experience was associated with referral to recovery-oriented services.Conclusions: Novel interventions are needed to (1) promote office-based treatment for opioid use disorder through continuing medical education, (2) provide physicians with access to recovery-oriented resources and (3) increase patient autonomy in healthcare decision making. These proposed evidence-based interventions will promote best practices for women and their infants and greater accessibility to standard of care. AD - Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA. Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA. AN - 31244358 AU - Howard, H. G. AU - Freeman, K. DA - Mar DO - 10.1080/0167482x.2019.1634048 DP - NLM ET - 2019/06/28 J2 - Journal of psychosomatic obstetrics and gynaecology KW - *Pregnancy *opioid use disorders *treatment interventions LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0167-482x SP - 74-81 ST - U.S. Survey of factors associated with adherence to standard of care in treating pregnant women with opioid use disorder T2 - J Psychosom Obstet Gynaecol TI - U.S. Survey of factors associated with adherence to standard of care in treating pregnant women with opioid use disorder VL - 41 ID - 930957 ER - TY - JOUR AB - Background & objective Buprenorphine is an underutilized pharmacotherapy that can play a key role in combating the opioid epidemic. Individuals with opioid use disorder (OUD) often struggle to find physicians that prescribe buprenorphine. Many physicians do not have the waiver to prescribe buprenorphine, and a large proportion of physicians that are waivered do not prescribe to capacity. This study aimed to quantitatively understand why physicians do not utilize buprenorphine for the treatment of OUD more frequently. Methods Physicians (n = 558) with and without the waiver to prescribe buprenorphine were surveyed about perceived drawbacks associated with prescribing buprenorphine. Furthermore, resources were identified that would encourage those without the waiver to obtain it, and those with the waiver to accept more new patients. The survey was distributed online to physicians in the spring/summer of 2016 via the American Society for Addiction Medicine and American Medical Association listservs. Results and conclusions A logistic regression analysis was used to identify reasons that respondents indicated no willingness to increase prescribing (χ2(4) = 73.18, p < 0.001); main reasons were lack of belief in agonist treatment (OR 3.98, 95% CI, 1.43 to 11.1, p = 0.008), lack of time for additional patients (OR 5.54, 95% CI, 3.5 to 8.7, p < 0.001), and belief that reimbursement rates are insufficient (OR 2.50, 95% CI, 1.3 to 4.8, p = 0.006). Differences between non-waivered and waivered physicians concerning attitudes toward buprenorphine treatment as well as resources that would increase willingness to prescribe are also discussed. Identifying barriers to buprenorphine utilization is crucial in expanding treatment options for individuals with OUD. AD - K.E. Dunn, 5510 Nathan Shock Drive, Baltimore, MD, United States AU - Huhn, A. S. AU - Dunn, K. E. DB - Embase Medline DO - 10.1016/j.jsat.2017.04.005 KW - buprenorphine article health belief human major clinical study medical society patient counseling patient education physician attitude prescription priority journal reimbursement time LA - English M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2017 SN - 1873-6483 0740-5472 SP - 1-7 ST - Why aren't physicians prescribing more buprenorphine? T2 - Journal of Substance Abuse Treatment TI - Why aren't physicians prescribing more buprenorphine? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615449230&from=export http://dx.doi.org/10.1016/j.jsat.2017.04.005 VL - 78 ID - 931165 ER - TY - JOUR AB - PURPOSE: Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODS: We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents. RESULTS: Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine. CONCLUSION: Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. AD - University of Washington, Department of Family Medicine, Research Section, Seattle, Washington. AN - 24615308 AU - Hutchinson, E. AU - Catlin, M. AU - Andrilla, C. H. AU - Baldwin, L. M. AU - Rosenblatt, R. A. C2 - Pmc3948759 DA - Mar-Apr DO - 10.1370/afm.1595 DP - NLM ET - 2014/03/13 J2 - Annals of family medicine KW - Adult Aged Aged, 80 and over Buprenorphine/*therapeutic use Female Humans Male Middle Aged Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians'/*statistics & numerical data *Primary Health Care Washington buprenorphine opiate addiction opiate substitution treatment primary health care rural health LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2014 SN - 1544-1709 (Print) 1544-1709 SP - 128-33 ST - Barriers to primary care physicians prescribing buprenorphine T2 - Ann Fam Med TI - Barriers to primary care physicians prescribing buprenorphine VL - 12 ID - 931005 ER - TY - JOUR AB - PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODS We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents. RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P =.04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine. CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. AD - [Hutchinson, Eliza; Catlin, Mary; Andrilla, C. Holly A.; Baldwin, Laura-Mae; Rosenblatt, Roger A.] Univ Washington, Dept Family Med, Res Sect, Seattle, WA 98195 USA. Rosenblatt, RA (corresponding author), Univ Washington, Dept Family Med, Box 354696, Seattle, WA 98195 USA. rosenb@uw.edu AN - WOS:000336799900006 AU - Hutchinson, E. AU - Catlin, M. AU - Andrilla, C. H. A. AU - Baldwin, L. M. AU - Rosenblatt, R. A. DA - Mar-Apr DO - 10.1370/afm.1595 J2 - Ann. Fam. Med. KW - buprenorphine opiate substitution treatment rural health primary health care opiate addiction ADDICTION SPECIALISTS FACILITATORS MANAGEMENT POLICY Primary Health Care Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2014 SN - 1544-1709 SP - 128-133 ST - Barriers to Primary Care Physicians Prescribing Buprenorphine T2 - Annals of Family Medicine TI - Barriers to Primary Care Physicians Prescribing Buprenorphine UR - ://WOS:000336799900006 VL - 12 ID - 931292 ER - TY - JOUR AB - Purpose of Study: Opioid addiction is a major problem in Washington State, however office-based treatment is in short supply. The Rural Opioid Addiction Management Program (Project ROAM) trains office-based physicians to prescribe buprenorphine, a medication-assisted opioid addiction treatment that requires a physician to obtain a Drug Enforcement Administration waiver. Project ROAM has trained 120 physicians in the last two years, yet not all have incorporated buprenorphine treatment into their practices. This study aimed to determine what proportion of trained physicians has implemented this treatment modality and to identify barriers that prevent physicians from adopting this clinical approach. Methods Used: We completed interviews with 92 Project ROAM-trained physicians (response rate = 77%) to determine demographic information, clinic characteristics, attitudes, and barriers to prescribing buprenorphine. Respondents were classified into three groups: non-waivered physicians, nonprescribing waivered physicians, and prescribing waivered physicians. Summary of Results: Most respondents reported positive attitudes toward buprenorphine, yet only 29 (31.5%) have prescribed the medication to treat opioid addiction. The majority were family physicians practicing in small safety net or private practice clinics. Prescribing was significantly associated with institutional support (p=.021) and physician confidence in the management of opioid addiction (p=.038). Time constraints, lack of patient need, resistance from practice partners, lack of specialty backup for complex problems, and lack of psychosocial support services were other major barriers cited by non-prescribing physicians. Conclusions: Less than half of Project ROAM-trained physicians have prescribed buprenorphine to treat opioid addiction. The low rate of treatment adoption is not associated with physician attitudes about the medication but may be related to barriers such as a lack of support from clinic management or a physician's lack of confidence in his/her ability to manage opioid addiction. Future efforts to increase the availability of buprenorphine treatment should continue to include physician education but also emphasize advocacy and education at the level of clinic management. AD - E. Hutchinson, University of Washington, School of Medicine, Seattle, WA, United States AU - Hutchinson, E. AU - Rosenblatt, R. DB - Embase DO - 10.231/JIM.0b013e31827d3ac9 KW - opiate buprenorphine physician human addiction medical research hospital drug therapy education physician attitude psychosocial care patient private practice safety general practitioner interview medical decision making government United States LA - English M1 - 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2013 SN - 1081-5589 SP - 115 ST - Understanding and overcoming barriers to office-based physicians' treatment of opioid addiction T2 - Journal of Investigative Medicine TI - Understanding and overcoming barriers to office-based physicians' treatment of opioid addiction UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70993475&from=export http://dx.doi.org/10.231/JIM.0b013e31827d3ac9 VL - 61 ID - 931204 ER - TY - JOUR AB - The practice of prescribing opioid drugs for opioid dependent patients in the U.S. has been subjected to special government scrutiny for almost 100 years. From 1920 until 1964, doctors who used opioids to treat addicts risked federal and/or state criminal prosecution. Although that period ended when oral methadone maintenance was established as legitimate medical practice, public concern about methadone diversion and accidental overdose fatalities, combined with political pressure from both hostile bureaucracies and groups committed to drug-free treatments, led to the development of unprecedented and detailed Food and Drug Administration (FDA) regulations that specified the manner in which methadone (and later, levo-alpha-acetyl methadol, or levomethadyl acetate, (LAAM)) could be provided. In 1974, Congress gave the Drug Enforcement Administration (DEA) additional oversight of methadone treatment programs. Efforts to liberalize the FDA regulations over the past 30 years have been resisted by both the DEA and existing treatment providers. Additional flexibility for clinicians may evolve from the most recent effort to create an accreditation system to replace some of the FDA regulations. The development of buprenorphine, a partial opioid agonist, as an effective treatment for opioid addiction reopened the possibility for having a less burdensome oversight process, especially because of its reduced toxicity if ingested by non-tolerant individuals. New legislation, the Drug Addiction Treatment Act (DATA) of 2000, created an opportunity for clinicians with special training to be exempted from both federal methadone regulations and the requirement to obtain a special DEA license when using buprenorphine to treat addicts. Some details of how the DATA was developed, moved through Congress, and signed into law are described. © 2003 Elsevier Science Ireland Ltd. All rights reserved. AD - J.H. Jaffe, Department of Psychiatry, Division of Alcohol and Drug Abuse, Univ. of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MA 21201, United States AU - Jaffe, J. H. AU - O'Keeffe, C. DB - Embase Medline DO - 10.1016/S0376-8716(03)00055-3 KW - buprenorphine levacetylmethadol methadone mu opiate receptor agonist opiate partial agonist accreditation criminal law drug approval drug dependence drug fatality drug marketing drug overdose drug research drug tolerability drug utilization Food and Drug Administration heroin dependence human law licence medical practice opiate addiction physician politics postgraduate education practice guideline prescription priority journal rehabilitation center review side effect United States LA - English M1 - 2 SUPPL. M3 - Review N1 - Embase Elsevier literature search May 7, 2021 PY - 2003 SN - 0376-8716 SP - S3-S11 ST - From morphine clinics to buprenorphine: Regulating opioid agonist treatment of addiction in the United States T2 - Drug and Alcohol Dependence TI - From morphine clinics to buprenorphine: Regulating opioid agonist treatment of addiction in the United States UR - https://www.embase.com/search/results?subaction=viewrecord&id=L36556056&from=export http://dx.doi.org/10.1016/S0376-8716(03)00055-3 VL - 70 ID - 931223 ER - TY - JOUR AB - Background: Opioid use disorders are a major medical and public health concern. Buprenorphine is approved for the treatment of opioid use disorders; however, a shortage of physicians prescribing buprenorphine is a significant barrier to treatment access. The aims of this study were to evaluate opinions of internal medicine attending and resident physicians about buprenorphine and assess interest in becoming waivered to prescribe. Methods: Internal medicine resident and attending physicians at a primary care clinic in a large academic hospital were invited to complete surveys. The study sample was composed of physicians who were not waivered to prescribe buprenorphine. Survey data included demographic information, level of training, buprenorphine waiver status, interest in becoming waivered to prescribe buprenorphine, and beliefs about buprenorphine for treatment of opioid use disorders. High interest in becoming waivered was defined as a Likert response >3 (1 = No interest, 5 = Very interested). Results: Of the 44 physician respondents, 39 were not waivered to prescribe buprenorphine and constituted the sample; of those, 27 were residents and 12 were attending physicians. Twenty-six of the 39 nonwaivered respondents (66.7%) had high interest in becoming waivered. Those with high interest in becoming waivered were significantly more likely to be younger (P = .007) and to strongly believe in buprenorphine effectiveness (P = .023). Discussion: Most physicians in this academic training program showed high interest in prescribing buprenorphine, and belief in buprenorphine effectiveness was associated with high interest in becoming waivered. AD - a Division of General Internal Medicine, Department of Medicine , University of Washington , Seattle , Washington , USA. AN - 29578857 AU - James, J. R. AU - Gordon, L. M. AU - Klein, J. W. AU - Merrill, J. O. AU - Tsui, J. I. DO - 10.1080/08897077.2018.1449176 DP - NLM ET - 2018/03/27 J2 - Substance abuse KW - Adult Age Factors *Attitude of Health Personnel Buprenorphine/*therapeutic use *Drug Prescriptions Female Humans Male Narcotic Antagonists/therapeutic use *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Physicians/*psychology Practice Patterns, Physicians' *Buprenorphine *opioid use disorder *training LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0889-7077 SP - 11-13 ST - Interest in prescribing buprenorphine among resident and attending physicians at an urban teaching clinic T2 - Subst Abus TI - Interest in prescribing buprenorphine among resident and attending physicians at an urban teaching clinic VL - 40 ID - 930945 ER - TY - JOUR AB - Study Objectives: There is growing evidence that medication assisted therapy (MAT) which includes buprenorphine can lead to improved outcomes for patients with opiate use disorder (OUD), increased follow up with addiction treatment programs, as well as reduced illicit drug use and medical system costs for drug related emergency department (ED) visits. Emergency providers may serve to provide an induction to MAT and referrals to outpatient MAT providers. However, there continue to be barriers to utilization of buprenorphine from the ED including fears of precipitating withdrawal, fears of diversion or overdose, and beliefs that additional licenses are needed to offer treatment. The novel coronavirus epidemic threatens to pose even greater barriers to treatment access. EDs continue to serve patients throughout this crisis and may provide a critical role in continuing to link patients to MAT and provide care to patients with OUD. Methods: Our institution had planned to study the impact of an X-waiver training program for residents in our large, urban residency program. Closures during the coronavirus decreased patient volumes for many health care settings, especially outpatient clinics where much of MAT is delivered. We hypothesized that the “safer at home” order would have minimal impact on the percentage of patients presenting with OUD related complaints, as this would be coupled with less access to community resources that had previously provided support. We considered OUD-related ED visits as those which included any of the following: visits with a discharge diagnosis related to OUD, patients administered buprenorphine or naloxone while in the ED, and visits where a prescription for buprenorphine or naloxone was given on discharge. We analyzed these visit rates compared with all ED visits per month. Results: The number of ED visits in January 2020 and February 2020 were 13,933 and 12,639 with rates of OUD-related visits 24 and 32 per 10,000, respectively. Social distancing guidelines were announced in Los Angeles on March 11, and stay at home orders began March 19, 2020. In April and May, there were 6,649 and 8,385 ED visits, however, rates of OUD-related visits were 59 and 35 per 10,000. Conclusion: Restrictive requirements on MAT dispensation already limits access to office-based treatment; during the coronavirus, the closure of clinics and other ancillary services to support persons with OUD threaten those most at risk of relapse. The COVID-19 pandemic and the changes in response to it have exacerbated disparities for marginalized populations. In order to combat these disparities, we need to recognize and bolster the systems of care serving these patient groups. Our ED continued to see steady rates of OUD-related visits, reinforcing the importance of continuing efforts to provide MAT from our social safety net. ED MAT programming represents an important portal to care, especially as a stop gap when other access points are destabilized. [Formula presented] AU - Johnson, E. AU - Lam, C. AU - Axeen, S. AU - Trotsky-Sirr, R. AU - Schneberk, T. DB - Embase DO - 10.1016/j.annemergmed.2020.09.094 KW - buprenorphine naloxone opiate adult California conference abstract controlled study coronavirus disease 2019 drug safety drug therapy emergency ward human opiate addiction outpatient pandemic patient volume pharmacokinetics practice guideline prescription resident social distancing training LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S33 ST - 84 The Opioid Epidemic Meets the Coronavirus Pandemic: Rates of Emergency Department Visits for Opiate Use Disorder during COVID-19 T2 - Annals of Emergency Medicine TI - 84 The Opioid Epidemic Meets the Coronavirus Pandemic: Rates of Emergency Department Visits for Opiate Use Disorder during COVID-19 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008409929&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.094 VL - 76 ID - 931061 ER - TY - JOUR AB - Study Objectives: As the opiate epidemic continues, patient access to comprehensive care for opiate use disorder (OUD) remains a challenge. Buprenorphine administration in acute opioid withdrawal can lead to improved outcomes for patients with OUD, increased follow-up with addiction treatment, reduced injection drug use and fewer drug-related ED visits. Emergency providers can provide an induction to buprenorphine and a bridge to outpatient treatment. However, across the spectrum of practice, there continue to be barriers to utilization of buprenorphine, including fears of precipitating withdrawal, fears of diversion, and confusion about license requirements. Residency education on can impact an emerging generation of physicians as they develop lasting practice patterns. We examined the impact of X waiver training on these barriers among residents. Methods: LAC+USC is an urban, tertiary care facility with a large emergency medicine residency. We conducted X waiver training for all EM residents. Prior to training, we surveyed residents on barriers and biases surrounding patients with OUD. The survey deployed was an abbreviated version of that used by Lowenstein et. al. Three months after training, residents were again surveyed regarding their comfort with buprenorphine and biases surrounding OUD. We also stratified responses by buprenorphine adoption, comparing residents who reported prescribing buprenorphine or using it to treat withdrawal, with residents who had not given buprenorphine. We analyzed surveys using matched pair t-tests; findings discussed below reached a statistical significance of p<0.05 unless stated otherwise. Results: 49 of 74 residents completed the pre-training survey, and 34 of these completed the follow-up survey. Barriers and Knowledge Residents reported improved preparedness to treat aspects of OUD across all areas queried. Residents reported decreases in perceived barriers to providing buprenorphine based treatment, specifically decreases in concerns about access to care, specialty backup, insurance, and increased comfort prescribing naloxone. We also identified decreases in institution-specific barriers, including dosing protocols and resistance from senior residents. There were no significant differences in perceived barriers or statements surrounding clinical preparedness to treat OUD when we compared residents who had treated a patient with buprenorphine with those who had not. Biases after training, residents were significantly less likely to agree with the statement "patients with OUD are more challenging than the average patient" and "patients like this irritate me," and more likely to report that they felt comfortable counseling patients, prescribing buprenorphine, and treating opiate withdrawal. Residents who had given buprenorphine were significantly less likely to agree with the statement “there is little I can do to help patients like this” and more likely to report finding “caring for patients with OUD as satisfying as my other clinical activities.” Conclusion: X-waiver training improved resident comfort providing buprenorphine-based treatment and increased comfort prescribing naloxone. Training not only increased resident perceived efficacy and preparedness to treat OUD but also decreased agreement with some bias-related statements surrounding OUD. As the opiate epidemic continues to smolder, incorporating X waiver training into residency education may improve comprehensive care for OUD. AU - Johnson, E. AU - Lam, C. AU - Bluthenthal, R. AU - Trotsky-Sirr, R. AU - Schneberk, T. DB - Embase DO - 10.1016/j.annemergmed.2020.09.224 KW - buprenorphine naloxone opiate adoption adult care behavior comfort conference abstract controlled study counseling drug efficacy drug therapy emergency medicine follow up human insurance licence opiate addiction prescription residency education statistical significance tertiary care center LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S82 ST - 211 Impact of X-Waiver Training on Resident Barriers and Biases Surrounding Buprenorphine Treatment for Opiate Use Disorder T2 - Annals of Emergency Medicine TI - 211 Impact of X-Waiver Training on Resident Barriers and Biases Surrounding Buprenorphine Treatment for Opiate Use Disorder UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008409863&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.224 VL - 76 ID - 931059 ER - TY - JOUR AB - Study Objectives: Despite a growing awareness of the opiate epidemic, access to comprehensive care for opiate use disorder (OUD) remains a challenge. Buprenorphine administration in acute opioid withdrawal can lead to improved outcomes for patients with OUD, increased follow up with addiction treatment, reduced illicit drug use and lower medical system costs for drug related ED visits. Emergency providers may serve to provide an induction to medication-assisted therapy (MAT), decreasing the risk of use after discharge, and referring patients to outpatient MAT providers. However, across the spectrum of practice, there continue to be barriers to utilization of buprenorphine, including fears of precipitating withdrawal, fears of diversion or overdose, and beliefs that additional licenses are needed to offer treatment. Residents in training have been shown to carry forward practices learned in residency; thus, targeting educational interventions to these emerging physicians has the potential to affect downstream practice patterns and improve patient care. Methods: LAC+USC is an urban, tertiary care facility with a large emergency medicine residency. We conducted X-waiver training for all emergency residents, which concluded in January of 2020. We examined the number of residents who obtained their X-waiver following the training and changes in patient care including the number of patients dosed with buprenorphine in the ED for withdrawal, buprenorphine prescriptions, and naloxone prescriptions. Given nationwide changes in volume of patients seen in the ED during the coronavirus pandemic, the denominator used for these comparisons was per 1,000 ED patient visits. Results: Prior to the X-waiver training, there were three X-waivered residents in the department. 54 residents completed X-waiver training, and as of March 2020, 17 residents were X-waivered. We saw marked increases in buprenorphine treatment and prescribing after the X-waiver intervention (see figure 1). These increases in treatment observed for OUD patients persisted while adjusting for ED volumes. Conclusion: The X-waiver training effectively and markedly improved rates of buprenorphine and naloxone delivery to patients with OUD. As the opiate epidemic continues to smolder, it will continue to be important to guide resident practice to comprehensive care for OUD. This intervention provides a quantitative roadmap of MAT adoption for programs who provide X-waiver programming for residents. [Formula presented] AU - Johnson, E. AU - Lam, C. AU - Bluthenthal, R. AU - Trotsky-Sirr, R. AU - Schneberk, T. DB - Embase DO - 10.1016/j.annemergmed.2020.09.067 KW - buprenorphine buprenorphine plus naloxone naloxone opiate adoption adult conference abstract controlled study Coronavirinae drug overdose drug therapy drug withdrawal emergency medicine emergency ward female human implementation science licence major clinical study male nonhuman opiate addiction pandemic patient care prescription resident tertiary care center LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S23 ST - 57EMF X-Waiver Training for Resident Physicians Increases Emergency Department Buprenorphine Delivery: An Implementation Science Evaluation T2 - Annals of Emergency Medicine TI - 57EMF X-Waiver Training for Resident Physicians Increases Emergency Department Buprenorphine Delivery: An Implementation Science Evaluation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008410278&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.067 VL - 76 ID - 931062 ER - TY - JOUR AB - BACKGROUND AND AIMS: Expanding access to medication-assisted treatment with buprenorphine is a cornerstone of the opioid crisis response, yet buprenorphine remains underutilized. Research has identified multiple barriers to prescribing buprenorphine. This study aimed to examine clinician characteristics, prescribing practices and barriers and incentives to prescribing buprenorphine among clinicians with a federal Drug Addiction Treatment Act of 2000 (DATA) waiver to prescribe buprenorphine for opioid use disorder treatment. DESIGN: Electronic survey of 4225 clinicians conducted between March and April 2018. SETTING: United States. PARTICIPANTS: Clinicians obtaining an initial federal DATA waiver or an increase in authorized patient limit to prescribe buprenorphine for opioid use disorder treatment in 2017. MEASUREMENTS: Descriptive statistics and multivariable logistic regression examined clinician characteristics, prescribing practices and primary barriers and incentives to prescribing buprenorphine or prescribing at or near the authorized patient limit. FINDINGS: Among respondents, 75.5% had prescribed buprenorphine since obtaining a DATA waiver; the mean (standard deviation) number of patients treated in the past month was 26.6 (40.3), and 13.1% of providers were prescribing at or near their patient limit in the past month. Lack of patient demand, cited by 19.4% of clinicians, was the most common primary barrier to prescribing buprenorphine or prescribing to the authorized patient limit, followed by time constraints in practice (14.6%) and insurance reimbursement, prior authorization or other insurance requirements (13.2%). Increased patient demand (22.2%), institutional support for buprenorphine treatment (12.5%) and increased reimbursement (12.2%) were the most endorsed primary incentives for buprenorphine prescribing. Multivariable logistic regression models identified multiple clinician characteristics associated with buprenorphine prescribing and prescribing at or near the authorized patient limit. CONCLUSIONS: US clinicians recently waivered to prescribe buprenorphine for opioid use disorder treatment appear to prescribe well below their patient limit, and many do not prescribe at all. AD - Substance Abuse and Mental Health Services Administration, Rockville, MD, USA. AN - 30194876 AU - Jones, C. M. AU - McCance-Katz, E. F. DA - Mar DO - 10.1111/add.14436 DP - NLM ET - 2018/09/09 J2 - Addiction (Abingdon, England) KW - Adult Aged Buprenorphine/*therapeutic use Drug and Narcotic Control/legislation & jurisprudence Female Health Services Needs and Demand Humans Logistic Models Male Middle Aged Motivation Narcotic Antagonists/*therapeutic use Nurse Practitioners *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Physician Assistants Practice Patterns, Nurses' *Practice Patterns, Physicians' Reimbursement Mechanisms Surveys and Questionnaires United States *Agonist treatment *buprenorphine *drug addiction treatment act of 2000 *medication-assisted treatment *opioid use *treatment of opioid use disorder LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0965-2140 SP - 471-482 ST - Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder T2 - Addiction TI - Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder VL - 114 ID - 930941 ER - TY - JOUR AB - BACKGROUND: Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment. METHODS: Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training. RESULTS: At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training. CONCLUSIONS: This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness. AD - Jennifer Jones, MSN, PMHNP, CARN-AP, Matthew Tierney, MS, PMHNP, FAAN, Sandra Mallisham, DNP, PMHNP, and Gabrielle Jacobs, MSW, MSN, PMHNP, San Francisco Veterans Affairs Health Care System, California, and University of California San Francisco School of Nursing. Shao-Yun Chien, BS, University of California San Francisco School of Nursing. AN - 33264198 AU - Jones, J. AU - Tierney, M. AU - Jacobs, G. AU - Chien, S. Y. AU - Mallisham, S. DA - Oct/Dec DO - 10.1097/jan.0000000000000366 DP - NLM ET - 2020/12/03 J2 - Journal of addictions nursing LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1088-4602 SP - 261-268 ST - Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder T2 - J Addict Nurs TI - Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder VL - 31 ID - 930906 ER - TY - JOUR AB - PURPOSE: Opioid use disorder is a prevalent and chronic condition that can lead to adverse outcomes if untreated. Medication-assisted treatment (MAT) with buprenorphine in a primary care setting has the potential to increase availability of treatment and reduce harm; however, retention in MAT is key for patient success. This study's purpose was to examine predictors of retention in a MAT program for OUD in a family medicine residency clinic. METHODS: A retrospective chart review was conducted for 238 patients diagnosed with OUD and receiving MAT at a family medicine residency clinic between 2015 to 2017, with visit and prescription data collected through December 2018. Cox-proportional hazards models were used to examine the length of time in treatment. RESULTS: Over three-fourths of our patients were retained for at least 3 months, 69% for at least 6 months, and 48% retained for at least 1 year. Physician continuity of care and having insurance coverage significantly predicted retention and longer duration of treatment. CONCLUSIONS: Continuity of care and having health insurance were key predictors of patient retention in MAT care. Our findings emphasize the clinical significance of maintaining physician continuity of care to improve retention of patients with OUD in MAT programs. Future research could explore what aspects of continuity of care lead to retention in OUD treatment. AD - From the Department of Family Medicine and Community Health North Memorial Family Medicine Residency Program, University of Minnesota, Minneapolis, MN (KJ, MDS, MLC, TN, RL); Research Division, HealthPartners Institute, Minneapolis, MN (SH). AN - 33219064 AU - Justesen, K. AU - S, A. Hooker AU - Sherman, M. D. AU - Lonergan-Cullum, M. AU - Nissly, T. AU - Levy, R. DA - Nov-Dec DO - 10.3122/jabfm.2020.06.200086 DP - NLM ET - 2020/11/22 J2 - Journal of the American Board of Family Medicine : JABFM KW - *Buprenorphine *Continuity of Patient Care *Duration of Therapy *Family Physicians *Internship and Residency *Opioid-Related Disorders *Primary Health Care *Proportional Hazards Models *Retrospective Studies LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1557-2625 SP - 848-857 ST - Predictors of Family Medicine Patient Retention in Opioid Medication-Assisted Treatment T2 - J Am Board Fam Med TI - Predictors of Family Medicine Patient Retention in Opioid Medication-Assisted Treatment VL - 33 ID - 930828 ER - TY - JOUR AB - Opioid use during pregnancy poses serious risks for the mother and the unborn child. Opioid-use disorder may be managed with medication-assisted treatment (MAT) in an outpatient setting, but few MAT practices specifically address the challenges faced by pregnant women. This article describes a medical office-based educational support group for women in MAT for opioid-use disorder who were pregnant and/or parenting young children. Focus groups were conducted to elicit patient feedback. Women indicated that they found the educational support groups beneficial and offered suggestions. In-office educational support groups for pregnant women in treatment for opioid-use disorder are feasible and well received. AD - a Department of Family Medicine , Primary Care Research Institute, University at Buffalo , Buffalo , NY , USA. b Master of Public Health Program, Daemen College , Amherst , NY , USA. c School of Social Work , University at Buffalo , Amherst , NY , USA. d Center for Development of Human Services , Institute for Community Health Promotion , Rochester , NY , USA. AN - 28594601 AU - Kahn, L. S. AU - Mendel, W. E. Msw PhD AU - Fallin, K. L. Msw AU - Borngraber, E. A. Msw AU - Nochajski, T. H. AU - Rea, W. E. Mba Lmsw AU - Blondell, R. D. Md DA - Aug DO - 10.1080/00981389.2017.1327470 DP - NLM ET - 2017/06/09 J2 - Social work in health care KW - Adult *Ambulatory Care Facilities Education, Nonprofessional/*methods Female Humans Mothers Opioid-Related Disorders/*therapy Pregnancy Pregnancy Complications/*therapy *Education *maternal *opioid-use disorder *pregnancy and parenting LA - eng M1 - 7 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0098-1389 SP - 649-665 ST - A parenting education program for women in treatment for opioid-use disorder at an outpatient medical practice T2 - Soc Work Health Care TI - A parenting education program for women in treatment for opioid-use disorder at an outpatient medical practice VL - 56 ID - 930876 ER - TY - JOUR AB - PURPOSE: The United States is in the midst of an unprecedented public health crisis, with annual morbidity and mortality data related to opioid use consistently increasing and appearing more worrisome. To mitigate such consequences, it is critical that those with opioid use disorders are provided with and have access to evidence-based treatment modalities. METHODS: The project utilized a course scaffolding approach to integrate a comprehensive substance use framework into an advanced practice nursing curriculum, with an emphasis on medication-assisted treatment as part of an advanced pharmacology course required for licensure. RESULTS: Students' knowledge assessment increased significantly, from an average of 2.82 to 3.78 out of 5 items, t(217) = -10.31, p < .01. CONCLUSIONS: Educators and academic administrators must be steadfast in their resolve to include substance use, and specifically opioid use, education into all areas and levels of nursing study. AD - Brayden Kameg, BSN, RN, Robert Kaufman, PharmD, and Ann M. Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN, University of Pittsburgh School of Nursing, Pennsylvania. Dawn Lindsay, PhD, Institute for Research, Education and Training in Addictions, Pittsburgh, Pennsylvania. AN - 30180001 AU - Kameg, B. AU - Kaufman, R. AU - Lindsay, D. AU - Mitchell, A. M. DA - Jul/Sep DO - 10.1097/jan.0000000000000232 DP - NLM ET - 2018/09/05 J2 - Journal of addictions nursing KW - Buprenorphine/administration & dosage *Curriculum Education, Nursing, Graduate/*organization & administration Evidence-Based Nursing Humans Methadone/administration & dosage Naltrexone/administration & dosage Narcotic Antagonists/administration & dosage Nursing Education Research Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy/epidemiology United States/epidemiology LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1088-4602 SP - 163-166 ST - Integration of Medication-Assisted Treatment Information for Opioid Use Disorders Into a Graduate Nursing Curriculum T2 - J Addict Nurs TI - Integration of Medication-Assisted Treatment Information for Opioid Use Disorders Into a Graduate Nursing Curriculum VL - 29 ID - 930927 ER - TY - JOUR AB - Opioid overdose remains the leading cause of accidental death, with 64,000 deaths attributable to opioid-related overdoses in 2016 and a 20% increase in mortality since 2015. Advanced practice registered nurses (APRNs) are now eligible to prescribe buprenorphine. The purpose of this project was to develop educational training materials regarding opioid use management; widely disseminate these materials; monitor reach and intervention efficacy in precipitating practice change; and to evaluate barriers and facilitators of buprenorphine prescribing. The authors developed a three-webinar series pertaining to opioid use management. A broad marketing and dissemination approach was utilized. Demographic data was collected when individuals registered to participate in the webinar series. Follow-up data was collected post-webinar and sought to assess practice change, and barriers to and facilitators of buprenorphine prescribing. Of the 670 individuals that viewed one or more of the live webinars, 218 (32.5%) completed a portion of one or both of the follow-up surveys (at 3- and 6-months post-webinar). Of the respondents, 39 (18%) had obtained the DATA 2000 (buprenorphine) waiver since viewing the webinar series, and 11 (5.1%) were in the process of obtaining the DATA 2000 waiver. Barriers to buprenorphine prescribing included regulatory factors, patient-specific factors, and provider-specific factors. Facilitators to buprenorphine prescribing included institutional support and mentorship, collaboration with professional organizations, increased community awareness, and patient outcomes. APRNs should be abreast of best practices in the management of opioid use disorders. Barriers to and facilitators of buprenorphine prescribing must be understood and addressed. AD - Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA. AN - 32584628 AU - Kameg, B. N. AU - Mitchell, A. DA - Oct DO - 10.1080/01612840.2020.1749917 DP - NLM ET - 2020/06/26 J2 - Issues in mental health nursing LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0161-2840 SP - 940-945 ST - Technology-Based Educational Approaches to Address Opioid Use Management by Advanced Practice Registered Nurses T2 - Issues Ment Health Nurs TI - Technology-Based Educational Approaches to Address Opioid Use Management by Advanced Practice Registered Nurses VL - 41 ID - 930899 ER - TY - JOUR AD - Louise Kaplan is an associate professor at Washington State University Vancouver, Vancouver, Wash., and family NP at Tumwater Family Practice Clinic, Tumwater, Wash. AN - 30585906 AU - Kaplan, L. DA - Mar DO - 10.1097/01.npr.0000550252.04526.79 DP - NLM ET - 2018/12/27 J2 - The Nurse practitioner KW - Buprenorphine/therapeutic use Humans Methadone/therapeutic use Naltrexone/therapeutic use Narcotic Antagonists/therapeutic use Nurse Practitioners/*legislation & jurisprudence Opiate Substitution Treatment/*nursing Opioid-Related Disorders/*drug therapy/*nursing Practice Patterns, Nurses'/*legislation & jurisprudence United States LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0361-1817 SP - 10-12 ST - Medication-assisted treatment for opioid use disorder T2 - Nurse Pract TI - Medication-assisted treatment for opioid use disorder VL - 44 ID - 930808 ER - TY - JOUR AB - OBJECTIVE: To evaluate the impact of Pain Skills Intensive trainings (PSIs) as a complement to the Indian Health Service (IHS) and the Chronic Pain and Opioid Management TeleECHO Program (ECHO Pain) collaboration. DESIGN: On-site PSIs conducted over two to three days were added to complement ECHO Pain at various IHS areas to enhance pain skills proficiency among primary care teams and to expand the reach of ECHO collaboration to ECHO nonparticipants. SETTING: This evaluation focuses on two PSI trainings offered to IHS clinicians in Albuquerque, New Mexico, and Spokane, Washington, in 2017. METHODS: The mixed-methods design comprises CME surveys and focus groups at the end of training and 12 to 18 months later. Quality of training and perceived competence were evaluated. RESULTS: Thirty-eight participants attended the two PSI workshops. All provided CME survey results, and 28 consented to use of their postsession focus group results. Nine clinicians participated in the virtual follow-up focus groups. IHS clinicians rated the PSIs highly, noting their hands-on and interdisciplinary nature. They reported above-average confidence in their skills. Follow-up focus groups indicated they were pursuing expanded options for their patients, consulting other clinicians, serving as pain consultants to their peers, and changing prescribing practices clinic-wide. However, rurality significantly limits access to ancillary and complementary services for many. Clinicians reported the need for additional training in integrating behavioral health into their practice. CONCLUSIONS: Hands-on pain skills and information on medication-assisted treatment (MAT) are critical to the successful treatment of chronic pain and opioid use disorder. The PSIs provide clinicians with critical competencies in assessment and screening, pain management, and communication skills, complementing required IHS training and telementoring from ECHO Pain. AD - UNM Department of Neurosurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Project ECHO, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Indian Health Service, Albuquerque, New Mexico, USA. AN - 32556294 AU - Katzman, J. G. AU - Gygi, K. AU - Swift, R. AU - Comerci, G. AU - Bhatt, S. AU - Daitz, B. AU - Martin, C. AU - Fore, C. DA - Sep 1 DO - 10.1093/pm/pnaa151 DP - NLM ET - 2020/06/20 J2 - Pain medicine (Malden, Mass.) KW - *Chronic Pain *Continuing Medical Education *Hands-on Pain Skills *Interdisciplinary Pain Education *Opioids *Project ECHO LA - eng M1 - 9 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1526-2375 SP - 1769-1778 ST - How Hands-On Pain Skills Intensive Trainings Complement ECHO Pain and Opioid Management Programs: A Program Evaluation with the Indian Health Service T2 - Pain Med TI - How Hands-On Pain Skills Intensive Trainings Complement ECHO Pain and Opioid Management Programs: A Program Evaluation with the Indian Health Service VL - 21 ID - 930989 ER - TY - JOUR AB - Pennsylvania has the third highest rate of death due to drug overdose (44.3 per 100,000) in the country, which is significantly higher than the national rate. This continues to have drastic societal impact. Medication assisted treatment (MAT), which includes opioid agonist medications, is the gold standard in treatment for OUD; however, a significant gap remains between the number of individuals in need of treatment and the number of MAT providers. Penn State Health established a system to address the opioid epidemic through the Pennsylvania Coordinated Medication Assisted Treatment program utilizing lessons learned from existing validated models. Connecting primary care sites and hospital systems through a combination of Hub and Spoke, bridge clinic services provided at the Hub, peer recovery services, Project Extension for Community Health Outcomes (ECHO), and layered emergency department (ED) initiation of buprenorphine, this model is an innovative approach that addresses many known barriers to MAT treatment initiation. Early results within the first six months indicate significantly shortened wait time for patients seeking treatment, provision of waiver training to 70 local physicians to prescribe buprenorphine, and improved knowledge and ability to provide patient care for providers participating in our first Project ECHO cohort. AD - Pennsylvania Psychiatric Institute, 2501 N 3rd St, Harrisburg, PA 17110, USA; Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA. Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA. Electronic address: efrancis@psu.edu. Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA. AN - 31540612 AU - Kawasaki, S. AU - Francis, E. AU - Mills, S. AU - Buchberger, G. AU - Hogentogler, R. AU - Kraschnewski, J. C2 - Pmc7194237 C6 - Nihms1576174 DA - Nov DO - 10.1016/j.jsat.2019.08.016 DP - NLM ET - 2019/09/22 J2 - Journal of substance abuse treatment KW - Adult Buprenorphine/*administration & dosage Emergency Service, Hospital/organization & administration Evidence-Based Medicine/*organization & administration Female Health Knowledge, Attitudes, Practice Humans Male Middle Aged Models, Organizational Opiate Substitution Treatment/*methods Opioid Epidemic Opioid-Related Disorders/*drug therapy Patient Acceptance of Health Care Pennsylvania Physicians/organization & administration Practice Patterns, Physicians'/statistics & numerical data Primary Health Care/organization & administration *Addiction *Hub-and-spoke system *Medication assisted treatment *Opioid LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0740-5472 (Print) 0740-5472 SP - 58-64 ST - Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania T2 - J Subst Abuse Treat TI - Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania VL - 106 ID - 930857 ER - TY - JOUR AB - BACKGROUND: Professional treatment and non-professional mutual-help organizations (MHOs) play important roles in mitigating addiction relapse risk. More recently, a third tier of recovery support services has emerged that are neither treatment nor MHO that encompass an all-inclusive flexible approach combining professionals and volunteers. The most prominent of these is Recovery Community Centers (RCCs). RCC's goal is to provide an attractive central recovery hub facilitating the accrual of recovery capital by providing a variety of services (e.g., recovery coaching; medication assisted treatment [MAT] support, employment/educational linkages). Despite their growth, little is known formally about their structure and function. Greater knowledge would inform the field about their potential clinical and public health utility. METHOD: On-site visits (2015-2016) to RCCs across the northeastern U.S. (K = 32) with semi-structured interviews conducted with RCC directors and online surveys with staff assessing RCCs': physicality and locality; operations and budgets; leadership and staffing; membership; and services. RESULTS: Physicality and locality: RCCs were mostly in urban/suburban locations (90%) with very good to excellent Walk Scores reflecting easy accessibility. Ratings of environmental quality indicated neighborhood/grounds/buildings were moderate-good attractiveness and quality. Operations: RCCs had been operating for an average of 8.5 years (SD = 6.2; range 1-33 years) with budgets (mostly state-funded) ranging from $17,000-$760,000/year, serving anywhere from a dozen to more than two thousand visitors/month. Leadership and staffing: Center directors were mostly female (55%) with primary drug histories of alcohol (62%), cocaine (19%), or opioids (19%). Most, but not all, directors (90%) and staff (84%) were in recovery. Membership: A large proportion of RCC visitors were male (61%), White (72%), unemployed (50%), criminal-justice system-involved (43%) and reported opioids (35%) or alcohol (33%) as their primary substance. Roughly half were in their first year of recovery (49%), but about 20% had five or more years. Services: RCCs reported a range of services including social/recreational (100%), mutual-help (91%), recovery coaching (77%), and employment (83%) and education (63%) assistance. Medication-assisted treatment (MAT) support (43%) and overdose reversal training (57%) were less frequently offered, despite being rated as highly important by staff. CONCLUSIONS: RCCs are easily accessible, attractive, mostly state-funded, recovery support hubs providing an array of services to individuals in various recovery stages. They appear to play a valued role in facilitating the accrual of social, employment, housing, and other recovery capital. Research is needed to understand the relative lack of opioid-specific support and to determine their broader impact in initiating and sustaining remission and cost-effectiveness. AD - Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America. Electronic address: jkelly11@mgh.harvard.edu. Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America. Decision Sciences Institute, Providence, RI, United States of America. DePaul University, United States of America. AN - 32087832 AU - Kelly, J. F. AU - Fallah-Sohy, N. AU - Vilsaint, C. AU - Hoffman, L. A. AU - Jason, L. A. AU - Stout, R. L. AU - Cristello, J. V. AU - Hoeppner, B. B. C2 - Pmc7039941 C6 - Nihms1547546 DA - Apr DO - 10.1016/j.jsat.2019.12.009 DP - NLM ET - 2020/02/24 J2 - Journal of substance abuse treatment KW - *Addiction *Recovery *Recovery coaching *Recovery community centers *Substance use disorder *Support services LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 (Print) 0740-5472 SP - 1-10 ST - New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States T2 - J Subst Abuse Treat TI - New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States VL - 111 ID - 930980 ER - TY - JOUR AB - OBJECTIVE: Buprenorphine medication-assisted treatment (B-MAT) is an efficacious and popular outpatient treatment for opioid use disorder. However, the likelihood of buprenorphine diversion is a public health concern. We examined the relationship between attitudes toward diversion as predictors of both sharing and selling buprenorphine. METHOD: Participants (n=476) were patients undergoing short-term inpatient opioid detoxification. Multinomial logistic regression was used to estimate the adjusted association of sharing and selling buprenorphine with demographics, substance use behaviors, and attitudes toward sharing and selling buprenorphine. RESULTS: Among the two hundred persons who had ever been prescribed buprenorphine (73.4% male, 89% heroin users), 50.5% reported they had shared buprenorphine and 28.0% reported they had sold buprenorphine. Controlling for other covariates, the odds of sharing buprenorphine were 3.17 (95% CI 1.21; 8.32) times higher for persons who agreed that it was "right to share buprenorphine with dope sick friends" than for those who did not agree with this attitude. Attitudes toward selling (OR 2.92; 95% CI 1.35; 6.21) and sharing (OR 4.12; 95% CI 1.64; 10.32) buprenorphine were the only significant correlates of selling, with the odds of selling exponentially greater among persons with favorable attitudes toward sharing or selling buprenorphine. CONCLUSIONS: Although considered diversion, sharing B-MAT is normative among B-MAT patients. Assessing B-MAT patients' attitudes about diversion may help identify patients requiring enhanced oversight, education, or intervention aimed at modifying attitudes to reduce their likelihood to share or sell buprenorphine. AD - Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States. Electronic address: Shannon_Kenney@brown.edu. Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States. Warren Alpert Medical School of Brown University, Providence, RI 02912, United States; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States. Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Boston University School of Public Health, Boston, MA 02118, United States. AN - 28554602 AU - Kenney, S. R. AU - Anderson, B. J. AU - Bailey, G. L. AU - Stein, M. D. C2 - Pmc7189524 C6 - Nihms1579876 DA - Jul DO - 10.1016/j.jsat.2017.04.017 DP - NLM ET - 2017/05/31 J2 - Journal of substance abuse treatment KW - Adult Analgesics, Opioid/*administration & dosage *Attitude Buprenorphine/*administration & dosage Female Humans Male Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Prescription Drug Diversion/*statistics & numerical data *Buprenorphine *Diversion *Medication-assisted treatment *Opioid use LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0740-5472 (Print) 0740-5472 SP - 43-47 ST - The relationship between diversion-related attitudes and sharing and selling buprenorphine T2 - J Subst Abuse Treat TI - The relationship between diversion-related attitudes and sharing and selling buprenorphine VL - 78 ID - 930855 ER - TY - JOUR AB - This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4-6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment. AD - Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States. Electronic address: mkidorf@jhmi.edu. Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States. AN - 29709732 AU - Kidorf, M. AU - Brooner, R. K. AU - Leoutsakos, J. M. AU - Peirce, J. DA - Jun 1 DO - 10.1016/j.drugalcdep.2018.03.009 DP - NLM ET - 2018/05/02 J2 - Drug and alcohol dependence KW - Adult Analgesics, Opioid/*administration & dosage Counseling Female Humans Male Methadone/*administration & dosage Motivation Needle-Exchange Programs Opiate Substitution Treatment/*methods/psychology Opioid-Related Disorders/*drug therapy/psychology Patient Compliance/*psychology Referral and Consultation Reinforcement, Psychology Treatment Outcome *Methadone maintenance *Syringe exchange *Treatment initiation *Treatment retention LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0376-8716 SP - 343-350 ST - Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial T2 - Drug Alcohol Depend TI - Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial VL - 187 ID - 930925 ER - TY - JOUR AB - 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. AD - Phoenix VA Health Care System, Phoenix, AZ, USA. VA St. Louis Health Care System, St. Louis, MO, USA. Saint Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA. AN - 33289022 AU - Kirby, T. AU - Connell, R. AU - Linneman, T. DA - Feb 8 DO - 10.1093/ajhp/zxaa386 DP - NLM ET - 2020/12/09 J2 - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists KW - *group education *medication-assisted treatment *opioid *opioid use disorder *opioid-related disorders LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1079-2082 SP - 301-309 ST - Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans T2 - Am J Health Syst Pharm TI - Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans VL - 78 ID - 931015 ER - TY - JOUR AB - Background: Opioid use and overdose are escalating in the United States. Primary care providers are in a strategic position to assess patients for medication-assisted treatment (MAT). Objectives: To describe the implementation of MAT in an integrated primary care residency clinic and assess provider comfort levels with evaluating patients for high-risk opioid use, conduct crucial conversations about MAT treatment options and referral to MAT for evaluation and treatment. Methods: As part of a Primary Care Training and Enhancement grant through Health Resources and Services Administration, we used an implementation process to allow for optimal clinic flow. The process included assessment of patient populations, identifying a provider champion, organizing multidisciplinary team, engaging a practice facilitator, designing clinic model and infrastructure, creating the electronic health record order sets along with provider and staff training. Providers responded to brief questions to evaluate comfort levels in 3 domains: identifying high-risk opioid use, conducting crucial conversations about treatment options and referral to MAT for evaluation and treatment. Discussion: Incorporating MAT within an integrated primary care clinic and residency program with waiver training for residents was a successful and innovative program. The availability of MAT provided a solution for patients that could benefit from this type of treatment. MAT presence gave providers the opportunity to refer these patients for treatment that had not previously been as accessible. Conclusion: An integrated primary care practice with an embedded MAT can be successful with an organized structure to optimize clinic flow. AD - Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA. Northwest Area Health Education Center, Wake Forest School of Medicine, Winstons Salem, NC, USA. AN - 32644863 AU - Kirk, J. K. AU - Yount, T. AU - Boyd, C. T. AU - Cassidy-Vu, L. AU - Koehler, A. N. AU - Spangler, J. G. C2 - Pmc7350034 DA - Jan-Dec DO - 10.1177/2150132720940723 DP - NLM ET - 2020/07/10 J2 - Journal of primary care & community health KW - *medication-assisted treatment (MAT) *office-based opioid treatment *opioid *outpatient-based opioid treatment (OBOT) of interest with respect to the research, authorship, and/or publication of this article. LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2150-1319 (Print) 2150-1319 SP - 2150132720940723 ST - Launching a Medication-Assisted Treatment in an Outpatient Office-Based Practice T2 - J Prim Care Community Health TI - Launching a Medication-Assisted Treatment in an Outpatient Office-Based Practice VL - 11 ID - 930818 ER - TY - JOUR AB - OBJECTIVES: Urine drug testing (UDT) can play an important role in addiction medicine. Indeed, the American Society of Addiction Medicine (ASAM) recently released a white paper, detailing the history of UDT, emphasizing recent advances in the laboratory and clinical science of UDT, and discussed the potential for broadening clinical utility of UDT. We conducted a survey of ASAM members to better understand their knowledge, attitudes, and practices with regard to UDT. METHODS: ASAM leadership along with clinical and laboratory experts developed a large pool of items on knowledge, attitudes, and practices around the use and implementation of UDT. These were condensed and converted to a web-based format. Two mass e-mails were sent for recruitment to the survey, with the first e-mail resulting in an open rate of 37% and the follow-up e-mail having an open rate of 34%. RESULTS: A total of 365 respondents completed the survey, with 51% indicating they were Board Certified in Addiction Medicine/Addiction Psychiatry. Up to 93% of respondents indicated they were waivered to prescribe buprenorphine, and 20% indicated that they were certified as a Medical Review Officer (MRO). A total of 93% felt confident in their ability to interpret the results of UDT, 90% used UDT to monitor both medication and illicit substance use, and 79% either agreed (48%) or strongly agreed (31%) with the statement "it is important to do adulteration testing for aberrant behavior." Urine drug testing was most likely to be ordered "when a patient is demonstrating problematic behavior" (70%), and for "baseline testing for new patients plus random selection of current patients" (57%). SIGNIFICANCE: The survey revealed that UDT is widely used and highly integrated into the assessment and management of people with addictions undergoing treatment by ASAM members. Greater than 94% of respondents use testing to determine adherence, to monitor abstinence, and to detect an early relapse. The majority felt confident in their ability to interpret and use UDT results, and the vast majority had reportedly used it in changing patient management. Education gaps do exist, however, and should be the focus of future education efforts on UDT. AD - Millennium Research Institute (KLK, SDP), San Diego, CA; Millennium Health (KLK, AR, SDP), San Diego, CA; Professional Assistance Program of New Jersey (LEB), Princeton, NJ; and American Society of Addiction Medicine (LEB, MM), Chevy Chase, MD. AN - 26335003 AU - Kirsh, K. L. AU - Baxter, L. E. AU - Rzetelny, A. AU - Mazuk, M. AU - Passik, S. D. DA - Sep-Oct DO - 10.1097/adm.0000000000000146 DP - NLM ET - 2015/09/04 J2 - Journal of addiction medicine KW - Aged Female *Health Knowledge, Attitudes, Practice Humans Illicit Drugs/*urine Male Middle Aged *Societies, Medical Substance Abuse Detection/*methods Surveys and Questionnaires *Urinalysis LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 1932-0620 SP - 399-404 ST - A Survey of ASAM Members' Knowledge, Attitudes, and Practices in Urine Drug Testing T2 - J Addict Med TI - A Survey of ASAM Members' Knowledge, Attitudes, and Practices in Urine Drug Testing VL - 9 ID - 931023 ER - TY - JOUR AB - The limited availability of medication-assisted treatment has created a treatment gap leaving many opioid dependent individuals without access to appropriate treatment. Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 are presented. During the first year, an estimated 63,204 opioid dependent patients were treated with buprenorphine; many were dependent on prescription opioids and were new to drug treatment. Prescribing physicians reported high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion. However, many waivered physicians had not provided buprenorphine treatment. Prescribers identified challenges such as induction logistics, recordkeeping requirements, the 30-patient limit, DEA involvement, and limited patient compliance. Buprenorphine treatment could potentially reduce the treatment gap by providing safe and effective treatment for opioid dependence and by attracting patients who do not typically seek care at opioid treatment programs. AD - Westate, Rockville, MD 20850,USA. wendykissin@westat.com AN - 17088229 AU - Kissin, W. AU - McLeod, C. AU - Sonnefeld, J. AU - Stanton, A. DO - 10.1300/J069v25n04_09 DP - NLM ET - 2006/11/08 J2 - Journal of addictive diseases KW - Attitude of Health Personnel Behavior, Addictive/*rehabilitation Buprenorphine/*therapeutic use Documentation Drug Prescriptions/*statistics & numerical data Health Personnel/*statistics & numerical data Humans Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*rehabilitation *Professional Competence Surveys and Questionnaires LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2006 SN - 1055-0887 (Print) 1055-0887 SP - 91-103 ST - Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence T2 - J Addict Dis TI - Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence VL - 25 ID - 931001 ER - TY - JOUR AB - RATIONALE: Opioid overdose deaths and healthcare costs associated with opioid use disorder (OUD) continue to escalate while the majority of addiction treatment providers in the United States do not use medication-assisted treatment (MAT) in spite of proven efficacy. The primary resistance to the use of MAT has been associated with the philosophical conflict many 12-step based treatment programs have with the use of these medications. OBJECTIVE: This study sought to determine whether patients self-selecting into a treatment program based upon the 12-step philosophy would elect to use MAT and, if so, what initial outcomes might result. METHODS: This naturalistic, prospective study of patients (N = 253) with OUD included a combination of OUD-specific group therapy and the use of buprenorphine-naloxone, oral naltrexone, injectable naltrexone, or no medication with standard 12-step treatment initiated in a residential or day treatment setting with outpatient follow-up. Baseline assessment of subjects with OUD included level of craving and opioid withdrawal symptom severity. Post-residential treatment outcomes at 1- and 6-months included craving, opioid withdrawal, residential treatment completion, continuing care compliance, medication compliance, substance use frequency and 12-step meeting attendance. RESULTS: Irrespective of medication condition, nearly all patients successfully completed residential treatment and the majority attended additional programming afterward. Among those who elected to take a medication (71%), differences were associated with medication compliance. Patients who reported compliance with their medication at 1 and 6 months following residential treatment had significantly higher abstinence rates than patients who reported noncompliance. Among those who relapsed post-discharge, neither medication use nor compliance was significantly related to a change in the frequency of alcohol use days or drug use days at 6 months. CONCLUSION: These preliminary results suggest that it is feasible to administer medications, including partial opioid agonists like buprenorphine, within the context of 12-step based treatment and taking these medications as prescribed is associated with favorable outcomes. AD - Pear Therapeutics, Boston, MA, United States of America. Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, Center City, MN 55012, United States of America. Electronic address: mseppala@hazeldenbettyford.org. AN - 31370985 AU - Klein, A. A. AU - Seppala, M. D. DA - Sep DO - 10.1016/j.jsat.2019.06.009 DP - NLM ET - 2019/08/03 J2 - Journal of substance abuse treatment KW - Adult Ambulatory Care *Behavior Therapy Buprenorphine, Naloxone Drug Combination/administration & dosage/therapeutic use Combined Modality Therapy Day Care, Medical Feasibility Studies Female Follow-Up Studies Humans Male Naltrexone/administration & dosage/therapeutic use Narcotic Antagonists/administration & dosage/*therapeutic use *Opiate Substitution Treatment Opioid-Related Disorders/*therapy *Outcome Assessment, Health Care *Patient Compliance Prospective Studies *Residential Treatment *12-step treatment *Buprenorphine/naloxone *Medication-assisted treatment *Naltrexone *Opioid use disorder LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0740-5472 SP - 51-63 ST - Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results T2 - J Subst Abuse Treat TI - Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results VL - 104 ID - 930827 ER - TY - JOUR AB - Purpose We examined the impact on geographic distribution of medications to treat opioid use disorder (MOUD) in Oregon after the Comprehensive Addiction and Recovery Act (CARA) was implemented in February 2017 to include nurse practitioner (NP) prescribers. Methods We conducted interrupted time series analysis with linear regression on prescriptions dispensed for buprenorphine used for MOUD in the Oregon Prescription Drug Monitoring Database written by physician (MD/DO) and NP prescribers January 1, 2016, to December 31, 2018. We analyzed total prescriptions by prescriber type and pharmacy ZIP Code using STATA 16.1. Findings From January 1, 2016, to December 31, 2018, 420,765 eligible prescriptions were written by waivered MD/DO and/or NP prescribers. Prior to CARA, buprenorphine use was increasing steadily at 140 prescriptions per month (95% CI: 78-201; P < .01). Following CARA, dispensing increased by 88 prescriptions per month (95% CI: 23-152; P = .01). The absolute number increased in rural areas immediately after CARA implementation (368 prescriptions; 95% CI: 124-613; P < .01). NP contribution to total buprenorphine prescribing increased significantly in both urban and rural areas (0.44% per month [95% CI: 0.30%-0.57%; P < .01] and 0.74% per month [95% CI: 0.62%-0.85%; P < .01]). The contribution of NPs had a particularly large impact for very rural (frontier) areas, where NPs provided 36% of all buprenorphine prescriptions by the end of 2018. Conclusion Changes in federal law regarding MOUD had a positive impact on both supply and geographic distribution in Oregon, particularly in frontier areas comprising 10 of 36 counties (27%). AD - [Klein, Tracy A.] Washington State Univ, Coll Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686 USA. [Geddes, Jonah] Portland State Univ, Oregon Hlth & Sci Univ, Sch Publ Hlth, Portland, OR 97207 USA. [Hartung, Daniel] Oregon Hlth & Sci Univ, Oregon State Univ, Coll Pharm, Portland, OR 97201 USA. Klein, TA (corresponding author), Washington State Univ, Coll Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686 USA. taklein@wsu.edu AN - WOS:000589010900001 AU - Klein, T. A. AU - Geddes, J. AU - Hartung, D. DO - 10.1111/jrh.12538 J2 - J. Rural Health KW - access to care buprenorphine nursing INTERRUPTED TIME-SERIES UNITED-STATES BARRIERS TRENDS Health Care Sciences & Services Health Policy & Services Public, Environmental & Occupational Health LA - English M3 - Article; Early Access N1 - Web of Science Clarivate Analytics literature search May 7, 2021 SN - 0890-765X SP - 8 ST - The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon T2 - Journal of Rural Health TI - The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon UR - ://WOS:000589010900001 ID - 931233 ER - TY - JOUR AB - PURPOSE: We examined the impact on geographic distribution of medications to treat opioid use disorder (MOUD) in Oregon after the Comprehensive Addiction and Recovery Act (CARA) was implemented in February 2017 to include nurse practitioner (NP) prescribers. METHODS: We conducted interrupted time series analysis with linear regression on prescriptions dispensed for buprenorphine used for MOUD in the Oregon Prescription Drug Monitoring Database written by physician (MD/DO) and NP prescribers January 1, 2016, to December 31, 2018. We analyzed total prescriptions by prescriber type and pharmacy ZIP Code using STATA 16.1. FINDINGS: From January 1, 2016, to December 31, 2018, 420,765 eligible prescriptions were written by waivered MD/DO and/or NP prescribers. Prior to CARA, buprenorphine use was increasing steadily at 140 prescriptions per month (95% CI: 78-201; P < .01). Following CARA, dispensing increased by 88 prescriptions per month (95% CI: 23-152; P = .01). The absolute number increased in rural areas immediately after CARA implementation (368 prescriptions; 95% CI: 124-613; P < .01). NP contribution to total buprenorphine prescribing increased significantly in both urban and rural areas (0.44% per month [95% CI: 0.30%-0.57%; P < .01] and 0.74% per month [95% CI: 0.62%-0.85%; P < .01]). The contribution of NPs had a particularly large impact for very rural (frontier) areas, where NPs provided 36% of all buprenorphine prescriptions by the end of 2018. CONCLUSION: Changes in federal law regarding MOUD had a positive impact on both supply and geographic distribution in Oregon, particularly in frontier areas comprising 10 of 36 counties (27%). AD - College of Nursing, Washington State University Vancouver, Vancouver, Washington. School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon. College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon. AN - 33188544 AU - Klein, T. A. AU - Geddes, J. AU - Hartung, D. DA - Nov 13 DO - 10.1111/jrh.12538 DP - NLM ET - 2020/11/15 J2 - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association KW - access to care buprenorphine nursing LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0890-765x ST - The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon T2 - J Rural Health TI - The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon ID - 930846 ER - TY - JOUR AB - OBJECTIVE: The U.S. Food and Drug Administration's approval of buprenorphine in 2002 expanded options for treating opioid use disorder (OUD). Physicians who intend to treat OUD patients with buprenorphine must seek a waiver to prescribe it, which may contribute to state-by-state variation in the supply of waivered physicians. METHOD: This study integrates data extracted from the U.S. Drug Enforcement Agency's database of waivered physicians with state-level indicators of the macro environment, health-related resources, and treatment demand. RESULTS: In December 2013, the average state had 8.0 waivered physicians per 100,000 residents (SD = 5.2). Large regional differences between states in the Northeast relative to states in the Midwest, South, and West were observed. The percentage of residents covered by Medicaid as well as the population-adjusted availability of opioid treatment programs and substance use disorder treatment facilities were positively associated with buprenorphine physician supply. Buprenorphine physician supply was positively correlated with states' rates of overdose deaths, suggesting that physicians may seek the waiver in response to the magnitude of the opioid problem in their state. CONCLUSIONS: States with greater health-related resources, particularly in terms of the supply of opioid treatment programs and substance use disorder treatment programs, had more waivered physicians in 2013. The finding regarding Medicaid coverage suggests that states implementing Medicaid expansion under health reform may experience additional growth in buprenorphine physician supply. However, large regional disparities in the supply of waivered physicians may impede access to care for many Americans with OUD. AD - Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky. AN - 26098042 AU - Knudsen, H. K. C2 - Pmc4495082 DA - Jul DO - 10.15288/jsad.2015.76.644 DP - NLM ET - 2015/06/23 J2 - Journal of studies on alcohol and drugs KW - Buprenorphine/*administration & dosage Health Care Reform Humans Medicaid Narcotic Antagonists/*administration & dosage Opioid-Related Disorders/*drug therapy Physicians/*statistics & numerical data United States LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 1937-1888 (Print) 1937-1888 SP - 644-54 ST - The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis T2 - J Stud Alcohol Drugs TI - The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis VL - 76 ID - 930990 ER - TY - JOUR AB - Background: Increasing access to buprenorphine treatment is a critical tool for addressing the opioid epidemic in the United States. In 2016, a federal policy change allowed physicians who meet specific requirements to treat up to 275 concurrent buprenorphine patients. This study examines state-level measures of buprenorphine treatment supply over 21 months since this policy change and estimates associations between the supply of 275-patient waivers and state characteristics. Methods: Monthly state-level measures of the number of physicians holding the 275-patient waiver per 100,000 residents were constructed from September 2016 to May 2018 using the Drug Enforcement Agency's Controlled Substance Act database. State characteristics were obtained from publicly available sources. Mixed-effects regression models were estimated to examine change over time. Results: During the 21-month period, the number of physicians waivered to treat 275 patients increased from 153 to 4009 physicians. The mean supply of 275-patient physicians per 100,000 state residents significantly increased from 0.07 (SD = 0.21) in September 2016 to 1.43 (SD = 1.08) in May 2018 (t = -9.84, df = 50, P < .001). The final mixed-effects regression model indicated that Census division and the preexisting supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers over the study period. Conclusions: Although uptake of the 275-patient waiver has exceeded initial projections, growth is uneven across the United States. Unequal patterns of growth pose a challenge to efforts to increase treatment availability as a means of addressing the opioid epidemic. AD - Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA. Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA. Center for Clinical Management Research (CCMR), Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. AN - 31295057 AU - Knudsen, H. K. AU - Lin, L. A. AU - Lofwall, M. R. C2 - Pmc6954348 C6 - Nihms1534029 DO - 10.1080/08897077.2019.1635959 DP - NLM ET - 2019/07/12 J2 - Substance abuse KW - *Buprenorphine *Data 2000 *opioid use disorder treatment LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0889-7077 (Print) 0889-7077 SP - 259-268 ST - Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis T2 - Subst Abus TI - Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis VL - 41 ID - 930907 ER - TY - JOUR AB - Background: Increasing access to buprenorphine treatment is a critical tool for addressing the opioid epidemic in the United States. In 2016, a federal policy change allowed physicians who meet specific requirements to treat up to 275 concurrent buprenorphine patients. This study examines state-level measures of buprenorphine treatment supply over 21 months since this policy change and estimates associations between the supply of 275-patient waivers and state characteristics. Methods: Monthly state-level measures of the number of physicians holding the 275-patient waiver per 100,000 residents were constructed from September 2016 to May 2018 using the Drug Enforcement Agency's Controlled Substance Act database. State characteristics were obtained from publicly available sources. Mixed-effects regression models were estimated to examine change over time. Results: During the 21-month period, the number of physicians waivered to treat 275 patients increased from 153 to 4009 physicians. The mean supply of 275-patient physicians per 100,000 state residents significantly increased from 0.07 (SD = 0.21) in September 2016 to 1.43 (SD = 1.08) in May 2018 (t = -9.84, df = 50, P < .001). The final mixed-effects regression model indicated that Census division and the preexisting supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers over the study period. Conclusions: Although uptake of the 275-patient waiver has exceeded initial projections, growth is uneven across the United States. Unequal patterns of growth pose a challenge to efforts to increase treatment availability as a means of addressing the opioid epidemic. AD - [Knudsen, Hannah K.; Lofwall, Michelle R.] Univ Kentucky, Dept Behav Sci, 845 Angliana Ave,Room 204, Lexington, KY 40508 USA. [Knudsen, Hannah K.; Lofwall, Michelle R.] Univ Kentucky, Ctr Drug & Alcohol Res, 845 Angliana Ave,Room 204, Lexington, KY 40508 USA. [Lin, Lewei (Allison)] Univ Michigan, Dept Psychiat, Ann Arbor, MI 48109 USA. [Lin, Lewei (Allison)] Vet Affairs Ann Arbor Healthcare Syst, CCMR, Ann Arbor, MI USA. Knudsen, HK (corresponding author), Univ Kentucky, Dept Behav Sci, 845 Angliana Ave,Room 204, Lexington, KY 40508 USA.; Knudsen, HK (corresponding author), Univ Kentucky, Ctr Drug & Alcohol Res, 845 Angliana Ave,Room 204, Lexington, KY 40508 USA. hannah.knudsen@uky.edu AN - WOS:000476140800001 AU - Knudsen, H. K. AU - Lin, L. W. AU - Lofwall, M. R. DA - Apr DO - 10.1080/08897077.2019.1635959 J2 - Subst. Abus. KW - Buprenorphine DATA 2000 opioid use disorder treatment INSURANCE-COVERAGE UNITED-STATES PRESCRIBE BUPRENORPHINE AGONIST TREATMENT HEALTH-INSURANCE OVERDOSE DEATHS PHYSICIANS CARE DEPENDENCE ACCESS Substance Abuse LA - English M1 - 2 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2020 SN - 0889-7077 SP - 259-268 ST - Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis T2 - Substance Abuse TI - Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis UR - ://WOS:000476140800001 VL - 41 ID - 931261 ER - TY - JOUR AB - Aims: Physicians in the US who are waivered to prescribe buprenorphine for opioid dependence are limited to 30 patients at any one time in the first year, after which they may submit a notification to treat up to 100 patients concurrently. Some contend these patient limits are a barrier to treatment. This study aims to address whether the 100-patient limit should be raised. Methods: The percentages of physicians holding the 30-patient and 100-patient waivers were extracted from the DEA's Controlled Substance Act Registrants Database. Data on current caseloads and perceptions of the 100-patient limit were obtained via mailed surveys of current prescribers (n = 193) from June-November 2014. Results: In November 2014, 25,738 physicians were waivered to prescribe buprenorphine; only 31.0% held the 100-patient waiver. The average caseload was greater for 100-patient prescribers (mean = 63.3, SD = 34.6) than 30-patient prescribers (mean = 19.6, SD = 21.0; t =-10.2, p < .001), but both averages represent just two-thirds of current treatment capacity. When rating the statement, “I could provide quality care to more than 100 patients if there was a higher patient limit” on a scale ranging from 1 (strongly disagree) to 5 (strongly agree), the average response was 3.2 (SD = 1.4). Although 100-patient prescribers more strongly endorsed this statement (mean = 3.6, SD = 1.3) than 30-patient prescribers (mean = 2.6, SD = 1.2; t =-5.4, p < .001), the mean for the 100-patient prescribers was between “neither” and “agree.” Conclusions: Current prescribers of buprenorphine report ambivalence about providing high quality care to more than 100 patients. Furthermore, prescribers are only treating about twothirds of the patients allowed by their waivers. These data, coupled with the limited number of prescribers with the 100-patient waiver, suggest that raising the patient limits may have a limited impact on treatment access while potentially eroding the quality of care. AD - H.K. Knudsen, Behavioral Science, University of Kentucky, Lexington, KY, United States AU - Knudsen, H. K. AU - Lofwall, M. R. DB - Embase DO - 10.1016/j.drugalcdep.2015.07.318 KW - buprenorphine controlled substance human patient college drug dependence physician data base opiate addiction averaging LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2015 SN - 0376-8716 SP - e115 ST - Access to buprenorphine treatment: Is the patient limit a barrier? T2 - Drug and Alcohol Dependence TI - Access to buprenorphine treatment: Is the patient limit a barrier? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72176695&from=export http://dx.doi.org/10.1016/j.drugalcdep.2015.07.318 VL - 156 ID - 931185 ER - TY - JOUR AB - BACKGROUND: Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states. METHODS: Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states' approaches to implementing ACA. RESULTS: The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs. CONCLUSIONS: This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered. AD - Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA. Electronic address: hannah.knudsen@uky.edu. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 203, Lexington, KY 40508, USA. Electronic address: michelle.lofwall@uky.edu. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 201, Lexington, KY 40508, USA. Electronic address: jennifer.havens@uky.edu. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA. Electronic address: sharon.walsh@uky.edu. AN - 26483356 AU - Knudsen, H. K. AU - Lofwall, M. R. AU - Havens, J. R. AU - Walsh, S. L. C2 - Pmc4663127 C6 - Nihms729346 DA - Dec 1 DO - 10.1016/j.drugalcdep.2015.09.032 DP - NLM ET - 2015/10/21 J2 - Drug and alcohol dependence KW - Buprenorphine/*therapeutic use Drug Prescriptions/*statistics & numerical data Humans Medicaid Opioid-Related Disorders/*drug therapy Patient Protection and Affordable Care Act/*legislation & jurisprudence Physicians/*supply & distribution/trends Prospective Studies United States Affordable Care Act Buprenorphine Health insurance exchanges Medicaid expansion Physician supply LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 0376-8716 (Print) 0376-8716 SP - 36-43 ST - States' implementation of the Affordable Care Act and the supply of physicians waivered to prescribe buprenorphine for opioid dependence T2 - Drug Alcohol Depend TI - States' implementation of the Affordable Care Act and the supply of physicians waivered to prescribe buprenorphine for opioid dependence VL - 157 ID - 931011 ER - TY - JOUR AD - Division of Pain Medicine, Department of Anesthesia, University of Virginia, Charlottesville, Virginia, USA LRK9G@hscmail.mcc.virginia.edu. AN - 31431488 AU - Kohan, L. DA - Aug 19 DO - 10.1136/rapm-2019-100907 DP - NLM ET - 2019/08/23 J2 - Regional anesthesia and pain medicine KW - opioids, adverse effects pain medicine resident education LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1098-7339 ST - One prescription for the opioid crisis: require buprenorphine waivers for pain medicine fellows T2 - Reg Anesth Pain Med TI - One prescription for the opioid crisis: require buprenorphine waivers for pain medicine fellows ID - 930877 ER - TY - JOUR AB - BACKGROUND: Project ECHO (Extension for Community Healthcare Outcomes) trains and mentors primary care providers (PCPs) in the care of patients with complex conditions. ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic based at the University of New Mexico Health Sciences Center that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. METHODS: Since 2005, specialists in treatment of SUDs and behavioral health disorders at Project ECHO have offered a weekly 2-hour Integrated Addictions and Psychiatry (IAP) TeleECHO Clinic focused on supporting PCP evaluation and treatment of SUDs and behavioral health disorders. We tabulate the number of teleECHO clinic sessions, participants, and CME/CEU (continuing medical education/continuing education unit) credits provided annually. This teleECHO clinic has also been used to recruit physicians to participate in DATA-2000 buprenorphine waiver trainings. Using a database of the practice location of physicians who received the buprenorphine waiver since 2002, the number of waivered physicians per capita in US states was calculated. The increase in waivered physicians practicing in underserved areas in New Mexico was evaluated and compared with the rest of the United States. RESULTS: Since 2008, approximately 950 patient cases have been presented during the teleECHO clinic, and more than 9000 hours of CME/CEU have been awarded. Opioids are the substances discussed most commonly (31%), followed by alcohol (21%) and cannabis (12%). New Mexico is near the top among US states in DATA-2000 buprenorphine-waivered physicians per capita, and it has had much more rapid growth in waivered physicians practicing in traditionally underserved areas compared with the rest of the United States since the initiation of the teleECHO clinic focused on SUDs in 2005. CONCLUSION: The ECHO model provides an opportunity to promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas. AD - a ECHO Institute, University of New Mexico Health Sciences Center , University of New Mexico , Albuquerque , New Mexico , USA. b Truman Clinic, University Hospital , Albuquerque , New Mexico , USA. c El Centro Family Health Center , Espanola , New Mexico , USA. AN - 26848803 AU - Komaromy, M. AU - Duhigg, D. AU - Metcalf, A. AU - Carlson, C. AU - Kalishman, S. AU - Hayes, L. AU - Burke, T. AU - Thornton, K. AU - Arora, S. C2 - Pmc4873719 DO - 10.1080/08897077.2015.1129388 DP - NLM ET - 2016/02/06 J2 - Substance abuse KW - Buprenorphine/*therapeutic use Community Health Services/*methods Curriculum Education, Medical, Continuing/*statistics & numerical data Humans Opioid-Related Disorders/*drug therapy Primary Health Care/*methods Telecommunications/statistics & numerical data Buprenorphine distance education opioid-related disorders substance-related disorders vulnerable populations LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0889-7077 (Print) 0889-7077 SP - 20-4 ST - Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders T2 - Subst Abus TI - Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders VL - 37 ID - 930992 ER - TY - JOUR AB - Greater integration of medication-assisted treatment (MAT) for opioid use disorder (OUD) in U.S. primary care settings would expand access to treatment for this condition. Models for integrating MAT into primary care vary in structure. This article summarizes findings of a technical report for the Agency for Healthcare Research and Quality describing MAT models of care for OUD, based on a literature review and interviews with key informants in the field. The report describes 12 representative models of care for integrating MAT into primary care settings that could be considered for adaptation across diverse health care settings. Common components of existing care models include pharmacotherapy with buprenorphine or naltrexone, provider and community education, coordination and integration of OUD treatment with other medical and psychological needs, and psychosocial services and interventions. Models vary in how each component is implemented. Decisions about adopting MAT models of care should be individualized to address the unique milieu of each implementation setting. AD - From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington. AN - 27919103 AU - Korthuis, P. T. AU - McCarty, D. AU - Weimer, M. AU - Bougatsos, C. AU - Blazina, I. AU - Zakher, B. AU - Grusing, S. AU - Devine, B. AU - Chou, R. C2 - Pmc5504692 C6 - Nihms870055 DA - Feb 21 DO - 10.7326/m16-2149 DP - NLM ET - 2016/12/06 J2 - Annals of internal medicine KW - Buprenorphine/therapeutic use Combined Modality Therapy Education, Medical, Continuing Health Education Humans Naltrexone/therapeutic use Narcotic Antagonists/*therapeutic use *Opiate Substitution Treatment Opioid-Related Disorders/complications/*drug therapy Primary Health Care/*organization & administration Psychotherapy LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0003-4819 (Print) 0003-4819 SP - 268-278 ST - Primary Care-Based Models for the Treatment of Opioid Use Disorder: A Scoping Review T2 - Ann Intern Med TI - Primary Care-Based Models for the Treatment of Opioid Use Disorder: A Scoping Review VL - 166 ID - 930799 ER - TY - JOUR AB - Introduction: Buprenorphine is the first drug approved for office-based treatment of opioid use disorder (OUD), but the waiver and 8-hour training required by the Drug Enforcement Administration (DEA) to prescribe it contribute to low numbers of buprenorphine providers. Although surveys of residents and program directors suggest there is a strong interest in obtaining skills needed to adequately treated OUD, few residency programs incorporate this training, posing a significant logistical challenge for residents wishing to obtain the waiver. A 2019 survey of residency program directors suggested less than a third of programs encourage or require a waiver for buprenorphine prescription, with less than a quarter of surveyed directors reporting that their program dedicates at least 12 hours to addiction medicine.3 To the best of our knowledge, no existing studies have investigated medical students' perspectives on buprenorphine training during residency. Thus, the goal of this study was to examine medical students' attitudes and beliefs about treating patients with OUD, and to what extent they look for these training opportunities when identifying potential residency programs. Methods: A nine-question online survey was distributed to University of Maryland SOM medical students (MS1-3) via email list-serv in May 2019. Responses were collected over one week. The survey evaluated attitudes towards OUD, buprenorphine training, and career aspirations. Results: The survey was sent out to three cohorts of medical students (474 students) with a 35% response rate (n=167). Of those who responded, 70% reported wanting to pursue primary care and 98% agreed/strongly agreed that primary care plays an important role in addressing the opioid epidemic.With regards to buprenorphine training, 98% agreed/strongly agreed that training should be offered within a primary care residency, 89% agreed/strongly agreed that if given time in residency, they would be interested in completing the training, and 53% reported that a residency program offering buprenorphine training would attract them to that program. Additionally, 94% endorsed that it was important to them to have training in treating OUD; however only 34% knew that there is an 8-hour training required to obtain the Bupe-X waiver to prescribe buprenorphine. All respondents agreed that buprenorphine training should be either required and incorporated into residency (60%), or optional but embedded with protected time (40%). Conclusions: The national shortage of buprenorphine providers impedes access to care for patients suffering from OUD and contributes to the ongoing opioid epidemic. Expanding buprenorphine training in residency programs may reduce the shortage of providers and our data suggest that medical students highly value this training opportunity. Residency programs should consider trainee interests and provide opportunities for their residents to receive buprenorphine training, particularly given the favorable impact this may have for expanding access to treatment. AD - Z. Kozak AU - Kozak, Z. AU - Pappas, A. DB - Embase KW - buprenorphine opiate adult aspiration attitude career conference abstract controlled study drug therapy e-mail female human major clinical study male Maryland medical student opiate addiction primary medical care resident LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1935-3227 SP - e402-e403 ST - Medical Students' Desire for Buprenorphine Training in Residency T2 - Journal of Addiction Medicine TI - Medical Students' Desire for Buprenorphine Training in Residency UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634656427&from=export VL - 14 ID - 931050 ER - TY - JOUR AB - Objectives: Opioid addiction affects over 2 million patients in the United States. The advent of buprenorphine and the passage of the Drug Addiction Treatment Act in 2000 have revolutionized the opioid treatment delivery system by granting physicians the ability to administer office-based opioid treatment (OBOT), thereby giving patients greater access to treatment. The purpose of this consensus panel was to synthesize the most current evidence on the use of buprenorphine in the office-based setting and to make recommendations that will enable and allow additional physicians to begin to treat opioidaddicted individuals. Methods: Literature published from 2000 to 2009 was searched using the PubMed search engine and yielded over 375 articles published in peer-reviewed journals, including some that were published guidelines. These articles were submitted to a consensus panel composed of researchers, educators, and clinicians who are leaders in the field of addictionmedicine with specific expertise in the use of OBOT. The panel discussed results and agreed upon consensus recommendations for several facets of OBOT. Results: On the basis of the literature review and consensus discussions, the panel developed a series of findings, conclusions, and recommendations regarding the use of buprenorphine in office-based treatment of opioid addiction. Conclusions: Therapeutic outcomes for patients who self-select office-based treatment with buprenorphine are essentially comparable to those seen in patients treated with methadone programs. There are few absolute contraindications to the use of buprenorphine, although the experience and skill levels of treating physicians can vary considerably, as can access to the resources needed to treat comorbid medical or psychiatric conditions-all of which affect outcomes. It is important to conduct a targeted assessment of every patient to confirm that the provider has resources available to meet the patient's needs. Patients should be assessed for a broad array of biopsychosocial needs in addition to opioid use and addiction, and should be treated, referred, or both for help in meeting all their care needs, including medical care, psychiatric care, and social assistance. Current literature demonstrates promising efficacy of buprenorphine, though further research will continue to demonstrate its effectiveness for special populations, such as adolescents, pregnant women, and other vulnerable populations. Since the time of this review, several new studies have provided new data to continue to improve our understanding of the safety and efficacy of buprenorphine for special patient populations. © 2011 American Society of Addiction Medicine. AD - M.L. Kraus, Yale University School of Medicine, New Haven, United States AU - Kraus, M. L. AU - Alford, D. P. AU - Kotz, M. M. AU - Levounis, P. AU - Mandell, T. W. AU - Meyer, M. AU - Salsitz, E. A. AU - Wetterau, N. AU - Wyatt, S. A. DB - Embase Medline DO - 10.1097/ADM.0b013e3182312983 KW - buprenorphine methadone article breast feeding chronic pain comorbidity consensus development coping behavior detoxification dose response drug contraindication drug dose reduction drug efficacy drug safety drug substitution drug withdrawal health care delivery hepatitis human Human immunodeficiency virus infection maintenance therapy needs assessment opiate addiction patient assessment patient counseling patient selection pregnant woman priority journal professional competence psychologic assessment treatment outcome LA - English M1 - 4 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2011 SN - 1932-0620 1935-3227 SP - 254-263 ST - Statement of the American society of addiction medicine consensus panel on the use of buprenorphine in office-based treatment of opioid addiction T2 - Journal of Addiction Medicine TI - Statement of the American society of addiction medicine consensus panel on the use of buprenorphine in office-based treatment of opioid addiction UR - https://www.embase.com/search/results?subaction=viewrecord&id=L364242826&from=export http://dx.doi.org/10.1097/ADM.0b013e3182312983 VL - 5 ID - 931209 ER - TY - JOUR AB - Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use. AD - Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD. Department of Medicine, University of California, San Francisco and Organization to Achieve Solutions In Substance Abuse (O.A.S.I.S.) Oakland, CA. Division of Digestive Diseases and Nutrition, National Institute on Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, MD. Division of Substance Abuse, Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY. AN - 25977607 AU - Kresina, T. F. AU - Sylvestre, D. AU - Seeff, L. AU - Litwin, A. H. AU - Hoffman, K. AU - Lubran, R. AU - Clark, H. W. C2 - Pmc4395041 DO - 10.4137/sart.s580 DP - NLM ET - 2008/01/01 J2 - Substance abuse : research and treatment KW - hepatitis medication assisted treatment methadone substance abuse treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2008 SN - 1178-2218 (Print) 1178-2218 SP - 15-61 ST - Hepatitis infection in the treatment of opioid dependence and abuse T2 - Subst Abuse TI - Hepatitis infection in the treatment of opioid dependence and abuse VL - 1 ID - 930977 ER - TY - JOUR AB - STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): With a high burden of opioid use disorder (OUD) in the area and difficulty accessing OUD treatment for our clinic population, we launched an embedded and navigator-managed buprenorphine clinic to streamline linkage of patients to evidence-based addiction treatment in primary care. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1) To increase access to treatment for patients with OUD in primary care 2) To enhance primary care capacity to treat patients with OUD in a timely manner 3) To expand the workforce to ensure clinic sustainability DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS) : We implemented a twice-monthly half-day buprenorphine clinic designed specifically to treat patients with opioid use disorder (OUD) and embedded it in a General Internal Medicine (GIM) outpatient practice. A patient navigator manages the clinic as the primary point of contact for referrals from the emergency department (ED), urgent care, inpatient teams, and outpatient practices. The clinic is staffed by a faculty primary care physician who has an x-waiver from the US Drug Enforcement Agency to prescribe buprenorphine for OUD. Outreach efforts are predominantly focused on patients already receiving their primary care at the GIM clinic housing the buprenorphine clinic. The buprenorphine clinic thus functions as an extension of the patients' care, encouraging them to seek addiction treatment in a known setting. To increase the number of clinicians who can follow patients evaluated in the buprenorphine clinic, a free and gift-card incentivized xwaiver training was organized for GIM faculty, nurse practitioners, and resident trainees. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): In the first year of the clinic, we aim to -Improve access to buprenorphine consultation as quantified by filling two-thirds of appointment slots (i.e. 4 of 7) and ensuring an average reasonable time (<14 days) from referral to evaluation -Increase the number of patient initiations on buprenorphine for OUD by 50% (from 8 to 12+/year) -Double the number of x-waivered GIM clinicians (from 15 previously to at least 30) FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): In the first three months of launching the clinic, we made progress on all measures. We filled 70% of appointment slots (above target), scheduled patients on average 17 days from referral (30% scheduled <14d, approaching target), and evaluated 22 total patients for buprenorphine. Fifteen patients were either initiated or maintained on buprenorphine (at target). Seven residents, two nurse practitioners, and four faculty physicians have received their waiver since the clinic and trainings launched (28 total x-waivered, approaching target). KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The creation of an embedded buprenorphine clinic in primary care, managed by a patient navigator, increases access to treatment for OUD. In the clinic's first three months, we have made significant progress toward our appointment and treatment goals and expect all numbers to ramp up to targets in upcoming months. Additionally, incentivizing clinicians to attend waiver trainings increases the likelihood that they will complete their certification and expand the pipeline of buprenorphine providers. AD - I. Kryzhanovskaya, Intern Medicine, UCSF, San Francisco, CA, United States AU - Kryzhanovskaya, I. AU - Gutierrez, V. DB - Embase DO - 10.1007/s11606-020-05890-3 KW - buprenorphine constitutive androstane receptor endogenous compound opiate addiction adult certification clinical article clinical evaluation conference abstract controlled study drug therapy emergency ward female general practitioner hospital patient housing human internal medicine male nurse practitioner outpatient patient referral pipeline quantitative analysis resident workforce LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1525-1497 SP - S676 ST - Navigating your way to treatment: Results from an embedded buprenorphine clinic in primary care T2 - Journal of General Internal Medicine TI - Navigating your way to treatment: Results from an embedded buprenorphine clinic in primary care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633956186&from=export http://dx.doi.org/10.1007/s11606-020-05890-3 VL - 35 ID - 931074 ER - TY - JOUR AB - BACKGROUND: Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. METHODS: In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents' provision of buprenorphine treatment during residency, (2) residents' provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. RESULTS: Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). CONCLUSION: These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence. AD - Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. AN - 23844954 AU - Kunins, H. V. AU - Sohler, N. L. AU - Giovanniello, A. AU - Thompson, D. AU - Cunningham, C. O. C2 - Pmc3799907 C6 - Nihms509769 DO - 10.1080/08897077.2012.752777 DP - NLM ET - 2013/07/13 J2 - Substance abuse KW - Adult Buprenorphine/*therapeutic use Education, Medical, Graduate/*methods Feasibility Studies Female Humans *Internship and Residency Male Medication Adherence Middle Aged Narcotic Antagonists/therapeutic use Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians' *Primary Health Care *Program Evaluation LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2013 SN - 0889-7077 (Print) 0889-7077 SP - 242-7 ST - A buprenorphine education and training program for primary care residents: implementation and evaluation T2 - Subst Abus TI - A buprenorphine education and training program for primary care residents: implementation and evaluation VL - 34 ID - 930944 ER - TY - JOUR AB - Purpose of Study: The amount of opioids prescribed for chronic pain has increased rapidly over the last two decades, a trend accompanied by opioid misuse, abuse, and addiction. Buprenorphine Management Therapy (BMT) has demonstrated effectiveness as a treatment modality for opioid addiction, and is especially useful in rural areas where Methadone Maintenance Therapy (MMT) is rarely available. The goal of this study is to determine the specialty, geographic location, and practice type of waivered buprenorphine prescribers in Washington State. Methods Used: We matched the April, 2011 Drug Enforcement Agency (DEA) registry of buprenorphine-waivered providers in the United States with the 2004 American Medical Association (AMA) Masterfile and online resources to determine the practice, specialty, geographic setting, age, and sex of waivered providers. Telephone calls to practices were used to fill in missing data. Summary of Results: The most common specialty of buprenorphinewaivered providers (N = 427) as of April, 2011 is family practice (36% of physicians), followed by psychiatry (30%). Overall, waivered primary care physicians outnumber other specialty care providers 213 to 173, with 41 providers having a specialty we categorized as “other” . Primary care providers constitute the plurality in all geographic locations (“Urban” areas, 46%; “Large Rural” , 52%; “Small Rural” , 86%; “Isolated Rural” , 100%). In urban areas, waivered providers work predominately in private clinics, while in rural areas the majority work in safety net settings. Compared to all patient care physicians in Washington State, waivered physicians are more likely to 55-64 years of age, and less likely to be <35. Conclusions: These data from Washington State demonstrate that primary care physicians are interested in BMT as a therapeutic approach to opioid addiction. Because they are well distributed throughout all areas and types of practices, they have the potential to provide access to all segments of the population. In rural areas, these providers are located primarily in federally subsidized clinics, which supports the need for continued funding of both primary care and mental health for the underinsured. The relative paucity of younger waivered providers suggests that training during residency would be a productive strategy in expanding treatment. AD - E. Kvamme, University of Washington, School of Medicine, Seattle, WA, United States AU - Kvamme, E. AU - Rosenblatt, R. DB - Embase DO - 10.231/JIM.0b013e318240c940 KW - buprenorphine opiate United States medical research human physician addiction rural area primary medical care geography general practitioner general practice telephone medical society register therapy mental health hospital maintenance therapy population patient care methadone treatment safety private hospital urban area psychiatry funding abuse chronic pain LA - English M1 - 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2012 SN - 1081-5589 SP - 144-145 ST - Specialty, geographic, and practice distribution of buprenorphine providers in washington state T2 - Journal of Investigative Medicine TI - Specialty, geographic, and practice distribution of buprenorphine providers in washington state UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70983020&from=export http://dx.doi.org/10.231/JIM.0b013e318240c940 VL - 60 ID - 931208 ER - TY - JOUR AB - We describe a Massachusetts Bureau of Substance Abuse Services' (BSAS) initiative to disseminate the office-based opioid treatment with buprenorphine (OBOT-B) Massachusetts Model from its development at Boston Medical Center (BMC) to its implementation at fourteen community health centers (CHCs) beginning in 2007. The Massachusetts Collaborative Care Model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients, holds promise for the effective expansion of treatment for opioid use disorders. The training of and technical assistance for the OBOT nurses as well as a limited program assessment are described. Data spanning 6years (2007-2013) report patient demographics, prior treatment for opioid use disorders, history of overdose, housing, and employment. The expansion of OBOT to the fourteen CHCs increased the number of physicians who were "waivered" (i.e., enabling their prescribing of buprenorphine) by 375%, from 24 to 114, within 3years. During this period the annual admissions of OBOT patients to CHCs markedly increased. Dissemination of the Massachusetts Model of the Office-Based Opioid Treatment with Buprenorphine employing a collaborative care model with a central role for nursing enabled implementation of effective treatment for patients with an opioid use disorder at community health centers throughout Massachusetts while effectively engaging primary care physicians in this endeavor. AD - Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. Electronic address: Colleen.LaBelle@bmc.org. Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. AN - 26233698 AU - LaBelle, C. T. AU - Han, S. C. AU - Bergeron, A. AU - Samet, J. H. C2 - Pmc4682362 C6 - Nihms740758 DA - Jan DO - 10.1016/j.jsat.2015.06.010 DP - NLM ET - 2015/08/04 J2 - Journal of substance abuse treatment KW - Adult Ambulatory Care/*organization & administration/statistics & numerical data Buprenorphine/*therapeutic use Community Health Centers/*organization & administration/statistics & numerical data Cooperative Behavior Female Humans Male Massachusetts Middle Aged Narcotics/*therapeutic use Opiate Substitution Treatment/*methods/statistics & numerical data Opioid-Related Disorders/*drug therapy Young Adult Access to treatment Buprenorphine Nurse care manager Opioid agonist therapy Opioid use disorder Waivered physicians LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0740-5472 (Print) 0740-5472 SP - 6-13 ST - Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers T2 - J Subst Abuse Treat TI - Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers VL - 60 ID - 930987 ER - TY - JOUR AB - We describe a Massachusetts Bureau of Substance Abuse Services' (BSAS) initiative to disseminate the office-based opioid treatment with buprenorphine (OBOT-B) Massachusetts Model from its development at Boston Medical Center (BMC) to its implementation at fourteen community health centers (CHCs) beginning in 2007. The Massachusetts Collaborative Care Model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients, holds promise for the effective expansion of treatment for opioid use disorders. The training of and technical assistance for the OBOT nurses as well as a limited program assessment are described. Data spanning 6 years (2007-2013) report patient demographics, prior treatment for opioid use disorders, history of overdose, housing, and employment. The expansion of OBOT to the fourteen CHCs increased the number of physicians who were "waivered" (i.e., enabling their prescribing of buprenorphine) by 375%, from 24 to 114, within 3 years. During this period the annual admissions of OBOT patients to CHCs markedly increased. Dissemination of the Massachusetts Model of the Office-Based Opioid Treatment with Buprenorphine employing a collaborative care model with a central role for nursing enabled implementation of effective treatment for patients with an opioid use disorder at community health centers throughout Massachusetts while effectively engaging primary care physicians in this endeavor. (C) 2015 Elsevier Inc. All rights reserved. AD - [LaBelle, Colleen T.; Bergeron, Alexis; Samet, Jeffrey H.] Boston Med Ctr, Dept Med, Gen Internal Med Sect, Clin Addict Res & Educ CARE Unit, Boston, MA 02118 USA. [LaBelle, Colleen T.; Han, Steve Choongheon; Samet, Jeffrey H.] Boston Univ, Sch Med, Dept Med, Sect Gen Internal Med,Clin Addict Res & Educ CARE, Boston, MA 02118 USA. [Samet, Jeffrey H.] Boston Univ, Sch Publ Hlth, Dept Community Hlth Sci, Boston, MA 02118 USA. LaBelle, CT (corresponding author), Clin Addict Res & Educ CARE Unit, Gen Internal Med Sect, 801 Massachusetts Ave,Second Floor, Boston, MA 02118 USA. Colleen.LaBelle@bmc.org AN - WOS:000366882500002 AU - LaBelle, C. T. AU - Han, S. C. AU - Bergeron, A. AU - Samet, J. H. DA - Jan DO - 10.1016/j.jsat.2015.06.010 J2 - J. Subst. Abus. Treat. KW - Opioid agonist therapy Buprenorphine Waivered physicians Nurse care manager Access to treatment Opioid use disorder MANAGEMENT DEPENDENCE ILLNESS Psychology, Clinical Substance Abuse LA - English M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2016 SN - 0740-5472 SP - 6-13 ST - Office-Based Opioid Treatment with Buprenorphine (OBOT-B): State-wide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers T2 - Journal of Substance Abuse Treatment TI - Office-Based Opioid Treatment with Buprenorphine (OBOT-B): State-wide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers UR - ://WOS:000366882500002 VL - 60 ID - 931286 ER - TY - JOUR AB - BACKGROUND: Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. OBJECTIVE: The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. DATA SOURCES: PubMed, EMBASE, CINAHL, and PsychInfo. METHODS: We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. RESULTS: We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient "agreements," and using home inductions to make treatment more convenient for patients and providers. CONCLUSIONS: The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed. AD - Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America. Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America. University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America. Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America. Division of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America. AN - 29040331 AU - Lagisetty, P. AU - Klasa, K. AU - Bush, C. AU - Heisler, M. AU - Chopra, V. AU - Bohnert, A. C2 - Pmc5645096 DO - 10.1371/journal.pone.0186315 DP - NLM ET - 2017/10/19 J2 - PloS one KW - Adult Buprenorphine/therapeutic use Delivery of Health Care Humans Methadone/therapeutic use Opioid-Related Disorders/*drug therapy/epidemiology *Primary Health Care LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1932-6203 SP - e0186315 ST - Primary care models for treating opioid use disorders: What actually works? A systematic review T2 - PLoS One TI - Primary care models for treating opioid use disorders: What actually works? A systematic review VL - 12 ID - 930793 ER - TY - JOUR AB - Intro/Background: The US Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Opioid misuse has resulted in a dramatic increase in deaths over the past 2 decades and imposes an enormous public health burden across the US. Particularly high are the rates of premature death in young Americans. This has resulted in a call for action to develop programs to mitigate the risk of opioid addiction and opioid-related deaths. Purpose/Objective: The primary aim of the educational initiatives is to measure the impact of a multifaceted Opioid Stewardship Program leveraging simulationbased education to promote the development and utilization of systems-based solutions to mitigate the risk of opioid use disorder. Secondary aims include measuring changes in misconceptions around opioid use disorder and knowledge gains around strategies to mitigate risk of opioid misuse. Methods: This is a prospective mixed-method study measuring the effect of simulation-based training (SBT) on the development of systems-based solutions to address opioid use disorders. ED Faculty learners participated in stations with standardized patients designed to mimic challenging clinical scenarios, ie drugseeking behavior, opioid withdrawal, and acute pain management. Subjects completed pre and post-course surveys with free-response questions probing for their attitudes around opioid use disorders and their knowledge of treatment strategies. Outcomes (if available): The post-course survey revealed overall positive reactions for 42 faculty learners. Over 90% reported the session was either 'quite' or 'extremely effective' in promoting good prescribing strategies, educating patients prescribed opioids, and highlighting strategies for administering buprenorphine. Free-text responses emphasized a commitment to opioid responsible practices through prescribing less euphoria-inducing opioids, improving comprehensive discharge instructions, and better awareness of both the community and institutional resources available to support patients dealing with opioid use disorder. Summary: An emerging concept in the fight against opioid misuse is Opioid Stewardship, which has been described as “coordinated interventions designed to improve, monitor, and evaluate the use of opioids to support and protect human health”. Key elements of a recently successful Opioid Stewardship Program (OSP) implemented across a large health system included a multifaceted approach to impact opioid prescribing, addiction services, information technology tools, and provider education. Many educational programs around opioid misuse revolve around traditional didactic methods of teaching. Even commonly accessible online modules are grounded in passive educational strategies. In order to effectively change misconceptions about opioid use disorder, it is critical to engage practitioners initiatives that promote critical self-reflection. Through the use of deliberate practice, and structured debriefing, simulation-based training is ideally suited to uncover erroneous misconceptions and behaviors. Furthermore, simulation that integrates the use of standardized patients enables practitioners to improve complex communication skills such as motivational interviewing, which is critical to help patients suffering from opioid addiction contemplate change. Simulation faculty developed 3 stimulation scenarios with standardized patients based on 1) Strategies in acute pain management 2) Management of patients in acute opioid withdrawal and 3) Approach to a patient after a non-lethal overdose of opioids. Over 13 weeks, 3-4 faculty met for 2 hours to first discuss practices and biases surrounding patients with opioid use disorder. Faculty then rotated through each scenario and de-briefed individually and as a group. Knowledge gained and goals for practice change were recorded in a post-course survey. The initial reactions of our learners to this initiative have been positive. Ongoing research is evaluating practice change by monitoring opioid prescribing practi es, utilization of outpatient resources for opioid use disorder, and tracking faculty who electively engage in X-Waiver training to provide other treatment options for those with opioid use disorder. AD - M. Lamberta, Maimonides Medical Center AU - Lamberta, M. AU - Aghera, A. AU - Cardell, A. M. AU - Elahi, N. AU - Motov, S. AU - Strayer, R. J. DB - Embase DO - 10.1111/acem.13961 KW - buprenorphine opiate adult analgesia attitude awareness case report clinical article communication skill conference abstract drug overdose drug therapy drug withdrawal euphoria female human information technology male motivational interviewing opiate addiction outpatient physician prescription prospective study simulation training teaching LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1553-2712 SP - S330-S331 ST - A faculty opioid stewardship program integrating simulation based-training with standardized patients T2 - Academic Emergency Medicine TI - A faculty opioid stewardship program integrating simulation based-training with standardized patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632417997&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 931081 ER - TY - JOUR AB - Statement of Problem Or Question (One Sentence): How do we provide effective, dignified primary care for medically complex patients with homelessness in a safety-net health system? Objectives of Program/Intervention (No More Than Three Objectives): To effectively engage homeless patients with complex barriers to primary care To provide dignified, trauma-informed care focused on patient-oriented care goals while addressing addiction, mental health, and chronic disease To implement an interdisciplinary care team model in a safety-net health care system combining primary care, social work, care coordination, and nursing Description of Program/Intervention, Including Organizational Context (E.G. Inpatient Vs. Outpatient, Practice or Community Characteristics): Unstably housed people with complex chronic disease often receive fragmented care from various emergency departments and inpatient settings, accruing high rates of acute care utilization without improvements in health. Recently, intensive outpatient models have emerged to better manage high need patients. Here we describe our efforts to create a complex care clinic for medically, socially, and behaviorally complex patients with unstable housing at the largest safety-net health system in the United States. Launched in August 2018, the clinic aims to engage patients in a trusting healthcare environment and break the cycle of disease, addiction, and housing instability. Our team includes four buprenorphine-waivered internal medicine physicians, a social worker, care coordinator, and home care nurse provided by our system's Medicaid Health Home. Patients are referred from the ED, inpatient service, other clinics, street outreach organizations, shelters, and jails. They receive extensive care coordination; on-site addiction, medical, and social services; home nursing visits; and collaboration with shelters and community based organizations. Measures of Success (Discuss Qualitative And/Or Quantitative Metrics Which Will Be Used To Evaluate Program/Intervention): A quantitative analysis will be used to determine program impact on clinical outcomes and utilization, patient experience, and provider satisfaction. Both quantitative and qualitative measures will be used to evaluate clinic capacity, services provided, patient engagement, and progress towards patient-oriented care goals. Findings To Date (It Is Not Sufficient To State Findings Will Be Discussed): From August through December 2018, 156 referrals were given appointments and 83 patients completed at least one appointment. Of those, at least 44 patients (53%) returned for a second visit. On average patients completed 2.1 visits. We had a 16% cancellation rate and 38% no show rate. Patients are mostly male, middle-aged and street or shelter dwelling with common diagnosis of substance use disorder, lower extremity wounds, and hypertension. Our most engaged patients (> 3 visits, n=15) have seen an average reduction in ED visits by 68% and inpatient admissions by 58% within our system compared to pre-clinic intervention. Key Lessons For Dissemination (What Can Others Take Away For Implementation To Their Practice Or Community?): Relationships have been a core element of patient care, building an interdisciplinary team, and developing referral and collaborative resources internally and in the community. Our focus on a patient-directed care plan, warm hand-offs, continuity of care, and community outreach has also allowed this model to succeed. AD - Y. Lan, Bellevue Hospital Center, New York, NY, United States AU - Lan, Y. AU - Knudsen, J. AU - Garment, A. R. AU - Goldstein, A. D. AU - Hughes, J. AU - Young, A. M. AU - Hosein, M. AU - Hosseinipour, N. AU - Holmes, I. DB - Embase DO - 10.1007/11606.1525-1497 KW - buprenorphine adult care coordinator clinical outcome conference abstract controlled study coordination drug dependence drug safety emergency care emergency ward home care housing human hypertension internal medicine major clinical study male medicaid mental health middle aged nurse nursing organization outcome assessment outpatient patient referral primary medical care program impact quantitative analysis satisfaction social work wound LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1525-1497 SP - S704-S705 ST - An interdisciplinary clinic for medically complex new yorkers without homes T2 - Journal of General Internal Medicine TI - An interdisciplinary clinic for medically complex new yorkers without homes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629003072&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 931126 ER - TY - JOUR AB - AIMS: To examine perceptions of extended-release (XR) buprenorphine injections among people who regularly use opioids in Australia. DESIGN: Cross-sectional survey prior to implementation. XR-buprenorphine was registered in Australia in November 2018. SETTING: Sydney, Melbourne and Hobart. Participants A total of 402 people who regularly use opioids interviewed December 2017 to March 2018. MEASUREMENTS: Primary outcome concerned the proportion of participants who believed XR-buprenorphine would be a good treatment option for them, preferred weekly versus monthly injections and perceived advantages/disadvantages of XR-buprenorphine. Independent variables concerned the demographic characteristics and features of current opioid agonist treatment (OAT; medication-type, dose, prescriber/dosing setting, unsupervised doses, out-of-pocket expenses and travel distance). FINDINGS: Sixty-eight per cent [95% confidence interval (CI) = 63-73%] believed XR-buprenorphine was a good treatment option for them. They were more likely to report being younger [26-35 versus > 55 years; odds ratio (OR) = 3.16, 95% CI = 1.12-8.89; P = 0.029], being female (OR = 1.67, 95% CI = 1.04-2.69; P = 0.034), < 10 years school education (OR = 1.87, 95% CI = 1.12-3.12; P = 0.016) and past-month heroin (OR = 1.81, 95% CI = 1.15-2.85; P = 0.006) and methamphetamine use (OR = 1.90, 95% CI = 1.20-3.01; P = 0.006). Fifty-four per cent reported no preference for weekly versus monthly injections, 7% preferred weekly and 39% preferred monthly. Among OAT recipients (n = 255), believing XR-buprenorphine was a good treatment option was associated with shorter treatment episodes (1-2 versus ≥ 2 years; OR = 3.93, 95% CI = 1.26-12.22; P = 0.018), fewer unsupervised doses (≤ 8 doses past-month versus no take-aways; OR = 0.50; 95% CI = 0.27-0.93; P = 0.028) and longer travel distance (≥ 5 versus < 5 km; OR = 2.10, 95% CI = 1.20-3.65; P = 0.009). Sixty-nine per cent reported 'no problems or concerns' with potential differences in availability, flexibility and location of XR-buprenorphine. CONCLUSIONS: Among regular opioid users in Australia, perceptions of extended-release buprenorphine as a good treatment option are associated with being female, recent illicit drug use and factors relating to the (in)convenience of current opioid agonist treatment. AD - School of Psychology, University of Wollongong, Wollongong, NSW, Australia. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia. Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. School of Medicine, University of Tasmania, Hobart, Tasmania, Australia. Burnet Institute, Melbourne, Victoria, Australia. Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia. Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia. AN - 31860767 AU - Larance, B. AU - Degenhardt, L. AU - Grebely, J. AU - Nielsen, S. AU - Bruno, R. AU - Dietze, P. AU - Lancaster, K. AU - Larney, S. AU - Santo, T., Jr. AU - Shanahan, M. AU - Memedovic, S. AU - Ali, R. AU - Farrell, M. C2 - Pmc7292758 C6 - Nihms1065579 DA - Jul DO - 10.1111/add.14941 DP - NLM ET - 2019/12/21 J2 - Addiction (Abingdon, England) KW - Adult Australia/epidemiology Buprenorphine/*therapeutic use Cross-Sectional Studies Delayed-Action Preparations/*therapeutic use Drug Users/*psychology Female Humans Injections, Subcutaneous/*psychology Male Middle Aged Opiate Substitution Treatment/*psychology Opioid-Related Disorders/*drug therapy Patient Preference *Buprenorphine depot *buprenorphine injection *depot preparations *medication-assisted treatment *opioiduse disorder *patient preferences LA - eng M1 - 7 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0965-2140 (Print) 0965-2140 SP - 1295-1305 ST - Perceptions of extended-release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia T2 - Addiction TI - Perceptions of extended-release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia VL - 115 ID - 930845 ER - TY - JOUR AB - BACKGROUND: Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few PCPs follow standard practice guidelines regarding assessment and monitoring. This cluster randomized controlled trial will determine whether four implementation strategies; nurse care management, use of a patient registry, academic detailing, and electronic tools, will increase PCP adherence to chronic opioid therapy guidelines and reduce opioid misuse among patients, relative to electronic tools alone. The implementation strategies and intervention content are based on the chronic care model. METHODS: We include 53 PCPs from three Boston-area community health centers and one urban safety-net hospital-based primary care practice who have at least four patients meeting the following inclusion criteria: 1) age≥18; 2) one or more completed visits to the primary care practice in the past year; 3) long-term opioid treatment defined as three or more opioid prescriptions written at least 21days apart within 6months and 4) an inpatient or outpatient ICD-9-CM diagnosis for musculoskeletal or neuropathic pain. We consider PCPs to be study subjects, and obtained a waiver of informed consent for patients because the study is promoting an established standard of care. We enrolled participants (PCPs) from December 2012 through March 2015. PCPs were randomized to receive the intervention, which includes four components: 1) nurse care management, 2) use of a patient registry, 3) academic detailing, and 4) electronic tools, or a control condition, which includes only the use of the electronic tools. The intervention PCPs receive the services of a nurse-managed registry for planning individual patient care and conducting population-based care for patients receiving opioids for chronic pain. In academic detailing visits, trained co-investigators provide intervention PCPs with individualized education to change prescribing practice. Electronic tools, located on a web site external to the EMR, www.mytopcare.org, include validated instruments to assess patient status, and management resources to facilitate PCP adherence to suggested monitoring. Electronic tools are available to PCPs in both study arms. The primary outcomes are PCP adherence to chronic opioid therapy guidelines and patient opioid misuse. Secondary outcomes include measures of substance abuse, possible opioid diversion, and level of opioid risk among patients. We will follow PCPs and their estimated 1200 chronic pain patients for 1year after study enrollment. To determine whether the intervention condition achieves greater adherence to guidelines and reduced opioid misuse after 1year compared to the control condition, we will compare the baseline and follow-up measures of the individual patients, stratifying by intervention status and noting differences that are statistically significant at the p=0.05 level. Analyses will be based on intent-to-treat. RESULTS: Randomization resulted in groups with similar baseline characteristics. The ages of PCPs are evenly distributed, with inclusion of both PCPs who have recently completed training and those who have been in practice for more than 20years. Two-thirds of enrolled PCPs are women, and one-third are non-white. DISCUSSION: The study will determine the impact of this multicomponent intervention on improving PCP adherence to guidelines and reducing opioid misuse among patients. AD - Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA; Department of Community Health Sciences, Boston University School of Public Health. Electronic address: karen.lasser@bmc.org. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA. Department of Health Policy and Management, Boston University School of Public Health. Department of Community Health Sciences, Boston University School of Public Health. AN - 26256769 AU - Lasser, K. E. AU - Shanahan, C. AU - Parker, V. AU - Beers, D. AU - Xuan, Z. AU - Heymann, O. AU - Lange, A. AU - Liebschutz, J. M. C2 - Pmc4679615 C6 - Nihms709318 DA - Jan DO - 10.1016/j.jsat.2015.06.018 DP - NLM ET - 2015/08/11 J2 - Journal of substance abuse treatment KW - Adult Boston *Clinical Protocols Guideline Adherence/*standards Health Personnel/*standards Humans Opioid-Related Disorders/*prevention & control *Outcome Assessment, Health Care Prescription Drug Misuse/*prevention & control Primary Health Care/*standards *Registries Academic detailing Cluster randomized trial Nurse care management Patient registry Prescription opioid misuse Primary care LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0740-5472 (Print) 0740-5472 SP - 101-9 ST - A Multicomponent Intervention to Improve Primary Care Provider Adherence to Chronic Opioid Therapy Guidelines and Reduce Opioid Misuse: A Cluster Randomized Controlled Trial Protocol T2 - J Subst Abuse Treat TI - A Multicomponent Intervention to Improve Primary Care Provider Adherence to Chronic Opioid Therapy Guidelines and Reduce Opioid Misuse: A Cluster Randomized Controlled Trial Protocol VL - 60 ID - 931013 ER - TY - JOUR AB - Background: Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few PCPs follow standard practice guidelines regarding assessment and monitoring. This cluster randomized controlled trial will determine whether four implementation strategies; nurse care management, use of a patient registry, academic detailing, and electronic tools, will increase PCP adherence to chronic opioid therapy guidelines and reduce opioid misuse among patients, relative to electronic tools alone. The implementation strategies and intervention content are based on the chronic care model. Methods: We include 53 PCPs from three Boston-area community health centers and one urban safety-net hospital-based primary care practice who have at least four patients meeting the following inclusion criteria: 1) age >= 18; 2) one or more completed visits to the primary care practice in the past year; 3) long-term opioid treatment defined as three or more opioid prescriptions written at least 21 days apart within 6 months and 4) an inpatient or outpatient ICD-9-CM diagnosis for musculoskeletal or neuropathic pain. We consider PCPs to be study subjects, and obtained a waiver of informed consent for patients because the study is promoting an established standard of care. We enrolled participants (PCPs) from December 2012 through March 2015. PCPs were randomized to receive the intervention, which includes four components: 1) nurse care management, 2) use of a patient registry, 3) academic detailing, and 4) electronic tools, or a control condition, which includes only the use of the electronic tools. The intervention PCPs receive the services of a nurse-managed registry for planning individual patient care and conducting population-based care for patients receiving opioids for chronic pain. In academic detailing visits, trained co-investigators provide intervention PCPs with individualized education to change prescribing practice. Electronic tools, located on a web site external to the EMR, www.mytopcare. org, include validated instruments to assess patient status, and management resources to facilitate PCP adherence to suggested monitoring. Electronic tools are available to PCPs in both study arms. The primary outcomes are PCP adherence to chronic opioid therapy guidelines and patient opioid misuse. Secondary outcomes include measures of substance abuse, possible opioid diversion, and level of opioid risk among patients. We will follow PCPs and their estimated 1200 chronic pain patients for 1 year after study enrollment To determine whether the intervention condition achieves greater adherence to guidelines and reduced opioid misuse after 1 year compared to the control condition, we will compare the baseline and follow-up measures of the individual patients, stratifying by intervention status and noting differences that are statistically significant at the p = 0.05 level. Analyses will be based on intent-to-treat. Results: Randomization resulted in groups with similar baseline characteristics. The ages of PCPs are evenly distributed, with inclusion of both PCPs who have recently completed training and those who have been in practice for more than 20 years. Two-thirds of enrolled PCPs are women, and one-third are non-white. Discussion: The study will determine the impact of this multicomponent intervention on improving PO adherence to guidelines and reducing opioid misuse among patients. (C) 2015 Elsevier Inc. All rights reserved. AD - [Lasser, Karen E.; Shanahan, Christopher; Beers, Donna; Heymann, Orlaith; Lange, Allison; Liebschutz, Jane M.] Boston Univ, Sch Med, Boston Med Ctr, Clin Addict Res & Educ CARE Unit,Sect Gen Interna, Boston, MA 02118 USA. [Lasser, Karen E.; Xuan, Ziming] Boston Univ, Sch Publ Hlth, Dept Community Hlth Sci, Boston, MA USA. [Parker, Victoria] Boston Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA. Lasser, KE (corresponding author), 801 Massachusetts Ave,Crosstown 2, Boston, MA 02118 USA. karen.lasser@bmc.org AN - WOS:000366882500013 AU - Lasser, K. E. AU - Shanahan, C. AU - Parker, V. AU - Beers, D. AU - Xuan, Z. M. AU - Heymann, O. AU - Lange, A. AU - Liebschutz, J. M. DA - Jan DO - 10.1016/j.jsat.2015.06.018 J2 - J. Subst. Abus. Treat. KW - Prescription opioid misuse Primary care Cluster randomized trial Nurse care management Patient registry Academic detailing PRESCRIPTION MONITORING PROGRAMS DISORDERS IDENTIFICATION TEST CHRONIC PAIN MANAGEMENT CHRONIC NONCANCER PAIN CLINICAL GUIDELINES SUBSTANCE-ABUSE CONSEQUENCES VALIDATION DEPRESSION STRATEGIES Psychology, Clinical Substance Abuse LA - English M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2016 SN - 0740-5472 SP - 101-109 ST - A Multicomponent Intervention to Improve Primary Care Provider Adherence to Chronic Opioid Therapy Guidelines and Reduce Opioid Misuse: A Cluster Randomized Controlled Trial Protocol T2 - Journal of Substance Abuse Treatment TI - A Multicomponent Intervention to Improve Primary Care Provider Adherence to Chronic Opioid Therapy Guidelines and Reduce Opioid Misuse: A Cluster Randomized Controlled Trial Protocol UR - ://WOS:000366882500013 VL - 60 ID - 931287 ER - TY - JOUR AB - Introduction: Despite numerous measures to increase access to life-saving buprenorphine treatment and avenues to recovery in the City of Philadelphia, numerous residents of the neighborhoods most affected by the opioid epidemic still are unable to access treatment. Begin the Turn is a low-barrier, trauma-informed mobile care unit with access to outreach services, counseling, case management, and buprenorphine treatment designed to address the overdose crisis in North Philadelphia. Methods: The program identified fatal overdose hot-spots using GIS mapping and data from the City of Philadelphia. Two locations were selected for intervention. The unit was equipped with basic medical supplies, naloxone, and a private clinical environment, and staff included three outreach specialists with lived experience in chemical dependence and recovery, a counselor, a case manager, and at least one buprenorphine-waivered physician. Patients were enrolled after initial contact with an outreach worker and completed an intake session with a counselor and urine drug screen before beginning medical treatment. During the initial 6 months of operation, patient demographics, social needs, and clinical data were collected in REDCap electronic data capture tools hosted at Temple University for analysis. Patients were also screened for trauma history using a validated Adverse Childhood Experiences survey instrument. 3-month follow-up overdose data were obtained from the City of Philadelphia and mapped using GIS software to compare with previous maps. Results: Begin the Turn provided buprenorphine treatment for 125 individuals and made 619 recorded outreach contacts. Patients had a mean age of 39.6 years and a median onset of use at 20 years of age. 66% (n=125) of patients reported IV use, 95% (n=125) of patients reported previous experiences with addiction treatment, and 52% (n=125) of patients had previously suffered an overdose. 61% (n=125) of patients reported a peak use of greater than 10 bags of heroin daily. 118 patients completed the Adverse Childhood Experiences survey with a mean score of 4.75 (n=118). Overdose data before intervention and at 3 months are presented graphically and show a reduction in overdose events at one intervention site. Conclusions: The initial 6 months of operation have identified a population with high rates of trauma and overdose. Early overdose data show a promising reduction in events. The mobile recovery unit has served to increase access to treatment for this population; future efforts will explore retention in treatment and the public health effects of mobile unit intervention. AD - I. Latham AU - Latham, I. AU - Jett, R. D. DB - Embase KW - buprenorphine diamorphine naloxone adult case manager child childhood adversity conference abstract controlled study counselor demography drug dependence drug overdose drug therapy female follow up human human tissue injury major clinical study male medical device Pennsylvania personal experience physician public health remission social needs software worker young adult LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1935-3227 SP - e386 ST - Begin the Turn: A Mobile Recovery Unit T2 - Journal of Addiction Medicine TI - Begin the Turn: A Mobile Recovery Unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634656433&from=export VL - 14 ID - 931051 ER - TY - JOUR AB - The United States is facing a major crisis with the current opioid epidemic. Tens of thousands of individuals are dying each year due to abuse and misuse of heroin and prescription opiate drugs. Nurses play an integral role in these aspects of health care and offer solutions by providing education; preventive measures; treatments, including medication-assisted treatments (MATs); and ongoing recovery options for individuals with opioid use disorders. Nurses provide education, issue prescriptions and dispense medications, and provide overall physical and mental health care to patients struggling with this "disease of the brain," and with the signing of the Comprehensive Addiction and Recovery Act, advanced practice RNs will soon be able to include MATs related to buprenorphine as part of their treatment plan. The current article explores the anatomy, physiology, and genetics of addiction and how they relate to the pharmacological MATs used to treat opioid use disorders. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 18-23.]. AN - 28135387 AU - Leahy, L. G. DA - Jan 1 DO - 10.3928/02793695-20170119-03 DP - NLM ET - 2017/01/31 J2 - Journal of psychosocial nursing and mental health services KW - Cause of Death Combined Modality Therapy Drug Approval Drug Overdose/mortality/nursing/prevention & control Epidemics/*statistics & numerical data Humans Narcotics/*supply & distribution/*therapeutic use *Nurse's Role Opiate Substitution Treatment/methods/*nursing Opioid-Related Disorders/mortality/*nursing Psychotherapy Substance Abuse Treatment Centers United States LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 0279-3695 (Print) 0279-3695 SP - 18-23 ST - The Opioid Epidemic: What Does it Mean for Nurses? T2 - J Psychosoc Nurs Ment Health Serv TI - The Opioid Epidemic: What Does it Mean for Nurses? VL - 55 ID - 930796 ER - TY - JOUR AB - Background: Medication-assisted treatment (MAT) with buprenorphine is widely acknowledged as effective treatment for opioid use disorder (OUD), it remains underutilized. The ability to prescribe buprenorphine for OUD has recently been expanded beyond waivered physicians to include waivered nurse practitioners and physician assistants. Further efforts have included extending buprenorphine prescribing beyond specialty treatment settings into primary care. HRSA awarded a joint project between the School of Medicine and Betty Irene Moore School of Nursing at University of California, Davis a 5-year Primary Care Training Enhancement grant in 2016 to develop and test a community-based collaborative interprofessional primary care model, and in 2017 supplemental funding was addended to include MAT-related training. This poster describes an educational needs assessment conducted among key informants to identify both faculty and community provider perceptions of learners' needs around MAT. Methods: Using an iterative feedback process, the authors developed and piloted a semistructured interview questionnaire. Five interviewers conducted interviews either over the phone or in person from October 2018 to March 2019. Key informants represented two groups of health care providers at UC Davis: faculty and community partners. Interviewees were asked about either current student learners (medical, physician assistant, and nursing students, pharmacy or medical residents) in the case of faculty. Community partners were asked about new graduates from these programs. Quantitative and qualitative data were collected and recorded in an online manager, Qualtrics. Analysis was completed utilizing Nvivo 12. One researcher independently coded the data, refining the codes using an iterative process in consultation with the larger group of five interviewers. Results: A total of 24 interviews were conducted: 11 faculty, 11 community partners, and 2 respondents who were both faculty and community partners. Most faculty (73%) and community partners (64%) saw students/recent graduates as unprepared or somewhat unprepared to work with patients with OUD. Based on rank ordering of priorities, faculty felt that students needed the most additional training in working with patients with prescription OUD, whereas community partners felt recent graduates needed the most additional training in working with patients who misuse prescription opioids but do not have OUD. Both groups identified motivational interviewing and related patient-prescriber communication skills as areas where additional training was needed. Both groups felt confident that additional training/ education could be provided within their organizations, but both saw multiples barriers to doing so, particularly time limitations in busy schedules or full curricula. Both groups thought that interprofessional training in a workshop or simulation would be valuable. Conclusions: The study highlighted that significant gaps in knowledge and skills to manage patients with OUD are perceived by both faculty and community partners and that neither group had current structures in place to provide this training. Based on these results, we further developed a 4-hour long interprofessional workshop on the assessment and treatment of opioid use disorder in the primary care setting. The workshop included a didactic session led by a topic expert, and a simulation in which groups of two to three learners worked with a faculty facilitator to assess, diagnose, and treat a patient with opioid use disorder, played by a standardized patient. In total 83 learners and 18 faculty from nursing, medicine, and pharmacy participated. AD - M. Leamon, University of California Davis, UC Davis Health System AU - Leamon, M. AU - Bakerjian, D. AU - Kayingo, G. AU - Edwards, J. AU - Marin, A. AU - Yang, C. DB - Embase DO - 10.1111/ajad.13032 KW - opiate adult California case report clinical article communication skill conference abstract consultation drug therapy education female funding human male manager motivational interviewing needs assessment nursing student organization perception physician assistant prescription primary medical care questionnaire resident school health nursing semi structured interview simulation LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1521-0391 SP - 228 ST - A needs assessment of mat education among a health providers who work with interprofessional learners T2 - American Journal on Addictions TI - A needs assessment of mat education among a health providers who work with interprofessional learners UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633284749&from=export http://dx.doi.org/10.1111/ajad.13032 VL - 29 ID - 931083 ER - TY - JOUR AB - Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence. AD - Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA ; Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA. Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA. AN - 25629034 AU - Lee, J. AU - Kresina, T. F. AU - Campopiano, M. AU - Lubran, R. AU - Clark, H. W. C2 - Pmc4299453 DO - 10.1155/2015/137020 DP - NLM ET - 2015/01/30 J2 - BioMed research international KW - Alcoholism/*drug therapy Drug Monitoring Drug Overdose/prevention & control Humans Opioid-Related Disorders/*drug therapy Prescription Drugs/therapeutic use *Primary Health Care LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 2314-6133 (Print) SP - 137020 ST - Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care T2 - Biomed Res Int TI - Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care VL - 2015 ID - 930871 ER - TY - JOUR AD - Department of Population Health, Department of Medicine/Division of General Internal Medicine and Clinical Innovation, NYU Langone Health, New York, NY, USA. AN - 30666748 AU - Lee, J. D. AU - McNeely, J. DA - Mar DO - 10.1111/add.14545 DP - NLM ET - 2019/01/23 J2 - Addiction (Abingdon, England) KW - *Buprenorphine Humans *Nurse Practitioners *Opioid-Related Disorders *Physician Assistants *X-waiver *nurse practitioner *opioid use disorders *pharmacotherapy *physician assistant *primary care LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0965-2140 SP - 483-484 ST - Commentary on Jones & McCance-Katze (2019): Buprenorphine and the glass half full-why can't we prescribe more of it, and will nurse practitioners and physician assistants fulfill a chronic unmet need? T2 - Addiction TI - Commentary on Jones & McCance-Katze (2019): Buprenorphine and the glass half full-why can't we prescribe more of it, and will nurse practitioners and physician assistants fulfill a chronic unmet need? VL - 114 ID - 930981 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: The Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) initiative focuses on training and mentoring health professionals in the treatment of opioid use disorders (OUD) using pharmacological strategies. Led by the American Academy of Addiction Psychiatry (AAAP), PCSS-MAT is a consortium representing four of the five national professional organizations authorized by DATA 2,000-AAAP, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, and American Society of Addiction Medicine. DATA organizations are authorized to train physicians to prescribe buprenorphine for OUD treatment. The primary aim of PCSS-MAT is to substantially increase evidence-based practices with medications for OUD. METHODS: This review describes the development of PCSS-MAT, an ongoing national initiative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), to address the training needs posed by this critical public health problem. Core initiatives include: (1) Training and mentoring activities for primary care physicians; (2) Outreach to multidisciplinary professional organizations, (3) Creating a resource portal for families, patients, and communities for OUD treatment. RESULTS: Educational outreach to providers addresses the needs of patients with OUD and common co-occurring psychiatric and medical disorders. DISCUSSION AND CONCLUSIONS: The overall scope of PCSS-MAT is to increase access to evidence-based treatment of substance use disorders as a public health priority. Recently enacted legislation requires office-based opioid treatment programs to offer all Food and Drug Administration-approved (FDA) forms of MAT. SCIENTIFIC SIGNIFICANCE: Working with health care providers to effectively deliver MAT is key to integrating behavioral and physical medicine. (Am J Addict 2016;25:603-609). AD - New York State Psychiatric Institute & Department of Psychiatry, Columbia University, New York, New York. Department of Psychiatry, Columbia University, New York, New York. Alkermes, Inc., Waltham, Massachusetts. American Academy of Addiction Psychiatry, East Providence, Rhode Island. AN - 28051841 AU - Levin, F. R. AU - Bisaga, A. AU - Sullivan, M. A. AU - Williams, A. R. AU - Cates-Wessel, K. C2 - Pmc5486864 C6 - NIHMS865876 taken a position with Alkermes. DA - Dec DO - 10.1111/ajad.12454 DP - NLM ET - 2017/01/05 J2 - The American journal on addictions KW - *Education/methods/organization & administration Humans Medication Therapy Management/education Opiate Substitution Treatment/*methods *Opioid-Related Disorders/epidemiology/therapy Physicians, Primary Care/*education Public Health/methods United States/epidemiology LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 1055-0496 (Print) 1055-0496 SP - 603-609 ST - A review of a national training initiative to increase provider use of MAT to address the opioid epidemic T2 - Am J Addict TI - A review of a national training initiative to increase provider use of MAT to address the opioid epidemic VL - 25 ID - 930968 ER - TY - JOUR AB - Background: Opioid use disorder (OUD) and chronic pain are common, often co-occurring, conditions that are highly prevalent amongVeterans.Within the San FranciscoVeterans AffairsHealthcare System(SFVAHCS), only 33.0% of Veterans with OUD are prescribed pharmacotherapy treatment and over 1,000 have risk factors for developing OUD (e.g., prescribed chronic opioids). Buprenorphine, an evidence-based and highly effective treatment for bothOUD and pain, can be prescribed by primary care providers (PCPs) with additional training and anX-waiver fromtheDEA.Of the 87 SFVAHCS PCPs, 17 (19.5%) arewaivered; however, only 7 (8.0%) have prescribed buprenorphinewithin the past 6 months. We sought to understand barriers to prescribing buprenorphine and identify interventions to increase PCP prescribing. Methods:We created and distributed an online survey to all SFVAHCS PCPs (n=87) who work in geriatric, infectious disease, tele-primary care, and rural and urban primary care settings. Non-waivered providers were surveyed to evaluate interest in becoming waivered and barriers to obtaining a waiver. Waivered providers were surveyed to evaluate barriers to prescribing buprenorphine and solutions to increase prescribing. Results: Of the 40 survey responders (46.0% response rate), 25 (62.5%) were not waivered and 15 (37.5%) were waivered. Some non-waivered providers expressed interest in obtaining an X-waiver (mean 3.60 on a 5-point Likert scale, where 5=very interested). The most frequently reported barriers to becoming waivered were: 1) lack of time to complete training (n=17); 2) limited access to training (n=9); and 3) lack of incentive to become waivered (n=8). Among waivered providers, the most commonly reported barriers to prescribing were: 1) lack of knowledge and/or experience (n=9); 2) lack of clinic support/infrastructure (n=8); and 3) lack of time to counsel patients during visits (n=6). Interventions that waivered providers were interested in included: 1) a ''buprenorphine mentor'' to call as needed (mean 4.57 on a 5- point Likert scale, where 5=very interested); 2) educational materials (mean 4.14); 3) a 1-hour refresher course (mean 4.00); and 4) data identifying potential candidates for buprenorphine (mean 4.00). Conclusions: Based on our survey of SFVAHCS PCPs, there are simple, actionable strategies that may increase the proportion of Veterans who have access to evidence-based treatment for OUD and chronic pain. Providing time, training resources, and employer incentives could increase the number of waivered PCPs.Oncewaivered, PCPs need further support to ensure confidence and skills in routine prescribing of buprenorphine. Strategies include mentorship, provider educational materials, and establishing clinic infrastructure to reduce the administrative burden of prescribing buprenorphine. AD - S. Leyde AU - Leyde, S. AU - Macri, J. DB - Embase KW - buprenorphine opiate adult chronic pain communicable disease conference abstract controlled study employer female human incentive Likert scale major clinical study male mentor prescription primary medical care refresher course skill veteran LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1935-3227 SP - e398-e399 ST - Increasing access to buprenorphine: Understanding barriers and solutions in primary care T2 - Journal of Addiction Medicine TI - Increasing access to buprenorphine: Understanding barriers and solutions in primary care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634656507&from=export VL - 14 ID - 931054 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: With 47 600 opioid-related deaths in 2017, the yearly deaths have surpassed the HIV/AIDS peak yearly death rates. Residential rehabilitation (RR) and medication-assisted treatments (MAT) are commonly utilized treatments for opioid use disorder (OUD). METHODS: All patients (n = 182) who were admitted to the Boston Veterans Health Administration for inpatient admission for medically supervised opioid withdrawal in 2015 were included. Deceased patients were matched 1:1, based on age and sex to living patients from the 182-patient cohort. Nationwide electronic medical records were analyzed from 2015 through 2018. Via multilinear regression, risk factor correlation to all-cause mortality (the dependent variable) was our main outcome. Primary risk factors included recurrent admissions for medically supervised withdrawals and exposure to RR or MAT. Secondary risk factors were opioid use traits, nonopioid drug use, partner support, education level, homelessness, and employment. RESULTS: 18.4% (n = 34) were deceased by the time of follow-up-equivalent to 4760 deaths per 100 000 person-years. A total of 61.8% (n = 21) of these deaths were directly related to opioid use. Completion of RR correlated with lower predicted mortality (β = -8.21, P = 0.03). In contrast, attending RR but not completing correlated with higher predicted mortality rate (β = 6.51, P = 0.046). Concurrent benzodiazepine use (β = 8.99, P = 0.047), generalized anxiety disorder (β = 7.13, P = 0.03) and major depressive disorder (β = 5.44, P = 0.04) increased risk of death. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: OUD carries a shockingly high lethality in Veterans requiring inpatient admission for opioid withdrawal, particularly when there are untreated comorbid psychiatric conditions. RR and MAT are correlated to lower all-cause mortality in this population and should be highly utilized. Given the extremely high mortality, intensive system-wide interventions are needed for the care of Veterans with OUD. On the basis of the reduced predicted mortality with RR and MAT, further research into novel MATs as well as refining RR programs should be a major focus. (Am J Addict 2019;28:318-323). AD - Department of Veterans Affairs, Brockton Campus, Brockton, Massachusetts. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Department of Psychiatry, Harvard South Shore Psychiatry Residency Training Program, Brockton, Massachusetts. AN - 31067001 AU - Li, K. J. AU - Smedberg, D. L. AU - DeLisi, L. E. DA - Jul DO - 10.1111/ajad.12893 DP - NLM ET - 2019/05/09 J2 - The American journal on addictions KW - Adult Boston Case-Control Studies Combined Modality Therapy Female Follow-Up Studies *Hospitalization *Hospitals, Veterans Humans Male Middle Aged Opioid-Related Disorders/mortality/psychology/*therapy Retrospective Studies Risk Factors *Substance Abuse Treatment Centers Treatment Outcome *Veterans Health Young Adult LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1055-0496 SP - 318-323 ST - A Retrospective 4-year Outcome Study of Veterans Admitted to an Acute Inpatient Detoxification Unit for Opioid Use Disorder T2 - Am J Addict TI - A Retrospective 4-year Outcome Study of Veterans Admitted to an Acute Inpatient Detoxification Unit for Opioid Use Disorder VL - 28 ID - 930862 ER - TY - JOUR AB - For over 30 years, medication-assisted treatment for preventing relapse in opiate use disorder has been limited to methadone maintenance and withdrawal treatments followed by naltrexone; however, buprenorphine has emerged as an exciting and successful pharmacotherapy alternative. Buprenorphine is a partial μ-opioid receptor agonist with less abuse potential and a favorable safety profile compared to methadone and offers a great opportunity of office-based opioid addiction treatment (OBOT) to improve patient access. However, we have limited number of providers certified to prescribe buprenorphine in South Dakota. We need to address potential barriers for its expansion, including concerns of diversion and abuse, insufficient knowledge on buprenorphine and addiction treatment, and lack of access to addiction specialists and treatment resources. Since buprenorphine does retain some abuse potential, good office practice needs to be implemented as we expand its access. We need to choose appropriate candidates for OBOT with clear expectations at the intake. We need to enforce urine drug screens, pill counts, and use of prescription monitoring programs. It is also important to provide or refer patients to addiction counseling services and more intensive levels of care including methadone maintenance and residential care when needed. AD - University of South Dakota Sanford School of Medicine. Avera Behavioral Health Center, Sioux Falls, South Dakota. Michael E. DeBakey Veterans Affairs Medical Center. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. AN - 28817853 AU - Li, X. AU - Kosten, T. DA - Spec DP - NLM ET - 2016/01/01 J2 - South Dakota medicine : the journal of the South Dakota State Medical Association LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0038-3317 (Print) 0038-3317 SP - 64-67 ST - Treating Addiction to Prescription Opioids T2 - S D Med TI - Treating Addiction to Prescription Opioids VL - No ID - 930954 ER - TY - JOUR AB - Background: Evidence is emerging on how state-wide marijuana legalization and increased supply of DATA-2000 waivered providers may be associated with outcomes related to opioids. It is unknown whether such associations remain at the neighborhood level. Objectives: This study examined the associations of neighborhood availability of marijuana dispensaries and DATA-2000 waivered providers with opioid-related hospital stays. Methods: Discharge-level records of inpatient (N = 264,013) and observation stays (N = 12,621) were obtained from the Washington Comprehensive Hospital Abstract Reporting System from January through June 2016. Outcomes were indicators for inpatient stays related to opioid use disorder (OUD), inpatient stays related to opioid overdose, and observation stays related to OUD. Primary predictors were the density of marijuana dispensaries and DATA-2000 waivered providers at the zip code level. Multilevel logistic regressions with random intercepts were used to examine the cross-sectional associations, controlling for other patient and neighborhood characteristics. Results: Patients living in neighborhoods with one more recreational marijuana dispensaries per square mile were more likely (OR = 1.54, p = .017) to be diagnosed with OUD in inpatient stays. Living in neighborhoods with increased density of medical marijuana dispensaries or DATA-2000 waivered providers was not associated with being diagnosed with OUD or opioid overdose in inpatient or observation stays. Conclusions: Recreational and medical marijuana dispensaries were differentially associated with opioid-related hospital stays. Further investigations are warranted to explore the causal pathways of the findings. AD - Department of Family Medicine and Public Health, University of California, San Diego, San Diego, USA. AN - 31448651 AU - Liang, D. AU - Shi, Y. C2 - Pmc6892428 C6 - Nihms1540015 DO - 10.1080/10826084.2019.1650775 DP - NLM ET - 2019/08/27 J2 - Substance use & misuse KW - Adolescent Adult Aged Child Cross-Sectional Studies Female Humans *Legislation, Drug *Length of Stay Male *Medical Marijuana Middle Aged Opioid-Related Disorders/*therapy Residence Characteristics Washington Young Adult *Marijuana dispensary *buprenorphine *hospitalization *marijuana *opioids LA - eng M1 - 14 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1082-6084 (Print) 1082-6084 SP - 2387-2399 ST - The Associations of Neighborhood Availability of Marijuana Dispensaries and DATA-2000 Waivered Providers with Hospital Stays Related to Opioids T2 - Subst Use Misuse TI - The Associations of Neighborhood Availability of Marijuana Dispensaries and DATA-2000 Waivered Providers with Hospital Stays Related to Opioids VL - 54 ID - 930884 ER - TY - JOUR AB - Needs and Objectives: The opioid epidemic in the US has become a major issue in healthcare and is destructive to individuals, families, and communities. Despite the decrease in opioid prescriptions, an unintended consequence is increased use of illicit or dangerous opioids such as heroin and fentanyl. In 2017, there was an estimated 72,306 drug overdose related deaths and the Emergency Departments (ED) nationally saw a 30% increase in opioid related overdoses. Innovative programs can help ensure patients are offered optimal treatment options. Most primary care physicians self-report they lack the skills to identify and appropriately treat substance abuse disorders (SUDs). Studies have suggested that the best solution is to improve medical school curricula, which translates to better educated future physicians. Unfortunately, most curricula do not provide adequate education to identify and treat SUDs in the medical practice. Buprenorphine is a partial μ-receptor agonist that is utilized to treat opioid addiction. To prescribe buprenorphine, an 8-hour Medication Assisted Treatment (MAT) training must be completed. Only 808 of the 28,206 active physicians (< 3%) in the state of Michigan are registered to prescribe buprenorphine. We developed an innovative approach to provide students with the skills to understand how to prescribe buprenorphine and build confidence to medically manage opioid use disorders in the future. By completing the training and obtaining their permanent license, students will have completed all requirements to prescribe buprenorphine as a physician. Setting and Participants: Third year medical students on their internal medicine clerkship are offered the MAT training during their 8-week rotation. Description: The MAT training is offered online by the American Osteopathic Academy of Addiction Medicine twice a month and is free of charge. Training consists of a 4.25-hr webinar and 3.75-hr online module. Students who complete the training can choose to take one day off their clerkship. A pre-and post-experience survey is completed to assess how the training has impacted perspectives on patients with SUDs. Evaluation: Preliminary data suggests medical students do feel there is a lack of SUDs education in the curricula. However students have a strong interest in learning how to prescribe and utilize buprenorphine in their medical practice. After completing the training, medical students report that they have a better foundation on when buprenorphine can be prescribed and how to recognize SUDs. Discussion/Reflection/Lessons Learned: Medical students recognize opioid use disorders is an important issue within communities and want to help their future patients. This training has importance to all students regardless of their interested specialty. Offering the MAT training can supplement the school's curricula and is generalizable to use by other medical schools. AD - I. Lien, Wayne State University School of Medicine, Detroit, MI, United States AU - Lien, I. AU - Chou, J. S. AU - Levine, D. L. AU - Waineo, E. DB - Embase DO - 10.1007/11606.1525-1497 KW - buprenorphine endogenous compound mu opiate receptor agonist opiate addiction medicine adult adverse drug reaction conference abstract death drug overdose drug therapy education emergency ward epidemic female general practitioner human internal medicine learning licence major clinical study male medical practice medical school medical student Michigan opiate addiction preliminary data rotation self report side effect skill substance abuse LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1525-1497 SP - S836-S837 ST - Preparing future physicians to care for patients with opioid use disorder-buprenorphine waiver training course during medical school T2 - Journal of General Internal Medicine TI - Preparing future physicians to care for patients with opioid use disorder-buprenorphine waiver training course during medical school UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629001392&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 931125 ER - TY - JOUR AB - Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency. AD - Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI, USA. Department of Internal Medicine, Kaiser Permanente Oakland Medical Center , Oakland, CA, USA. Department of Psychiatry and Behavioral Neurosciences, Detroit Medical Center , Detroit, MI, USA. Department of Internal Medicine, Detroit Medical Center , Detroit, MI, USA. AN - 33222656 AU - Lien, I. C. AU - Seaton, R. AU - Szpytman, A. AU - Chou, J. AU - Webber, V. AU - Waineo, E. AU - Levine, D. C2 - Pmc7717470 DA - Dec DO - 10.1080/10872981.2020.1847755 DP - NLM ET - 2020/11/24 J2 - Medical education online KW - Adult Clinical Clerkship/*organization & administration Curriculum Female Health Knowledge, Attitudes, Practice Humans Internal Medicine/*education Male Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy Young Adult MAT waiver Medical school curriculum development buprenorphine medication-assisted treatment opioid use disorder student training LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1087-2981 SP - 1847755 ST - Eight-hour medication-assisted treatment waiver training for opioid use disorder: integration into medical school curriculum T2 - Med Educ Online TI - Eight-hour medication-assisted treatment waiver training for opioid use disorder: integration into medical school curriculum VL - 26 ID - 930932 ER - TY - JOUR AB - Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency. AD - [Lien, Irvin C.; Seaton, Randell; Szpytman, Aaron; Chou, Jody; Webber, Victoria; Waineo, Eva; Levine, DianeL.] Wayne State Univ, Sch Med, Dept Internal Med, Detroit, MI USA. [Lien, Irvin C.] Kaiser Permanente, Oakland Med Ctr, Dept Internal Med, Oakland, CA 94611 USA. [Waineo, Eva] Detroit Med Ctr, Dept Psychiat & Behav Neurosci, Detroit, MI USA. [Levine, DianeL.] Detroit Med Ctr, Dept Internal Med, Detroit, MI USA. Lien, IRC (corresponding author), Kaiser Permanente, Oakland Med Ctr, Dept Internal Med, Oakland, CA 94611 USA. irvin.c.lien@kp.org AN - WOS:000591518100001 AU - Lien, I. R. C. AU - Seaton, R. AU - Szpytman, A. AU - Chou, J. AU - Webber, V. AU - Waineo, E. AU - Levine, D. C7 - 1847755 DA - Jan DO - 10.1080/10872981.2020.1847755 J2 - Med. Educ. Online KW - Medical school curriculum development opioid use disorder medication-assisted treatment student training buprenorphine MAT waiver Education & Educational Research LA - English M1 - 1 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2021 SN - 1087-2981 SP - 4 ST - Eight-hour medication-assisted treatment waiver training for opioid use disorder: integration into medical school curriculum T2 - Medical Education Online TI - Eight-hour medication-assisted treatment waiver training for opioid use disorder: integration into medical school curriculum UR - ://WOS:000591518100001 VL - 26 ID - 931231 ER - TY - JOUR AB - In March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing). AD - Clinical Addiction Research and Education Unit (JKL, AYW), Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; College of Pharmacy (JPB), University of Rhode Island, Kingston, RI; Network for Public Health Law (CSD), St. Paul, MN; Departments of Emergency Medicine and Epidemiology (TCG), Warren Alpert Medical School of Brown University, Providence, RI; and Department of Emergency Medicine (TCG), Boston University School of Medicine, Boston, MA. AN - 27261669 AU - Lim, J. K. AU - Bratberg, J. P. AU - Davis, C. S. AU - Green, T. C. AU - Walley, A. Y. C2 - Pmc5049966 DA - Sep-Oct DO - 10.1097/adm.0000000000000223 DP - NLM ET - 2016/06/05 J2 - Journal of addiction medicine KW - Drug Overdose/*prevention & control Drug Prescriptions/*standards Humans Naloxone/*therapeutic use Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy Pharmacists/*standards LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 1932-0620 (Print) 1932-0620 SP - 300-8 ST - Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists T2 - J Addict Med TI - Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists VL - 10 ID - 930931 ER - TY - JOUR AB - INTRODUCTION: Managing patients presenting with chronic pain is one of the most complex tasks in medicine. Simulation-based training (SBT) is a particularly useful tool to practice intricate scenarios in a safe learning environment. However, SBT was not available for the Pain Medicine residents and fellows at our university. Our goal was to develop SBT for the most relevant scenarios in chronic pain medicine that will optimize the trainees' skills and ultimately, the patients' experience, safety, and outcomes. Methods: Ethics approval was waived by the local ethics board, as the study fell within quality improvement work and course evaluation. After consent from all participants was obtained, the development process included the following key steps: 1) a formal needs assessment including detailed interviews with 6 clinicians and analysis of 386 patient experience surveys to select the most relevant competences, gaps in training, and clinical situations; 2) a formal Delphi consensus study among faculty members and trainees to select two SBT scenarios for development; and 3) the systematic development and refinement of the two scenarios using multiple focus group discussions and test-runs. Results: The needs assessment identified the following most relevant challenges in pain medicine: 1) management of patients with high-dose opioids, poor pain control, signs of misuse, or co-dependencies; 2) use of effective communication for deescalation, active listening, and motivational interviewing; and 3) detection and therapy of mental health issues. We developed two SBT scenarios addressing the management of chronic pain patients with 1) concomitant mental health issues, and 2) opioid addiction. Learning objectives included the identification of symptoms, assessment of suicide risk, demonstration of effective communication skills, evaluation of effectiveness and adverse effects of opioid therapy, and risk stratification. Test-run participants (n=6) found the scenarios to be relevant to their clinical practice, instructive and appreciated their authenticity. Discussion: Based on a thorough needs assessment with clinicians, students, and patients, we identified and developed SBT scenarios for two highly relevant clinical situations in chronic pain medicine. The preliminary participant evaluations indicate that our SBT scenarios have been a beneficial complement to the existing curriculum. Further testing and evaluation, incorporating the benefits of mini-debriefs, will be conducted. At the conference, we will share the final scenarios and discuss possibilities to ensure positive engagement from learners and instructors. AD - C. Ling, McMaster University AU - Ling, C. AU - Korz, L. AU - Schandelmaier, S. AU - Green, A. AU - Pakkal, O. AU - Fiala, C. AU - Monteiro, S. AU - Scheidecker, A. DB - Embase DO - 10.1007/s12630-019-01499-1 KW - opiate adult adverse drug reaction chronic pain clinical practice communication skill comparative effectiveness conference abstract consensus controlled study curriculum drug megadose drug therapy ethics female human interview major clinical study male mental health motivational interviewing needs assessment opiate addiction risk assessment side effect simulation training suicide therapy effect total quality management LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1496-8975 SP - S356-S357 ST - Development of simulation-based training scenarios for trainees in chronic pain medicine T2 - Canadian Journal of Anesthesia TI - Development of simulation-based training scenarios for trainees in chronic pain medicine UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631644569&from=export http://dx.doi.org/10.1007/s12630-019-01499-1 VL - 66 ID - 931144 ER - TY - JOUR AB - Background: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. Objective: This paper describes the protocol of a cluster randomized trial, targeting effective analgesia in clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. Methods: HIV physicians and advanced practice providers (n = 41) were recruited from September 2015 to December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n = 187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: (1) a nurse care manager and electronic registry to assist with patient management; (2) opioid education and academic detailing; and (3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12 months. In parallel, PLWH receiving LTOT (n = 170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n = 117). Conclusions: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US. AD - J.H. Samet, Section of General Internal Medicine, 801 Massachusetts Ave., 2nd floor, Boston, MA, United States AU - Lira, M. C. AU - Tsui, J. I. AU - Liebschutz, J. M. AU - Colasanti, J. AU - Root, C. AU - Cheng, D. M. AU - Walley, A. Y. AU - Sullivan, M. AU - Shanahan, C. AU - O’Connor, K. AU - Abrams, C. AU - Forman, L. S. AU - Chaisson, C. AU - Bridden, C. AU - Podolsky, M. C. AU - Outlaw, K. AU - Harris, C. E. AU - Armstrong, W. S. AU - del Rio, C. AU - Samet, J. H. DB - Embase Medline DO - 10.1080/15284336.2019.1627509 KW - NCT02525731 NCT02564341 adult analgesia article chronic pain clinical outcome clinical protocol cluster analysis cohort analysis controlled study drug dependence drug targeting drug urine level health care delivery health care personnel human Human immunodeficiency virus infected patient Human immunodeficiency virus infection intersectoral collaboration long term care longitudinal study major clinical study nurse manager opiate addiction patient care practice guideline prescription priority journal protocol compliance randomized controlled trial satisfaction self report LA - English M1 - 2 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 2578-7470 2578-7489 SP - 48-63 ST - Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study–a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV T2 - HIV Research and Clinical Practice TI - Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study–a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003825888&from=export http://dx.doi.org/10.1080/15284336.2019.1627509 VL - 20 ID - 931132 ER - TY - JOUR AB - Background: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. Objective: This paper describes the protocol of a cluster randomized trial, targeting effective analgesia in clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. Methods: HIV physicians and advanced practice providers (n = 41) were recruited from September 2015 to December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n = 187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: (1) a nurse care manager and electronic registry to assist with patient management; (2) opioid education and academic detailing; and (3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12 months. In parallel, PLWH receiving LTOT (n = 170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n = 117). Conclusions: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US. AD - a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine , Boston Medical Center , Boston , MA , USA. b Section of General Internal Medicine, Department of Medicine , University of Washington and Harborview Medical Center , Seatle , WA , USA. c Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA. d Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA. e Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA. f Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA. g Department of Medicine , Boston University School of Medicine , Boston , MA , USA. h Biostatistics and Epidemiology Data Analytics Center , Boston University School of Public Health , Boston , MA , USA. i Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA. AN - 31303143 AU - Lira, M. C. AU - Tsui, J. I. AU - Liebschutz, J. M. AU - Colasanti, J. AU - Root, C. AU - Cheng, D. M. AU - Walley, A. Y. AU - Sullivan, M. AU - Shanahan, C. AU - O'Connor, K. AU - Abrams, C. AU - Forman, L. S. AU - Chaisson, C. AU - Bridden, C. AU - Podolsky, M. C. AU - Outlaw, K. AU - Harris, C. E. AU - Armstrong, W. S. AU - Del Rio, C. AU - Samet, J. H. C2 - Pmc6693587 C6 - Nihms1534256 DA - Apr DO - 10.1080/15284336.2019.1627509 DP - NLM ET - 2019/07/16 J2 - HIV research & clinical practice KW - Analgesics, Opioid/*therapeutic use Boston Cohort Studies Guideline Adherence HIV Infections/*complications Humans Longitudinal Studies Pain Management/*methods/standards Physicians/statistics & numerical data Practice Guidelines as Topic Practice Patterns, Physicians' Primary Health Care Randomized Controlled Trials as Topic *Registries Time Factors *Hiv *addiction *chronic pain *long-term opioid therapy *pain management *prescription opioid misuse *substance use disorders LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2578-7489 (Print) 2578-7470 SP - 48-63 ST - Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV T2 - HIV Res Clin Pract TI - Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV VL - 20 ID - 930856 ER - TY - JOUR AB - Study Objectives: The emergency department (ED) is increasingly becoming the starting point to propel opiate use disorder (OUD) patients into appropriate medication assisted treatment (MAT) programs. And while the practicality and success of utilizing the ED to initiate MAT has been demonstrated, large scale buy-in to this model is lacking. We aimed to assess physicians’ perceptions of barriers to starting MAT in the ED, views of the utility of MAT, and abilities to link OUD patients to MAT programs in their respective communities. We also wanted to assess differences in opinions between residents and attendings to identify potential teaching points to enhance resident education. Methods: This was a cross-sectional study of emergency physicians affiliated with a residency program via a self-administered online survey. Questions consisted of either multiple-choice or yes/no answers to assess perceptions of barriers to starting OUD patients on MAT. Respondents included physicians with a range of years in emergency medicine practice that was self-disclosed. For our purposes, a facility capable of MAT was one that could provide at minimum buprenorphine/naloxone (Suboxone®) treatment. Statistics were performed by JMP software with a two-tailed Z-test of proportions. Results: A total of 98 physicians responded to the survey with 33% female and 55% resident physicians. An overwhelming majority, 80% of respondents would be interested in starting OUD patients on MAT, such as buprenorphine/naloxone (Suboxone®), and 94% either “agreed” or “strongly agreed” that MAT was helpful for OUD patients to overcome addiction but only 53% had knowledge of the X-waiver (mandated training to prescribe buprenorphine/naloxone [Suboxone®] long-term) and 32% knew of an outpatient community facility capable of continuing buprenorphine/naloxone (Suboxone®) management. When dividing responses by level of training, residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with what the X-waiver is (38% vs 73%, p=0.001), where community outpatient MAT facilities are (21% vs 43%, p=0.02), or having ever referred OUD patients to MAT programs in their individual practice (7% vs 30%, p=0.003). There were no differences between residents and attendings in perception of utility of MAT for OUD patients (96% vs 90%, p=0.27) or perception of condoning continued opiate use by prescribing naloxone (Narcan®) to discharged OUD patients from the ED (14% vs 15%, p=0.85). Conclusion: Support for MAT is high among all levels of emergency physicians but knowledge of community resources and required training (like the X-waiver) to prescribe certain forms of MAT remains a barrier. Among resident physicians compared to attending physicians, the knowledge gap of community MAT facilities and the practice of referring OUD patients for MAT is widened, demonstrating clear areas to bolster residency training. AU - Logan, G. AU - Craen, A. AU - Drone, E. AU - Houck, J. AU - Rivera Alvarez, F. AU - Patel, P. AU - Lebowitz, D. AU - Dub, L. AU - Elahi, N. AU - Ganti, L. DB - Embase DO - 10.1016/j.annemergmed.2020.09.095 KW - buprenorphine plus naloxone endogenous compound methionine adenosyltransferase naloxone opiate addiction adult conference abstract controlled study cross-sectional study drug therapy emergency medicine emergency physician emergency ward female human male outpatient perception prescription residency education software teaching LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S33-S34 ST - 85 Physician-perceived Barriers to Treating Opiate Use Disorder in the Emergency Department T2 - Annals of Emergency Medicine TI - 85 Physician-perceived Barriers to Treating Opiate Use Disorder in the Emergency Department UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008409879&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.095 VL - 76 ID - 931060 ER - TY - JOUR AB - Background: Emergency department (ED)-initiated buprenorphine for individuals with opioid use disorder increases treatment engagement at 30 days, but this practice has not been widely adopted. To better develop strategies for implementation of this practice, we sought to identify and evaluate physician perceived barriers and facilitators for 1) ED administration of buprenorphine and 2) obtaining a waiver to write prescriptions for buprenorphine (X-waiver). Methods: We conducted a web-based, cross-sectional survey of attending and resident physicians in two urban, academic EDs in Philadelphia in 11/2018. We asked participants “Please indicate the degree to which each of the following is a barrier/facilitator for prescribing buprenorphine from the ED” for 15 potential barriers and 9 facilitators. We also asked participants to rate 7 barriers and 6 facilitators to obtaining an X-waiver. Items were rated on a scale of 1-10 (10 as most significant). Mean scores were computed for each item, and the Mann-Whitney test was used to compare mean responses between waivered and nonwaivered providers. Results: The 84 out of 115 respondents (response rate 78%) were 62% male, 74% white, and 55% attending physicians. 21% had completed the X-waiver training. The top barriers for buprenorphine prescribing in the ED were: patient social barriers (e.g. homelessness or insurance) (mean score 7.7 out of 10), low patient interest in treatment (6.9), and availability of treatment referrals (6.4). The highest rated facilitators for buprenorphine prescribing were: access to referrals after discharge (8.5), care coordination services (8.1), and electronic medical record ordersets (7.9). Neither the top-rated barriers or facilitators differed by X-waiver status. Among providers without an X-waiver (n=66), the highest rated barriers to obtaining the waiver were: inconvenience (6.5) and time outside work (6.1).Top-rated facilitators were substituting training for a shift (8.5) or financial incentive (7.1). Conclusion: Providers perceived patient barriers and referral availability to be the most significant barriers regardless of X-waiver status. As ED-initiated buprenorphine treatment is scaled up, it will be critical to develop interventions addressing these patient and system-level barriers in addition to provider education. AD - M. Lowenstein, University of Pennsylvania, Perelman School of Medicine AU - Lowenstein, M. AU - Perrone, J. AU - Meisel, Z. F. AU - Delgado, K. AU - Smulowitz, P. DB - Embase DO - 10.1111/acem.13756 KW - buprenorphine opiate adult conference abstract controlled study coordination drug therapy education electronic medical record emergency ward female homelessness human insurance major clinical study male patient referral Pennsylvania prescription rank sum test resident LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1553-2712 SP - S96 ST - Barriers and facilitators of emergency department initiation of buprenorphine: A physician survey T2 - Academic Emergency Medicine TI - Barriers and facilitators of emergency department initiation of buprenorphine: A physician survey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627698558&from=export http://dx.doi.org/10.1111/acem.13756 VL - 26 ID - 931116 ER - TY - JOUR AB - Intro/Background: Opioid-related emergency department (ED) visits continue to rise at an alarming rate with 5% annual mortality observed among overdose survivors. Mortality was 60% lower among those receiving pharmacotherapy for opioid use disorder (OUD) in the subsequent year; however, only 1/3 did. Despite D'Onofrio's landmark study demonstrating that initiating buprenorphine and referral in the ED for treatment for OUD is feasible, highly effective, and cost-effective, this life-saving medication is rarely initiated in EDs. Purpose/Objective: Barriers to treatment exist at the patient, provider, and systems levels and include longstanding practice norms, limited experience using medications whose properties are often misunderstood, and the impact stigma has on patients seeking and providers offering treatment. We developed and piloted an experiential education session to mitigate these barriers and increase the likelihood that emergency providers will initiate buprenorphine for patients with OUD in the ED. Methods: We created a three case Group Objective Structured Clinical Examination (GOSCE) using standardized patients (SPs) trained to portray three commonly encountered patients with OUD. One participant interacts with one SP (8-10 minutes) while two other participants observe with a faculty member, followed by a 20 minute debrief. Participants are tasked to: a) Assess for ED-initiated buprenorphine and b) Discuss the patients' substance use; provide counseling and education where appropriate. Participants completed pre/post-GOSCE surveys. Outcomes (if available): Thirty-nine emergency medicine providers completed the GOSCE. Prior to the session, 50% had never administered buprenorphine to any patient, 35% in 1-2 patients, and 14% in 3 or more patients. Participants reported an increase in comfort administering buprenorphine comparing pre- and post OSCE surveys; 3.81 to 8.03 respectively (1 = not comfortable, 10 = very comfortable), p<0.001. Reported comfort discussing substance use disorders trended positively from 6.94 to 8.29 without achieving statistical significance. Summary: It is paramount that emergency medicine providers use all available tools and skills to address the current opioid epidemic. Despite evidence of the benefit of buprenorphine, it remains severely underutilized in the ED. Nationally only 0.9% of emergency physicians are X-waivered to prescribe buprenorphine. In our cohort, 50% had never administered buprenorphine to any ED patient. The primary goal of this experiential education session was to increase the likelihood that emergency providers will administer and initiate BUP treatment for patients with OUD in the ED. The three unique cases provided an intense simulated experience each with challenges often faced in the ED. Case 1: 28 year old man who is anxious to leave the ED after emerging from an opioid overdose after treatment with intranasal naloxone by EMS; Case 2: 35 year old man requesting detox admission from “Oxy”; Case 3: 24 year old woman who is requesting/demanding opioid pain medication after drainage of an abscess resulting from injection drug use. The structured debrief focused on enhancing emergency providers' ability to properly screen and treat patients with buprenorphine as well as improving communication skills discussing OUD. Our results demonstrated that the GOSCE effectively increased providers' reported comfort administering buprenorphine. Qualitative data suggests the session helped facilitate the use of non-stigmatizing language when discussing OUD, acquire strategies on how to discuss buprenorphine and OUD, and positively changed perceptions of buprenorphine & OUD. Participants also found it useful to have difficult patient conversations in the simulation followed by immediate constructive feedback in the debrief. Future study includes examining performance of participants rated by SPs, assessing self-reported comfort and rates of buprenorphine initiation among trainees at six months following the GOSCE. Also, we will track global and individual provider ates of buprenorphine administration and prescribing in our EDs through electronic health record abstraction. AD - D. Lugassy, NYU/Bellevue Hospital Center AU - Lugassy, D. AU - Mc Cormack, R. P. AU - Shin, S. M. AU - Zabar, S. AU - Ngyuen, A. AU - Moran, Z. AU - Di Salvo, P. DB - Embase DO - 10.1111/acem.13961 KW - buprenorphine naloxone opiate abscess adult case report clinical article clinical examination cohort analysis comfort communication skill conference abstract constructive feedback conversation counseling drug overdose drug therapy education electronic health record emergency medicine emergency physician emergency ward female human language male opiate addiction pain perception prescription problem patient simulation statistical significance stigma young adult LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1553-2712 SP - S330 ST - Demystifying and destigmatizing emergency department-initiated buprenorphine: A standardized experiential faculty development T2 - Academic Emergency Medicine TI - Demystifying and destigmatizing emergency department-initiated buprenorphine: A standardized experiential faculty development UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632417983&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 931080 ER - TY - JOUR AB - PROBLEM/CONDITION: Drug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. REPORTING PERIOD: Illicit drug use and drug use disorders during 2003-2014, and drug overdose deaths during 1999-2015. DESCRIPTION OF DATA: The National Survey of Drug Use and Health (NSDUH) collects information through face-to-face household interviews about the use of illicit drugs, alcohol, and tobacco among the U.S. noninstitutionalized civilian population aged ≥12 years. Respondents include residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories, migratory workers' camps, and halfway houses) and civilians living on military bases. NSDUH variables include sex, age, race/ethnicity, residence (metropolitan/nonmetropolitan), annual household income, self-reported drug use, and drug use disorders. National Vital Statistics System Mortality (NVSS-M) data for U.S. residents include information from death certificates filed in the 50 states and the District of Columbia. Cases were selected with an underlying cause of death based on the ICD-10 codes for drug overdoses (X40-X44, X60-X64, X85, and Y10-Y14). NVSS-M variables include decedent characteristics (sex, age, and race/ethnicity) and information on intent (unintentional, suicide, homicide, or undetermined), location of death (medical facility, in a home, or other [including nursing homes, hospices, unknown, and other locations]) and county of residence (metropolitan/nonmetropolitan). Metropolitan/nonmetropolitan status is assigned independently in each data system. NSDUH uses a three-category system: Core Based Statistical Area (CBSA) of ≥1 million persons; CBSA of <1 million persons; and not a CBSA, which for simplicity were labeled large metropolitan, small metropolitan, and nonmetropolitan. Deaths from NVSS-M are categorized by the county of residence of the decedent using CDC's National Center for Health Statistics 2013 Urban-Rural Classification Scheme, collapsed into two categories (metropolitan and nonmetropolitan). RESULTS: Although both metropolitan and nonmetropolitan areas experienced significant increases from 2003-2005 to 2012-2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period. Notably, past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12-17 years). The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropolitan status and changed over time. Across both metropolitan and nonmetropolitan areas, the prevalence of past-year illicit drug use disorders declined during 2003-2014. In 2015, approximately six times as many drug overdose deaths occurred in metropolitan areas than occurred in nonmetropolitan areas (metropolitan: 45,059; nonmetropolitan: 7,345). Drug overdose death rates (per 100,000 population) for metropolitan areas were higher than in nonmetropolitan areas in 1999 (6.4 versus 4.0), however, the rates converged in 2004, and by 2015, the nonmetropolitan rate (17.0) was slightly higher than the metropolitan rate (16.2). INTERPRETATION: Drug use and subsequent overdoses continue to be a critical and complicated public health challenge across metropolitan/nonmetropolitan areas. The decline in illicit drug use by youth and the lower prevalence of illicit drug use disorders in rural areas during 2012-2014 are encouraging signs. However, the increasing rate of drug overdose deaths in rural areas, which surpassed rates in urban areas, is cause for concern. PUBLIC HEALTH ACTIONS: Understanding the differences between metropolitan and nonmetropolitan areas in drug use, drug use disorders, and drug overdose deaths can help public health professionals to identify, monitor, and prioritize responses. Consideration of where persons live and where they die from overdose could enhance specific overdose prevention interventions, such as training on naloxone administration or rescue breathing. Educating prescribers on CDC's guideline for prescribing opioids for chronic pain (Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. MMWR Recomm Rep 2016;66[No. RR-1]) and facilitating better access to medication-assisted treatment with methadone, buprenorphine, or naltrexone could benefit communities with high opioid use disorder rates. AD - National Center for Injury Prevention and Control, CDC, Atlanta, GA. Office of the Assistant Secretary for Planning and Evaluation, Office of the Secretary, U.S. Department of Health and Human Services, Washington, DC. AN - 29145698 AU - Mack, K. A. AU - Jones, C. M. AU - Ballesteros, M. F. DA - Dec DO - 10.1111/ajt.14555 DP - NLM ET - 2017/11/18 J2 - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons KW - Drug Overdose/*mortality Humans Illicit Drugs/*poisoning Prevalence Rural Population/*statistics & numerical data Substance-Related Disorders/*epidemiology United States/epidemiology Urban Population/*statistics & numerical data LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1600-6135 SP - 3241-3252 ST - Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas-United States T2 - Am J Transplant TI - Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas-United States VL - 17 ID - 930800 ER - TY - JOUR AB - The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34 percent at residential treatment facilities and 9 percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees. AD - Johanna Catherine Maclean (catherine.maclean@temple.edu) is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania; a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts; and a research affiliate at the Institute of Labor Economics in Bonn, Germany. Hefei Wen is an assistant professor in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts. Kosali I. Simon is the Herman B. Wells Endowed Professor at the Paul H. O'Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana. Brendan Saloner is the Bloomberg Associate Professor of American Health in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. AN - 33523735 AU - Maclean, J. C. AU - Wen, H. AU - Simon, K. I. AU - Saloner, B. DA - Feb DO - 10.1377/hlthaff.2020.00404 DP - NLM ET - 2021/02/02 J2 - Health affairs (Project Hope) LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0278-2715 SP - 326-333 ST - Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities T2 - Health Aff (Millwood) TI - Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities VL - 40 ID - 931027 ER - TY - JOUR AB - The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34 percent at residential treatment facilities and 9 percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees. AD - [Maclean, Johanna Catherine] Temple Univ, Econ, Philadelphia, PA 19122 USA. [Maclean, Johanna Catherine] NBER, Cambridge, MA 02138 USA. [Maclean, Johanna Catherine] Inst Lab Econ, Bonn, Germany. [Wen, Hefei] Harvard Med Sch, Dept Populat Med, Div Hlth Policy & Insurance Res, Boston, MA 02115 USA. [Wen, Hefei] Harvard Pilgrim Hlth Care Inst, Boston, MA USA. [Simon, Kosali, I] Indiana Univ, Paul H ONeill Sch Publ & Environm Affairs, Bloomington, IN USA. [Simon, Kosali, I] Indiana Univ, Hlth Sci, Bloomington, IN USA. [Saloner, Brendan] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Amer Hlth, Baltimore, MD USA. Maclean, JC (corresponding author), Temple Univ, Econ, Philadelphia, PA 19122 USA.; Maclean, JC (corresponding author), NBER, Cambridge, MA 02138 USA.; Maclean, JC (corresponding author), Inst Lab Econ, Bonn, Germany. catherine.maclean@temple.edu AN - WOS:000614609300019 AU - Maclean, J. C. AU - Wen, H. F. AU - Simon, K. I. AU - Saloner, B. DA - Feb DO - 10.1377/hlthaff.2020.00404 J2 - Health Aff. KW - OPIOID USE DISORDERS INSURANCE Health Care Sciences & Services Health Policy & Services LA - English M1 - 2 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2021 SN - 0278-2715 SP - 326-333 ST - Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities T2 - Health Affairs TI - Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities UR - ://WOS:000614609300019 VL - 40 ID - 931229 ER - TY - JOUR AB - BACKGROUND: Opioid use in the United States is a national public health emergency. The primary treatment for opioid use disorder (OUD) is medication assisted treatment (MAT). Although effective in improving treatment outcomes in OUD, there is a need to develop behavioral treatments adjunctive to MAT. The current study investigates attentional bias in OUD as a possible target for adjunctive behavioral treatments. METHODS: Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2017. Eligible peer-reviewed studies evaluated attentional bias in opioid users, used a task to evaluate attentional bias that included active response to study stimuli, calculated attention bias by comparing response to drug and neutral stimuli, and could isolate attentional bias specific to opioid versus neutral stimuli from bias to other salient stimuli. CONCLUSIONS: The results of our systematic review and meta-analysis suggest that individuals with OUD exhibit robust attentional bias to opioid cues, even when engaged in MAT. Interventions that reduce attentional bias may be a useful adjunct to MAT. AD - VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA. Electronic address: ross.maclean@yale.edu. VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA. National Institutes of Health, Bethesda, MD, USA. National Cancer Institute, Rockville, MD, USA. Uniformed Services University of Health Sciences, Bethesda, MD, USA. AN - 30157467 AU - MacLean, R. R. AU - Sofuoglu, M. AU - Brede, E. AU - Robinson, C. AU - Waters, A. J. DA - Oct 1 DO - 10.1016/j.drugalcdep.2018.07.012 DP - NLM ET - 2018/08/30 J2 - Drug and alcohol dependence KW - Adult Analgesics, Opioid/adverse effects/therapeutic use Attentional Bias/*physiology *Cues Female Humans Male Opioid-Related Disorders/*diagnosis/epidemiology/*psychology *Attentional bias *Dot probe *Drug stroop *Heroin *Medication assisted treatment *Opioid use disorder LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0376-8716 SP - 270-278 ST - Attentional bias in opioid users: A systematic review and meta-analysis T2 - Drug Alcohol Depend TI - Attentional bias in opioid users: A systematic review and meta-analysis VL - 191 ID - 930837 ER - TY - JOUR AB - BACKGROUND: Opioid use disorder (OUD) and chronic pain are common, often co-occurring, conditions that are highly prevalent among Veterans. Within the San Francisco Veterans Affairs Healthcare System (SFVAHCS), only 33.0% of Veterans with OUD are prescribed pharmacotherapy treatment and over 1,000 have risk factors for developing OUD (e.g., prescribed chronic opioids). Buprenorphine, an evidence-based and highly effective treatment for both OUD and pain, can be prescribed by primary care providers (PCPs) with additional training and an X-waiver from the DEA. Of the 87 SFVAHCS PCPs, 17 (19.5%) are waivered; however, only 7 (8.0%) have prescribed buprenorphine within the past 6 months. We sought to understand barriers to obtaining an X-waiver, and identify interventions to increase buprenorphine prescribing from primary care. METHODS: We created and distributed an online survey to all SFVAHCS PCPs (n=87) who work in geriatric, infectious disease, teleprimary care, and rural and urban primary care settings. Non-waivered providers were surveyed to evaluate interest in becoming waivered and barriers to obtaining a waiver. Waivered providers were surveyed to evaluate barriers to prescribing buprenorphine and solutions to increase prescribing. RESULTS: Of the 40 survey responders (46.0% response rate), 25 (62.5%) were not waivered and 15 (37.5%) were waivered. Some nonwaivered providers expressed interest in obtaining an X-waiver (mean 3.60 on a 5-point Likert scale, where 5=very interested). The most frequently reported barriers to becoming waivered were: 1) lack of time to complete training (n=17); 2) limited access to training (n=9); and 3) lack of incentive to become waivered (n=8). Among waivered providers, the most commonly reported barriers to prescribing were: 1) lack of knowledge and/or experience (n=9); 2) lack of clinic support/ infrastructure (n=8); and 3) lack of time to counsel patients during visits (n=6). Interventions that waivered providers were interested in included: 1) a “buprenorphine mentor” to call as needed (mean 4.57 on a 5-point Likert scale, where 5=very interested); 2) educational materials (mean 4.14); 3) a 1-hour refresher course (mean 4.00); and 4) data identifying potential candidates for buprenorphine (mean 4.00). CONCLUSIONS: Based on our survey of SFVAHCS PCPs, there are simple, actionable strategies that may increase the proportion of Veterans who have access to evidence-based treatment for OUD and chronic pain. Providing time, training resources, and employee incentives could increase the number of waivered PCPs. Once waivered, PCPs need further support to ensure confidence and skills in routine prescribing of buprenorphine. Strategies include mentorship, provider educational materials, and establishing clinic infrastructure to reduce the administrative burden of prescribing buprenorphine. AD - J. Macri, UCSF Department of Medicine, San Francisco VA Health Care System, San Bruno, CA, United States AU - Macri, J. AU - Leyde, S. AU - Rife, T. AU - Patel, S. DB - Embase DO - 10.1007/s11606-020-05890-3 KW - buprenorphine opiate adult California chronic pain communicable disease conference abstract controlled study employee female health care system human Likert scale major clinical study male mentor prescription primary medical care refresher course skill veteran LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1525-1497 SP - S310 ST - Understanding barriers and solutions to obtaining and utilizing an X-waiver among Veterans Affairs primary care providers T2 - Journal of General Internal Medicine TI - Understanding barriers and solutions to obtaining and utilizing an X-waiver among Veterans Affairs primary care providers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633957684&from=export http://dx.doi.org/10.1007/s11606-020-05890-3 VL - 35 ID - 931077 ER - TY - JOUR AB - Introduction Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable and painful procedures for patients throughout their admission. There is growing evidence to suggest that chronic pain is becoming increasingly recognised as a long term problem for patients following an ICU admission [1]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU discharge at Glasgow Royal Infirmary. This study investigated the incidence and location of chronic pain in patients discharged from ICU and classified the analgesics prescribed according to the World Health Organization analgesic Methods The InS:PIRE programme involved individual sessions for patients and their caregivers with a physiotherapist and a pharmacist along with interventions from medical, nursing, psychology and community services. The physiotherapist documented the incidence and pain location during the assessment. The pharmacist recorded all analgesic medications prescribed prior to admission and at their clinic visit. The patient's analgesic medication was classified according to the WHO pain ladder from zero to three, zero being no pain medication and three being treatment with a strong opioid. Data collected was part of an evaluation of a quality improvement initiative, therefore ethics approval was waived. Results Data was collected from 47 of the 48 patients who attended the rehabilitation clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67 %)). Prior to admission to ICU 43 % of patients were taking analgesics and this increased to 81 % at the time of their clinic visit. The number of patients at step two and above on the WHO pain ladder also increased from 34 % to 56 %. Conclusions Of the patients seen at the InS:PIRE clinic two-thirds stated that they had new pain since their ICU admission. Despite the increase in the number and strength of analgesics prescribed, almost a quarter of patients still complained of pain at their clinic visit. These results confirm that pain continues to be a significant problem in this patient group. Raising awareness in primary care of the incidence of chronic pain and improving its management is essential to the recovery process following an ICU admission. AD - P. MacTavish, Glasgow Royal Infirmary, Glasgow, United Kingdom AU - MacTavish, P. AU - Devine, H. AU - McPeake, J. AU - Daniel, M. AU - Kinsella, J. AU - Quasim, T. DB - Embase DO - 10.1186/s13054-016-1208-6 KW - analgesic agent opiate intensive care hospital emergency medicine pain human patient chronic pain drug therapy pharmacist physiotherapist World Health Organization caregiver rehabilitation psychology employment independence social welfare nursing intensive care unit primary medical care total quality management male rehabilitation center ethics procedures APACHE LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2016 SN - 1364-8535 ST - Clasification of pain and its treatment and an intensive care rehabiliation clinic T2 - Critical Care TI - Clasification of pain and its treatment and an intensive care rehabiliation clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72279156&from=export http://dx.doi.org/10.1186/s13054-016-1208-6 VL - 20 ID - 931179 ER - TY - JOUR AB - Conventional wisdom suggests that coverage for substance abuse treatment under Medicaid is generally poor, and that access to care may be reduced when control over behavioral health services is given to private health plans, such as those under Medicaid managed care. To examine this premise, this study reports on a cross-sectional comparative survey of state Medicaid managed care programs conducted in the year 2000. Although not all states provided substance abuse benefits under their Medicaid programs, our findings suggest that a majority of states used managed care arrangements to provide substance abuse treatment, with most providing an array of covered services. Most Medicaid behavioral health plans were fully capitated. The number of comprehensive health plans providing substance abuse services was slightly higher than the number of behavioral health carveouts. About half of the waiver programs that covered substance abuse treatment covered methadone maintenance, but waiver programs employing comprehensive health plans were more likely to provide coverage for methadone maintenance. © 2006 Elsevier Inc. All rights reserved. AD - M. Maglione, RAND Corporation, Santa Monica, CA 90401, United States AU - Maglione, M. AU - Ridgely, M. S. DB - Embase Medline DO - 10.1016/j.jsat.2005.12.006 KW - methadone allopathy article comparative study drug dependence drug dependence treatment health behavior health care management health program human learning medicaid priority journal United States LA - English M1 - 4 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2006 SN - 0740-5472 SP - 285-290 ST - Is conventional wisdom wrong? Coverage for substance abuse treatment under Medicaid managed care T2 - Journal of Substance Abuse Treatment TI - Is conventional wisdom wrong? Coverage for substance abuse treatment under Medicaid managed care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L43729151&from=export http://dx.doi.org/10.1016/j.jsat.2005.12.006 VL - 30 ID - 931219 ER - TY - JOUR AB - Nationally, it was estimated that 11.4 million people misused opioids in 2017 with more than 47,000 opioid-related deaths. Although medication-assisted treatment (MAT) has been effective in enhancing treatment retention and decreasing frequency of opioid use, relapse rates for opioids and other substances remain high, emphasizing the importance of investigating novel interventions to augment MAT. One potential treatment approach is repetitive transcranial magnetic stimulation (rTMS)-a noninvasive, electrophysiological method of neuromodulation. Recently published studies of rTMS in individuals with alcohol, nicotine, and cocaine use disorder have suggested that this treatment shows promise in reducing cravings and substance use. The literature specific to rTMS and opioid use disorder (OUD) is limited to a single published study in heroin users, which showed that a single session of rTMS to the left dorsolateral prefrontal cortex (DLPFC) reduced cue-induced craving, with a further reduction following 5 consecutive days of rTMS. The following case report involved a 25-year-old Caucasian male diagnosed with OUD and cocaine use disorder. This subject continued to demonstrate ongoing substance use despite participating in comprehensive MAT with buprenorphine/naloxone in combination with psychosocial interventions. He was administered 7 separate sessions of rTMS targeting the left DLPFC. Substance-related cues were presented prior to, during, and following these rTMS administration sessions and the subject rated his substance cravings via a 100-point Visual Analog Scale. When compared with his cue-induced craving ratings, there was a mean reduction in craving for heroin and cocaine by ∼60% to 82% following the 7 administration sessions. Although this is a single case, further investigation of rTMS as an augmentation strategy for OUD and polysubstance use is warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved). AD - Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine. Department of Behavioral Medicine, Rockefeller Neuroscience Institute, West Virginia University School of Medicine. AN - 31647279 AU - Mahoney, J. J. AU - Marshalek, P. J. AU - Rezai, A. R. AU - Lander, L. R. AU - Berry, J. H. AU - Haut, M. W. C2 - Pmc7037539 C6 - Nihms1068587 DA - Feb DO - 10.1037/pha0000289 DP - NLM ET - 2019/10/28 J2 - Experimental and clinical psychopharmacology KW - Adult Cocaine Cocaine-Related Disorders/physiopathology/*therapy *Craving *Cues Heroin Heroin Dependence/physiopathology/*therapy Humans Male *Prefrontal Cortex Substance-Related Disorders Transcranial Magnetic Stimulation/*methods LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1064-1297 (Print) 1064-1297 SP - 1-5 ST - A case report illustrating the effects of repetitive transcranial magnetic stimulation on cue-induced craving in an individual with opioid and cocaine use disorder T2 - Exp Clin Psychopharmacol TI - A case report illustrating the effects of repetitive transcranial magnetic stimulation on cue-induced craving in an individual with opioid and cocaine use disorder VL - 28 ID - 930967 ER - TY - JOUR AB - The growing opioid crisis in the United States affects childbearing women and their infants at an alarming rate. Substance use disorders in pregnancy have transitioned from a topic barely addressed to one that has become mainstream in the issue of pregnancy management. Opioid use can include appropriate use of a prescribed medication, the misuse of street drugs, and maintenance on an opioid agonist treatment such as methadone. Identifying this population of childbearing women is critical to be able to organize the appropriate resources and to provide a comprehensive multidisciplinary evidence-based plan of care. All clinicians need to be educated in identifying and caring for the growing population of women with substance use disorders. Each component of the continuum from prenatal care, labor and birth, and postpartum has challenges and issues that can have a positive or negative impact on the outcome of the pregnancy and the mother-infant relationship. Risk assessment, medication-assisted treatment, pain management, and fostering maternal-infant bonding are important considerations in the care of the woman with substance use disorder. Unbiased empathetic nurses are well positioned to strongly advocate and intervene on behalf of women with substance use disorder, which in turn will help to create positive outcomes for the mother and her baby. AD - Kathleen Mahoney is an Assistant Professor, New Jersey City University, Jersey City, NJ. Dr. Mahoney can be reached via e-mail at Kmahoney2@njcu.edu Wendy Reich is a Perinatal Educator, RWJ Barnabas Health, Monmouth Medical Center, Long Branch, NJ. Susan Urbanek is a Maternal Child Health Educator, RWJ Barnabas Health, Community Medical Center, Toms River, NJ. AN - 31415268 AU - Mahoney, K. AU - Reich, W. AU - Urbanek, S. DA - Sep/Oct DO - 10.1097/nmc.0000000000000551 DP - NLM ET - 2019/08/16 J2 - MCN. The American journal of maternal child nursing KW - Female Humans Infant, Newborn Neonatal Abstinence Syndrome/nursing/*prevention & control Obstetric Nursing Opioid-Related Disorders/nursing/*prevention & control Pregnancy Pregnancy Complications/nursing/*prevention & control *Prenatal Care LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0361-929x SP - 284-288 ST - Substance Abuse Disorder: Prenatal, Intrapartum and Postpartum Care T2 - MCN Am J Matern Child Nurs TI - Substance Abuse Disorder: Prenatal, Intrapartum and Postpartum Care VL - 44 ID - 930797 ER - TY - JOUR AB - Methadone and buprenorphine/naloxone are medication assisted treatment (MAT) options for treating opioid use disorder, yet attitudes regarding their use within abstinence-based recovery homes have not been assessed. The present investigation examined attitudes regarding MAT utilization among residents living in Oxford Houses. This cross-sectional investigation compared residents (n = 87) receiving MAT whose recent drug use involved opioids, and two groups not receiving MATs; those who had used opioids and those who had used substances other than opioids. The vast majority of residents were not receiving MAT, yet 32% reported MAT histories. Negative attitudes regarding MAT were observed among residents who were not receiving MAT. Those presently receiving MAT reported mixed attitudes regarding the use of methadone and buprenorphine/naloxone, and two of these residents reported they had never been prescribed MAT. Findings suggest that abstinence-based recovery homes such as Oxford Houses may not be optimal resources for persons receiving MATs. AD - Social Science Department, Harry S. Truman College, 1145 W. Wilson Ave., Chicago, IL, 60640, USA. jmajer@ccc.edu. Psychology Department, Washington College, 300 Washington Ave., Chestertown, MD, 21620, USA. Department of Social, Behavioral, and Human Services, University of Washington, 1900 Commerce St., Tacoma, WA, 98402, USA. Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL, USA. AN - 29302767 AU - Majer, J. M. AU - Beasley, C. AU - Stecker, E. AU - Bobak, T. J. AU - Norris, J. AU - Nguyen, H. M. AU - Ogata, M. AU - Siegel, J. AU - Wiedbusch, E. AU - Dovale, I. AU - Gelfman, N. AU - Callahan, S. AU - Jason, L. A. DA - Jul DO - 10.1007/s10597-017-0218-4 DP - NLM ET - 2018/01/06 J2 - Community mental health journal KW - Analgesics, Opioid/therapeutic use Analysis of Variance *Attitude to Health Buprenorphine/therapeutic use Cross-Sectional Studies Drug Utilization/statistics & numerical data Female Halfway Houses Humans Male Methadone/therapeutic use Naloxone/therapeutic use Narcotic Antagonists/therapeutic use Opiate Substitution Treatment/*methods Opioid-Related Disorders/*psychology/*therapy Outpatients/*psychology Surveys and Questionnaires *Abstinence-based recovery homes *Buprenorphine/naloxone *Medication assisted treatment *Methadone *Oxford House *Suboxone LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0010-3853 SP - 571-577 ST - Oxford House Residents' Attitudes Toward Medication Assisted Treatment Use in Fellow Residents T2 - Community Ment Health J TI - Oxford House Residents' Attitudes Toward Medication Assisted Treatment Use in Fellow Residents VL - 54 ID - 930860 ER - TY - JOUR AB - The opioid epidemic has been called the "most consequential preventable public health problem in the United States." Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semi-synthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidence-based medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids.This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. KEY WORDS: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs). AD - Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. University Pain Medicine and Rehabilitation Center, Newark, NJ. Millennium Pain Center, Bloomington, IN. Massachusetts General Hospital and Harvard Medical School, Boston, MA. AN - 30045589 AU - Manchikanti, L. AU - Sanapati, J. AU - Benyamin, R. M. AU - Atluri, S. AU - Kaye, A. D. AU - Hirsch, J. A. DA - Jul DP - NLM ET - 2018/07/27 J2 - Pain physician KW - Analgesics, Opioid/therapeutic use Drug Overdose/epidemiology *Epidemics Fentanyl/adverse effects Health Policy/*legislation & jurisprudence Heroin/adverse effects Humans Illicit Drugs/adverse effects/*legislation & jurisprudence Opioid-Related Disorders/*epidemiology United States United States Food and Drug Administration LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1533-3159 SP - 309-326 ST - Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic T2 - Pain Physician TI - Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic VL - 21 ID - 930802 ER - TY - JOUR AB - Emergency departments (EDs) play an important role in the care of patients with opioid use disorder (OUD), as these patients often lack traditional sources of primary care. Medication for addiction treatment (MAT) with buprenorphine increases treatment retention in patients after presentation to an ED, and reduces ongoing illicit opioid use, risk of overdose, and death. Yet currently buprenorphine initiation is uncommon in the ED. In a recent national survey, 92% of responding emergency medicine providers did not work in EDs that could provide medication treatment to patients struggling with OUD. In May of 2018, the Massachusetts General Hospital (MGH) ED instituted an OUD treatment protocol, which offered patients buprenorphine initiation, becoming the first ED in the state (and among the first in the country) to do so. Although 90% of MGH ED physicians are now DEA-X waivered, there continues to be a low rate of MAT initiation in the ED. This study seeks to examine the behavioral barriers to emergency physician provision of MAT and patients' willingness to disclose and seek help in obtaining OUD treatment in our ED. In partnership with ideas42 (a behavioral economics nonprofit) a behavioral map was created. It contained all of all the decisions and actions that ED providers must make and take to successfully follow the MAT initiation protocol. Semi-structured interviews were conducted with 23 total medical providers from the MGH ED and the MGH Bridge Clinic: 4 nurse practitioners (including 2 specializing in addiction), 1 registered nurse, 2 recovery coaches, 4 physician assistants, 5 residents, and 7 attending physicians. Along with the provider interviews, we also conducted interviews with 10 patients to better understand their barriers to accessing OUD treatment in our ED. Four primary behavioral barriers impacting adherence to the MAT initiation protocol by providers were identified, specifically: time pressure, absent cues to ask about opioid misuse, uncertainty with treatment protocols, varied ideas of who is responsible to treat opioid use. Behavioral barriers identified by patients included: a focus on the present rather than the future, the necessity for important life events to pursue treatment, stigma, and mistrust of the system. These identified barriers have become the foundation of a design and testing process to improve provision of MAT in our ED. AD - A. Martin AU - Martin, A. AU - Butler, K. AU - Chavez, T. AU - Samuels-Kalow, M. AU - Raja, A. AU - Wakeman, S. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - buprenorphine opiate addiction adult behavioral economics clinical article clinical protocol conference abstract death drug overdose drug therapy emergency medicine emergency physician emergency ward female general hospital human life event low drug dose male Massachusetts nurse practitioner physician assistant registered nurse resident semi structured interview stigma uncertainty LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E26 ST - ED-initiated buprenorphine: Barriers and bottlenecks in the months Since Launch T2 - Journal of Addiction Medicine TI - ED-initiated buprenorphine: Barriers and bottlenecks in the months Since Launch UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628536265&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931119 ER - TY - JOUR AB - The emergency department (ED) plays a vital role in the care of patients with opioid use disorder (OUD), as these patients are often marginalized from traditional sources of primary care. EDs frequently attend to primary healthcare needs of patients with OUD in addition to offering overdose reversal, attention to injuries related to substance use, and access to OUD treatment. As a result, emergency physicians have the potential to intervene for patients with OUD at a critical moment in their lives. Currently, there is a considerable gap between evidence-based research and common practice when it comes to the care of the OUD patient seeking treatment for their addiction. Despite evidence demonstrating the benefit of initiating buprenorphine in the ED, only 0.9% of emergency physicians have obtained their DEA X waiver to prescribe buprenorphine. The goal of this intervention was to increase the number of waivered physicians in the ED through a dedicated campaign. To our knowledge, there has not yet been such an intervention, specifically targeted at increasing the number of emergency physicians waivered to prescribe buprenorphine. Methods: We assembled an interdisciplinary team of physicians, designers, and public policy students tasked with creating a dedicated campaign to increase the number of emergency physicians with DEA X waivers. Using principles from design thinking, we launched a series of targeted user interviews to segment the population of attendings in the department along the lines of how likely they were to be in the "Yes", "Maybe", and "No" groups, as it related to their interest in becoming waivered. We then sought to understand the major obstacles to attendings in each group completing the waiver training. After understanding these, we constructed a two-phased approach targeting attendings, aimed at having them commit to the waiver training program without making the training mandatory. We used concepts from behavioral economics to create a series of interventions to 'nudge' providers into taking the course. We also invited interested ED resident physicians to take the course. Results: We began with 1 waivered physician in the department. By the end of our month-long campaign, 37 of 46 attending physicians in our faculty group, and 22 ED resident physicians had either obtained their waiver or had been scheduled to take their waiver training course. Conclusions: A comprehensive campaign informed by behavioral economics was effective at increasing the number of emergency physicians waivered to prescribe buprenorphine. This model could be broadly implemented in order to effectively address the crisis of opioid addiction and overdose death. AD - A. Martin AU - Martin, A. AU - Kehoe, L. AU - White, B. AU - Raja, A. AU - Wakeman, S. DB - Embase DO - 10.1097/ADM.0000000000000417 KW - buprenorphine opiate adult behavioral economics conference abstract controlled study death drug overdose emergency physician emergency ward human injury interview opiate addiction public policy resident student thinking training LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1935-3227 SP - E10 ST - Get waivered: A campaign to get emergency physicians waivered to prescribe buprenorphine T2 - Journal of Addiction Medicine TI - Get waivered: A campaign to get emergency physicians waivered to prescribe buprenorphine UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627852263&from=export http://dx.doi.org/10.1097/ADM.0000000000000417 VL - 12 ID - 931154 ER - TY - JOUR AD - Harvard Affiliated Emergency Medicine Residency, Boston, MA. Harvard School of Public Health, Boston, MA. Harvard Kennedy School, Cambridge, MA. Department of Medicine, Massachusetts General Hospital, Boston, MA. Department of Emergency Medicine, Brigham Health, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: araja@mgh.harvard.edu. AN - 31272821 AU - Martin, A. AU - Kunzler, N. AU - Nakagawa, J. AU - Lee, B. AU - Wakeman, S. AU - Weiner, S. AU - Raja, A. S. DA - Nov DO - 10.1016/j.annemergmed.2019.04.035 DP - NLM ET - 2019/07/06 J2 - Annals of emergency medicine KW - Analgesics, Opioid/therapeutic use Attitude of Health Personnel Buprenorphine/therapeutic use Drug Overdose/*prevention & control *Emergency Medicine Health Care Reform *Health Promotion Humans Internship and Residency Opiate Substitution Treatment/*statistics & numerical data Opioid-Related Disorders Physicians/*statistics & numerical data LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0196-0644 SP - 691-696 ST - Get Waivered: A Resident-Driven Campaign to Address the Opioid Overdose Crisis T2 - Ann Emerg Med TI - Get Waivered: A Resident-Driven Campaign to Address the Opioid Overdose Crisis VL - 74 ID - 930960 ER - TY - JOUR AB - Background: EDs nationwide are expanding their roles in the care of patients with opioid use disorder (OUD), and many have begun ED-MAT programs. In May of 2018, our ED instituted an ED-MAT protocol. Since then, we have identified multiple behavioral barriers, affecting both providers and patients, that have limited wide-scale early adoption of our protocol. The lessons learned from our innovative program may be useful as other hospitals plan their own MAT programs. Objective: While greater than 90% of our attending physicians now have DEA-X waivers and are able to prescribe buprenorphine, there remains opportunity to increase the rate of MAT initiation in our ED. This is consistent with previous findings that many providers who obtain their waivers underutilize them. We set out to examine the behavioral barriers to providers' use of our MAT initiation protocol and patients' willingness to seek help in obtaining OUD treatment in our ED. Methods: A behavioral map was created to outline the decisions and actions required for ED providers to follow the MAT initiation protocol. Semi-structured interviews were conducted with 21 medical providers from our ED: 7 attending physicians, 5 residents, 4 physician assistants, 4 nurse practitioners, and 1 registered nurse. Along with the provider interviews, we also conducted interviews with 10 patients with OUD to better understand their barriers to treatment in our ED Outcomes: Four behavioral barriers impacting adherence to the MAT initiation protocol by providers were identified, specifically: time pressure, a lack of cues to ask about opioid misuse, uncertainty with treatment protocols, and a lack of clarity around who is responsible for the treatment of OUD. Behavioral barriers identified by patients included: a focus on the present rather than the future, the necessity for important life events to pursue treatment, stigma, and mistrust of the health system. AD - A. Martin, Brigham and Women's Hospital, Harvard Medical School AU - Martin, A. AU - Raja, A. AU - White, B. DB - Embase DO - 10.1111/acem.13757 KW - buprenorphine opiate adoption adult clinical article clinical protocol conference abstract drug therapy emergency ward female human life event male nurse practitioner physician assistant registered nurse resident semi structured interview stigma uncertainty LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1553-2712 SP - S308 ST - Emergency department-initiated medication-assisted treatment: Lessons learned one year after launch T2 - Academic Emergency Medicine TI - Emergency department-initiated medication-assisted treatment: Lessons learned one year after launch UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627700025&from=export http://dx.doi.org/10.1111/acem.13757 VL - 26 ID - 931117 ER - TY - JOUR AB - Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, and 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts. AD - National Development and Research Institutes, New York, NY 10010, USA. matusow@ndri.org AN - 23217610 AU - Matusow, H. AU - Dickman, S. L. AU - Rich, J. D. AU - Fong, C. AU - Dumont, D. M. AU - Hardin, C. AU - Marlowe, D. AU - Rosenblum, A. C2 - Pmc3602216 C6 - Nihms418406 DA - May-Jun DO - 10.1016/j.jsat.2012.10.004 DP - NLM ET - 2012/12/12 J2 - Journal of substance abuse treatment KW - *Criminal Law Data Collection Drug Users/*legislation & jurisprudence Humans Mandatory Programs Methadone/therapeutic use Narcotic Antagonists/therapeutic use Opiate Substitution Treatment/*methods Opioid-Related Disorders/*rehabilitation United States LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2013 SN - 0740-5472 (Print) 0740-5472 SP - 473-80 ST - Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes T2 - J Subst Abuse Treat TI - Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes VL - 44 ID - 930962 ER - TY - JOUR AB - The Center for Substance Abuse Treatment (CSAT) provided a grant to the American Academy of Addiction Psychiatry (AAAP) to provide a novel training program in OBOT to psychiatry residents at the PGY 3 and 4 level. A novel method for training developed at AAAP that includes four hours of self study with an examination followed by four hours of face-to-face training by a qualified trainer who practices OBOT has been offered to psychiatry residency programs that have an accredited Addiction Psychiatry residency program. Completion of this course provides the training necessary for residents to become waivered to practice OBOT (when fully licensed and having obtained a DEA registration). The structure of this program, topics presented, and participation to date will be presented. This novel training intervention may be generalizable to other residency training programs and offers a means of providing the underpinnings of addiction medicine to physicians-in-training. AD - E. McCance-Katz, University of California, San Francisco, American Academy of Addiction Psychiatry AU - McCance-Katz, E. DB - Embase DO - 10.1080/10550490902928197 KW - opiate psychiatry addiction residency education training physician substance abuse examination registration LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2009 SN - 1055-0496 SP - 322 ST - Psychiatry resident training in office-based treatment of opioid dependence (OBOT): A new method of addiction training and early results T2 - American Journal on Addictions TI - Psychiatry resident training in office-based treatment of opioid dependence (OBOT): A new method of addiction training and early results UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70022120&from=export http://dx.doi.org/10.1080/10550490902928197 VL - 18 ID - 931215 ER - TY - JOUR AB - The current opioid epidemic requires new approaches to increasing access to treatment for patients with opioid use disorders and to improve availability of medication assisted treatment. We propose a model where medical students complete the necessary training to be eligible for the waiver to prescribe opioid medications to treat these disorders by the time of medical school graduation. This plan would increase the number of Drug Abuse Treatment Act of 2000 (DATA 2000) waivered physicians who could gain additional experience in treating substance use disorders during residency and provide the access to clinical care needed for individuals suffering with opioid use disorder. (Am J Addict 2017;26:316-318). AD - The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, Rhode Island. Rhode Island Department of Health, Providence, Rhode Island. AN - 28394437 AU - McCance-Katz, E. F. AU - George, P. AU - Scott, N. A. AU - Dollase, R. AU - Tunkel, A. R. AU - McDonald, J. DA - Jun DO - 10.1111/ajad.12550 DP - NLM ET - 2017/04/11 J2 - The American journal on addictions KW - Analgesics, Opioid/therapeutic use Buprenorphine/*therapeutic use *Education, Medical *Health Services Accessibility Humans Opiate Substitution Treatment/*methods Opioid-Related Disorders/*drug therapy Students, Medical LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1055-0496 SP - 316-318 ST - Access to treatment for opioid use disorders: Medical student preparation T2 - Am J Addict TI - Access to treatment for opioid use disorders: Medical student preparation VL - 26 ID - 930890 ER - TY - JOUR AB - The Opiate Medication Initiative for Rural Oregon Residents trained physicians and counselors in Central and Southwestern Oregon to use buprenorphine and develop service models that supported patient participation in drug abuse counseling. The Change Book from Addiction Technology Transfer Centers was used to structure the change process. Fifty-one individuals (17 physicians, 4 pharmacists, 2 nurse practitioners, and 28 drug abuse counselors and administrators) from seven counties completed the training and contributed to the development of community treatment protocols. A pre-post measure of attitudes and beliefs toward the use of buprenorphine suggested significant improvements in attitude after training, especially among counselors. Eight months after training, 10 of 17 physicians trained had received waivers to use buprenorphine and 29 patients were in treatment with six of the physicians. The Change Book facilitated development of county change teams and structured the planning efforts. The initiative also demonstrated the potential to concurrently train physicians, pharmacists, and counselors on the use of buprenorphine. AD - Department of Public Health and Preventive Medicine, CB669, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland OR 97230-3079, USA. mccartyd@ohsu.edu AN - 15063914 AU - McCarty, D. AU - Rieckmann, T. AU - Green, C. AU - Gallon, S. AU - Knudsen, J. DA - Apr DO - 10.1016/s0740-5472(03)00247-2 DP - NLM ET - 2004/04/06 J2 - Journal of substance abuse treatment KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Counseling/*education *Education, Continuing Health Knowledge, Attitudes, Practice Humans Opioid-Related Disorders/*drug therapy Oregon Program Evaluation *Rural Health Services Technology Transfer Workforce LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2004 SN - 0740-5472 (Print) 0740-5472 SP - 203-8 ST - Training rural practitioners to use buprenorphine; using The Change Book to facilitate technology transfer T2 - J Subst Abuse Treat TI - Training rural practitioners to use buprenorphine; using The Change Book to facilitate technology transfer VL - 26 ID - 930972 ER - TY - JOUR AB - OBJECTIVE: To characterize hedonic eating behaviors such as sugar cravings, food preferences, and appetitive responsiveness for sweet and hyper-palatable foods, and to determine the prevalence of addictive like eating behaviors and food addiction (FA) in individuals receiving medication-assisted treatment (MAT) for opioid use disorder (OUD). DESIGN: Quasi-experimental. SETTING: Outpatient MAT center. PARTICIPANTS: Nonpregnant adult patients undergoing MAT (n = 116) receiving either buprenorphine/naloxone or methadone for at least 6 months. MAIN OUTCOME MEASURES: Hedonic eating, FA, and food craving. RESULTS: Of the aggregate sample, 13.3 percent met criteria for FA. More than onethird of all subjects endorsed consuming larger amounts of highly palatable food than intended, unsuccessful attempts to quit or cut down on eating such foods, and a great deal of time spent on consuming or recovering from consuming such foods. Both medication groups demonstrated greatest cravings for sweets and fast foods followed by carbohydrates and fats (p < 0.001). Similarly, subjects reported "giving in" most frequently to sweets and fast foods followed by carbohydrates then fats (p < 0.001). Greater appetitive responsiveness was noted in the presence of hyper-palatable foods. No group differences were found. Weight change was not associated with addictive like eating, food craving, or appetitive responsiveness. CONCLUSIONS: Individuals receiving MAT exhibit preferences for sweet and fast foods that appear to be influenced by the proximity of such foods. FA was present. Collectively, such eating behaviors and food preferences may pose additional adverse health consequences and associated co-morbidities. This underlies the importance of comprehensive healthcare for patients with OUD, including nutrition education and evaluation of eating behaviors and food preferences. AD - Nurse Practitioner, Department of Pediatrics, University of Vermont Medical Center, Burlington, Vermont. Associate Professor, Department of Nursing, University of Vermont, Burlington, Vermont. AN - 31850510 AU - McDonald, E. AU - Laurent, J. DA - Nov/Dec DO - 10.5055/jom.2019.0539 DP - NLM ET - 2019/12/19 J2 - Journal of opioid management KW - Adult Analgesics, Opioid Behavior, Addictive/*epidemiology/psychology Craving Dietary Fats Eating Fast Foods *Feeding Behavior/psychology *Food Preferences Humans *Opioid-Related Disorders/complications/therapy LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1551-7489 (Print) 1551-7489 SP - 487-494 ST - Hedonic eating behaviors and food preferences associated with medication-assisted treatment for opioid use disorder T2 - J Opioid Manag TI - Hedonic eating behaviors and food preferences associated with medication-assisted treatment for opioid use disorder VL - 15 ID - 930863 ER - TY - JOUR AD - executive director, Governor's Institute, Raleigh, North Carolina sara@govinst.org. AN - 31072954 AU - McEwen, S. DA - May-Jun DO - 10.18043/ncm.80.3.191 DP - NLM ET - 2019/05/11 J2 - North Carolina medical journal KW - Education, Medical Epidemics/*prevention & control Humans North Carolina/epidemiology Opioid-Related Disorders/*epidemiology Safety-net Providers Schools, Medical/*organization & administration LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0029-2559 (Print) 0029-2559 SP - 191-192 ST - Spotlight on the Safety Net: NC Medical Schools Step Up Efforts to Address the Opioid Epidemic: Waiver Training for Students T2 - N C Med J TI - Spotlight on the Safety Net: NC Medical Schools Step Up Efforts to Address the Opioid Epidemic: Waiver Training for Students VL - 80 ID - 931002 ER - TY - JOUR AB - The increased use of prescription opioids has resulted in widespread misuse. As a result, more than 40,000 Americans lost their lives to opiate overdose in 2016 alone. These data have led to a national movement focused on appropriate opioid prescribing practices. The Centers for Disease Control and Prevention (CDC) developed its Guidelines for Prescribing Opioids for Chronic Pain (2017), a template for pain management and substance assessment in primary care. These CDC guidelines aim to prevent misuse/deaths and early identification of substance use disorders. Although the guidelines are appropriate for initiation of opioid therapy, they are not sufficient to manage patients who have already developed misuse disorders. Other modalities such as medication-assisted treatment (MAT) have been described as beneficial for patients with high risk for or who have an opioid misuse disorder. This article builds on the CDC's 2017 advisory document by applying it in praxis: first, non-opioid medication therapy options and nonmedication therapy options are explored; next, a case study is presented of an integrated primary care-managed patient who presented with both chronic pain and established opioid use disorder. Although the CDC guidelines were not followed in the patient's initial prescription opioid treatment regimen, those guidelines were used as a starting point for follow-up treatment, helping both to assess the patient's risk for opioid misuse disorder and to determine that MAT was an appropriate method of treatment. AD - University of Colorado, College of Nursing, Aurora, Colorado. AN - 31169790 AU - Medina, R. AU - Sorrell, T. AU - Techau, A. AU - Weiss, J. DA - Dec DO - 10.1097/jxx.0000000000000238 DP - NLM ET - 2019/06/07 J2 - Journal of the American Association of Nurse Practitioners KW - Analgesics, Opioid/*therapeutic use Colorado Humans Male *Medically Underserved Area Middle Aged Nurse Practitioners Pain, Intractable/*drug therapy/nursing Practice Guidelines as Topic Practice Patterns, Nurses'/*standards *Vulnerable Populations LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2327-6886 SP - 766-772 ST - Treating chronic pain and opioid misuse disorder among underserved populations in Colorado T2 - J Am Assoc Nurse Pract TI - Treating chronic pain and opioid misuse disorder among underserved populations in Colorado VL - 31 ID - 930938 ER - TY - JOUR AB - CONTEXT: Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT). OBJECTIVE: Our objective was to explore palliative care providers' experiences with managing chronic pain in cancer survivors prescribed LTOT, specifically in ambulatory palliative care settings, and their strategies for overcoming challenges. METHODS: We recruited providers through leading national palliative care organizations who manage chronic pain in cancer survivors. Asked to consider only cancer survivors with chronic pain when responding, participants completed an online survey that included questions about use of opioid risk mitigation tools, confidence in addressing opioid misuse behaviors and discussing/recommending management approaches, and access to addiction treatment. RESULTS: Of 157 participants, most were physicians (83%) or nurse practitioners (15%). Most reported using opioid risk mitigation tools such as urine drug testing (71%), opioid treatment agreements (85%), and practitioner database monitoring programs (94%). Participants were confident (7-8/10) managing the most commonly encountered opioid misuse behaviors (missing appointments, marijuana use, and using more opioids than prescribed) and in their ability to recommend nonpharmacologic and nonopioid pharmacologic treatments for chronic pain (10/10). They were least confident prescribing naloxone or managing addiction (5/10); only 27% reported having training or systems in place to address addiction. Only 13% had a waiver to prescribe buprenorphine. CONCLUSION: Palliative care providers are comfortable with many aspects of managing chronic pain in cancer survivors on LTOT, although challenges persist, including the lack of systems-based approaches and training in addiction treatment. AD - Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: merlinjs@pitt.edu. Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA. Palliative Medicine Program, Division of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA. Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Division Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA. Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. AN - 30342243 AU - Merlin, J. S. AU - Patel, K. AU - Thompson, N. AU - Kapo, J. AU - Keefe, F. AU - Liebschutz, J. AU - Paice, J. AU - Somers, T. AU - Starrels, J. AU - Childers, J. AU - Schenker, Y. AU - Ritchie, C. S. DA - Jan DO - 10.1016/j.jpainsymman.2018.10.493 DP - NLM ET - 2018/10/21 J2 - Journal of pain and symptom management KW - Adult *Ambulatory Care Analgesics, Opioid/*therapeutic use Cancer Survivors Chronic Pain/*drug therapy Female Humans Male Middle Aged Nurse Practitioners Opioid-Related Disorders/prevention & control/urine Pain Management *Palliative Care Physicians Practice Guidelines as Topic Practice Patterns, Physicians' *ambulatory medicine *cancer pain *cancer survivor *opioids LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0885-3924 SP - 20-27 ST - Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers T2 - J Pain Symptom Manage TI - Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers VL - 57 ID - 931014 ER - TY - JOUR AB - BACKGROUND: The lifetime prevalence of unintentional pregnancy among women enrolled in medically assisted treatment (MAT) for opioid use disorder (OUD) has been reported to exceed 80%. Consistent voluntary contraception use by women enrolled in MAT programs can reduce their risk of unintended pregnancies and increase their opportunity to plan the family size they want, yet little is understood about past and current contraception use or associated barriers and facilitators for this population of women. MATERIALS AND METHODS: Women enrolled in treatment for OUD at two MAT clinics in East Tennessee were invited to participate in an anonymous survey about contraception. We describe the sociodemographic and health characteristics of the women (N = 287; estimated response rate of 81.0%), report on their contraception knowledge and attitudes, and assess how these characteristics are associated with current contraception use. RESULTS: Most of the 287 women had been sexually active in the past 12 months (88%), were pregnant at least once (98%), and were insured (58%). Women having undergone bilateral tubal ligation had a greater average number of pregnancies (including those while on birth control), lower mean levels of depressed mood, and higher mean level of agreement that avoiding pregnancy now was important and that pregnant women should not use painkillers, compared to the women not using contraception. CONCLUSIONS: Strategies to ensure all women enrolled in MAT for OUD have knowledge of effective contraception and affordable, quality contraception care that is responsive to their complicated and oftentimes traumatic histories are necessary to enhance the women's reproductive health. AD - 1 Department of Public Health, University of Tennessee , Knoxville, Knoxville, Tennessee. 2 Knox County Health Department, Knoxville, Tennessee. AN - 29969340 AU - Meschke, L. L. AU - McNeely, C. AU - Brown, K. C. AU - Prather, J. M. DA - Oct DO - 10.1089/jwh.2017.6564 DP - NLM ET - 2018/07/04 J2 - Journal of women's health (2002) KW - Adult Communication Barriers *Contraception Behavior/psychology/statistics & numerical data Demography Female *Health Knowledge, Attitudes, Practice Humans *Opioid-Related Disorders/epidemiology/psychology/therapy Pregnancy Pregnancy, Unplanned/*psychology Reproductive Health/statistics & numerical data Sex Education/*methods Socioeconomic Factors United States/epidemiology *contraception *medically assisted treatment *medication-assisted treatment *opioid use LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 1540-9996 SP - 1215-1224 ST - Reproductive Health Knowledge, Attitudes, and Behaviors Among Women Enrolled in Medication-Assisted Treatment for Opioid Use Disorder T2 - J Womens Health (Larchmt) TI - Reproductive Health Knowledge, Attitudes, and Behaviors Among Women Enrolled in Medication-Assisted Treatment for Opioid Use Disorder VL - 27 ID - 930912 ER - TY - JOUR AB - Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy. AD - HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA. dsm@mail.med.upenn.edu AN - 20803321 AU - Metzger, D. S. AU - Zhang, Y. C2 - Pmc3155767 C6 - Nihms312447 DA - Nov DO - 10.1007/s11904-010-0059-z DP - NLM ET - 2010/08/31 J2 - Current HIV/AIDS reports KW - Alcoholism Buprenorphine/therapeutic use Clinical Protocols Drug Users HIV Infections/etiology/*prevention & control/transmission Health Promotion Humans Methadone/therapeutic use Naltrexone/therapeutic use *Opiate Substitution Treatment Risk Reduction Behavior Risk-Taking Substance Abuse, Intravenous/complications/*drug therapy/rehabilitation Substance-Related Disorders/complications/*drug therapy/rehabilitation LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2010 SN - 1548-3568 (Print) 1548-3568 SP - 220-5 ST - Drug treatment as HIV prevention: expanding treatment options T2 - Curr HIV/AIDS Rep TI - Drug treatment as HIV prevention: expanding treatment options VL - 7 ID - 930905 ER - TY - JOUR AB - As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the implementation plan in California's Hub and Spoke system. Training and technical assistance are designed to: increase the number and capacity of waivered prescribers; enhance skills of prescribers and multidisciplinary teams; and create systems change. Activities include buprenorphine waiver trainings and provider support, a practice facilitator program, Project ECHO sessions, webinars, clinical skills trainings, and regional learning collaboratives. This overview highlights the steps California is taking to build treatment capacity to address the opioid epidemic. AD - University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: gmiele@mednet.ucla.edu. Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America. Electronic address: lauren.caton@stanford.edu. University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: tfreese@mednet.ucla.edu. Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America. Electronic address: mpmcg@stanford.edu. University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: kdarfler@mednet.ucla.edu. University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: vpearce@mednet.ucla.edu. California Department of Health Care Services, 1500 Capitol Ave, Sacramento, CA 95814, United States of America. Electronic address: marlies.perez@dhcs.ca.gov. University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; Center for Behavior and Health, University of Vermont, 1 So Prospect Street, Burlington, VT 05405, United States of America. Electronic address: rrawson@mednet.ucla.edu. AN - 31399272 AU - Miele, G. M. AU - Caton, L. AU - Freese, T. E. AU - McGovern, M. AU - Darfler, K. AU - Antonini, V. P. AU - Perez, M. AU - Rawson, R. C2 - Pmc6893120 C6 - Nihms1536785 DA - Jan DO - 10.1016/j.jsat.2019.07.013 DP - NLM ET - 2019/08/11 J2 - Journal of substance abuse treatment KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use California Government Programs *Health Plan Implementation Health Services Accessibility/*organization & administration Humans Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Primary Health Care/*organization & administration State Government *Buprenorphine *California state targeted response *Implementation *Opioid epidemic *Opioid use disorder treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 (Print) 0740-5472 SP - 20-25 ST - Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and anticipated impact T2 - J Subst Abuse Treat TI - Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and anticipated impact VL - 108 ID - 930864 ER - TY - JOUR AB - Background and aims: Background: Repeated audit cycles revealed a 38-46% failure rate in adequate epidural analgesia provision for surgical patients. Reasons for failure were multifactorial including unilateral block, missed segments and catheter migration. In spite of interventions to remedy the situation the success rate could not be improved. Aim: To improve the efficacy of epidural analgesia and reduce the failure rate Methods: Local ethics approval was sought but waived for this service improvement initiative. A working group to formulate a strategy was established with anaesthetic and pain team representation. A Guideline and training package was developed and approved to enable nurses working within the Acute Pain Team to administer bolus doses of diamorphine 2 - 3mg via the epidural catheter as a top up. A repeat audit was carried out over a 6 month period. Results: During the 6 month study period there were 176 epidural infusions performed. The success rate had increased to 81%. 52 patients had diamorphine bolus top ups. The19% failure rate was due to catheter migration, persistent hypotension and inappropriate catheter placement. There was an increase in pruritus but no increase in other side effects. Conclusions: This audit revealed a significant improvement in epidural efficacy. Reasons for this include the development of the nurse initiative as issues relating to inadequate analgesia are now addressed in a more timely manner. Diamorphine is an effective epidural analgesic in small doses and associated with very few side effects. There have been no adverse events associated with this change in practice. AD - S. Millerchip, Anaesthetics Pain, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom AU - Millerchip, S. AU - Hillermann, C. DB - Embase DO - 10.1097/AAP.0000000000000142 KW - diamorphine analgesic agent anesthetic agent epidural anesthesia society regional anesthesia pain therapy nursing human clinical audit catheter epidural drug administration nurse side effect analgesia pruritus hypotension patient epidural catheter ethics surgical patient LA - English M1 - 5 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2014 SN - 1098-7339 SP - e320-e321 ST - A nursing initiative to improve efficacy of epidural analgesia T2 - Regional Anesthesia and Pain Medicine TI - A nursing initiative to improve efficacy of epidural analgesia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71688182&from=export http://dx.doi.org/10.1097/AAP.0000000000000142 VL - 39 ID - 931196 ER - TY - JOUR AB - Introduction: Medication treatment (MAT) is first-line treatment for opioid use disorder (OUD); buprenorphine is ideal for many patients given its high efficacy, good safety profile, and prescription in the outpatient setting. However, only 2.2% of U.S. physicians have the DATA 2000 waiver required to prescribe medication, including only 3.0% of primary care physicians and 16% of psychiatrists.Waiver training for medical students could bypass many barriers established physicians face, such as lack of flexible time, while improving students' OUD education. Methods: Twenty-six medical students completed waiver training in October 2019 andwere surveyed on knowledge, attitudes, and motivations to treat OUD before and after the 4-hour in-person training. The survey was adapted from a survey created at Harvard Medical School, combining aspects of the Buprenorphine Attitudes, Intentions, and Confidence Scale; the Medical Condition Regard Scale; and the Drug and Drug Problems Perceptions Questionnaire. Comparisons were made between pre- and post-training scores using independent samples t-tests. A control group (n=29) not attending training was also compared to students attending the training (pre-training). Results: After training, students had significantly better understanding that OUD is a treatable condition (P=0.008) and felt more prepared to treat OUD (P=0.001), and felt less that these patients were difficult to work with (P=0.049). Students also had an increased intent to prescribe buprenorphine in their future clinical practice. Compared to student participants pre-training, control students reported lower preference in working with patients with OUD (P=0.027), were more likely to feel there is little they can do to help (P=0.024), had more concerns about buprenorphine diversion (P=0.003), and were less likely to intend to obtain the DATA waiver (P=0.000). Conclusion: Medical students who attended the training showed improved knowledge about OUD and attitudes regarding working with patients with OUD.A control group of students who did not sign up for the training reported more negative attitudes about working with these patients and less understanding of the role they can play in treatment of OUD. Many of the students not pursuing training may benefit from the knowledge and attitude changes we observed after training. Given the continued opioid crisis and dearth of MAT prescribers in most communities, getting students prepared for and excited to care for people with substance use is an important step in improving patient-access and the culture of medicine. AD - L. Miller-Lloyd AU - Miller-Lloyd, L. AU - Landry, J. DB - Embase KW - buprenorphine opiate adult attitude clinical article clinical practice conference abstract controlled study drug abuse drug therapy female human male medical school medical student motivation opiate addiction perception questionnaire substance use LA - English M1 - 6 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1935-3227 SP - e403 ST - Medical Students Show Attitude Changes After CompletingMATWaiver Training T2 - Journal of Addiction Medicine TI - Medical Students Show Attitude Changes After CompletingMATWaiver Training UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634656437&from=export VL - 14 ID - 931052 ER - TY - JOUR AB - BACKGROUND: Overdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations' efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to concerns regarding reimbursement. Throughout the USA, the prevalence of OUD far exceeds the capacity of the OUD pharmacotherapy treatment system. Poor access to OUD pharmacotherapy prescribers has become a workforce development need for the addiction treatment field and a significant health issue. METHODS: This cluster randomized controlled trial (RCT) is designed to increase buprenorphine and extended-release naltrexone treatment capacity for OUD. The implementation intervention to be tested is a bundle of OUD pharmacotherapy capacity building practices called the Prescriber Recruitment Bundle (PRB), which was developed and piloted in a previous statewide buprenorphine implementation study. For this cluster RCT, organizational sites will be recruited and then randomized into one of two arms: (1) control, with treatment as usual and access to a website with PRB resources, or (2) intervention, with organizations implementing the PRB using the Network for the Improvement of Addiction Treatment organizational change model over a 24-month intervention period and a 10-month sustainability period. The primary treatment outcomes for each organizational site are self-reported monthly counts of buprenorphine slots, extended-release naltrexone capacity, number of buprenorphine patients, and number of extended-release naltrexone patients. This trial will be conducted in Florida, Ohio, and Wisconsin, resulting in 35 sites in each arm, for a total sample size of 70 organizations. DISCUSSION: This study addresses three issues of substantial public health significance: (1) the pressing opioid misuse epidemic, (2) the low uptake of OUD treatment pharmacotherapies, and (3) the need to increase prescriber participation in the addiction treatment workforce. TRIAL REGISTRATION: ClinicalTrials.gov NCT02926482. AD - Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA. todd.molfenter@chess.wisc.edu. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave., Room 204, Lexington, KY, 40508, USA. Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct., Madison, WI, 53715-1896, USA. Institute for Clinical and Translational Research, University of Wisconsin-Madison, 4116 Signe Skott Cooper Hall, 701 Highland Ave, Madison, WI, 53705, USA. Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA. , 1075E Educational Sciences, 1025 West Johnson St., Madison, WI, 53706-1706, USA. , 1 West Wilson St. Rm 850, Madison, WI, 53703, USA. , 30 E. Broad St., 8th Floor, Columbus, OH, 43215, USA. AN - 29141653 AU - Molfenter, T. AU - Knudsen, H. K. AU - Brown, R. AU - Jacobson, N. AU - Horst, J. AU - Van Etten, M. AU - Kim, J. S. AU - Haram, E. AU - Collier, E. AU - Starr, S. AU - Toy, A. AU - Madden, L. C2 - Pmc5688699 DA - Nov 15 DO - 10.1186/s13012-017-0665-x DP - NLM ET - 2017/11/17 J2 - Implementation science : IS KW - Buprenorphine/therapeutic use Capacity Building/organization & administration Family Practice/education Health Personnel/*education Humans Naltrexone/therapeutic use Narcotic Antagonists/*therapeutic use Opiate Substitution Treatment/*methods Opioid-Related Disorders/*therapy Organizational Innovation Psychiatry/education Research Design Staff Development/*organization & administration Telemedicine/organization & administration United States Workflow Addiction treatment Buprenorphine Evidence-based practice implementation Medication-Assisted Treatment Naltrexone University of Wisconsin’s Health Sciences Institutional Review Board. CONSENT FOR PUBLICATION: Not applicable COMPETING INTERESTS: The NIATx organizational change model was developed by the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin-Madison. Todd Molfenter, Ph.D., is a faculty member at the CHESS Center. Also, Dr. Molfenter is affiliated with the NIATx Foundation, the organization responsible for making the NIATx organizational change model to address access to and retention in behavioral health services available to the public. Dr. Molfenter has worked extensively with his institution to manage any conflicts of interest, and the NIATx Foundation will have no role in this study. The other authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1748-5908 SP - 135 ST - Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial T2 - Implement Sci TI - Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial VL - 12 ID - 930974 ER - TY - JOUR AB - A tremendous treatment gap exists for the care of persons with opioid use disorder. The vast majority of waivered practitioners, more than 90%, are in urban United States counties. The Comprehensive Addiction and Recovery Act of July 2016 enabled nurse practitioners to help fill that gap by prescribing buprenorphine for opioid use disorder. Free training is available for nurse practitioners who can play a key part in stemming the opioid epidemic in the US by obtaining a Drug Enforcement Administration waiver to prescribe buprenorphine, which is a mainstay treatment for opioid addiction. (C) 2019 Elsevier Inc. All rights reserved. AD - [Moore, Dorothy James] San Jose State Univ, Valley Sch Nursing, San Jose, CA 95192 USA. Moore, DJ (corresponding author), San Jose State Univ, Valley Sch Nursing, San Jose, CA 95192 USA. Dorothy.moore@sjsu.edu AN - WOS:000466893000011 AU - Moore, D. J. DA - May DO - 10.1016/j.nurpra.2019.01.005 J2 - JNP-J. Nurse Pract. KW - buprenorphine drug treatment medically assisted treatment opioid use disorder BUPRENORPHINE NALOXONE Nursing LA - English M1 - 5 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2019 SN - 1555-4155 SP - 323-327 ST - Nurse Practitioners' Pivotal Role in Ending the Opioid Epidemic T2 - Jnp-Journal for Nurse Practitioners TI - Nurse Practitioners' Pivotal Role in Ending the Opioid Epidemic UR - ://WOS:000466893000011 VL - 15 ID - 931263 ER - TY - JOUR AB - Opioid use disorder (OUD) has been declared a national crisis, as prevalence of OUD has increased remarkably over the past decade (Jones, 2017). While Medication Assisted Treatment (MAT) is the standard of care for OUDs, several key barriers to implementation have been noted throughout the clinical and research literature (DeFlavio et al., 2015). As a first step toward enhancing implementation and dissemination of MAT across the state of South Carolina, a needs assessment was conducted with key persons from 33 agencies to inform our efforts. Results provided descriptive information regarding medical providers and patients seen within agencies. Of the 33 agencies, 6 agencies (18%) reported having buprenorphine-waivered providers on staff (total of 11 medical providers across the 6 agencies). Agencies reported that they referred a mean of 4.63 patients to other facilities for MAT in the past month. Barriers to providing MAT were identified, with the most significant barrier including the lack of medical staff to prescribe buprenorphine (47%). Overall, the current study reiterates the gap between treatment need and capacity for OUD patients, and highlights factors associated with barriers to MAT adoption in state-funded county drug and alcohol agencies across a southern, predominantly rural state. AD - Medical University of South Carolina, United States of America. Electronic address: moreland@musc.edu. Medical University of South Carolina, United States of America. South Carolina Department of Alcohol and Other Drug Abuse Services, United States of America. AN - 31303360 AU - Moreland, A. AU - McCauley, J. AU - Barth, K. AU - Bogdon, C. AU - Killeen, T. AU - Haynes, L. AU - Jennings, L. AU - Guille, C. AU - Goldsby, S. AU - Brady, K. C2 - Pmc6893121 C6 - Nihms1534429 DA - Jan DO - 10.1016/j.jsat.2019.06.006 DP - NLM ET - 2019/07/16 J2 - Journal of substance abuse treatment KW - Buprenorphine/therapeutic use Health Personnel/*organization & administration Health Services Accessibility/*organization & administration Humans *Needs Assessment Opiate Substitution Treatment *Opioid Epidemic Opioid-Related Disorders/drug therapy/epidemiology *Practice Patterns, Physicians' Referral and Consultation Rural Population South Carolina LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 (Print) 0740-5472 SP - 4-8 ST - Assessing the needs of front-line providers in addressing the opioid crisis in South Carolina T2 - J Subst Abuse Treat TI - Assessing the needs of front-line providers in addressing the opioid crisis in South Carolina VL - 108 ID - 930933 ER - TY - JOUR AD - Stanford University School of Medicine, Palo Alto, CA, USA. npm@stanford.edu. Stanford University School of Medicine, Palo Alto, CA, USA. AN - 30414072 AU - Morris, N. P. AU - Bentzley, B. S. DA - Feb DO - 10.1007/s40596-018-1005-4 DP - NLM ET - 2018/11/11 J2 - Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Drug and Narcotic Control/*legislation & jurisprudence Education, Medical, Graduate Humans *Internship and Residency Opioid-Related Disorders/*drug therapy Psychiatry/*education LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1042-9670 SP - 131-134 ST - Requiring Buprenorphine Waivers for Psychiatry Residents T2 - Acad Psychiatry TI - Requiring Buprenorphine Waivers for Psychiatry Residents VL - 43 ID - 930951 ER - TY - JOUR AB - Background: Overdose is the leading cause of preventable death in the United States. There have been efforts to distribute naloxone as a tool for harm reduction to those who need it; however, negative attitudes of healthcare workers and lack of knowledge may impact distribution. Medical schools have begun training students in opioid overdose prevention and treatment; initial studies found trainings improve student knowledge in responding to overdoses, but it remains unclear whether the traditional curriculum contributes to this knowledge. The present study aimed to evaluate baseline medical student knowledge about opioids, opioid overdoses, and naloxone use. Methods: We distributed 15-minute online surveys via the email lists of all four classes at the Wayne State University School of Medicine as part of a wider initiative on Opioid Overdose Prevention and Response Training. Student participation was voluntary and confidential. These baseline surveys included questions about past experiences and knowledge of opioid use disorder (OUD) and overdoses, clinical experiences, and attitudes towards patients with OUD. These were assessed with the validated Opioid Overdose Knowledge (OOK), Opioid Overdose Attitudes, and Medical Conditions Regard Scales (adapted for substance use disorders [SUDs]). Results: In all, 252 students (29.0% M1, 25% M2, 21.8% M3, 24.2% M4) completed the survey. We found differences in total knowledge (OOKS) across class years (M1, 44.68 ± 4.86; M2, 48.05 ± 4.62; M3, 47.24 ± 5.22; M4, 49.37 ± 4.29; F(3, 251) = 11.8; P < .001), although within subsections of the measure there were no differences between class years. Students with more clinical experience (eg, M4s) scored higher on the subscales regarding naloxone use and signs of an opioid overdose; scores for the opioid overdose risk factor subscale and the actions in an overdose subscale did not differ between classes. Improvements across measures of opioid overdose attitudes were also found across class year (F(3, 251) = 4.2; P = .006). Notably, students in the final year of training scored lower on certain subscales of the Medical Conditions Regard Scale, indicating less willingness to work with patients with SUDs. We also identified interest in medication treatment and naloxone trainings should these opportunities arise. Conclusions: The results highlight how gradual exposure to knowledge and activities concerning OUD through clinical experience improve student knowledge and overall attitudes regarding opioid overdose. Improving this knowledge-base earlier in the undergraduate medical curriculum by complementing volunteering opportunities with additional training sessions such as the buprenorphine-waiver training program or in-house naloxone training is believed to improve attitudes, knowledge, and confidence prior to starting clinical rotations. Unfortunately, results also showed more negative attitudes among students with more clinical experience (M4s) towards patients with SUDs. This indicates a need for further training during clinical years and education of best ways to respond positively when working with this patient population. These findings support a continued, integrated curriculum on OUD and naloxone in medical education with a need for an improved focus on methods to improve students' attitudes toward patients with OUD. Summary: The present study aimed to evaluate baseline medical student knowledge about opioids, opioid overdoses, and naloxone use. As a point of focus, the study aimed to identify how people's knowledge in areas and attitudes towards patients differed depending on their medical school training. Variables such as volunteering clinical experiences and whether students were in the pre-clinical or clinical portion of their training were noted with the aim of identifying the best way to complement the curriculum at Wayne State University School of Medicine for training professionals capable of understanding and treating a population dealing with SUDs. AD - T. Moses, Wayne State University, School of Medicine AU - Moses, T. AU - Ramos, R. AU - Garmo, M. AU - Waineo, E. AU - Greenwald, M. DB - Embase DO - 10.1111/ajad.13032 KW - buprenorphine naloxone opiate adult attitude conference abstract controlled study curriculum drug dependence drug overdose e-mail female human knowledge base major clinical study male medical education medical school medical student preclinical study prevention risk factor rotation LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1521-0391 SP - 211-212 ST - Knowledge and attitude changes towards opioid use disorder and naloxone use among medical students T2 - American Journal on Addictions TI - Knowledge and attitude changes towards opioid use disorder and naloxone use among medical students UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633284922&from=export http://dx.doi.org/10.1111/ajad.13032 VL - 29 ID - 931084 ER - TY - JOUR AB - BACKGROUND: American Indian/Alaskan Native (AI/AN) communities are second only to White Americans in mortality from opioid use disorder (OUD), while the smallest racial/ethnic minority population group in the USA. Those in rural communities experience significant health care disparities, including poorer treatment access for substance use disorder. This systematic scoping review aimed to trend the emerging evidence on opioid use disorder (OUD) management among rural AI/AN communities as well as workforce training needs. METHOD: We searched the Medline, Embase, PsycInfo, SSCI, and Digital theses databases for empirical study publications on OUD management among AI/AN rural communities across the continuum of prevention, treatment and care. Eight studies met the following criteria: (a) focused on OUD; (b) sampled rural AI/AN members; (c) investigated prevention, treatment and/or care perspectives and/or practices or health provider preparation; and (d) published during the period 2009-2020. Included studies met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) quality control standards. FINDINGS: Six of eight of the studies (75%) were surveys with community members and other stakeholders on OUD management within rural AI/AN communities rather than active interventions within this population. Moreover, five of eight of the studies (63%) reported a preference for culturally grounded health and wellness interventions with rural AI/AN, involving families, and community interventionists, utilizing community reinforcement approaches. Three of eight studies (37.5%) reported need for the cultural adaption of medication-assisted treatments (MAT) and use of culturally informed recovery care approaches. One of eight studies (12.5%) proposed to use culturally adapted contingency management behavioral approaches for OUD treatment and recovery care. CONCLUSION: The evidence is trending to endorse culturally adapted OUD management with rural AI/AN communities, prioritizing prevention education, and use of MAT with cultural adaptation and whole person approaches to sustainable recovery care. Mental health care should be a part OUD prevention, treatment and recovery care in rural AI/AN rural communities. AD - University of North Texas, TX, United States; The University of Sydney, Australia; The University of Johannesburg, South Africa. Electronic address: Elias.Mpofu@unt.edu. University of North Texas, TX, United States. Electronic address: Stan.Ingman@unt.edu. Meharry Medical College, TN, United States. Electronic address: pmatthews-juarez@mmc.edu. University of North Texas, TX, United States. Electronic address: SolymarRivera@my.unt.edu. Meharry Medical College, TN, United States. Electronic address: pjuarez@mmc.edu. AN - 33359980 AU - Mpofu, E. AU - Ingman, S. AU - Matthews-Juarez, P. AU - Rivera-Torres, S. AU - Juarez, P. D. DA - Mar DO - 10.1016/j.addbeh.2020.106743 DP - NLM ET - 2020/12/29 J2 - Addictive behaviors KW - *Alaskan Native *American Indian *Medically assisted treatments *Opioid use disorder *Prevention *Rural LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0306-4603 SP - 106743 ST - Trending the evidence on opioid use disorder (OUD) continuum of care among rural American Indian/Alaskan Native (AI/AN) tribes: A systematic scoping review T2 - Addict Behav TI - Trending the evidence on opioid use disorder (OUD) continuum of care among rural American Indian/Alaskan Native (AI/AN) tribes: A systematic scoping review VL - 114 ID - 930831 ER - TY - JOUR AB - The federal response to the opioid use disorder crisis has included a mobilization of resources to encourage office-based pharmacotherapy with buprenorphine, an effort culminating in the 2016 Comprehensive Addiction and Recovery Act, signed into law as Public Law 114-198. The Comprehensive Addiction and Recovery Act was designed to increase access to treatment with special emphasis on services for pregnant women and follow-up for infants affected by prenatal substance exposure. In this effort, the Comprehensive Addiction and Recovery Act laudably expands eligibility for obtaining a waiver to prescribe buprenorphine to nurse practitioners and physician assistants. However, certified nurse-midwives and certified midwives, who care for a significant proportion of pregnant and postpartum women and attend a significant proportion of births in the United States, were not included in the Comprehensive Addiction and Recovery Act legislation. In this commentary, we argue that an "all-hands" approach to providing office-based medication-assisted treatment for opioid use disorder is essential to improving access to treatment. Introduced in the House of Representatives in September 2017, the Addiction Treatment Access Improvement Act (H.R. 3692) would allow midwives to apply for the federal waiver to prescribe buprenorphine and is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. We support this change and encourage the U.S. Congress to act quickly to allow midwives to prescribe medication-assisted treatment for pregnant women with opioid use disorder. AD - George Washington University School of Nursing, Washington, DC; Dartmouth Hitchcock Medical Center Perinatal Addiction Treatment Program, Hanover, New Hampshire; the American College of Nurse-Midwives, Silver Spring, Maryland; and Virginia Commonwealth University, Richmond, Virginia. AN - 29420414 AU - Murphy, J. AU - Goodman, D. AU - Johnson, M. C. AU - Terplan, M. DA - Mar DO - 10.1097/aog.0000000000002493 DP - NLM ET - 2018/02/09 J2 - Obstetrics and gynecology KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Female Health Services Accessibility/*legislation & jurisprudence Humans Midwifery/*legislation & jurisprudence Nurse Midwives/legislation & jurisprudence *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Pregnancy Pregnancy Complications/*drug therapy United States LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0029-7844 SP - 542-544 ST - The Comprehensive Addiction and Recovery Act: Opioid Use Disorder and Midwifery Practice T2 - Obstet Gynecol TI - The Comprehensive Addiction and Recovery Act: Opioid Use Disorder and Midwifery Practice VL - 131 ID - 930823 ER - TY - JOUR AB - This study assessed the social, demographic and clinical determinants of whether an opioid-dependent patient received buprenorphine versus an alternative therapy. A retrospective cohort analysis of opioid-dependent adults enrolled in Group Health Cooperative between January 1, 2006 and December 1, 2010 was performed. Increasing the number of physicians with DATA waivers in a region and living in a relatively-populated area increased the likelihood of being treated with buprenorphine, indicating that lack of access is a potential barrier. Comorbidity also appeared to be a factor in receipt of treatment, with the effect varying by diagnosis. Finally, patients with an insurance plan allowing health services to be sought from any provider, with increased cost sharing, were significantly more likely to receive buprenorphine, implying that patient demand is a factor. Programs integrating patient education, physician training, and support from addiction specialists would be likely facilitators of increasing access to this cost-effective treatment. AD - Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA 99210-1495, USA. Electronic address: sean.murphy@wsu.edu. Group Health Research Institute, Seattle, WA 98101, USA. College of Nursing, Washington State University, Spokane, WA 99210-1495, USA. Washington State University, Spokane, WA 99210-1495, USA. AN - 24209382 AU - Murphy, S. M. AU - Fishman, P. A. AU - McPherson, S. AU - Dyck, D. G. AU - Roll, J. R. DA - Mar DO - 10.1016/j.jsat.2013.09.003 DP - NLM ET - 2013/11/12 J2 - Journal of substance abuse treatment KW - Adult Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Cohort Studies Female Humans Male Middle Aged Opioid-Related Disorders/*drug therapy Retrospective Studies Buprenorphine Opioid dependence Treatment determinants LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2014 SN - 0740-5472 SP - 315-9 ST - Determinants of buprenorphine treatment for opioid dependence T2 - J Subst Abuse Treat TI - Determinants of buprenorphine treatment for opioid dependence VL - 46 ID - 930948 ER - TY - JOUR AB - Introduction: Infective endocarditis is often the end-stage repercussion of needle sharing and life-threatening drug abuse behaviors. Nearly 340 patients were admitted to the 4 Lee Health system hospitals with infective endocarditis accounting for more than 6000 total inpatient days costing a total of $14.8 M in care. Twenty-nine percentage of these patients are readmitted to the hospital within 30 days. In response to this crisis, Shipley Cardiothoracic Center of Lee Health took on the task of developing a medication-assisted treatment (MAT) program for opioid use disorder/intravenous drug abuse (OUD/IVDA) for our endocarditis patients. We recognized the unique opportunity to act as a portal to bring high-risk patients into treatment for opioid abuse and addiction as well as the potential cost management effects this intervention could have. Methods: We developed a MAT induction protocol utilizing the Clinical Opioid Withdrawal Scale and the best practices recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Society of Addiction Medicine (ASAM). A behavioral contract and a policy for the protocol were established as well. The key to the program was the START team (SubsTance Abuse Response Team) a specialist in addiction medicine, a pharmacist, social worker, and licensed clinical social worker from Spiritual Care services. The protocol was initially limited to a pilot study for 2 months. Results: This project quickly caught fire. Our cardiac surgeon, Dr. Hummel and his PA, Ms. Schaffer became X-waivered. Soon afterward, our hospitalists followed suit and 12 hospitalists now have their X-waiver with more pending. In our Emergency Department, 24 ED physicians are now X-waivered. Nursing very quickly became engaged. Our first patient, a 25-year-old woman with repeat endocarditis was successfully placed on protocol and had her redo operation. She has maintained 120 days of sobriety so far. Another male patient, 32 years old has also maintained 90 days of sobriety. Conclusions: Implementation of this type of protocol is never easy and one of the more difficult obstacles to overcome is the stigma and marginalization of this population in the minds of providers. Utilizing ASAM's X-waiver training has helped to provide education regarding best practices, evidence- based medicine, and the humanization of the problem. We have embarked on intensive, system-wide education projects, seminars, and posters to help alleviate personal bias. We know this is a very time-consuming population that carries with it typically poor financial demographics, multiple social issues, and very specialized needs for continued care outside of the hospital. Their needs often overwhelm a short-staffed care management team and their frequently volatile behavior makes nursing recruitment and engagement challenging.We are proud of our efforts and realize this might not be a protocol for every cardiac surgery program. But for those patients admitted to us with endocarditis because of OUD/IVDA, we now offer hope as well as the expertise of our surgeons. It is our belief that we will impact the surgical burden of endocarditis in this population. AD - C. Murtagh-Schaffer AU - Murtagh-Schaffer, C. AU - Hummel, B. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - opiate addiction medicine adult bacterial endocarditis cardiac surgeon conference abstract drug therapy drug withdrawal education emergency ward female heart surgery high risk patient hospital patient human intravenous drug abuse major clinical study male medical staff nursing opiate addiction pharmacist pilot study risk assessment social worker spiritual care stigma substance abuse surgery LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E38-E39 ST - Stop endocarditis with START T2 - Journal of Addiction Medicine TI - Stop endocarditis with START UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628537169&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931124 ER - TY - JOUR AB - Background: There have been a growing number of residency buprenorphine-naloxone clinics with the goal that this should become a part of regular chronic care delivery in a primary care practice. The Penn primary-care-focused residency programs (Primary Care Internal Medicine and Family Medicine) have developed buprenorphine-naloxone residency clinics. The goal of this study is to compare the impact on patient perceptions, role and comfort of residents incorporating this into their scope of practice, and likelihood of including this into their clinical practice as attending physicians. Methods: Residents participated in at least two half-day clinic sessions, seeing between 6 to 10 patients in a half day. All residents participated in waiver training and had an additional two didactic sessions on the topic. Surveys were provided to primary care residents and family medicine residents between April to June 2018. At this time primary care residents had all participated in 2 sessions of the clinic and were asked to rate changes in attitudes, knowledge, and perceptions post implementation. Family medicine residents had not begun their clinic yet and so baseline data was gathered. Results: 14 residents participated in the survey. Using a Wilcox-rank sum comparison we had significant changes (p< 0.01) with a change from Strongly Disagree to Agree in comfort prescribing. Other findings included being moree likely to recommend prescribing buprenorphine-naloxone and increased comfort being a PCP for a patient with opioid addiction. Residents strongly agreed that after participation they felt more empathy for this patient population. Finally they felt more empowered to care and enjoyed caring for this patients with addiction (Disagree to Strongly Agree). Key barriers pre implementation identified were lack of mental health care, logistics, and challenging patients. Conclusions: While this represents a very limited data set, it shows that residents attitudes, knowledge, and comfort changed significantly post a direct patient care experience with patients actively prescribing buprenorphine naloxone. We are in the process of comparing this data to the family medicine pre and post data to see if carries across [Figure Presented]. AD - D.R. Nandiwada, University of Pennsylvania, Ardmore, PA, United States AU - Nandiwada, D. R. AU - Chertok, J. AU - Larson, B. AU - Lieberman, D. AU - Shalaby, M. DB - Embase DO - 10.1007/11606.1525-1497 KW - buprenorphine plus naloxone adult clinical article clinical practice comfort conference abstract controlled study empathy family medicine female human male mental health care opiate addiction outpatient department patient care perception prescription primary medical care resident scope of practice LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1525-1497 SP - S346 ST - Resident perceptions of buprenorphine-naloxone prescribing post addiction clinic implementation T2 - Journal of General Internal Medicine TI - Resident perceptions of buprenorphine-naloxone prescribing post addiction clinic implementation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629004327&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 931130 ER - TY - JOUR AB - Opioid use disorder (OUD) and related overdose deaths have become a crisis of epidemic proportions in the United States. In 2018, over 10 million people age 12 years or older misused opioids.Substance use is also correlated with increased physical and mental health disorders, and developmental challenges among youths. Medication-assisted treatment (MAT) has been reported to reduce mortality, opioid use, and human immunodeficiency virus and hepatitis C virus transmission while increasing treatment retention in adults. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to explore best practices for youths at risk of opioid use disorders and/or overdose. SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. SBCYOR focuses on high-risk and addicted individuals between the ages of 12 to 24 years in San Bernardino County's correctional system. It utilizes a strategy of collaboration, prevention, risk mitigation, medication, psychological treatment, and community outreach. This study aimed to evaluate the implementation and progress of SBCYOR. AD - Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA. Probation Department, San Bernardino County Department of Probation, San Bernardino, USA. Emergency Medicine, California University of Science and Medicine, Colton, USA. Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, USA. Obstetrics and Gynecology, California University of Science and Medicine, Colton, USA. AN - 32821635 AU - Neeki, M. M. AU - Dong, F. AU - Archambeau, B. AU - Cerda, M. AU - Ratliff, S. AU - Goff, A. AU - Roloff, K. AU - Tran, L. C2 - Pmc7431298 DA - Aug 16 DO - 10.7759/cureus.9781 DP - NLM ET - 2020/08/22 J2 - Cureus KW - adolescence buprenorphine harm reduction medication-assisted treatment opioid use disorder youth LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2168-8184 (Print) 2168-8184 SP - e9781 ST - San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder T2 - Cureus TI - San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder VL - 12 ID - 930852 ER - TY - JOUR AB - IMPORTANCE: The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. OBJECTIVE: To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. EXPOSURES: State-level NAS incidence and county-level uninsured rates and rurality. MAIN OUTCOMES AND MEASURES: Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. RESULTS: Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). CONCLUSIONS AND RELEVANCE: Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy. AD - Medical student, Yale School of Medicine, New Haven, Connecticut. Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, University of Pennsylvania, Philadelphia. AN - 33306115 AU - Nguemeni Tiako, M. J. AU - Culhane, J. AU - South, E. AU - Srinivas, S. K. AU - Meisel, Z. F. C2 - PMC7733157 for Post & Schell, PC. Dr Meisel reported receiving grants from the National Institutes of Health/National Institute on Drug Abuse, Patient Centered Outcomes Research Institute, and the Centers for Disease Control and Prevention during the conduct of the study. Dr South reported receiving grants from the Robert Wood Johnson Foundation and the Centers for Diseases and Control and Prevention during the conduct of this study. No other disclosures were reported. DA - Dec 1 DO - 10.1001/jamanetworkopen.2020.29043 DP - NLM ET - 2020/12/12 J2 - JAMA network open KW - Adult *Buprenorphine/administration & dosage/adverse effects Cross-Sectional Studies Female Humans Infant, Newborn Male Medicaid *Methadone/administration & dosage/adverse effects Narcotic Antagonists/administration & dosage/adverse effects *Neonatal Abstinence Syndrome/epidemiology/etiology/prevention & control *Obstetrics/education/methods/statistics & numerical data *Opioid-Related Disorders/diagnosis/drug therapy/epidemiology Physicians/*statistics & numerical data Pregnancy *Pregnancy Complications/diagnosis/drug therapy/epidemiology Prevalence Rural Health/statistics & numerical data Staff Development/methods United States/epidemiology LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2574-3805 SP - e2029043 ST - Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine T2 - JAMA Netw Open TI - Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine VL - 3 ID - 930915 ER - TY - JOUR AB - BACKGROUND: Integrated care models for HIV and substance use disorder (SUD) care are proposed as a strategy for closing gaps in the HIV care continuum and decreasing HIV transmission. We examined attitudes regarding integration of HIV and SUD treatment among HIV-infected patients with illicit drug and unhealthy alcohol use. METHOD: We conducted a cross-sectional survey of HIV-infected patients receiving care at 5 HIV clinics in Hanoi, Vietnam, regarding substance use and attitudes toward HIV and SUD treatment integration. We used multivariate logistic regression to identify correlates of integrated care preference. RESULT: Among 312 participants with current or past illicit drug use or unhealthy alcohol use, 81.4% preferred integrated treatment for HIV and SUD. In multivariate analysis, completing a college education (aOR 0.22, 95% CI 0.08, 0.65), risk of depression (aOR 3.51, 95% CI 1.57, 7.87), ever having received medication-assisted treatment for opioid use disorder (aOR 4.20, 95% CI 1.65, 10.69), being comfortable discussing substance use with counselors/nurses (aOR 3.86, 95% CI 1.38, 10.81) and having discussed alcohol use with their health providers (aOR 2.34, 95% CI 1.09, 4.99) were associated with patients' preference for integrated care, after adjusting for age and gender. CONCLUSION: Most, but not all, HIV-infected patients with substance use preferred integrated HIV and SUD treatment. Our findings suggest that policies to expand integration of HIV and SUD treatment will be well received by most patients, and that stand-alone treatment options should be preserved for a significant minority. AD - Hanoi Medical University, Hanoi, Vietnam. Electronic address: nguyenbichdiep@hmu.edu.vn. Oregon Health and Science University, Portland, OR, USA. Hanoi Medical University, Hanoi, Vietnam. AN - 27568511 AU - Nguyen Bich, D. AU - Korthuis, P. T. AU - Nguyen Thu, T. AU - Van Dinh, H. AU - Le Minh, G. C2 - Pmc5517304 C6 - Nihms872133 DA - Oct DO - 10.1016/j.jsat.2016.07.003 DP - NLM ET - 2016/08/30 J2 - Journal of substance abuse treatment KW - Adult Alcohol-Related Disorders/rehabilitation Cross-Sectional Studies Delivery of Health Care, Integrated/*organization & administration Depression Female HIV Infections/*therapy Humans Logistic Models Male Multivariate Analysis *Patient Preference Substance-Related Disorders/*rehabilitation Surveys and Questionnaires Vietnam Young Adult *Alcohol abuse *Hiv *Injection drug use *Integrated model *Vietnam LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 0740-5472 (Print) 0740-5472 SP - 57-63 ST - HIV Patients' Preference for Integrated Models of Addiction and HIV Treatment in Vietnam T2 - J Subst Abuse Treat TI - HIV Patients' Preference for Integrated Models of Addiction and HIV Treatment in Vietnam VL - 69 ID - 930922 ER - TY - JOUR AB - Introduction: Due to the advances in modern medicine, 90% of adolescents and young adults with specialheath care needs (AYA-SHCN) survive into adulthood. The value of internal medicine-pediatrics (med-peds)training is exemplied during the transition of care (ToC) from pediatric to adult services of AYA-SHCN. This isdemonstrated in the case of an 18-year-old woman with lipodystrophy syndrome (LDS) during her recent ToCexperience. Case Presentation: At the age of eleven, this patient noticed an enlarging abdomen and wasting ofher lower extremity bulk. Lipodystrophy was suspected based on her pattern of fat loss. Workup revealedtransaminasemia and hypertriglyceridemia. A liver biopsy demonstrated non-alcoholic steatohepatitis (NASH).She was started on metreleptin for NASH in the setting of lipodystrophy. Despite improvement in thetriglyceride level, metreleptin was discontinued due to her development of neutralizing antibodies against thesynthetic hormone. Her course was complicated by autoimmune hepatitis, diabetes, persistent proteinuria,and chronic pancreatitis with pseudocyst formation requiring plasmapheresis for hypertriglyceridemia Chronic, non-terminal pain secondary to her pancreatitis led to chronic opioid use. Currently, she is on a trial of leptin receptor antagonist infusions with clinical improvement. Discussion: LDS is a rare group ofdisorders characterized by lack of subcutaneous fat. There is no denitive treatment for LDS. Complicationsinclude pancreatitis, renal impairment, steatohepatitis and diabetes. Thoughtful ToC for this patient wasparamount given her LDS, co-morbidities, and numerous subspecialists. ToC is dened as a purposefulmovement of AYA-SHCN from child-centered to adult-oriented health care. To optimize our patient's transitionprocess, the med-peds physicians; resident primary care physician (PCP) and attending, had a ToC meetingwith the inpatient pediatric teams best acquainted with her case. The information from this meeting washelpful during the patient's admission to the adult ward, which culminated with a warm hand off between hermed-peds PCP and the inpatient resident. Med-peds providers, more than their internist counterparts, arecomfortable with childhood-onset chronic medical conditions. The internal medicine training aids in chronicpain management given that opioid use is more common in the adult population. For example, only 0.8% ofbuprenorphine waivered clinicians identify as pediatricians. Compared to pediatric trainees, med-pedsresidents report more comfort in providing care to patients with chronic disease management. Consideringthe smaller number of med-peds graduates, improvement in ToC medicine must involve other specialist.Pediatricians can provide early education and assess for readiness via a transition readiness assessmentquestionnaire. Internists can assess self-management skills as patients gain more responsibility for their ownmedical care. Conclusion: LDS are rare and non-curative disorders that can manifest during adolescence. Thiscase highlights the benets of med-peds training during ToC while illustrating the need for best practices asthe AYA-SCHN population grows. AD - M.H.N. Nguyen, Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, MI, United States AU - Nguyen, M. H. N. AU - George, N. B. AU - Fausneaucht, A. AU - Helmstetter, N. DB - Embase DO - 10.1542/peds.147.3-MeetingAbstract.619 KW - endogenous compound hormone leptin receptor metreleptin neutralizing antibody opiate abdomen adolescence adult autoimmune hepatitis case report child childhood chronic disease chronic pancreatitis clinical article comfort comorbidity complication conference abstract diabetes mellitus drug therapy female general practitioner HIV associated lipodystrophy hospital patient human hypertriglyceridemia internist kidney disease liver biopsy lower limb nonalcoholic steatohepatitis pain pediatrician pediatrics plasmapheresis proteinuria pseudocyst resident responsibility school child self care skill subcutaneous fat transitional care young adult LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2021 SN - 1098-4275 SP - 617-619 ST - Challenges of transitioning from pediatric to adult care in apatient with lipodystrophy syndrome T2 - Pediatrics TI - Challenges of transitioning from pediatric to adult care in apatient with lipodystrophy syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634620862&from=export http://dx.doi.org/10.1542/peds.147.3-MeetingAbstract.619 VL - 147 ID - 931042 ER - TY - JOUR AB - BACKGROUND: Employment is one of the less studied but a significant outcome of medication-assisted treatment. Thus, we aimed to explore employment outcomes of medication-assisted treatment with hydromorphone (HDM) or diacetylmorphine (DAM). The secondary aim was to estimate characteristics of this population as well as treatment-related factors associated with these outcomes. METHODS: This was a secondary analysis of a randomized, double blind controlled trial. A total of 102 and 100 participants were randomized to receive injectable DAM or HDM for 6 months respectively. In stage 2, 144 participants were randomized again to receive either oral or injectable forms of the medication they received for another 6 months. Participants were interviewed at 5 timepoints: before and 3, 6, 9 and 12 months after treatment assignment. Generalized estimating equations (GEE) with a logit link was fitted to determine factors related to paid work in the past 30 days. RESULTS: Mean age of participants was 44.3 (SD = 9.6) and 59 (29.2%) participants were men. At each timepoint, 6-8 (3.6%-4.1%) participants reported employment in the past 30 days and 40 to 52 (19.7%-26.7%) reported minimum 1 day of paid work. University or college education [OR = 2.12: 95% CI = (1.25, 3.62), P = 0.01] was significantly associated with paid work after adjustment for age, gender, treatment arms, timepoints, days receiving study treatment, physical health, psychological health and crack cocaine use in the past 30 days. CONCLUSION: The rate of employment was lower among participants of this study compared to similar studies on heroin-assisted treatment. Higher education was associated with increased odds of paid work. A large gap exists between employment rate and the proportion of participants who reported paid work. Supported employment and occupational therapy could optimize the employment outcomes of this population. AD - Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences (CHEOS), Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada. Electronic address: mnikoo@cheos.ubc.ca. University of Basel, Department of Psychiatry (UPK), Division of Addictive Disorders, Switzerland. Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences (CHEOS), Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada. Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada. Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Canada. AN - 29655955 AU - Nikoo, M. AU - Vogel, M. AU - Choi, F. AU - Song, M. J. AU - Burghardt, J. AU - Zafari, Z. AU - Tabi, K. AU - Frank, A. AU - Barbic, S. AU - Schütz, C. AU - Jang, K. AU - Krausz, M. DA - Jul DO - 10.1016/j.drugpo.2018.03.021 DP - NLM ET - 2018/04/16 J2 - The International journal on drug policy KW - Adult Double-Blind Method Educational Status Employment/*statistics & numerical data Female Heroin/therapeutic use Humans Hydromorphone/therapeutic use Male Opioid-Related Disorders/drug therapy Randomized Controlled Trials as Topic/*statistics & numerical data *Treatment Outcome Young Adult *Diacetylmorphine *Education *Employment *Heroin-assisted treatment *Medication-assisted treatment *Opioid dependence LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0955-3959 SP - 18-24 ST - Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone T2 - Int J Drug Policy TI - Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone VL - 57 ID - 930935 ER - TY - JOUR AB - OBJECTIVES: Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. METHODS: We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. RESULTS: Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P < 0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%). CONCLUSIONS: Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem. AD - Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (BRN); Dartmouth Psychiatric Research Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (ECS, BM); Department of Psychiatry, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (AM, CL-H); Department of Biomedical Data Science, and Department of Community and Family Medicine, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (HX); Department of Vermont Health Access, Williston, Vermont (BT); Departments of Psychiatry and Family Medicine, University of Vermont College of Medicine, Burlington, Vermont (JB); Primary Care Health Partners, Bennington, Vermont (GK); Hawthorn Recovery Center, Bennington, Vermont (NK); Connecticut Valley Recovery Services, Windsor, Vermont (CFL); Northwestern Medical Center Comprehensive Pain Management, St. Albans, Vermont (WR); Department of Psychiatry and of Community and Family Medicine, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (MPM). AN - 26900669 AU - Nordstrom, B. R. AU - Saunders, E. C. AU - McLeman, B. AU - Meier, A. AU - Xie, H. AU - Lambert-Harris, C. AU - Tanzman, B. AU - Brooklyn, J. AU - King, G. AU - Kloster, N. AU - Lord, C. F. AU - Roberts, W. AU - McGovern, M. P. C2 - Pmc4865252 C6 - Nihms782884 DA - Mar-Apr DO - 10.1097/adm.0000000000000200 DP - NLM ET - 2016/02/24 J2 - Journal of addiction medicine KW - Buprenorphine/therapeutic use *Clinical Competence *Cooperative Behavior Health Services Accessibility/*organization & administration Humans *Learning Narcotic Antagonists/therapeutic use Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Practice Patterns, Physicians' *Quality of Health Care Vermont LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2016 SN - 1932-0620 (Print) 1932-0620 SP - 117-23 ST - Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders T2 - J Addict Med TI - Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders VL - 10 ID - 930983 ER - TY - JOUR AB - Objectives:Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont.Methods:We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology.Results:Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P<0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%).Conclusions:Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem. AD - [Nordstrom, Benjamin R.] Geisel Sch Med Dartmouth, Dept Psychiat, Lebanon, NH USA. [Saunders, Elizabeth C.; McLeman, Bethany] Dartmouth Geisel Sch Med, Dartmouth Psychiat Res Ctr, Lebanon, NH USA. [Meier, Andrea; Lambert-Harris, Chantal] Dartmouth Geisel Sch Med, Dept Psychiat, Lebanon, NH USA. [Xie, Haiyi] Dartmouth Geisel Sch Med, Dept Biomed Data Sci, Lebanon, NH USA. [Xie, Haiyi] Dartmouth Geisel Sch Med, Dept Community & Family Med, Lebanon, NH USA. [Tanzman, Beth] Dept Vermont Hlth Access, Williston, VT USA. [Brooklyn, John] Univ Vermont, Coll Med, Dept Psychiat, Burlington, VT USA. [Brooklyn, John] Univ Vermont, Coll Med, Dept Family Med, Burlington, VT USA. [King, Gregory] Primary Care Hlth Partners, Bennington, VT USA. [Kloster, Nels] Hawthorn Recovery Ctr, Bennington, VT USA. [Lord, Clifton Frederick] Connecticut Valley Recovery Serv, Winsdor, VT USA. [Roberts, William] Northwestern Med Ctr Comprehens Pain Management, St Albans, VT USA. [McGovern, Mark P.] Dartmouth Geisel Sch Med, Dept Psychiat & Community & Family Med, 46 Centerra Pkwy,Suite 301, Lebanon, NH 03766 USA. McGovern, MP (corresponding author), Dartmouth Geisel Sch Med, Dept Psychiat & Community & Family Med, 46 Centerra Pkwy,Suite 301, Lebanon, NH 03766 USA. Mark.P.McGovern@dartmouth.edu AN - WOS:000374748800007 AU - Nordstrom, B. R. AU - Saunders, E. C. AU - McLeman, B. AU - Meier, A. AU - Xie, H. Y. AU - Lambert-Harris, C. AU - Tanzman, B. AU - Brooklyn, J. AU - King, G. AU - Kloster, N. AU - Lord, C. F. AU - Roberts, W. AU - McGovern, M. P. DA - Mar-Apr DO - 10.1097/adm.0000000000000200 J2 - J. Addict. Med. KW - buprenorphine learning collaborative opioid use disorders quality improvement SUBSTANCE-ABUSE TREATMENT UNITED-STATES BUPRENORPHINE HEALTH DEPENDENCE ADOPTION IMPACT Substance Abuse LA - English M1 - 2 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2016 SN - 1932-0620 SP - 117-123 ST - Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders T2 - Journal of Addiction Medicine TI - Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders UR - ://WOS:000374748800007 VL - 10 ID - 931284 ER - TY - JOUR AB - Purpose: This article summarizes lessons learned from five AHRQ grants to implement Medication for Opioid Use Disorder (MOUD) in rural primary care practices. Methods: Lessons learned were extracted from quarterly and annual grantee progress reports, minutes from quarterly virtual meetings, and minutes and notes from annual grantee in-person meetings. The lessons learned were drafted by the authors and reviewed by the grantees for accuracy. Results: The experience of these projects suggest that recruiting providers in rural areas and engaging them to initiate and sustain provision of MOUD is very difficult. Innovative approaches and providing supports are required for supporting providers to overcome barriers. Implications: Implementation of MOUD in rural primary care is challenging but success is more likely if implementers are attentive to the needs of individual providers, are flexible and tailor implementation to the local situation, and provide on-going support. AD - Center for Evidence and Practice Improvement (CEPI), Agency for Healthcare Research and Quality, Rockville, Maryland, USA. Task Order Officer, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, Maryland, USA. AN - 33705264 AU - Nourjah, P. AU - Kato, E. DA - Mar 11 DO - 10.1080/08897077.2021.1891600 DP - NLM ET - 2021/03/12 J2 - Substance abuse KW - Medication assisted treatment of opioid medications for opioid use disorder primary health care rural health substance abuse LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0889-7077 SP - 1-4 ST - "One size does not fit all" and other lessons learned from grants for implementation of the AHRQ medication assisted treatment for opioid use disorder in rural primary care T2 - Subst Abus TI - "One size does not fit all" and other lessons learned from grants for implementation of the AHRQ medication assisted treatment for opioid use disorder in rural primary care ID - 931026 ER - TY - JOUR AB - BACKGROUND: Opioid use disorder is often treated with short term hospitalization and medically supervised withdrawal from opioids followed by counseling alone without medication assisted treatment (MAT). More evidence is needed to confirm the expectation that the rate of relapse would be high after short term inpatient treatment and withdrawal from opioids without follow-up MAT. OBJECTIVE/METHODS: To examine relapse to opioid use disorder in a randomized, multi-site effectiveness trial of extended-release injection naltrexone (XR-NTX) vs community-based treatment as usual (TAU) without medication, as a function of the type of clinical service where treatment was initiated-short-term inpatient (N=59), long-term inpatient (N=48), or outpatient (N=201). Inpatients typically were admitted to treatment actively using opioids and had completed withdrawal from opioids before study entry. Outpatients typically presented already abstinent for varying periods of time. RESULTS: One month after randomization, relapse rates on TAU by setting were: short-term inpatient: 63%; long term inpatient: 14%; outpatient: 28%. On XR-NTX relapse rates after one month were low (<12%) across all three settings. At the end of the 6 month trial, relapse rates on TAU were high across all treatment-initiation settings (short term inpatient 77%; long term inpatient 59%; outpatient 61%), while XR-NTX exerted a modest protective effect against relapse across settings (short term inpatient: 59%; long term inpatient 46%; outpatient 38%). CONCLUSIONS: Short term inpatient treatment is associated with a high rate of relapse among patients with opioid use disorder. These findings support the recommendation that medically supervised withdrawal from opioids should be followed by medication assisted treatment. AD - New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States. Electronic address: nunesed@nyspi.columbia.edu. Friends Research Institute, Inc. Baltimore, MD, United States. Office of Research, Department of Medicine, University of Massachusetts - Baystate and Baystate Health, Springfield, MA, USA. Friends Research Institute, Maryland Treatment Centers, Baltimore, MD, United States. NYU School of Medicine, Department of Population Health, New York, NY, United States. Center for Biomedical Ethics and Humanities and Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States. Columbia University Medical Center, New York, NY, United States. The University of Pennsylvania, CMCVAMC, Philadelphia, PA, United States. Baystate Health, Springfield, MA, United States. The University of Pennsylvania, Philadelphia, PA, United States. AN - 28473233 AU - Nunes, E. V. AU - Gordon, M. AU - Friedmann, P. D. AU - Fishman, M. J. AU - Lee, J. D. AU - Chen, D. T. AU - Hu, M. C. AU - Boney, T. Y. AU - Wilson, D. AU - O'Brien, C. P. C2 - Pmc5755382 C6 - Nihms873646 DA - Feb DO - 10.1016/j.jsat.2017.04.016 DP - NLM ET - 2017/05/06 J2 - Journal of substance abuse treatment KW - Adult Female Humans *Injections, Intramuscular Inpatients/*statistics & numerical data Male Middle Aged Naltrexone/*administration & dosage Narcotic Antagonists/*administration & dosage Opioid-Related Disorders/*drug therapy Outpatients/statistics & numerical data Randomized Controlled Trials as Topic *Recurrence Substance Withdrawal Syndrome *Detoxification *Injection naltrexone *Inpatient *Medically supervised withdrawal *Medication assisted treatment *Opioid use disorder *Relapse *Residential LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0740-5472 (Print) 0740-5472 SP - 49-55 ST - Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone T2 - J Subst Abuse Treat TI - Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone VL - 85 ID - 930851 ER - TY - JOUR AB - Research Objective: Residential treatment for mental and substance use disorders (M/SUDs) historically is not compensated by Medicaid due to the Institutions for Mental Disease payment exclusion. As the opioid epidemic has evolved, however, residential treatment is a more common setting for care. This study sought to identify the regulations and other policies regarding oversight of residential M/ SUD treatment at the state level. Study Design: After conducting an environmental scan and interviewing experts, we developed a template to provide a coding structure for data collection. We gathered source data for all states and the District of Columbia by reviewing statutes and regulations governing behavioral health treatment or licensure. Detailed state summaries were prepared and shared with states for validation. StateMedicaid regulations and waiver requirements related to residential treatment were also reviewed. Population Studied: Residential treatment was defined as clinical treatment services provided in a 24-hour living environment. This definition eliminated programs such as group homes or recovery housing, unless regulations or state personnel indicated that clinical treatment must be provided by such facilities. We excluded facilities exclusively associated with the criminal justice system or located in inpatient settings. Principal Findings: Residential mental health treatment facilities are less likely to be regulated/licensed than are residential SUD treatment facilities. Most states require inspection at licensure, with somewhat fewer allowing for cause-based inspections. Few state regulations include requirements for medical directors and more require the provision of “sufficient” staffing than incorporate ratios. Few incorporate explicit regulatory requirements for training staff in trauma-informed care or suicide assessment/prevention. Specific requirements related to placement are most common in SUD residential treatment, reflecting the ASAM criteria. Few states mandate client follow-up or aftercare to be provided by the residential facility postdischarge. Less than half of all state regulations regarding SUD residential treatment explicitly call for use of some type of evidence-based treatment, with fewer for mental health treatment. Requirements related to medication-assisted treatment are seldom expressly incorporated into residential treatment regulations. Thirty-six and 48 states have promulgated some quality assurance regulations for residential mental health and SUD treatment, respectively. Conclusions: Whereas many states have some measure of oversight and licensure of residential treatment, specific criteria related to evidence-based practices and quality are not included in many states. A complementary review of state oversight should be undertaken regarding residential settings that do not provide clinical treatment, such as recovery homes. Implications for Policy or Practice: Oversight and licensure of residential treatment are complicated by the often-bifurcated structure of state agencies, requirements specific to public funding, and nonregulatory approaches to oversight that can include contracting requirements, Medicaid waivers, and policy documents. Although licensure or oversight standards that are incorporated into laws and regulations may be the clearest mechanism for oversight, in some cases, it may not allow the flexibility required to operate within the states. Other mechanisms, such as state policy documents or requiring facility policies and procedures to address specific matters as part of licensure, may also achieve the same outcome with greater flexibility. AD - P. O'Brien, IBM Watson Health, Santa Barbara, CA, United States AU - O'Brien, P. AU - White, M. AU - Mulvaney-Day, N. DB - Embase DO - 10.1111/1475-6773.13478 KW - adult conference abstract controlled study criminal justice District of Columbia follow up funding housing human injury licensing medicaid medical director mental health prevention quality control remission residential care residential home suicide LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1475-6773 SP - 104-105 ST - State oversight of adult residential treatment for behavioral health conditions T2 - Health Services Research TI - State oversight of adult residential treatment for behavioral health conditions UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633914545&from=export http://dx.doi.org/10.1111/1475-6773.13478 VL - 55 ID - 931071 ER - TY - JOUR AB - Purpose: To identify the limitations of the Drug Addiction Treatment Act of 2000 (DATA 2000) and to discuss the merits of one possible solution: granting nurse practitioners (NPs) the authority to prescribe buprenorphine. Data sources: The DATA 2000 and related literature. Conclusions: Abuse of prescription opioid medications is a significant economic and public health burden. Buprenorphine is a highly effective medication that is used in the outpatient treatment of opioid-dependent patients. However, the DATA 2000 permits only physicians to prescribe this medication, substantially reducing patient access to potentially life-sustaining treatment. Implications for practice: Like diabetes and cardiovascular disease, addiction is a chronic condition that can be treated with lifestyle modifications, patient education, and appropriate medication. NPs are highly effective care-givers to patients with chronic disease. Granting NPs prescriptive authority for buprenorphine will improve access to treatment and patient outcomes. It will also enhance NP autonomy and authority, especially in states in which NPs practice independently. AD - [O'Connor, Alane B.] Maine Dartmouth Family Med Residency, Fairfield, ME 04937 USA. [O'Connor, Alane B.] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA. O'Connor, AB (corresponding author), Maine Dartmouth Family Med Residency, 4 Sheridan Dr, Fairfield, ME 04937 USA. aoconnor@mainegeneral.org AN - WOS:000295521800006 AU - O'Connor, A. B. DA - Oct DO - 10.1111/j.1745-7599.2011.00656.x J2 - J. Am. Acad. Nurse Pract. KW - Buprenorphine nurse practitioners prescriptive authority opioid dependence addiction Drug Addiction Treatment Act of 2000 PRIMARY-CARE OUTCOMES PHYSICIANS SPECIALISTS Health Care Sciences & Services Nursing LA - English M1 - 10 M3 - Article N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2011 SN - 1041-2972 SP - 542-545 ST - Nurse practitioners' inability to prescribe buprenorphine: Limitations of the Drug Addiction Treatment Act of 2000 T2 - Journal of the American Academy of Nurse Practitioners TI - Nurse practitioners' inability to prescribe buprenorphine: Limitations of the Drug Addiction Treatment Act of 2000 UR - ://WOS:000295521800006 VL - 23 ID - 931298 ER - TY - JOUR AB - INTRODUCTION AND AIMS: To determine the effectiveness of injectable hydromorphone and dicaetylmorphine for Indigenous participants in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) clinical trial. The study additionally aims to explore the prevalence and frequency of crack cocaine use among subgroups of participants (by gender and ethnicity). This secondary analysis is particularly relevant given the current need for expanded medication assisted treatments for opioid dependence across North America. DESIGN AND METHODS: Participants self-identifying as First Nations, Métis or Inuit were included in the analysis of Indigenous participants. Six-month treatment outcomes are reported as the difference between diacetylmorphine and hydromorphone treatment arms among Indigenous participants and change from baseline to 6 months in each treatment arm. Differences in outcomes are tested between Indigenous and non-Indigenous participants. Crack cocaine use was explored to determine differences between and within subgroups. RESULTS: Approximately one-third of SALOME participants self-identified as Indigenous. Indigenous participants presented to treatment with more structural vulnerabilities (e.g. lower education, higher rates of foster care and separation from biological parents) compared to non-Indigenous participants. After 6 months, Indigenous participants in both treatment arms had a significant reduction in days of street heroin use, opioid use, crack cocaine use and illegal activity. Treatment retention did not differ by treatment arm. DISCUSSION AND CONCLUSIONS: Indigenous people that are not engaged by first-line treatments for opioid dependence are in need of effective alternative treatments. Given the political and logistical barriers facing diacetylmorphine, hydromorphone could serve as a more accessible medication to reach and treat this population. [Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, March DC, Schechter MT. Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-termopioid dependence. Drug Alcohol Rev 2018;37:137-146]. AD - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, Vancouver, Canada. School of Population and Public Health, University of British Columbia, Vancouver, Canada. Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada. Crosstown Clinic, Providence Health Care, Vancouver, Canada. Department of Psychiatry, University of British Columbia, Vancouver, Canada. Northern Ontario School of Medicine, Sudbury, Canada. Centre for Excellence in Indigenous Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada. AN - 28593748 AU - Oviedo-Joekes, E. AU - Palis, H. AU - Guh, D. AU - Marchand, K. AU - Brissette, S. AU - Lock, K. AU - MacDonald, S. AU - Harrison, S. AU - Anis, A. H. AU - Krausz, M. AU - Marsh, D. C. AU - Schechter, M. T. DA - Jan DO - 10.1111/dar.12573 DP - NLM ET - 2017/06/09 J2 - Drug and alcohol review KW - Adult Canada Double-Blind Method Female Heroin/*therapeutic use Humans Hydromorphone/*therapeutic use Inuits Male Middle Aged Narcotics/*therapeutic use *Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Treatment Outcome *Indigenous people *clinical trial injectable opioid assisted treatment *opioid dependence LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0959-5236 SP - 137-146 ST - Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-term opioid dependence T2 - Drug Alcohol Rev TI - Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-term opioid dependence VL - 37 ID - 930963 ER - TY - JOUR AB - Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits of these models and identify means of treating other substance use disorders in primary care. AD - Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA. Electronic address: Christine.Pace@bmc.org. Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Box G-BH, 700 Butler Drive, Providence, RI 02906, USA; Department of Family Medicine, Brown University, Memorial Hospital of RI, 111 Brewster Street, Pawtucket, RI 02860, USA; Psychosocial Research, Butler Hospital, 345 Blackstone Boulevard Providence, RI 02906, USA. AN - 29933816 AU - Pace, C. A. AU - Uebelacker, L. A. DA - Jul DO - 10.1016/j.mcna.2018.02.004 DP - NLM ET - 2018/06/24 J2 - The Medical clinics of North America KW - Alcoholism/diagnosis/therapy Attitude of Health Personnel Continuity of Patient Care/organization & administration Cooperative Behavior Humans Inservice Training Insurance, Health, Reimbursement Mass Screening/*organization & administration Motivational Interviewing/methods Opioid-Related Disorders/diagnosis/therapy Primary Health Care/*organization & administration Referral and Consultation/*organization & administration Social Stigma Substance-Related Disorders/*diagnosis/psychology/*therapy Behavioral health integration Collaborative care Medication-assisted treatment Screening and brief intervention LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0025-7125 SP - 567-586 ST - Addressing Unhealthy Substance Use in Primary Care T2 - Med Clin North Am TI - Addressing Unhealthy Substance Use in Primary Care VL - 102 ID - 930798 ER - TY - JOUR AB - Substance use disorder (SUD), more specifically opioid use disorder, is a national epidemic. Although there is an emphasis on treatment and increasing treatment locations, there continues to be a gap between the number of people with SUD and the number of treatment centers. To help narrow this gap, some primary care clinicians started providing medication-assisted treatment (MAT) on an outpatient basis in their offices. This option enables clinicians to provide treatment in their own communities, which increases access to treatment and decreases costs. It also enables the clinician and the person with SUD/opioid use disorder to build a relationship, which many clinicians believe is the foundation of successful treatment. The clinician, whether a doctor, a physician assistant, or an advanced practice nurse, has to obtain a Drug Addiction Treatment Act 2000 waiver to provide MAT beyond naltrexone, which has a required educational program and includes a limitation on the number of clients. Conversely, a possible drawback to this type of treatment is the potential for the disruption of continuity of care with regard to psychotherapy treatment. Federal law mandates that therapy is available and provided to people receiving MAT. The clinician may not be able to provide this service and would need to refer the person with SUD for psychotherapy treatment. It may be clinically significant for a type of follow-up communication to be implemented so that the clinician and the therapy provider can maximize SUD treatment success. AD - Tonja M. Padgett, RN, DNP, ACNS-BC, Indiana University School of Nursing, Indianapolis. AN - 31800513 AU - Padgett, T. M. DA - Oct/Dec DO - 10.1097/jan.0000000000000305 DP - NLM ET - 2019/12/05 J2 - Journal of addictions nursing KW - *Health Services Accessibility Humans Naltrexone/*therapeutic use Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy/nursing *Outpatients Patient Education as Topic Primary Health Care United States LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1088-4602 SP - 238-241 ST - The Advantages and Disadvantages of Medication-Assisted Treatment in Primary Care Offices T2 - J Addict Nurs TI - The Advantages and Disadvantages of Medication-Assisted Treatment in Primary Care Offices VL - 30 ID - 930803 ER - TY - JOUR AB - Background: The 2016 Comprehensive Addiction and Recovery Act (CARA) expanded addiction treatment for opioid use disorder (OUD) and authorized nurse practitioners and physician assistants to prescribe medication- assisted treatment (MAT) for OUD until 2021. As nurse practitioners are more likely to serve rural and Medicaid-eligible populations than physicians, and physician assistants specialize in expanding physicians' practice, authorizing both providers to prescribe MAT may increase access to OUD treatment. Limited information was known about nurse practitioners and physician assistant experiences in providing MAT. Methods: We disseminated an online Qualtrics survey from July to August 2018 to a random sample of 3711 nurse practitioners and physician assistants. The sample included high-frequency providers, or those who practiced addiction medicine or addiction psychiatry, and low-frequency providers who were less likely to engage in MAT. We targeted nurse practitioners and physician assistants who received the federal buprenorphine prescribing waiver (n=653) those who prescibe extended-release naltrexone (ie, Vivitrol( R)) according to a comprehensive list maintained by the drug manufacturer, Alkermes, Inc. (n=426). Survey themes included demographics, professional characteristics, practice settings, screening for substance use disorder, substance use disorder maintenance, MAT drug knowledge and usage, and treatment barriers. Results:We received 240 responses to the survey. Most providers screened 76 to 100% of their new patients for substance use disorders, but provided treatment for only 0 to 25% of patients. Nurse practitioners and physician assistants were more likely to rely on physical observation, patient selfreporting of drug use/cravings, and urinalysis when screening for OUD, rather than on standardized mental health and addiction screening tools. Respondents were confident in their ability to detect OUD in a patient, but less confident in their ability to treat it. Those surveyed were most familiar with oral buprenorphine, followed by methadone and oral naltrexone, and agreed that all 3 medications decrease cravings, rates of relapse, and rates of overdose. They also agreed that MAT should be combined with counseling and peer support, and that these supports increase MAT's efficacy. Respondents were largely unfamiliar with newer formulations of MAT medications, such as injected or implanted buprenorphine. Conclusions: Nurse practitioners and physician assistants may increase patient access to MAT through implementation of policies aimed at strengthening education and training. Standardizing graduate program and professional training curricula to feature MAT and OUD treatment as a core requirement, incorporating CARA's training requirements to equip graduating practitioners with a buprenorphine waiver, and implementing coursework to help identify and reduce stigmas are strategies for ensuring that workforces have the tools and training to effectively treat OUD. Expanding patient panels and reducing the amount of training required for a waiver could also incentivize nurse practitioners and physician assistants to apply for a buprenorphine waiver. Integrating behavioral health and medical provider settings through co-location or telehealth, as well as increasing students' access to active peer MAT providers through telecommunication technology, would also improve access to services and providers' competency in treating OUD. AD - C. Page AU - Page, C. AU - Andraka-Christou, B. AU - Buche, J. AU - Foney, D. AU - Beck, A. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - buprenorphine methadone naltrexone opiate addiction medicine adult conference abstract counseling craving drug combination drug dependence drug formulation drug overdose drug therapy education female human major clinical study male mental health nurse practitioner peer group physician assistant prescription psychiatry random sample recurrence risk remission stigma student telehealth urinalysis workforce LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E13-E14 ST - Nurse practitioner and physician assistant provision of MAT for opioid use disorder T2 - Journal of Addiction Medicine TI - Nurse practitioner and physician assistant provision of MAT for opioid use disorder UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628536769&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931122 ER - TY - JOUR AB - The increasing prevalence of opioid use disorder (OUD) in the United States has led to an ongoing public health crisis. At the present time, more than 150 Americans die each day of opioid-related overdoses. This epidemic of opioid overdose deaths, first characterized by prescription opioid misuse, has transitioned into heroin and fentanyl use. Medication assisted treatment with methadone and buprenorphine has been shown to be effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone also is an effective medication for some opioid addicted individuals as well as for those with alcohol dependence. The OUD crisis has led to an increasing demand for medication assisted treatment through opioid treatment programs (OTPs) and office-based opioid treatment via the Drug Abuse Treatment Act of 2000 (DATA 2000). Treatment capacity, however, must be further expanded to meet the growing demand, especially in rural and other underserved areas. The American Association for the Treatment of Opioid Dependence (AATOD) presents this policy paper to address some of the issues that impact the development of future policies in the use of medications in OUD treatment and the prevention of opioid overdose. These issues include: Should treating OUD be viewed as a public health intervention with the principal component of care and treatment being the utilization of federally approved medications (methadone, buprenorphine, and extended release injectable naltrexone)? Should resources be prioritised to treating OUD with medications and additional clinical services? Should there be coordination to organize service delivery to treat this illness through a continuum of service delivery components? Should there be a better connection/coordination between DATA 2000 practices and OTPs to address treatment capacity and facilitate inter-facility referrals from one practice to the next? This paper provides a historical perspective of the nation’s current policies for delivering medication assisted treatment for OUD. By understanding the system and principles of care that guide how medication assisted treatment is delivered today, policy-makers can develop future policies that offer greater stability, are based on evidence, and reflect best practices. AD - M. Parrino, American Association for the treatment of Opioid Dependence (AATOD), 225 Varick Street, Suite 402, New York, NY, United States AU - Parrino, M. DB - Embase KW - buprenorphine diamorphine fentanyl illicit drug methadone naloxone naltrexone opiate alcoholism article attention deficit disorder counseling criminal behavior criminal justice drug abuse drug dependence drug detoxification environmental stress Food and Drug Administration general practice health care delivery health care organization heroin dependence human medical education medical practice mental disease mortality opiate addiction practice guideline prescription prevalence priority journal public health recidivism risk management social interaction social stigma socioeconomics stigma substance abuse symptom work experience LA - English M1 - 3 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 2531-4122 1592-1638 SP - 27-35 ST - Using medication assisted treatment to treat opioid use disorder: Learning from past experience to guide policy T2 - Heroin Addiction and Related Clinical Problems TI - Using medication assisted treatment to treat opioid use disorder: Learning from past experience to guide policy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002014593&from=export VL - 21 ID - 931115 ER - TY - JOUR AB - Effective treatment of opioid use disorder (OUD) must target both the medical and psychosocial aspects of a patient's condition. This, in turn, requires a collaboration between medical providers and social supports. We would like to illustrate a key difficulty in this collaboration for some patients in our country: many post-discharge recovery houses continue to refuse to allow patients to remain on medication treatment for OUD (M-OUD). This barrier to M-OUD access in recovery houses is a significant obstacle to effective OUD treatment. AD - Vanderbilt University School of Medicine, Nashville, Tennessee, USA. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA. AN - 31800375 AU - Patel, P. AU - Ramaswamy, R. AU - Mardam Bey, R. DO - 10.1080/08897077.2019.1695038 DP - NLM ET - 2019/12/05 J2 - Substance abuse KW - Buprenorphine/therapeutic use Cost-Benefit Analysis/economics/trends Halfway Houses/economics/*trends Health Services Needs and Demand/economics/trends Homeless Persons/statistics & numerical data Humans Insurance Coverage/economics/*trends *Intersectoral Collaboration Narcotic-Related Disorders/economics/*rehabilitation Patient Discharge/economics/*trends Tennessee *Medication assisted treatment *Tennessee *buprenorphine *homelessness *post-discharge *recovery homes *recovery houses *transitional care facilities LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0889-7077 SP - 11-13 ST - Persisting gaps in M-OUD coverage at post-discharge recovery houses necessitate our continued advocacy T2 - Subst Abus TI - Persisting gaps in M-OUD coverage at post-discharge recovery houses necessitate our continued advocacy VL - 41 ID - 930806 ER - TY - JOUR AB - Summary: The care of children with cancer is emotionally difficult under the best of circumstances. When, in addition, there are superimposed limitations in access to care, when children are unnecessarily separated from their parents or when war imposes additional threat upon families dealing with childhood cancer, the psychological burdens are often nearly unbearable. Children are adrift, left alone and fearful, parents are torn in many directions. Providers are confronted with terrible choices in order to be able to provide muchneeded medical attention. Our symposium, proposed by the IPOS Human Rights Task Force, offers examples of human rights challenges in the care of children with cancer under conditions of war, hospital detention or limited medication in several African and Asian nations. We also offer an example of successful resolution engineered by a vibrant coalition of providers, government agencies and non-governmental human rights organizations. Discussion centers on how international health organizations and governments can work together to provide needed data of high quality and to counter issues of unethical or unequal treatment in low-resource settings. Chair: Andrea Farkas Patenaude Ph.D., Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Boston MA USA, Vice-Chair, IPOS Human Rights Task Force. Discussants: William Breitbart M.D., Chairman, Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York NY. Past President of IPOS, Chair IPOS Human Rights Task Force. Catherine G. Lam M.D., Pediatric Oncologist, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA. Supporting Abstract 1: PARENTS' AND HEALTH-CARE PROVIDERS' PERSPECTIVES ON HOSPITAL DETENTION PRACTICES IN KENYA S Mostert, MD, PhD1; F Njuguna, MD; RHM van der Burgt, Bsc1; S Langat, MSc2; A Seijffert, BSc3; J Musimbi, MSc2; G Olbara, MD2; J Skiles, MD3; T Vik, MD3; GJL Kaspers, MD, PhD1 1 Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands 2 Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya 3 Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, United States of America Background: Corruption plays a major role in health-care systems in developing countries and can result in hospital detention practices (HDP). Patients at Kenyan public hospitals are detained if families cannot pay medical bills. Access to health insurance and waiving procedure to prevent detention is limited. This study explores perspectives of parents and health-care providers (HCP) on health insurance access, waiving procedure and HDP. Methods: Semi-structured questionnaires were completed by 46 parents of childhood cancer patients who abandoned treatment (response rate 87%) and by 104 HCP involved in childhood cancer care (response rate 78%). Results: Of 46 children, 78% had no health-insurance and 53% could not pay medical bills and were detained. In total, 37% of detained patients received no information about waiving procedure and their bills were not waived. Parents reported desperation (95%) and powerlessness (95%). Most parents (87%) felt HDP must cease. After parents apply for health insurance, it takes too long before treatment costs are covered according to 67% of HCP. Parents are scared by waiving procedures and may never return to hospital (68%). Poor families delay visiting hospital and may seek alternative treatment instead (92%). When poor families finally attend hospital, disease may be advanced (94%). Parents sometimes abandon detained children if they cannot pay hospital bills (68%). HDP is not approved by 84% of HCP. Conclusions: HDP and waiving procedure are highly distressing for parents and may jeopardize treatment outcomes. HCP acknowledge that access to health insurance needs improvement. Most disapprove of HDP. These factors require urg nt attention and modification. Supporting Abstract 2: PROFESSIONALS' DILEMMAS FACING HOSPITAL DETENTION IN WITH CHILDREN WITH CANCER Ketan Kulkarni1, Andrea Patenaude2, Saskia Mostert3, Festus Njuguna4, Carmen Salaverria5, Catherine Lam6 1. 1IWK Health Center, Halifax, NS, Canada 2. 2Dana-Farber Cancer Institute, Harvard Medical School, Boston MA USA 3. 3VU University Medical Center, Amsterdam, Netherlands 4. 4Moi Hospital, Eldoret, Kenya 5. 5National Children's Hospital Benjamin Bloom, San Salvador, El Salvador 6. 6St. Jude Children's Research, Hospital, Memphis, TN, USA Background: Hospital detention (HoD) is defined as a practice whereby patients are denied release after medical discharge due to families' inability to pay hospital bills. Recently, HoD has been recognized as a global phenomenon. Few data exist about the extent of HoD or about dilemmas professionals experience when encountering HoD. The Global Hospital Detention Taskforce (GHDT) of the SIOP PODC Committee has initiated studies in this area. Methods: An informal email enquiry was circulated to over 100 pediatric oncologists in Asia (primarily India) working in public and private hospitals, enquiring about HoD practices and professionals' experiences and responses. Replies were assessed qualitatively. Results: 20 responses were received. The narrative responses confirmed providers' experiences with HoD. Providers described the sensitivity and complexity of problems HoD raises for professionals as well as for patients and parents. We report procedural, professional, political and psychological issues encountered and discuss methodological challenges to research in this area. Conclusions: There is a need for carefully designed studies to optimize data collection about roles professionals can take regarding HoD without jeopardizing their positions. The GHDT, recognizing professionals may face significant professional and psychological dilemmas, plans to conduct a refined physician perspectives survey to better understand the issues. The data will inform future steps towards increased recognition of the extent and adverse impact of HoD and the dilemmas for providers. Future goals are to utilize the data to develop effective interventions sensitive to the needs of all stakeholders, including frontline providers, to effectively end hospital detention of patients. Supporting Abstract 3: PSYCHOLOGICAL CHALLENGES FACED WHEN FIGHTING CHILDHOOD CANCER DURING WARTIME IN SYRIA Oumaya FAWAZ M.D.1 and Andrea F PATENAUDE Ph.D.2 1 Department of Pediatric Oncology, Al Bairouni University Hospital for Cancer, Damascus, Syria 2 Dana-Farber Cancer Institute, Harvard Medical School, Boston MA USA Background: Childhood cancer is a challenge for the child, his/her parents and medical care providers in limited resources countries. This becomes more difficult when war conditions and violence are present. Methods: The Department of Pediatric Oncology at Al Bairouni Hospital in Damascus, one of 3 Syrian hospitals offering specialized pediatric cancer treatment, was opened in 2010. Much of Syria has experienced war in the intervening 6 years. From observations and discussions with colleagues, patients and parents, we report on ways in which concurrent occurrence of war adds multiple burdens and challenges the psychological equilibrium and coping efforts of patients, parents and providers. Results: Disempowerment was the major psychological burden. Fear, anxiety and lose of hope were also burdensome. Psychological challenges faced when treating cancer during wartime include: changing the life priority of the child and his/her family, lack of medication availability and increased costs, difficulties and dangers of transport of patients to and from the hospital location, and the heavy, resulting psychological impacts on patient, parents and medical care providers. Exposure to war and worry about the safety of near and distant family members affects medical care provider's attention, availability and energy as well. Conclusions: Childhood cancer is a complicated problem in Syria. Unsafe ospital locations and difficulties of transport and other problems create challenge in the childhood cancer management and increase the psychological burdens facing patients, their families and health care providers during wartime. Supporting Abstract 4: DIGNITY IN PAIN: HOW THE BATTLE FOR HUMAN RIGHTS MADE MORPHINE CONSTANTLY AVAILABLE TO PEDIATRIC ONCOLOGY PATIENTS IN SENEGAL (WEST AFRICA) Sokhna NDIAYE1, Dr Serigne Modou NDIAYE, Pr Claude MOREIRA3 1Pediatrics department, University Hospital Aristide le Dantec, Dakar, Senegal 2Psychiatric department, Hopital Principal de Dakar, Dakar, Senegal 3Pediatrics department, University Hospital Aristide le Dantec, Dakar, Senegal Background/objectives: In Senegal, pediatric oncology patients arrive at hospital at advanced stages of their disease. Both human and material resources are sparse. Morphine was inconsistently available. This study assesses the impact of lack of morphine on distress levels of patients, parents, and providers and the reports the battle for access to morphine and its outcome on patient care. Design/methods: Qualitative data from group and individual therapy sessions were reviewed. Our sample included 24 children, 5 and 15 years old, 10 parents, 3 doctors, and 7 nurses. During therapeutic groups with children, we explored the impact lack of morphine had on pain management. We conducted structured interviews and focus groups with parents, doctors, and nurses and contributed to a report Human Rights Watch exploring medical and political causes for the shortage and psychological repercussions on care. Results: Reports showed the morphine shortage was agonizing for everyone. Children and parents were frightened, for they associated intensity of pain with severity of the illness. AD - A. Patenaude, Dana-Farber Cancer Institute, Boston, United States AU - Patenaude, A. DB - Embase DO - 10.1002/pon.4272 KW - morphine adolescent analgesia anxiety attention behavioral science Canada cancer center cancer epidemiology cancer patient cancer therapy child child health childhood cancer clinical article clinical trial controlled clinical trial controlled study detention developing country distress syndrome doctor nurse relation doctor patient relationship e-mail El Salvador family study female government health care personnel health care system health center health insurance hematology human human dignity human tissue India Indiana information processing Kenya male Massachusetts medical school multicenter study narrative Netherlands New York oncologist organization pain intensity palliative therapy patient referral pediatrics powerlessness psychiatric department psychiatry psychological balance recognition Senegal structured interview structured questionnaire Syrian Arab Republic teaching university hospital violence war exposure LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2016 SN - 1057-9249 SP - 99-100 ST - Human rights and children with cancer: Finding solutions to human rights issues faced by child patients, parents and providers T2 - Psycho-Oncology TI - Human rights and children with cancer: Finding solutions to human rights issues faced by child patients, parents and providers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612930727&from=export http://dx.doi.org/10.1002/pon.4272 VL - 25 ID - 931176 ER - TY - JOUR AB - BACKGROUND: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), many individuals discontinue treatment soon after starting. This study assesses predictors of buprenorphine adherence using Prescription Drug Monitoring Program (PDMP) data. METHODS: PDMP data for Philadelphia, Pennsylvania were used to measure 180-day adherence to buprenorphine among new initiates. Adherence was classified using percent days covered (PDC), and new initiates with PDC ≥ 0.80 were classified as adherent. Multivariable logistic regression was conducted to determine factors associated with buprenorphine adherence. RESULTS: Between January 2017 and December 2018, 10,669 Philadelphia residents initiated buprenorphine and 26.6 % remained adherent after 180 days. Demographic factors associated with greater odds of adherence included age category and female sex (aOR: 1.37; 95 % CI: 1.25-1.50). Those filling an opioid prescription, other than buprenorphine, during the follow-up period had lower odds of adherence than those who did not fill an opioid prescription (aOR: 0.62; 95 % CI: 0.50-0.77). Odds of adherence was greater for those on the film formulation (aOR: 1.37; 95 % CI: 1.25-1.50) than the tablet formulation. Those filling medium (aOR: 1.76; 95 % CI: 1.55-2.00) and high dose (aOR: 5.11; 95 % CI: 4.30-6.17) buprenorphine prescriptions had higher odds of adherence than those filling low dose prescriptions. CONCLUSIONS: Individual demographics, receipt of an opioid prescription, buprenorphine formulation, and buprenorphine dose were all associated with adherence to buprenorphine. Ongoing strategies to address OUD need to prioritize increasing retention in long-term evidence-based buprenorphine treatment while also encouraging providers to regularly consult the PDMP to ensure patient compliance. AD - Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA. Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA. Electronic address: kendra.viner@phila.gov. AN - 33035714 AU - Pizzicato, L. N. AU - Hom, J. K. AU - Sun, M. AU - Johnson, C. C. AU - Viner, K. M. DA - Nov 1 DO - 10.1016/j.drugalcdep.2020.108317 DP - NLM ET - 2020/10/10 J2 - Drug and alcohol dependence KW - Adolescent Adult Aged Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Female Humans Longitudinal Studies Male *Medication Adherence/psychology Middle Aged Opiate Substitution Treatment/methods/psychology/*trends Opioid-Related Disorders/*drug therapy/psychology Philadelphia/epidemiology Prescription Drug Monitoring Programs/*trends Young Adult *Buprenorphine *Drug monitoring programs *Medication adherence *Medication assisted treatment *Opioid use disorder *Prescription LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0376-8716 SP - 108317 ST - Adherence to buprenorphine: An analysis of prescription drug monitoring program data T2 - Drug Alcohol Depend TI - Adherence to buprenorphine: An analysis of prescription drug monitoring program data VL - 216 ID - 930821 ER - TY - JOUR AB - Background: Qualitative interview of an existing patient panel with substance use disorders (SUD) revealed several regional deficiencies: comprehensive addiction and obstetric management for pregnant women, withdrawal management and initiation of medication-assisted treatment (MAT) during hospitalizations, and significant delays accessing MAT because of regional availability. Three programmatic focus areas were identified: immediate access to MAT for high-risk individuals, improved quality of inpatient SUD management, and increased provider training to improve MAT availability. Objective: East Pierce Addiction Medicine (EPAM) is a multidisciplinary, multisite project to improve the continuum of care of an underserved population of people with substance use disorders in East Pierce County, WA. Three interrelated components of this project include: outpatient MAT (with integrated obstetric care when appropriate), hospital-based SUD consultation services, and Resident/Fellow MAT training. Methods: We reviewed EPAM outcomes from the Substance Treatment and Recovery Training (START) Clinic (a half-day, walk-in, integrated obstetric and medication-assisted treatment [MAT] program), our inpatient consultation service, and MAT training offered by our Fellowship faculty. We retrospectively reviewed patient registries from September 2017 to October 2018 maintained for Quality Improvement purposes. Practice data was obtained via individual interview of program graduates. Results: Eighty-two percentage (50) of the 61 patients seen by START achieved a full-term (>37 weeks) birth, and 87% (53) were discharged from the hospital with infant custody. The inpatient consultation team assessed 130 patients, 73% (95) of which were identified as benefitting from intervention and consented to on-going care. Eighty-four percentage of these patients (80) received a referral to a treatment program, of which 43% (41) were connected with our own outpatient clinic. Of the 95 patients consenting to intervention, 54% (51) initiated MAT while admitted. Finally, we provided buprenorphine waiver training over a 4-year period to 123 participants from 7 sites. Of the East Pierce Family Medicine residents who have graduated to date (24), 46% (11) self-report that they provide MAT as part of their practice. Conclusions: Although published literature reveals a 15% to 30% preterm delivery rate in pregnant women with illicit substance use, our data from the START Clinic demonstrates term delivery rate consistent with other programs. Data from our inpatient consultation program shows a high acceptance and MAT initiation rate, laying the groundwork for more patient- and systemfocused outcome data in the future. Finally, 2014 study showed only 28% of physicians trained to prescribe buprenorphine serving a comparable demographic continued to provide this treatment in their practice. This suggests that our approach of offering both academic training and hands-on skill development increases the likelihood that our graduates will expand regional availability of MAT. AD - A. Plawman AU - Plawman, A. AU - Espanol, E. AU - Borst, D. AU - Jenkins, A. DB - Embase DO - 10.1097/ADM.0000000000000548 KW - buprenorphine addiction medicine adult conference abstract controlled study custodial care drug dependence drug withdrawal family medicine female human infant interview major clinical study obstetric delivery outpatient department patient referral pregnant woman prematurity remission resident retrospective study self report skill total quality management LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1935-3227 SP - E37 ST - Residency-based addiction medicine services improve quality and access to care T2 - Journal of Addiction Medicine TI - Residency-based addiction medicine services improve quality and access to care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628537044&from=export http://dx.doi.org/10.1097/ADM.0000000000000548 VL - 13 ID - 931123 ER - TY - JOUR AB - The purpose of this study was to pilot-test a mind-body intervention called Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to buprenorphine for individuals with opioid use disorder (OUD). MABT, a manualized 8 week protocol, teaches interoceptive awareness skills to promote self-care and emotion regulation. A small study was designed to assess MABT recruitment and retention feasibility, and intervention acceptability, among this population. Individuals were recruited from two office-based programs providing buprenorphine treatment within a large urban community medical center. Participants were randomized to receive either treatment as usual (TAU), or TAU plus MABT. Assessments administered at baseline and 10-week follow-up included validated self-report health questionnaires and a process measure, the Multidimensional Assessment of Interoceptive Awareness, to examine interoceptive awareness skills. An additional survey and exit interview for those in the MABT study arm were administered to assess intervention satisfaction. Results showed the ability to recruit and enroll 10 participants within two-weeks, and no loss to follow-up. The MABT study group showed an increase in interoceptive awareness skills from baseline to follow-up, whereas the control group did not. Responses to the satisfaction questionnaire and exit interview were positive, indicating skills learned, satisfaction with the interventionists, and overall perceived benefit of the intervention. In summary, study results demonstrated recruitment and retention feasibility, and high intervention acceptability. This pilot study suggests preliminary feasibility of successfully implementing a larger study of MABT as an adjunct to office-based medication treatment for opioid use disorder. AD - Department of Biobehavioral Nursing and Health Informatics, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: cynthiap@uw.edu. Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98195, USA. Department of Biobehavioral Nursing and Health Informatics, University of Washington, Box 357266, Seattle, WA 98195, USA. Department of Psychosocial and Community Health Nursing, University of Washington, Box 357263, Seattle, WA 98185, USA. AN - 31174929 AU - Price, C. J. AU - Merrill, J. O. AU - McCarty, R. L. AU - Pike, K. C. AU - Tsui, J. I. C2 - Pmc6874727 C6 - Nihms1531080 DA - Jan DO - 10.1016/j.jsat.2019.05.013 DP - NLM ET - 2019/06/09 J2 - Journal of substance abuse treatment KW - Adult Analgesics, Opioid/*therapeutic use *Awareness Buprenorphine/*therapeutic use Female Humans Male *Mind-Body Therapies *Mindfulness Opioid-Related Disorders/*drug therapy Patient Satisfaction Pilot Projects Self Report Surveys and Questionnaires *Buprenorphine *Interoception *Medication-assisted treatment *Mind-body therapy *Opioid use disorder *STR grants LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 (Print) 0740-5472 SP - 123-128 ST - A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder T2 - J Subst Abuse Treat TI - A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder VL - 108 ID - 930875 ER - TY - JOUR AB - Introduction: Outpatient prescribing of buprenorphine-naloxone has increased since amendments to the Drug Addiction Treatment Act of 2000. Patients with substance use disorders have also been found to have a higher rate of hospitalizations; therefore, suggesting a potential for increased utilization of buprenorphine products in the inpatient setting as a continuation of treatment. When considering the pharmacokinetic principles of the buprenorphine-naloxone products, there is not one direct interchange between each of the products. There is a current lack of literature that reports the rates of appropriate formulary conversions in hospitalized patients. Research Question or Hypothesis: To evaluate the rates of appropriate conversion from patient's home buprenorphine-naloxone product to the formulary product. Study Design: Retrospective chart review Methods: Hospitalized patients receiving buprenorphine-naloxone as a continuation of home medication were considered for inclusion. The primary outcome was rates of appropriate conversion from home buprenorphine-naloxone product to formulary buprenorphinenaloxone films. Appropriate conversion was determined by a predetermined conversion chart. Secondary outcomes included describing trends of inappropriate conversions and rates of IV naloxone use. Descriptive statistics and chi square tests were used for data analysis using IBM SPSS Version 26. Results: One hundred patients were randomized for inclusion, one patient was deemed not eligible after randomization. For the primary end point, 52/99 (52.5%) patients had buprenorphine-naloxone converted appropriately. Of the patients with inappropriate conversions, 31 received a decreased amount of buprenorphine. Seven patients were prescribed >3 films/dose, with three patients receiving unfeasible amounts of 5, 6, and 8 films/dose respectively. Six patients received IV naloxone, with one patient receiving six films per dose and one patient receiving a higher dose of buprenorphine than their home dose. Conclusion: Nearly half of patients had buprenorphine-naloxone inappropriately converted to the formulary buprenorphine-naloxone films. This demonstrates the need for education on pharmacokinetic differences between buprenorphine-naloxone products and implementation of a formulary interchange. AD - H. Protich, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, United States AU - Protich, H. AU - Tolliver, A. AU - Richardson, E. DB - Embase DO - 10.1002/jac5.1351 KW - buprenorphine buprenorphine plus naloxone naloxone adult conference abstract controlled study data analysis software drug megadose drug therapy education female hospital patient human major clinical study male medical record review outcome assessment pharmacokinetics randomization randomized controlled trial retrospective study substitution reaction LA - English M1 - 8 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 2574-9870 SP - 1641 ST - Evaluation of inpatient formulary substitution of buprenorphine-naloxone products T2 - JACCP Journal of the American College of Clinical Pharmacy TI - Evaluation of inpatient formulary substitution of buprenorphine-naloxone products UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634123198&from=export http://dx.doi.org/10.1002/jac5.1351 VL - 3 ID - 931104 ER - TY - JOUR AB - BACKGROUND: Opioid dependence is a significant problem for adolescents in the United States. Psychosocial treatment for adolescents with opioid use disorders may be effective, although it has not been well studied. METHODS: This paper describes a 13-week psychoeducational group therapy program with parallel tracks for adolescents with opioid use disorders and their parents attending an outpatient substance use program in a children's hospital. In addition to group therapy, participating adolescents received medical care, including medication-assisted treatment for opioid dependence, drug testing, medical follow-up, psychopharmacology, individual counseling, and parent guidance. Data were collected as part of a quality improvement project for the program. Forty-two adolescents and 72 parents attended the group program between 2006 and 2009. Frequencies were computed and a weighted kappa was used to assess agreement between adolescent and parent reports of use and driving risk. RESULTS: Of the 42 adolescents participating in the 13-week group program, 36 (86%) completed 3 or more group sessions, and 24 (57%) completed 10 or more sessions. Twenty-two (52%) adolescent participants reported abstinence from all substances on each of their weekly evaluations. Adolescent-parent agreement for substance use was good to very good: weighted kappa (95% confidence interval) .76 (.60, .87), but poor for driving risk, weighted kappa .11 (-.20, .40). CONCLUSIONS: Completion rates and self-report of outcomes from this group program indicate promise and warrant further testing. AD - a Adolescent Substance Abuse Program, Boston Children's Hospital , Boston , Massachusetts , USA. AN - 25174347 AU - Pugatch, M. AU - Knight, J. R. AU - McGuiness, P. AU - Sherritt, L. AU - Levy, S. DO - 10.1080/08897077.2014.958208 DP - NLM ET - 2014/09/02 J2 - Substance abuse KW - Adolescent Adolescent Behavior/*psychology Adult Combined Modality Therapy *Family Therapy Female Health Knowledge, Attitudes, Practice Humans Male Opioid-Related Disorders/drug therapy/*psychology/*therapy Parents/*psychology Patient Compliance Patient Education as Topic Self Report Treatment Outcome Young Adult Adolescents group therapy, parents opioid-related disorders substance use treatment LA - eng M1 - 4 N1 - PubMed NLM literature search May 7, 2021 PY - 2014 SN - 0889-7077 SP - 435-41 ST - A group therapy program for opioid-dependent adolescents and their parents T2 - Subst Abus TI - A group therapy program for opioid-dependent adolescents and their parents VL - 35 ID - 930848 ER - TY - JOUR AB - Background: The introduction of buprenorphine as office-based treatment for opioid dependence was designed to expand treatment capacity, but virtually there are no data about use of this medication in rural areas. Methods: The survey of the first cohort of physicians in rural Washington State who obtained buprenorphine waivers (2002-2010) to determine the volume of treated patients, physician appraisal of the efficacy of this treatment, and perceived barriers to treatment was conducted. Twenty-four (73 percent) of the 33 rural buprenorphine-certified physicians practicing in the state were interviewed in 2010. Results: Twenty physicians (83 percent) were actively prescribing buprenorphine/naloxone for treatment of addiction. Those currently prescribing averaged 23 active patients and had treated 125 patients since certification. All respondents reported that buprenorphine was efficacious in the treatment of addiction and 95 percent recommended that other rural colleagues adopt buprenorphine treatment. The following four major barriers were cited: 1) lack of adequate financial support from Medicaid, the largest source of third-party coverage for these patients; 2) unavailability of local mental health and behavioral addiction treatment services; 3) difficulty in finding consultants to assist in managing complex patients; and 4) shortages of other rural physicians providing this service. Conclusions: Buprenorphine is viewed as a highly effective treatment of opioid addiction by early adopters in rural Washington State, but relatively few rural physicians currently provide this service. In adequate insurance coverage, a shortage of effective links with consultants and colleagues, and the lack of mental health services are persistent barriers to the use of this modality in rural Washington State. © 2012 Journal of Opioid Management, All Rights Reserved. AD - T.L. Quest, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States AU - Quest, T. L. AU - Merrill, J. O. AU - Roll, J. AU - Saxon, A. J. AU - Rosenblatt, R. A. DB - Embase Medline DO - 10.5055/jom.2012.0093 KW - buprenorphine methadone naloxone article certification clinical practice consultation drug dependence treatment drug efficacy health care cost health survey human medicaid mental health service opiate addiction prescription rural area United States LA - English M1 - 1 M3 - Article N1 - Embase Elsevier literature search May 7, 2021 PY - 2012 SN - 1551-7489 SP - 29-38 ST - Buprenorphine therapy for opioid addiction in rural Washington: The experience of the early adopters T2 - Journal of Opioid Management TI - Buprenorphine therapy for opioid addiction in rural Washington: The experience of the early adopters UR - https://www.embase.com/search/results?subaction=viewrecord&id=L364524918&from=export http://dx.doi.org/10.5055/jom.2012.0093 VL - 8 ID - 931207 ER - TY - JOUR AB - Study Objectives: COVID-19 has created opportunities to explore remote learning technologies that can be used to improve the treatment of various patient populations. As a result, many educational conferences moved to digitally broadcasted remote formats. Get Waivered sought to deliver a live, nationwide, digitally broadcasted Drug Enforcement Administration (DEA) buprenorphine waiver course. On May 20, 2020, from 10 AM to 6 PM Eastern Standard Time, Get Waivered Remote hosted an interactive virtual DEA-X waiver session. Most sessions target primary care or addiction medicine specialists, and little is known about what questions emergency clinicians have about this process. Information obtained can inform future EM-oriented waiver courses, especially those sponsored by the ACEP. In order to foster information exchange among participants and facilitators and maximize user experience, the Get Waivered Remote platform implemented the ZoomTM chat function to provide a forum for real-time information exchange. Aim 1: Better understand participant questions and concerns on obtaining a DEA-X waiver in real-time. Aim 2: Demonstrate how the medical education community can utilize live, synchronized, remote platforms to improve clinician education accessibility. Aim 3: Introduce aspects for improvement and propose additional techniques in digital nudge methodologies to increase the number of waivered clinicians through the use of remote platforms. Methods: We retrospectively reviewed and analyzed the question-and-answer contents of exported data from the chat. The contents were qualitatively assessed using a framework that evaluated the poster's intention (PI) and comment features (CF). Results: PI: A total of 450 posts were analyzed. Seeking information represented 53.32% of posts. Non-question represented 24.78% of posts. The remaining PI categories spanned topics such as seeking discussion, answering a question, or furthering discussion. CF: Making an Inquiry - Course Content represented 33.78% of posts. Making an Inquiry - Attendance/Course Credit and Making an Inquiry - Technologically Related represented 17.78% and 14.67% of posts, respectively. The remaining CF categories spanned topics such as Making an Inquiry - Administrative Questions about the Waiver Process, Requesting Resources, and others. Conclusion: Results show that most participants sought to obtain information with the intention of receiving a response from course moderators or facilitators in real-time. It may be worth investigating why there was not as much bidirectional conversation among participants. Most participants posted questions about course content, receiving course credit, and others primarily technologically related. Potential reasons for the last two topics include: heterogeneity in user technological ability, connectivity issues, uncertainty on the impact of switching devices, and lack of periodic attendance checks. Implementing a method to collect attendance periodically, possibly through the use of the ZoomTM poll tool, may be helpful in the future. [Formula presented] AU - Raber, J. P. AU - He, S. AU - Shayer, D. AU - Lai, D. AU - Raja, A. AU - Martin, A. DB - Embase DO - 10.1016/j.annemergmed.2020.09.199 KW - buprenorphine addiction medicine adult conference abstract conversation coronavirus disease 2019 course content female government human learning male medical education physician primary medical care retrospective study uncertainty LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S72-S73 ST - 187 Get Waivered Remote: Comment Analysis of an Interactive Digital Educational Course for Physicians Obtaining a DEA-X Waiver T2 - Annals of Emergency Medicine TI - 187 Get Waivered Remote: Comment Analysis of an Interactive Digital Educational Course for Physicians Obtaining a DEA-X Waiver UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008409844&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.199 VL - 76 ID - 931058 ER - TY - JOUR AB - OBJECTIVES: The opioid crisis significantly affects residents of rural communities who already experience poor health outcomes based on social determinants. Therefore, this project evaluated the reported availability and accessibility of opioid use disorder (OUD) treatment resources in rural Utah county pharmacies through a multistep process intended to estimate the distance (miles) to registered (waivered) OUD care providers and community pharmacies and, thus, the ability to fill prescriptions for OUD treatment medications. METHODS: First, the United States Department of Agriculture Economic Research Service dichotomous classification scheme was used to identify nonmetropolitan counties. Second, online resources were used to identify the volume of waivered treatment providers and community pharmacies by county. Third, the driving distances to both resources were estimated according to ZIP Code and county. Finally, the immediate availability of filling a prescription for OUD treatment medications was determined by surveying community pharmacists in rural Utah counties. RESULTS: Nineteen of the 29 Utah counties were identified as rural and included in the study. Pharmacists in 50 of the 75 viable pharmacies completed surveys (66.7% usable response rate). OUD treatment medications were immediately available for dispensing in 90% (45 of 50) of the responding pharmacies. Two of the 19 counties (10.5%) lacked a pharmacy, and 6 of the 19 counties (31.6%) lacked a registered OUD treatment provider. Driving distances ranged from 1 mile to 71 miles to the nearest pharmacy and from 1 mile to 96 miles to the nearest waivered treatment provider. CONCLUSION: OUD treatment medications were readily available in some but not all rural Utah pharmacies. However, geographic barriers may prevent reasonable access to treatment providers and pharmacies for residents of smaller, remote communities. AN - 33933362 AU - Ragsdale, R. J. AU - Nickman, N. A. AU - Slager, S. AU - Fox, E. R. DA - Mar 31 DO - 10.1016/j.japh.2021.03.019 DP - NLM ET - 2021/05/03 J2 - Journal of the American Pharmacists Association : JAPhA LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1086-5802 ST - A 2019 evaluation of opioid use disorder treatment resources in rural Utah counties T2 - J Am Pharm Assoc (2003) TI - A 2019 evaluation of opioid use disorder treatment resources in rural Utah counties ID - 931017 ER - TY - JOUR AB - OBJECTIVES: The COVID-19 pandemic changed the way that healthcare is delivered, with non-urgent care becoming almost entirely virtual. Underserved communities already battling the opioid epidemic had new challenges in accessing medication assisted treatment (MAT). The investigators sought to determine if patients were retaining access to their opioid use disorder (OUD) treatment and maintaining sobriety during the pandemic, with the intention of using this information to improve subsequent patient care while the pandemic continues. METHODS: In the assessment, seventy-five patient Epic EMR (electronic medical record) charts were reviewed to collect information on demographics, socioeconomic factors, healthcare access and sobriety during the pandemic period between March 1(st), 2020 and June 15(th), 2020. Patient charts were selected based on those receiving office-based opioid treatment (OBOT) for OUD at an urban healthcare center. RESULTS: 98.7% of patients accessed the healthcare center in some form since March 1st, 2020. The most common form of communication was through telemedicine with 94.6% of calls over audio. Out of the 21 toxicology screens performed during the pandemic period, 16 (76%) patients were found to be adhering to their buprenorphine treatment. Only 78.7% had documented they had Narcan at their disposal. Among all patients, 11 (14.6%) reoccurrences in opioid use were documented during the pandemic period. Few patients (76%) were adhering to their prescribed buprenorphine treatment, revealing that patients may not be receiving needed MAT support amid the pandemic. CONCLUSION: This assessment reveals short-comings of patient education in managing craving and the maintenance of support systems amid social-isolating conditions. AD - University of Kansas School of Medicine-Wichita, Wichita, Kansas. Morehouse School of Medicine, Atlanta, USA. Massachusetts General Hospital, Boston, USA. AN - 33754956 AU - Rahman, F. AU - Evans, N. AU - Bernhardt, J. DO - 10.1080/10826084.2021.1901935 DP - NLM ET - 2021/03/24 J2 - Substance use & misuse KW - Covid-19 Opioid use disorder office-based opioid treatment (OBOT) quality improvement LA - eng M1 - 7 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1082-6084 SP - 1005-1009 ST - Access to OUD Treatment and Maintenance of Sobriety amid the COVID-19 Pandemic T2 - Subst Use Misuse TI - Access to OUD Treatment and Maintenance of Sobriety amid the COVID-19 Pandemic VL - 56 ID - 931016 ER - TY - JOUR AB - BACKGROUND: Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction. OBJECTIVE: A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions. METHODS: Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions. RESULTS: Both the historical control group (N = 37) and the intervention group (N = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found. CONCLUSION: Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment. AD - Aurora Behavioral Health Services, Advocate Aurora Health, Wauwatosa, WI. Electronic address: publishing675@aurora.org. Aurora Behavioral Health Services, Advocate Aurora Health, Wauwatosa, WI; Aurora Research Institute, Advocate Aurora Health, Wauwatosa, WI. Department of Pharmacy Services, Aurora St. Luke's Medical Center, Advocate Aurora Health, Milwaukee, WI. Department of Quality Management, Aurora St. Luke's Medical Center, Advocate Aurora Health, Milwaukee, WI. Department of Nursing, Aurora St. Luke's Medical Center, Advocate Aurora Health, Milwaukee, WI. Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, Advocate Aurora Health, Milwaukee, WI. AN - 32778422 AU - Ray, V. AU - Waite, M. R. AU - Spexarth, F. C. AU - Korman, S. AU - Berget, S. AU - Kodali, S. AU - Kress, D. AU - Guenther, N. AU - Murthy, V. S. DA - Nov-Dec DO - 10.1016/j.psym.2020.06.019 DP - NLM ET - 2020/08/12 J2 - Psychosomatics KW - *addiction *cardiovascular surgery *inpatient *medication-assisted treatment *multidisciplinary team *opioid use disorders LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0033-3182 SP - 678-687 ST - Addiction Management in Hospitalized Patients With Intravenous Drug Use-Associated Infective Endocarditis T2 - Psychosomatics TI - Addiction Management in Hospitalized Patients With Intravenous Drug Use-Associated Infective Endocarditis VL - 61 ID - 930830 ER - TY - JOUR AB - Needs and Objectives: There is an increasing need for resident education on substance use disorders (SUDs). The purpose of our curriculum was to improve residents' knowledge, skills, and attitudes on treating patients with SUDs. Setting and Participants: First and second year residents from NYU's Primary Care, Internal Medicine program participated in the Block of Addiction Medicine (BAM!) curriculum. Clinical settings included buprenorphine/methadone clinics and outpatient treatment programs in a large, urban safety net hospital system. Description: BAM! is an intensive two week curriculum focused on SUDs. To improve residents' knowledge, we included didactic sessions on substances, including alcohol, opiates, and tobacco. Sessions covered epidemiology, biology, and treatment, including pharmacologic options, with all residents receiving buprenorphine prescribing waiver training. BAM! was delivered by an interdisciplinary faculty that included addiction medicine specialists, department of health officials, and general practitioners, nurses, and social workers who have worked extensively with patients with SUDs. Workshops built skills including screening, brief interventions, and referral to treatment (SBIRT) and motivational interviewing. Residents attended buprenorphine/methadone clinics, outpatient treatment programs, and 12-step (AA/NA) meetings. Residents shared lunch in a non-clinical setting with patients in recovery to understand their perspectives on living with addiction. Evaluation: Residents' attitudes and self-perceived efficacy in treating SUDs were surveyed. Pre and post data was obtained on 15 of 16 participants. Using the medical condition regard scale (MCRS), an 11 item questionnaire on biases/emotions/expectations for treating patients with SUD, we found a statistically significant improvement in the composite score, from 44.46 to 47.0 (p=0.026). Of 15 residents, 11 reported improved ability to effectively screen for SUD, 10 reported improved comfort in screening patients for SUD, 12 reported improved knowledge in using medically assisted treatment (MAT), and 14 reported improved ability to effectively treat patients with MAT (all p<.001 in Wilcoxon signed rank test). Qualitative feedback showed residents felt this curriculum was an essential part of their education; one participant commented: "this is a course that should be offered to every medical care provider." Discussion/Reflection/Lessons Learned: BAM! included a varied curriculum delivered by inter-professional faculty. Residents reported improved comfort in treating patients with SUDs and demonstrated a significant improvement on the MCRS in their already positive attitudes towards treating this patient population. Qualitative feedback indicated that residents enjoyed BAM! and found it important to their training. Given the increasing need for providers who are able to effectively treat SUDs, courses such as BAM! are an effective and essential part of residency. Further studies are needed to assess if the changes in residents' attitudes persist and whether we influenced practice. AD - H. Reich, NYU, New York, NY, United States AU - Reich, H. AU - Hanley, K. AU - Altshuler, L. DB - Embase DO - 10.1007/11606.1525-1497 KW - alcohol buprenorphine methadone addiction medicine adult biology clinical article comfort conference abstract controlled study curriculum drug combination drug dependence drug safety drug therapy education expectation female general practitioner human internal medicine male motivational interviewing nurse outpatient patient referral prescription questionnaire remission resident safety net hospital skill social worker tobacco Wilcoxon signed ranks test LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 1525-1497 SP - S790-S791 ST - Block of addiction medicine (BAM!): An intensive resident curriculum improves comfort with substance use disorders T2 - Journal of General Internal Medicine TI - Block of addiction medicine (BAM!): An intensive resident curriculum improves comfort with substance use disorders UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629004434&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 931131 ER - TY - JOUR AB - BACKGROUND: There is a gap between evidence-based treatment with medications for opioid use disorders (OUDs) and current practices of probation departments who supervise individuals with OUDs. Many probationers with OUDs cannot access FDA-approved medications to treat their disorders despite the strong evidence of their effectiveness. The barriers to medications for those under probation supervision include practitioners' negative attitudes toward medications, costs, stigma, and diversion risk. Probation officers have an ethical obligation to help their clients reduce barriers to access the care they need which in turn can improve their outcomes and increase public safety. RESULTS: The current study explores how probation departments respond to probationers with OUDs, focusing on the barriers to accessing OUD medications based on a survey of probation department directors/administrators (hereafter referred to as probation department leaders) in Illinois (N = 26). A majority of probation department leaders reported perceived staff barriers to their clients accessing medications. Reasons included lack of medical personnel experience, cost, need for guidance on medications, and regulations set by their organization or jurisdiction that prohibit client use of medications. Probation department leaders reported knowing less about the use of methadone and how it is administered, compared to buprenorphine and naltrexone. In addition, probation department leaders were generally more open to referring clients for treatment that include buprenorphine or naltrexone compared to methadone. Despite slightly less training or familiarity with methadone than the other medications, the number of probation department leaders who knew where to refer someone for each of the three FDA-approved medications was similar. CONCLUSIONS: The current study found probation department leaders perceive some barriers to their staff linking or referring their clients to OUD medications. Study findings indicate a need for administration- and staff-level training, interagency collaboration, and policy changes to increase access to, education on, and use of, medications for probation clients. Such efforts will ultimately help probation clients with OUDs stabilize and adhere to other probation requirements and engage in behavioral therapy, which may result in positive outcomes such as reduced recidivism, increased quality of life, and reduced mortality. AD - Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL, 60606, USA. Jessica.Reichert@Illinois.gov. Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL, 60606, USA. AN - 31139961 AU - Reichert, J. AU - Gleicher, L. C2 - Pmc6717960 DA - May 28 DO - 10.1186/s40352-019-0089-6 DP - NLM ET - 2019/05/30 J2 - Health & justice KW - Buprenorphine Mat Medication-assisted treatment Methadone Naltrexone Opioid Probation Substance use LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 2194-7899 (Print) 2194-7899 SP - 10 ST - Probation clients' barriers to access and use of opioid use disorder medications T2 - Health Justice TI - Probation clients' barriers to access and use of opioid use disorder medications VL - 7 ID - 930824 ER - TY - JOUR AB - OBJECTIVE: This paper will discuss the process of mapping opioid use disorder (OUD) treatment resources for pregnant women and discuss the intersection between treatment resources and rates of neonatal abstinence syndrome (NAS). DESIGN: A resource manual was developed through a systematic process with stakeholders across Illinois. Resources were mapped by county and overlaid with county rates of NAS, using hospital discharge data. RESULTS: Across Illinois, 89 treatment resources were identified for pregnant women insured by Medicaid. Resources were concentrated in 36% of Illinois' counties. Counties with limited treatment resources generally had high rates of NAS. Sixty-six percent of NAS cases among rural Illinois residents had no OUD treatment resources in their county. Rural counties had less access to medication-assisted treatment (MAT), the standard of care for treatment of OUD, compared with other counties across the state. CONCLUSIONS: Efforts to increase OUD treatment options for pregnant women insured by Medicaid should concentrate on geographic areas with limited access and high need. AD - University of Illinois Chicago, Chicago, IL, USA. Illinois Department of Public Health, Chicago, IL, USA. University of Illinois at Chicago, Chicago, IL, USA. AN - 33025600 AU - Reising, V. A. AU - Horne, A. AU - Bennett, A. C. DA - Jan DO - 10.1111/phn.12816 DP - NLM ET - 2020/10/08 J2 - Public health nursing (Boston, Mass.) KW - access to health care community assessment medication-assisted treatment neonatal abstinence syndrome opioid use disorder pregnancy substance use disorder LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0737-1209 SP - 98-105 ST - The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid T2 - Public Health Nurs TI - The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid VL - 38 ID - 930891 ER - TY - JOUR AB - There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment. AD - Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: rieckman@ohsu.edu. Department of Health Policy and Management, Univeristy of Georgia, 110 East Clayton Street, Athens, GA 30602. Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Department of Sociology, Center for Research on Behavioral Health and Human Services Delivery Institute for Behavioral Research, University of Georgia, 210 S Jackson St, Athens, GA 30602, USA. AN - 24594902 AU - Rieckmann, T. R. AU - Abraham, A. J. AU - Kovas, A. E. AU - McFarland, B. H. AU - Roman, P. M. C2 - Pmc4063285 C6 - Nihms572385 DA - May DO - 10.1016/j.addbeh.2014.01.016 DP - NLM ET - 2014/03/07 J2 - Addictive behaviors KW - Attitude of Health Personnel Biomedical Research Buprenorphine/*therapeutic use Counseling Female Humans Longitudinal Studies Male Middle Aged Narcotic Antagonists/*therapeutic use *Opiate Substitution Treatment Opioid-Related Disorders/*rehabilitation Social Networking Buprenorphine Implementation Research network participation interest. Dr. Amanda Abraham declares that she has no conflict of interest. Dr. Anne Kovas declares that she has no conflict of interest. Dr. Bentson McFarland declares that he has no conflict of interest. Dr. Paul Roman declares that he has no conflict of interest. LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2014 SN - 0306-4603 (Print) 0306-4603 SP - 889-96 ST - Impact of research network participation on the adoption of buprenorphine for substance abuse treatment T2 - Addict Behav TI - Impact of research network participation on the adoption of buprenorphine for substance abuse treatment VL - 39 ID - 931007 ER - TY - JOUR AB - Research has examined the safety, efficacy, feasibility, and cost-effectiveness of buprenorphine for the treatment of opioid dependence, but few studies have examined patient and provider experiences, especially in community health centers. Using de-identified electronic health record system (EHRS) data from 70 OCHIN community health centers (n = 1825), this cross-sectional analysis compared the demographics, comorbidities, and service utilization of patients receiving buprenorphine to those not receiving medication-assisted treatment (MAT). Compared to non-MAT patients, buprenorphine patients were younger and less likely to be Hispanic or live in poverty. Buprenorphine patients were less likely to have Medicaid insurance coverage, more likely to self-pay, and have private insurance coverage. Buprenorphine patients were less likely to have problem medical comorbidities or be coprescribed high-risk medications. It is important for providers, clinic administrators, and patients to understand the clinical application of medications for opioid dependence to ensure safe and effective care within safety net clinics. AD - OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA. rieckman@ohsu.edu. Department of Family Medicine, Oregon Health & Science University, Portland, OR, 97239-3098, USA. OCHIN Community Health Information Network, Portland, OR, 97201-5195, USA. Department of Public Administration and Policy, University of Georgia, Athens, GA, 30602, USA. AN - 28488155 AU - Rieckmann, T. R. AU - Gideonse, N. AU - Risser, A. AU - DeVoe, J. E. AU - Abraham, A. J. DA - Jul DO - 10.1007/s11414-017-9553-z DP - NLM ET - 2017/05/11 J2 - The journal of behavioral health services & research KW - Adolescent Adult Age Factors Buprenorphine/*therapeutic use Cross-Sectional Studies Female Humans Insurance Coverage Male Middle Aged Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy Socioeconomic Factors Young Adult LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2017 SN - 1094-3412 SP - 351-363 ST - Treating Opioid Dependence with Buprenorphine in the Safety Net: Critical Learning from Clinical Data T2 - J Behav Health Serv Res TI - Treating Opioid Dependence with Buprenorphine in the Safety Net: Critical Learning from Clinical Data VL - 44 ID - 930961 ER - TY - JOUR AB - Background: Medications for opioid use disorder (MOUD) significantly reduce morbidity and mortality from opioid use disorder (OUD). To prescribe MOUD, physicians must obtain a DEA waiver through requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000). We developed an Addiction Medicine curriculum that features DATA 2000 waiver training at the Robert Larner, MD College of Medicine (LCOM). Methods: All third-year medical students completed a virtual DATA 2000 waiver training at the commencement of clinical clerkships. We conducted a curriculum needs assessment followed by pre- and post-training surveys to evaluate MOUD pharmacology knowledge and best prescribing practices. Results: Of LCOM students surveyed, 77.6% reported interest in being waivered to prescribed MOUD for OUD treatment. Third-year medical students demonstrated increases in both MOUD Pharmacology Knowledge from 64.2% to 84.8% (chi-squared = 40.8; p < .001) and MOUD Best Prescribing Practices from 55.9% to 75.2% (chi-squared = 29.9; p < .001). Discussion: Surveys showed the majority of students felt waiver training was relevant to their future practice. An online DATA 2000 waiver training format effectively improved student knowledge of MOUD. Conclusion: This curriculum exposed medical students to DATA 2000 waiver training, MOUD pharmacology and best practices, and increased the number of future physicians eligible to treat OUD using MOUD. AD - [Riser, Elly; Sobel, Halle G.] Univ Vermont, Dept Med, Robert Larner MD Coll Med, Burlington, VT USA. [Holterman, Leigh Ann; Drouin, Jacqueline] Univ Vermont, Robert Larner MD Coll Med, Off Med Educ, Burlington, VT USA. [Maruti, Sanchit; Brooklyn, John R.] Univ Vermont, Dept Psychiat, Robert Larner MD Coll Med, Burlington, VT USA. [Brooklyn, John R.] Univ Vermont, Dept Family Med, Robert Larner MD Coll Med, Burlington, VT USA. [DeVoe, Stephen G.; Tompkins, Bradley J.] Univ Vermont, Dept Med, Qual Program, Robert Larner MD Coll Med, Burlington, VT USA. Riser, E (corresponding author), Univ Vermont, Med Ctr, Dept Med, Burlington, VT 05401 USA. elly.riser@uvmhealth.org AN - WOS:000637233800001 AU - Riser, E. AU - Holterman, L. A. AU - Maruti, S. AU - Brooklyn, J. R. AU - DeVoe, S. G. AU - Tompkins, B. J. AU - Drouin, J. AU - Sobel, H. G. DO - 10.1080/08897077.2021.1903653 J2 - Subst. Abus. KW - Addiction medicine medical student training medications for opioid use disorder waiver training DATA 2000 Substance Abuse LA - English M3 - Article; Early Access N1 - Web of Science Clarivate Analytics literature search May 7, 2021 SN - 0889-7077 SP - 8 ST - Integrating DATA 2000 waiver training into undergraduate medical education: The time is now T2 - Substance Abuse TI - Integrating DATA 2000 waiver training into undergraduate medical education: The time is now UR - ://WOS:000637233800001 ID - 931226 ER - TY - JOUR AB - Background: Medications for opioid use disorder (MOUD) significantly reduce morbidity and mortality from opioid use disorder (OUD). To prescribe MOUD, physicians must obtain a DEA waiver through requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000). We developed an Addiction Medicine curriculum that features DATA 2000 waiver training at the Robert Larner, MD College of Medicine (LCOM). Methods: All third-year medical students completed a virtual DATA 2000 waiver training at the commencement of clinical clerkships. We conducted a curriculum needs assessment followed by pre- and post-training surveys to evaluate MOUD pharmacology knowledge and best prescribing practices. Results: Of LCOM students surveyed, 77.6% reported interest in being waivered to prescribed MOUD for OUD treatment. Third-year medical students demonstrated increases in both MOUD Pharmacology Knowledge from 64.2% to 84.8% (chi-squared = 40.8; p < .001) and MOUD Best Prescribing Practices from 55.9% to 75.2% (chi-squared = 29.9; p < .001). Discussion: Surveys showed the majority of students felt waiver training was relevant to their future practice. An online DATA 2000 waiver training format effectively improved student knowledge of MOUD. Conclusion: This curriculum exposed medical students to DATA 2000 waiver training, MOUD pharmacology and best practices, and increased the number of future physicians eligible to treat OUD using MOUD. AD - Department of Medicine, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA. Office of Medical Education, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA. Department of Psychiatry, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA. Department of Family Medicine, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA. Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA. AN - 33821773 AU - Riser, E. AU - Holterman, L. A. AU - Maruti, S. AU - Brooklyn, J. R. AU - DeVoe, S. G. AU - Tompkins, B. J. AU - Drouin, J. AU - Sobel, H. G. DA - Apr 6 DO - 10.1080/08897077.2021.1903653 DP - NLM ET - 2021/04/07 J2 - Substance abuse KW - Addiction medicine Data 2000 medical student training medications for opioid use disorder waiver training LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0889-7077 SP - 1-8 ST - Integrating DATA 2000 waiver training into undergraduate medical education: The time is now T2 - Subst Abus TI - Integrating DATA 2000 waiver training into undergraduate medical education: The time is now ID - 930998 ER - TY - JOUR AB - INTRODUCTION: Recent years have seen a rise in maternal opioidrelated deaths and Neonatal Abstinence Syndrome (NAS). Screening with a validated, standardized tool can streamline identification of pregnant women with Opioid Use Disorder (OUD). The NIDA Quick Screen (NIDA) is a tool that has not been validated in this population and may help identify those with OUD METHODS: All pregnant women receiving care at Loyola University Medical Center Outpatient Center between January 2019 and July 2019 were eligible for NIDA screening at two time points: New Obstetric Visit and/or Return Obstetric Visit. NIDA, which screens for tobacco, alcohol, nonprescription medication use, and illicit drug use, was administered as standard of care by a nurse or research assistant at the start of the visit. A chart review of screened patients was then completed to validate results. ∗IRB and/or animal use committee approval was waived for this study. RESULTS: Out of 187 eligible patients screened, 4 (2.14%) resulted positive for OUD by systematic chart review. Of the patients identified for OUD, 3 (75%) were using prescribed opioids and 1 (25%) was using non-prescribed opioids (heroin). None (0%) of the patients with OUD (prescribed) screened positive by NIDA. Conversely, the patient with OUD (non-prescribed) screened positive via 'illicit drug use.' CONCLUSION: As evidenced by the study, NIDA is not sufficiently sensitive to capture the nuances of current opioid use, specifically prescription medication, in the pregnant population. Additionally, the inability of NIDA to indicate whether opioid use is current or previous, is a critical limitation in obstetric care. AD - T.R. Rodriguez, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States AU - Rodriguez, T. R. AU - Goodman, J. R. DB - Embase KW - alcohol diamorphine illicit drug opiate adult animal use conference abstract female health care quality human medical record review mother newborn nurse obstetric procedure outpatient pregnancy pregnant woman prescription systematic review tobacco university hospital LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1873-233X SP - 56S-57S ST - Optimizing care for mothers and newborns affected by opioid use disorder T2 - Obstetrics and Gynecology TI - Optimizing care for mothers and newborns affected by opioid use disorder UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633633998&from=export VL - 135 ID - 931102 ER - TY - JOUR AB - BACKGROUND: Expansion of buprenorphine for opioid use disorder treatment is a core component of the opioid overdose epidemic response. The Comprehensive Addiction and Recovery Act (CARA) of 2016 authorized nurse practitioners (NPs) and physician assistants (PAs) to obtain a DATA-waiver to prescribe buprenorphine. The objectives of this study are to examine national- and county-level buprenorphine prescription dispensing, patterns by patient demographics and clinician specialty, and county-level characteristics associated with buprenorphine dispensing. METHODS: Retrospective analysis of buprenorphine prescriptions dispensed from approximately 92% of all retail prescriptions in the US (2017-2018). Analyses include rates of buprenorphine prescriptions dispensed, by patient demographics and prescriber specialty, changes in buprenorphine prescriptions dispensed at the national- and county-level, and county-level characteristics associated with buprenorphine dispensing. RESULTS: Buprenorphine prescriptions dispensed increased by 9.1% nationally, from 40.7-44.4 per 1000 residents. From 2017 to 2018, NPs (351.9%) and PAs (257.3%) had the largest percent increases in dispensed buprenorphine prescriptions, accounting for 79.6% of the total increase. In 2018, county-level characteristics associated with high buprenorphine dispensing included. among others: greater potential buprenorphine treatment capacity, higher drug overdose death rates, and higher rates of Medicaid enrollment. Rural counties were associated with low buprenorphine dispensing. CONCLUSION: Buprenorphine dispensing rates increased in the US from 2017 to 2018, suggesting the addition of NPs and PAs by CARA has contributed to an increase in dispensed buprenorphine prescriptions. AD - National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta 30341, GA, United States. Electronic address: droehler@cdc.gov. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta 30341, GA, United States. AN - 32505044 AU - Roehler, D. R. AU - Guy, G. P., Jr. AU - Jones, C. M. DA - May 25 DO - 10.1016/j.drugalcdep.2020.108083 DP - NLM ET - 2020/06/07 J2 - Drug and alcohol dependence KW - Buprenorphine Opioid use disorder Policy LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0376-8716 SP - 108083 ST - Buprenorphine prescription dispensing rates and characteristics following federal changes in prescribing policy, 2017-2018: A cross-sectional study T2 - Drug Alcohol Depend TI - Buprenorphine prescription dispensing rates and characteristics following federal changes in prescribing policy, 2017-2018: A cross-sectional study VL - 213 ID - 930817 ER - TY - JOUR AB - Background: The United States opioid epidemic has caused increased morbidity and mortality, and added to the burdens of health care systems across the nation. Our Poison Control System (PCS) partnered with the Department of Health Services (DHS) and other community health care organizations, to develop the Opioid Assistance and Referral (OAR) Line, as part of a state-wide systematic response to this crisis. Method: On June 5, 2017, the Governor declared a state of emergency due to the opioid overdose epidemic. Our PCS participated in stakeholder meetings, convened by the Governor's Office and DHS, to help form the state's response to this crisis. The resulting Opioid Action Plan was submitted by the DHS to the Governor's Office on September 5, 2017, with 12 key recommendations. One of these recommendations included the implementation of a 24/7 Opioid Assistance and Referral (OAR) Line. The purpose of this line was to provide clinical guidance to prescribers, as well as management and referrals to the general public, and paralleled existing services and expertise provided by the PCS. Specific PCS directors and staff were identified to review research, develop standard operative procedures (Figure 1), identify community resources, and generate frequently asked questions. A two-part roll out was planned, initially to prescribers and subsequently to the general public. Results: On February 26, 2018 the OAR Line was initiated, with an advertised Go Live date on March 26, 2018 at 0700. Anticipated calls included: prescribing guidance, managing complex pain and/or opioid use disorder, crisis interventions, naloxone administration and education, substance abuse and behavioral health treatment resources, harm reduction programs, medication assisted treatment, and buprenorphine waivered training. Conclusions: Poison and Drug Information Centers have a unique opportunity to enhance their roles in the opioid crisis, and other public health projects, by working closely with lawmakers and Health Departments. Further research and data analysis will be required to evaluate and improve such interventions. AD - M. Roland, Center for Toxicology, Pharmacology, Education and Research, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States AU - Roland, M. AU - Schmid, K. AU - Dudley, S. AU - Kuhn, B. AU - Rigler, J. AU - Welch, S. AU - Boesen, K. J. AU - Shirazi, M. AU - Brooks, D. E. DB - Embase DO - 10.1080/15563650.2018.1506610 KW - buprenorphine naloxone opiate poison conference abstract control system controlled study crisis intervention data analysis drug information drug overdose education emergency epidemic harm reduction human pain patient referral poison center prescription public health service staff substance abuse LA - English M1 - 10 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1556-9519 SP - 1053-1054 ST - Poison centers respond to a state's opioid crisis T2 - Clinical Toxicology TI - Poison centers respond to a state's opioid crisis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624641955&from=export http://dx.doi.org/10.1080/15563650.2018.1506610 VL - 56 ID - 931162 ER - TY - JOUR AB - The use of medications to treat substance use disorders (SUDs) has emerged as a potentially central part of the treatment armamentarium. In this paper we present data from several recent US national surveys showing that despite the clinical promise of these medications, there has been limited adoption of pharmacotherapies in the treatment of SUDs. The data reveal variable patterns of use of disulfiram, buprenorphine, tablet naltrexone, acamprosate and injectable naltrexone. After examining the environmental and institutional context for the adoption of pharmacotherapies, the specific organizational facilitators and barriers of medication adoption are considered. The paper concludes with a discussion of the minimal clinical and administrative guidance available to enhance adoption, the lack of client and consumer knowledge of medications that puts a brake on their adoption and availability, and the difficulties that must be surmounted in bringing new medications to market. AD - Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens GA 30602, United States; Department of Sociology, University of Georgia, Athens GA 30602, United States. Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens GA 30602, United States; Department of Sociology, University of Georgia, Athens GA 30602, United States. Electronic address: aabraham@uga.edu. Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington KY, United States. AN - 21377275 AU - Roman, P. M. AU - Abraham, A. J. AU - Knudsen, H. K. C2 - Pmc3087632 C6 - Nihms282288 DA - Jun DO - 10.1016/j.addbeh.2011.01.032 DP - NLM ET - 2011/03/08 J2 - Addictive behaviors KW - Acamprosate Alcohol Deterrents/*therapeutic use Buprenorphine/therapeutic use Disulfiram/therapeutic use Humans Naltrexone/therapeutic use Narcotic Antagonists/*therapeutic use Patient Education as Topic Substance Abuse Treatment Centers/organization & administration/statistics & numerical data Substance-Related Disorders/*drug therapy Taurine/analogs & derivatives/therapeutic use United States LA - eng M1 - 6 N1 - PubMed NLM literature search May 7, 2021 PY - 2011 SN - 0306-4603 (Print) 0306-4603 SP - 584-589 ST - Using medication-assisted treatment for substance use disorders: evidence of barriers and facilitators of implementation T2 - Addict Behav TI - Using medication-assisted treatment for substance use disorders: evidence of barriers and facilitators of implementation VL - 36 ID - 930934 ER - TY - JOUR AB - BACKGROUND: While pregnant women in treatment for opioid use disorder (OUD) face considerable challenges, common material hardships- food insecurity and housing instability, known to negatively impact maternal-child health, have been inadequately researched within this population. This study describes food/housing hardships and evaluates associations with key psychosocial factors. METHODS: A single-site prospective study, 100 3rd trimester women receiving prenatal care and medication-assisted treatment for OUD were interviewed, including screening for food/housing hardships, depressive symptoms, intimate partner vulnerability; and self-reported post-traumatic stress disorder (PTSD) history. We developed a three-level categorization combining food/housing screening outcomes: 1) "both insecure"; 2) "either secure"; and 3) "both secure". Bivariate analyses and linear path analyses evaluated associations among psychosocial variables using "both secure" as the referent group. RESULTS: Of 100 women, 56% reported food insecurity; 61% housing instability; 42% "both insecure"; 33% "either insecure"; 25% "both secure". In unadjusted food/housing groups "either insecure" and "both insecure" reported significantly greater depressive symptoms; "both insecure" additionally reported significantly greater intimate partner vulnerability. Path analyses adjusted for PTSD and compared with "both secure" (adjusted mean = 6.2): "either insecure" had greater depressive symptom scores (adjusted means = 9.8, p = .01) while "both insecure" had greater depressive scores (adjusted means 10.5, p = .002). In addition, "both insecure" had a clinically important 5.7 point greater intimate partner vulnerability score. There were no significant interactions between food/housing and PTSD. CONCLUSIONS: Even in women receiving prenatal care and treatment for OUD, food/housing material hardships and associated psychosocial factors are of major concern, requiring screening and remediation. AD - Boston University School of Medicine, Department of Pediatrics, 771 Albany Street, Room G509, Boston, MA 02118, United States. Electronic address: rrosejac@bu.edu. Boston Medical Center, Department of Developmental and Behavioral Pediatrics, 72 E. Concord Street, Vose 426, Boston, MA 02118, United States. Electronic address: michelle.trevino-talbot@bmc.org. Boston University School of Medicine, Departments of Pediatrics and Psychiatry, 255 River Street, Mattapan, MA 02126, United States. Electronic address: mvibbert@bu.edu. Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, 85 East Newton Street, Room 957A, Boston, MA 02118, United States. Electronic address: clloyd@bu.edu. Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, Room 310, Boston, MA 02118, United States. Electronic address: hjcab@bu.edu. AN - 31301645 AU - Rose-Jacobs, R. AU - Trevino-Talbot, M. AU - Vibbert, M. AU - Lloyd-Travaglini, C. AU - Cabral, H. J. DA - Nov DO - 10.1016/j.addbeh.2019.106030 DP - NLM ET - 2019/07/14 J2 - Addictive behaviors KW - Adult Cohort Studies Depression/*epidemiology Female Food Supply/*statistics & numerical data Homeless Persons/*statistics & numerical data Housing/*statistics & numerical data Humans Intimate Partner Violence/*statistics & numerical data Mental Health Recovery Opioid-Related Disorders/epidemiology/*therapy Pregnancy Pregnancy Complications/epidemiology/*therapy Stress Disorders, Post-Traumatic/epidemiology Young Adult *Food insecurity *Housing instability *Material hardships *Maternal-child health *Opioid use disorder treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0306-4603 SP - 106030 ST - Pregnant women in treatment for opioid use disorder: Material hardships and psychosocial factors T2 - Addict Behav TI - Pregnant women in treatment for opioid use disorder: Material hardships and psychosocial factors VL - 98 ID - 930809 ER - TY - JOUR AB - PURPOSE: The United States is experiencing an epidemic of opioid-related deaths driven by excessive prescribing of opioids, misuse of prescription drugs, and increased use of heroin. Buprenorphine-naloxone is an effective treatment for opioid use disorder and can be provided in office-based settings, but this treatment is unavailable to many patients who could benefit. We sought to describe the geographic distribution and specialties of physicians obtaining waivers from the Drug Enforcement Administration (DEA) to prescribe buprenorphine-naloxone to treat opioid use disorder and to identify potential shortages of physicians. METHODS: We linked physicians authorized to prescribe buprenorphine on the July 2012 DEA Drug Addiction Treatment Act (DATA) Waived Physician List to the American Medical Association Physician Masterfile to determine their age, specialty, rural-urban status, and location. We then mapped the location of these physicians and determined their supply for all US counties. RESULTS: Sixteen percent of psychiatrists had received a DEA DATA waiver (41.6% of all physicians with waivers) but practiced primarily in urban areas. Only 3.0% of primary care physicians, the largest group of physicians in rural America, had received waivers. Most US counties therefore had no physicians who had obtained waivers to prescribe buprenorphine-naloxone, resulting in more than 30 million persons who were living in counties without access to buprenorphine treatment. CONCLUSIONS: In the United States opioid use and related unintentional lethal overdoses continue to rise, particularly in rural areas. Increasing access to office-based treatment of opioid use disorder--particularly in rural America--is a promising strategy to address rising rates of opioid use disorder and unintentional lethal overdoses. AD - WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington hollya@uw.edu. WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington Group Health Cooperative of Puget Sound, Seattle, Washington. AN - 25583888 AU - Rosenblatt, R. A. AU - Andrilla, C. H. AU - Catlin, M. AU - Larson, E. H. C2 - Pmc4291261 DA - Jan-Feb DO - 10.1370/afm.1735 DP - NLM ET - 2015/01/15 J2 - Annals of family medicine KW - Adult Buprenorphine/*therapeutic use Buprenorphine, Naloxone Drug Combination *Education, Medical Family Practice/education Female Humans Internal Medicine/education Male Middle Aged Naloxone/*therapeutic use Narcotic Antagonists/*therapeutic use Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy/epidemiology Physical and Rehabilitation Medicine/education Physicians/*supply & distribution Psychiatry/education Rural Population United States/epidemiology Urban Population Workforce buprenorphine opiate addiction opioid treatment programs primary health care rural health LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 1544-1709 (Print) 1544-1709 SP - 23-6 ST - Geographic and specialty distribution of US physicians trained to treat opioid use disorder T2 - Ann Fam Med TI - Geographic and specialty distribution of US physicians trained to treat opioid use disorder VL - 13 ID - 930971 ER - TY - JOUR AB - As the opioid epidemic continues to worsen throughout the United States, researchers and practitioners require additional tools to help in efforts to address use and prevent overdose. Although opioids are increasingly of concern to all racial and socioeconomic groups, specific geographic regions and sub-populations remain more burdened by overdoses than others. The example of Flint, Michigan, is used to contextualize the landscape of opioid overdose death and understand geographic and demographic variation in risk. Kernel density analysis and spatial joins in ArcGIS were used to map opioid overdose death clusters, treatment availability, and neighborhood-level conditions to uncover factors related to overdose death. Spatial analysis revealed three geographic clusters in opioid overdose death in Flint. These neighborhoods tended to be somewhat poorer but also significantly Whiter than the average Flint neighborhood. Alternatively, opioid overdose death clusters did not occur in predominately African-American neighborhoods. As well, treatment sites were not coincident with the location of overdose death clusters, suggesting a potential need for geographically-targeted interventions. Of the 47 treatment sites, only 29 offered medication-assisted treatment, and expansion of these programs may therefore be warranted. This work is of great importance to ongoing prevention and treatment efforts in Flint, but also to other communities with a need for better tools to monitor and intervene in the opioid epidemic. AD - Michigan State University, College of Human Medicine, Division of Public Health, United States; Michigan State University, College of Human Medicine, Department of Family Medicine, United States; Michigan State University, College of Social Science, Department of Geography, Environment, and Spatial Sciences, United States. Electronic address: sadlerr@msu.edu. Michigan State University, College of Human Medicine, Division of Public Health, United States; Michigan State University, College of Human Medicine, Department of Family Medicine, United States; Michigan State University, College of Human Medicine, Department of Epidemiology and Biostatistics, United States. AN - 31586805 AU - Sadler, R. C. AU - Furr-Holden, D. C2 - Pmc6884144 C6 - Nihms1543732 DA - Nov 1 DO - 10.1016/j.drugalcdep.2019.107560 DP - NLM ET - 2019/10/07 J2 - Drug and alcohol dependence KW - African Americans Analgesics, Opioid/*poisoning Continental Population Groups Drug Overdose/*epidemiology European Continental Ancestry Group Female Humans Male Michigan/epidemiology *Public Health Practice Residence Characteristics Seasons Socioeconomic Factors Spatial Analysis Substance-Related Disorders/epidemiology Time Factors United States *Geographic information systems (GIS) *Opioids *Overdose *Prevention LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0376-8716 SP - 107560 ST - The epidemiology of opioid overdose in Flint and Genesee County, Michigan: Implications for public health practice and intervention T2 - Drug Alcohol Depend TI - The epidemiology of opioid overdose in Flint and Genesee County, Michigan: Implications for public health practice and intervention VL - 204 ID - 930872 ER - TY - JOUR AB - It is important for nurses not working in the area of addictions to be informed of the diagnosis and treatment of opioid use disorder so that they may serve as a resource, educate others, and influence and refer individuals to seek treatment on the basis of best evidence. In this article, we provide an overview of the postscreening diagnosis and treatment of opioid use disorders with an emphasis on medication-assisted treatment, starting with the definition of substance use disorder, tolerance, dependence, and addiction. AD - Susan Salmond, EdD, RN, ANEF, FAAN, Executive Vice Dean and Professor, School of Nursing, Rutgers, The State University of New Jersey, Newark, and is the Research Editor for Orthopaedic Nursing. Virginia Allread, MPH, Executive Assistant, School of Nursing, Rutgers, The State University of New Jersey, Newark. Robert Marsh, PMHNP, APN, BC, Instructor, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ. AN - 30789485 AU - Salmond, S. AU - Allread, V. AU - Marsh, R. DA - Mar/Apr DO - 10.1097/nor.0000000000000522 DP - NLM ET - 2019/02/23 J2 - Orthopedic nursing KW - Analgesics, Opioid/*adverse effects Humans *Opiate Substitution Treatment Opioid-Related Disorders/*diagnosis/*drug therapy Orthopedic Nursing Severity of Illness Index LA - eng M1 - 2 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0744-6020 SP - 118-126 ST - Management of Opioid Use Disorder Treatment: An Overview T2 - Orthop Nurs TI - Management of Opioid Use Disorder Treatment: An Overview VL - 38 ID - 930804 ER - TY - JOUR AB - Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life. In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver. We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver. Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments. AD - Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA. Department of Internal Medicine, University of Central Florida, Orlando, FL, USA. Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. RAND Corporation, Pittsburgh, PA, USA. AN - 33798034 AU - Saloner, B. AU - Andraka Christou, B. AU - Gordon, A. J. AU - Stein, B. D. DA - Apr 2 DO - 10.1080/08897077.2021.1903659 DP - NLM ET - 2021/04/03 J2 - Substance abuse KW - Buprenorphine Data 2000 access to care policy quality of care LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0889-7077 SP - 1-5 ST - It will end in tiers: A strategy to include "dabblers" in the buprenorphine workforce after the X-waiver T2 - Subst Abus TI - It will end in tiers: A strategy to include "dabblers" in the buprenorphine workforce after the X-waiver ID - 931028 ER - TY - JOUR AB - Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life. In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver. We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver. Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments. AD - [Saloner, Brendan] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. [Andraka Christou, Barbara] Univ Cent Florida, Dept Hlth Management & Informat, Orlando, FL 32816 USA. [Andraka Christou, Barbara] Univ Cent Florida, Dept Internal Med, Orlando, FL 32816 USA. [Gordon, Adam J.] VA Salt Lake City Hlth Care Syst, Vulnerable Vet Innovat PACT VIP Initiat, Salt Lake City, UT USA. [Gordon, Adam J.] VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA. [Gordon, Adam J.] Univ Utah, Sch Med, Dept Internal Med, Program Addict Res Clin Care Knowledge & Advocacy, Salt Lake City, UT USA. [Stein, Bradley D.] RAND Corp, Pittsburgh, PA USA. Saloner, B (corresponding author), Johns Hopkins Sch Publ Hlth, Dept Hlth Policy & Management, 624 North Broadway,Room 344, Baltimore, MD 21205 USA. bsaloner@jhu.edu AN - WOS:000636100200001 AU - Saloner, B. AU - Christou, B. A. AU - Gordon, A. J. AU - Stein, B. D. DO - 10.1080/08897077.2021.1903659 J2 - Subst. Abus. KW - Buprenorphine quality of care access to care policy DATA 2000 Substance Abuse LA - English M3 - Editorial Material; Early Access N1 - Web of Science Clarivate Analytics literature search May 7, 2021 SN - 0889-7077 SP - 5 ST - It will end in tiers: A strategy to include "dabblers" in the buprenorphine workforce after the X-waiver T2 - Substance Abuse TI - It will end in tiers: A strategy to include "dabblers" in the buprenorphine workforce after the X-waiver UR - ://WOS:000636100200001 ID - 931227 ER - TY - JOUR AB - OBJECTIVE: The purpose of this study was to understand the barriers and facilitators that affect engagement with Project ECHO (Extension for Community Healthcare Outcomes) to implement medication-assisted treatment (MAT) in primary care settings. METHODS: A 12-session weekly curriculum was delivered to participating primary care providers and clinic staff (N=24 participants from 13 clinics). Participants completed attendance logs and a qualitative interview in order to identify factors that influence engagement in the ECHO sessions and the potential integration of MAT. RESULTS: Primary care providers and staff valued the ECHO sessions, but overall attendance was low and variable. Participants generally valued the didactic and interactive nature of the sessions but identified system-level constraints that limited engagement. Major barriers to participation included competing demands in patient care and the low degree of endorsement by clinic leadership. CONCLUSIONS: This brief report identifies key systematic challenges that may directly limit primary care providers' engagement in telementoring models such as Project ECHO. AD - Department of Psychiatry (Salvador, Bhatt, Fowler, James, Jacobsohn, and, at the time of the study, Ritz), Clinical and Translational Science Center (Brakey), and Department of Family and Community Medicine (Sussman), University of New Mexico Health Sciences Center, Albuquerque. AN - 31434561 AU - Salvador, J. AU - Bhatt, S. AU - Fowler, R. AU - Ritz, J. AU - James, R. AU - Jacobsohn, V. AU - Brakey, H. R. AU - Sussman, A. L. DA - Dec 1 DO - 10.1176/appi.ps.201900142 DP - NLM ET - 2019/08/23 J2 - Psychiatric services (Washington, D.C.) KW - Community Health Services/*methods Curriculum *Education, Medical, Continuing Health Personnel/*education Humans New Mexico Opiate Substitution Treatment Opioid-Related Disorders/*drug therapy Primary Health Care/*methods *Rural Health Services Telemedicine *Alcohol and drug abuse *Clinical and translational research *Primary care *Recruitment *Substance use LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1075-2730 SP - 1157-1160 ST - Engagement With Project ECHO to Increase Medication-Assisted Treatment in Rural Primary Care T2 - Psychiatr Serv TI - Engagement With Project ECHO to Increase Medication-Assisted Treatment in Rural Primary Care VL - 70 ID - 930825 ER - TY - JOUR AB - Background: Chronic pain is highly prevalent among people living with HIV (PLWH); managing pain with chronic opioid therapy (COT) is common. HIV physicians often diverge from opioid prescribing guidelines. Methods: The Targeting Effective Analgesia in Clinics for HIV (TEACH) study was a 2-arm cluster randomized trial to assess whether a collaborative care intervention increased guideline-concordant care for COT compared to standard practice among PLWH. From 2015-2016 we recruited HIV care providers who prescribed COT and their patients from two safety-net hospital-based HIV clinics. We randomized 41 providers, in a 1:1 ratio, to receive either the TEACH intervention (an IT-enabled nurse care manager; education and academic detailing; and access to addiction specialists) or the control condition (educational brochure). We assessed: a) ≥2 urine drug tests (UDTs) (primary); b) any early COT refills (primary); c) having an opioid treatment agreement (OTA); d) virologic suppression (VS); and e) provider's routine use of prescription monitoring programs (PMP). An intention-to-treat analysis was conducted using generalized estimating equations (GEE) logistic regression models. Results: The 41 providers and their 187 COT patients had the following baseline characteristics: providers-34% male; age 46 years; 63% white; 78% MDs; 12% buprenorphine waivered; patients-72% male; age 54 years; 28% white; 91% with undetectable HIV viral load; 15% with history of injection drug use. COT prescribers (n=21 with 87 patients) were randomized to the intervention arm. At 12-month follow up, the intervention arm had higher odds of ≥2 UDTs (70% vs. 18%, adjusted odds ratio [AOR]: 15.46, 95% confidence interval [CI]: 7.29-32.79; p<0.0001) and OTAs (75% vs. 11%, AOR: 128.21, 95% CI: 22.85-719.30, p<0.0001). We did not detect a difference in early refills (21% vs. 29%, AOR: 0.57, 95% CI: 0.26-1.24, p=0.15), routine use of PMP (55% vs. 25%, AOR: 3.65, 95% CI: 0.94-14.19, p=0.06), or HIV VS (88% vs. 84%, AOR: 1.14, 95% CI: 0.63-2.04, p=0.67) between the two arms. Conclusion: Participants in the TEACH intervention had higher odds of following 2 important guidelines for COT: ≥2 urine drug tests and treatment agreements. We did not detect significant differences in early refills, use of prescription monitoring programs, or viral suppression. The TEACH intervention is a promising strategy to improve adherence to guidelines for COT and does not appear to compromise viral suppression. AD - J.H. Samet, Boston University, Boston, MA, United States AU - Samet, J. H. AU - Liebschutz, J. AU - Cheng, D. AU - Colasanti, J. AU - Tsui, J. I. AU - Lira, M. C. AU - Forman, L. S. AU - Shanahan, C. W. AU - Sullivan, M. AU - Root, C. AU - Bridden, C. AU - Capozzi, C. AU - Armstrong, W. S. AU - Walley, A. Y. AU - Del Rio, C. DB - Embase KW - buprenorphine opiate addiction adult analgesia clinical trial conference abstract controlled study drug safety drug therapy education female follow up human Human immunodeficiency virus infected patient human tissue major clinical study male nurse manager practice guideline prescription randomized controlled trial safety net hospital virus load LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2019 SN - 2161-5853 SP - 344s-345s ST - Improving chronic opioid therapy among people living with HIV: A clinical RCT T2 - Topics in Antiviral Medicine TI - Improving chronic opioid therapy among people living with HIV: A clinical RCT UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634220871&from=export VL - 27 ID - 931145 ER - TY - JOUR AB - INTRODUCTION: Illicit opioid use has become a national crisis in Canada, with over 65 000 people seeking treatment for opioid use disorder (OUD) in Ontario and British Columbia alone. Medication-assisted treatment (MAT) is a common treatment for OUD. There is substantial variability in treatment outcomes used to evaluate effectiveness of MAT, making it difficult to establish clinically and scientifically relevant treatment effect. Furthermore, patients are often excluded from the process of determining these outcomes. The primary objective of this review is to examine outcomes currently used to measure MAT effectiveness and to identify patient-relevant outcomes to enhance effectiveness of treatment options. This review refers to patient-important outcomes as those outcomes patients consider important to or markers of treatment success. METHODS AND ANALYSIS: MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, National Institutes for Health Clinical Trials Registry and WHO International Clinical Trials Registry Platform databases will be searched. We will search databases from inception to the date the search is ran. Studies of interest include those evaluating the effectiveness of MAT for patients with OUD, with or without consultation with patients regarding what they consider to be important as an indicator of treatment success. Results will be analysed using thematic analysis and qualitative analysis where possible. This will result in comprehensive synthesis of all outcomes and measures found related to OUD treatment effectiveness. ETHICS AND DISSEMINATION: We are collaborating with Canadian Addiction Treatment Centres which provide MAT to patients with OUD who will participate in disseminating study results. Dissemination strategies will involve sharing study results through workshops, presentations, peer-reviewed publications, study reports, community presentations and resources in primary care settings. PROSPERO REGISTRATION NUMBER: CRD42018095553. AD - Medical Science Gradaute Program, McMaster University, Hamilton, Ontario, Canada. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. Arts and Sciences, McMaster University, Hamilton, Ontario, Canada. St. George's Hospital Medical School, University of London, London, UK. Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, Ontario, Canada. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. Canadian Addiction Treatment Centres, McMaster University, Markham, Ontario, Canada. Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada. Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada. Rand Teed Consulting Services, Craven, Saskatchewan, Canada. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. Bruyère Research Institute, Ottawa, Ontario, Canada. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada. Institute for Work and Health, St. Michael's Hospital, Ottawa, Ontario, Canada. Departments of Occupational Therapy and Medicine and the Clinical Epidemiology and Health Care Research Program, University of Toronto, Toronto, Ontario, Canada. Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada. Division of Pediatric Endocrinology, McMaster University, Hamilton, Ontario, Canada. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ontario, Canada. Centre for Evaluation of Medicines, Programs for Assessment of Technology in Health Research Institute, McMaster University, Hamilton, Ontario, Canada. AN - 30518592 AU - Sanger, N. AU - Shahid, H. AU - Dennis, B. B. AU - Hudson, J. AU - Marsh, D. AU - Sanger, S. AU - Worster, A. AU - Teed, R. AU - Rieb, L. AU - Tugwell, P. AU - Hutton, B. AU - Shea, B. AU - Beaton, D. AU - Corace, K. AU - Rice, D. AU - Maxwell, L. AU - Samaan, M. C. AU - de Souza, R. J. AU - Thabane, L. AU - Samaan, Z. C2 - Pmc6286642 DA - Dec 4 DO - 10.1136/bmjopen-2018-025059 DP - NLM ET - 2018/12/07 J2 - BMJ open KW - Age Factors Analgesics, Opioid/adverse effects Humans Meta-Analysis as Topic Opiate Substitution Treatment/methods/*standards Opioid-Related Disorders/*drug therapy Patient Reported Outcome Measures Sex Factors Systematic Reviews as Topic Treatment Outcome *medication-assisted treatment *opioid use disorder *patient-centred *protocol *systematic review LA - eng M1 - 12 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 2044-6055 SP - e025059 ST - Identifying patient-important outcomes in medication-assisted treatment for opioid use disorder patients: a systematic review protocol T2 - BMJ Open TI - Identifying patient-important outcomes in medication-assisted treatment for opioid use disorder patients: a systematic review protocol VL - 8 ID - 930904 ER - TY - JOUR AB - BACKGROUND: Neurocognitive dysfunction with buprenorphine has mixed evidence, with many confounding factors. We compared the neurocognitive functions in patients with opioid dependence on buprenorphine maintenance (Index Group; IG) with those on naltrexone (NG), opioid-dependent in early detoxification (OD), and healthy control (CG). MATERIALS & METHODS: The four groups were matched for age, sex, and years of education. Except for the healthy control group (CG; n = 30), the two other comparison groups had twenty participants each. Subjects with other substance use disorders, HIV infection, head injury, epilepsy, and severe mental illness were excluded. Cognitive tests consisted of Trail Making Tests (TMT-A & B), Digit Vigilance test (DVT), verbal and visual N-Back Test (NBT), Rey's Auditory Verbal Learning Test (RAVLT), Wisconsin Card Sorting Test (WCST), Controlled Oral Word Association Test (COWA), and Wechsler Adult Intelligence Scale (WAIS). RESULTS: IG performed significantly worse in TMT-B, DVT, verbal NBT, and WCST (non-perseverative error) than CG. When IQ was controlled for, significance persisted in TMT-B, a marker of poor cognitive flexibility. The OD showed significantly poorer performance than NG and CG in the TMT-A & B, visual and verbal NBT, DVT, and RAVLT. When compared to the IG, the performance of the OD was significantly poor in the TMT-A & B. IG performed worse than NG in TMT-B, and NG performed poorer (than CG) in RAVLT. CONCLUSION: Patients on medication-assisted treatment had significant cognitive impairment limited to fewer cognitive domains, however, the extent and severity were highest in the group with active opioid dependence. AD - Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: dr.rajoosaroj@yahoo.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ghoshabhishek12@gmail.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: drsubodhbn2002@gmail.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ritu_nehra@rediffmail.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: mahintamani@gmail.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: drdevenderrana@gmail.com. Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: db_sm2002@yahoo.com. AN - 32526693 AU - Saroj, R. AU - Ghosh, A. AU - Subodh, B. N. AU - Nehra, R. AU - Mahintamani, T. AU - Rana, D. K. AU - Basu, D. DA - Oct DO - 10.1016/j.ajp.2020.102181 DP - NLM ET - 2020/06/12 J2 - Asian journal of psychiatry KW - Buprenorphine Cognitive dysfunction Naltrexone Opioid dependence LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1876-2018 SP - 102181 ST - Neurocognitive functions in patients on buprenorphine maintenance for opioid dependence: A comparative study with three matched control groups T2 - Asian J Psychiatr TI - Neurocognitive functions in patients on buprenorphine maintenance for opioid dependence: A comparative study with three matched control groups VL - 53 ID - 930955 ER - TY - JOUR AB - BACKGROUND AND AIMS: Extended-release naltrexone (XR-NTX), a μ-opioid receptor antagonist for prevention of relapse to opioid dependence, has demonstrated efficacy compared with placebo and comparative effectiveness with buprenorphine-naloxone. We report outcomes for XR-NTX in Vivitrol's Cost and Treatment Outcomes Registry. DESIGN: Observational, open-label, single-arm, multi-center registry assessing baseline characteristics and clinical and health-related quality-of-life outcomes associated with XR-NTX treatment in clinical practice. SETTING: 32 US treatment centers from 2011 to 2013. PARTICIPANTS: Patients with opioid dependence who were prescribed XR-NTX treatment and then enrolled into the registry. MEASUREMENTS: Monthly visits were evaluated for the full population and for patient ubgroups retrospectively, defined by injection number, focusing on the period between baseline and month 6 (1-, 2/3- or 6-XR-NTX). FINDINGS: Of 403 enrolled patients, 395 were analyzed. Most patients (n = 349) received out-patient care. On average, patients received five injections (median = 3; range = 1-25). The median number of injections administered within 6 months was higher in patients who at baseline were employed (three versus two unemployed, P = 0.02) or had private insurance (five versus two self-payment, P = 0.005; versus two state-funded, P < 0.001). The 1-, 2/3- and 6-XR-NTX groups had 132, 152 and 111 patients, respectively. At baseline, the 6-XR-NTX patients were more likely to meet normal/minimal mental illness criteria and attend school and less likely to report recent drug use. Within 6 months, the 6-XR-NTX group demonstrated improvements in employment, mental health and psychosocial functioning, and decreases in opioid craving, drug use and drug-related behavior. CONCLUSIONS: Among opioid-dependent people receiving XR-NTX treatment, better mental health, higher education and lower recent drug use at baseline are associated with greater treatment duration; in turn, longer treatment duration is associated with lower relapse rates and improved outcomes generally. AD - Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, USA. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Alkermes, Inc., Waltham, MA, USA. Columbia University, New York, NY, USA. Friends Research Institute, Inc., Baltimore, MD, USA. AN - 29493836 AU - Saxon, A. J. AU - Akerman, S. C. AU - Liu, C. C. AU - Sullivan, M. A. AU - Silverman, B. L. AU - Vocci, F. J. DA - Aug DO - 10.1111/add.14199 DP - NLM ET - 2018/03/02 J2 - Addiction (Abingdon, England) KW - Adolescent Adult *Craving Educational Status *Employment Female Humans Male *Mental Health Middle Aged Naltrexone/*therapeutic use Narcotic Antagonists/*therapeutic use Opioid-Related Disorders/*drug therapy Registries Time Factors Treatment Outcome United States Young Adult *Extended-release naltrexone *Vivitrol *medication assisted treatment *opioid dependence *opioid use disorder *registry LA - eng M1 - 8 N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0965-2140 SP - 1477-1487 ST - Extended-release naltrexone (XR-NTX) for opioid use disorder in clinical practice: Vivitrol's Cost and Treatment Outcomes Registry T2 - Addiction TI - Extended-release naltrexone (XR-NTX) for opioid use disorder in clinical practice: Vivitrol's Cost and Treatment Outcomes Registry VL - 113 ID - 930866 ER - TY - JOUR AB - OBJECTIVE: To assess whether per capita buprenorphine distribution varies by regional racial/ethnic composition, Medicaid expansion status, and time period. METHODS: Our unit of analysis -- three-digit ZIP codes ("ZIP3s") -- was classified into quintiles based on percentage of White residents. A weighted linear regression model of buprenorphine distribution -- including White resident quintile, waivered prescriber rate, overdose rate, sociodemographic factors, and year fixed effects -- was estimated using national buprenorphine distribution data from 2007 to 2017. We report predictive margins of the buprenorphine distribution rate by quintile, as well as average marginal effects of waivered prescriber rate on buprenorphine distribution rate for each quintile. Analyses were stratified by Medicaid expansion status and time period (2007-2010, 2011-2014, 2015-2017). RESULTS: Buprenorphine distribution increased nationally during 2007-2017, yet growth was disproportionately greater for ZIP3s with higher percentages of White residents. Medicaid expansion states exhibited significant differences in buprenorphine distribution across ZIP3 quintiles during 2007-2010, the magnitude of which increased across time periods. Non-expansion states exhibited significant quintile differences during 2011-2014 and 2015-2017. The average marginal effect of increasing the waivered prescriber rate on the distribution rate was consistently smaller in ZIP3s with lower percentages of White residents, particularly in expansion states. CONCLUSIONS: We find ecological evidence consistent with racial/ethnic disparities in buprenorphine distribution. Our finding that increasing the waivered prescriber rate had differential effects by ZIP3 racial/ethnic composition suggest that broad initiatives to increase the number of waivered prescribers are likely insufficient to achieve equitable buprenorphine access. Rather, targeted and tailored policy efforts are warranted. AD - RAND Corporation, 20 Park Plaza #920, Boston, MA, 02216, USA. Electronic address: mschuler@rand.org. RAND Corporation, 20 Park Plaza #920, Boston, MA, 02216, USA. RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA. AN - 33873027 AU - Schuler, M. S. AU - Dick, A. W. AU - Stein, B. D. DA - Apr 20 DO - 10.1016/j.drugalcdep.2021.108710 DP - NLM ET - 2021/04/20 J2 - Drug and alcohol dependence KW - Buprenorphine Opioid use disorder Racial/ethnic disparities Treatment LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0376-8716 SP - 108710 ST - Growing racial/ethnic disparities in buprenorphine distribution in the United States, 2007-2017 T2 - Drug Alcohol Depend TI - Growing racial/ethnic disparities in buprenorphine distribution in the United States, 2007-2017 VL - 223 ID - 931031 ER - TY - JOUR AB - OBJECTIVE: To explore how state legislatures and departments of health are responding to the public health and economic issues of increases in opioid use disorder and the impact on pregnant women and infants. DESIGN: The design was a non-experimental descriptive study using a mixed methods survey research approach. SETTING: Electronic and telephone survey of individuals from state departments of health associated with departments of behavioral health and substance use, or child and family services. PARTICIPANTS: Fifty-two respondents employed by individual state departments of health and child and family services. METHODS: Univariate analysis and frequency distribution of ordinal variables was completed. Thematic analysis was used to analyze free text questions and identify themes. RESULTS: All states reported recent changes or plans to address the problem of opioid misuse in their state. Many respondents feel their state continues to lack adequate services for treatment. Some states are exploring unique methods for addressing this in a safe and timely fashion, such as moving medication-assisted treatment to primary care and expanding licensure to Primary Care Physicians (PCPs) and nurse practitioners. CONCLUSIONS: Our findings demonstrate an increased commitment throughout the United States to enhance access to clinically appropriate treatment of substance use disorder particularly during pregnancy, consider unique methods for addressing the problem of opioid dependency, and increase education and primary prevention programs. AD - Indiana University School of Nursing, Neonatal Nurse Practitioner, Commonwealth Neonatology, 4428 Old Fox Trail, Richmond, VA 23112, United States of America. Electronic address: Lascott1@iu.edu. Fairbanks School of Public Health, Health Policy and Management, Indiana University at Indianapolis, 1050 Wishard Blvd RG 5128, Indianapolis, IN 46202, United States of America. Electronic address: cylstone@iu.edu. Richard M. Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd RG 6066, Indianapolis, IN 46202, United States of America. Electronic address: jduwve@iu.edu. AN - 31711589 AU - Scott, L. F. AU - Stone, C. AU - Duwve, J. DA - Oct DO - 10.1016/j.apnu.2019.04.002 DP - NLM ET - 2019/11/13 J2 - Archives of psychiatric nursing KW - Adult Analgesics, Opioid/*adverse effects Family Therapy Female Health Personnel/statistics & numerical data *Health Policy Humans Infant, Newborn Interviews as Topic *Maternal-Child Health Services *Opioid-Related Disorders/therapy Pregnancy Pregnancy Complications Primary Health Care *Public Health State Health Plans United States *Maternal opioid use *Neonatal abstinence syndrome *Opioid use disorder LA - eng M1 - 5 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0883-9417 SP - 22-30 ST - Policy perceptions of US state public health and child and family services regarding maternal opioid use and neonatal exposure T2 - Arch Psychiatr Nurs TI - Policy perceptions of US state public health and child and family services regarding maternal opioid use and neonatal exposure VL - 33 ID - 930870 ER - TY - JOUR AB - BACKGROUND: Musculoskeletal (MSK) pain is common in people living with HIV (PLWH). Health care providers sometimes prescribe opioids to control pain, which may lead to opioid misuse. An interdisciplinary approach that includes physical therapy has been successful in managing MSK pain in various health care settings. Therefore, we sought to find the impact of recruiting a physical therapist (PT) on the number of opioid prescriptions and physical therapy referrals made by physicians in training to manage MSK pain in PLWH. METHODS: We performed a retrospective chart review of patients seen by Internal Medicine physicians in training in an HIV clinic in Detroit before (2017) and after (2018) recruiting a PT to the health care team and collected demographic and clinical data. We also surveyed the trainees to assess how the PT addition influenced their learning. Institutional review board waiver was obtained. RESULTS: Results showed that of all PLWH seen at the clinic, 28/249 (11%) and 37/178 (21%) had chronic MSK pain in the 2017 and 2018 data sets, respectively. In 2017, all 28 patients with MSK pain were prescribed opioids. This decreased in 2018 after the PT addition (10/37 patients; P < .0001). The number of physical therapy referrals significantly increased after the PT addition (2017: 5/28 patients; 2018: 17/37 patients; P = .03). Trainees felt that the PT helped improve their examination skills and develop a treatment plan for patients. CONCLUSIONS: The addition of a PT encouraged physicians in training to utilize nonopioid management of MSK pain in PLWH and enhanced their learning experience, as perceived by the trainees. AD - Wayne State University School of Medicine, Detroit, Michigan, USA. Wayne State University, Detroit, Michigan, USA. AN - 33728359 AU - Sebanayagam, V. AU - Chakur, N. AU - Baffoe, N. A. AU - Reed, B. AU - Weinberger, J. AU - Twardy, B. S. AU - Veltman, J. C2 - Pmc7944341 DA - Mar DO - 10.1093/ofid/ofab047 DP - NLM ET - 2021/03/18 J2 - Open forum infectious diseases KW - Hiv musculoskeletal pain opioid abuse physical therapy LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 2328-8957 (Print) 2328-8957 SP - ofab047 ST - Adding a Physical Therapist to the Health Care Team in an HIV Clinic Increases Physical Therapy Referrals and Reduces Opioid Prescriptions Provided for Chronic Musculoskeletal Pain in Patients Living With HIV T2 - Open Forum Infect Dis TI - Adding a Physical Therapist to the Health Care Team in an HIV Clinic Increases Physical Therapy Referrals and Reduces Opioid Prescriptions Provided for Chronic Musculoskeletal Pain in Patients Living With HIV VL - 8 ID - 931033 ER - TY - JOUR AB - Background. Musculoskeletal (MSK) pain is common in HIV patients in the ambulatory setting. Healthcare providers tend to prescribe opioids to control MSK pain in HIV patients, which increases the risk of opioid misuse. An interdisciplinary approach that includes physical therapy has been successful in managing MSK pain in various healthcare settings. Therefore, we sought to find the impact of recruiting a physical therapist (PT), on the number of opioid prescriptions and physical therapy referrals made by resident physicians to manage MSK pain in HIV patients. Methods. We performed a retrospective chart review of all patients seen by Internal Medicine (IM) residents in an HIV clinic in Detroit, before (01/17-05/17; 2017 dataset) and after (01/18-05/18; 2018 dataset) recruiting a physical therapist to the healthcare team. We collected demographic and clinical data from both datasets. We also surveyed the residents to assess how the PT addition influenced their comfort and knowledge in treating MSK pain in HIV patients. IRB waiver was obtained. Results. Results showed that of all HIV patients seen at the clinic, 28/249 (11%) and 37/178 (21%) had chronic MSK pain in the 2017 and 2018 datasets, respectively. In 2017, all 28 patients with MSK pain were prescribed opioids. This number significantly decreased in 2018 after the PT addition (10/37 patients; p< 0.0001). Moreover, the number of physical therapy referrals made by residents significantly increased after the PT addition (2017: 5/28 patients; 2018: 17/37 patients; p=0.03). Residents also recommended non-opioid interventions including orthopedics referrals (7/37 patients), braces/orthotics (3/37 patients) and non-opioid analgesics (26/37 patients) to patients after the PT addition. Survey responses showed that 7/9 residents (78%) felt that the physical therapist was helpful in improving their examination skills or developing a treatment plan for patients. The effect of recruiting a physical therapist on the number of opioid prescriptions and physical therapy referrals made by resident physicians Conclusion. In conclusion, our results show that the addition of a physical therapist to the team encourages physicians to utilize non-opioid management of MSK pain in HIV patients. We also find that physicians are satisfied with taking an interdisciplinary approach to pain management in HIV patients. AD - V. Sebanayagam, Wayne State University, School of Medicine, Detroit, MI, United States AU - Sebanayagam, V. AU - Chakur, N. AU - Weinberger, J. AU - Twardy, B. S. AU - Veltman, J. DB - Embase DO - 10.1093/ofid/ofaa439.1210 KW - opiate adult analgesia brace clinical article comfort conference abstract controlled study demography drug therapy female human Human immunodeficiency virus infected patient internal medicine male medical record review musculoskeletal pain orthotics physiotherapist physiotherapy prescription resident retrospective study skill LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 2328-8957 SP - S541 ST - Impact of physical therapy in the management of musculoskeletal pain in HIV patients T2 - Open Forum Infectious Diseases TI - Impact of physical therapy in the management of musculoskeletal pain in HIV patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L634731956&from=export http://dx.doi.org/10.1093/ofid/ofaa439.1210 VL - 7 ID - 931066 ER - TY - JOUR AB - STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Many primary care clinicians lack confidence and/or experience in substance use management, leading to significant stress, frustration, and burnout. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): In 2015, the Clinician Consultation Center (CCC) and Bureau of Primary Health Care launched a Substance Use Warmline (SUW), 855-300-3595, to increase access to timely, evidence-informed addiction medicine consultation for community health providers. The SUWaims to increase provider knowledge and skill through the delivery of tailored, expert clinical decision-support. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E. G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): A multidisciplinary team of expert nurses, Addiction Medicine-certified physicians, and clinical pharmacists provides free, on-demand telephone consultation for clinicians. The SUW offers advice on all aspects of substance use evaluation and management, including complex patients with cooccurring chronic pain, behavioral health issues, HIV, and other chronic conditions. The team logs case details in the CCC's secure standardized database. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/INTERVENTION): Callers are emailed a 5-item Likert survey after each consultation to assess satisfaction with the service. Respondents also have an option to submit free-text comments. The SUW also monitors monthly call volume and repeat callers. FINDINGS TO DATE (IT IS NOT SUFFICIENT TOSTATE FINDINGS WILL BE DISCUSSED): 63.7% of calls over the first year were from MDs/ DOs, and the number of calls increased by an average of 28% per month. >25% were internists and 30% of physician callers had DATA2000 waivers to prescribe buprenorphine. Prescription opioids were discussed in 64.2% of cases, followed by stimulants (31.1%), alcohol (28.3%), non-prescription opioids (17.9%), sedative/hypnotics (13.2%), and other substances (13.2%). 43.4% of cases involved polysubstance use. Consultants discussed a broad range of clinical topics: SUD screening and diagnosis, MAT options, opioid safety/dosing/tapering, urine toxicology use, behavioral interventions for SUD, and withdrawal management. Almost 60% of cases involved documented psychiatric co-morbidities, and over a third involved patients with chronic pain. Callers consistently rated the SUW highly: the vast majority indicated questions were answered thoroughly with useful, up to date information. All survey respondents said they would both utilize the SUW again and recommend it to colleagues. One caller noted: “This was a great resource. I was atmy wits' end trying different techniques and getting nowhere. I felt supported and I received new information to use.” Almost a third of all callers contacted the SUW more than once. KEYLESSONS FORDISSEMINATION(WHATCAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): The SUW appears to be a useful tool for primary care practitioners who have called to request on-demand, telephone-based substance use consultation. Early results suggest this service may help reduce or prevent burnout among providers managing complex patients who use drugs and/or are prescribed high-doses of opioids. AD - R. Sedillo, University of California-San Francisco, San Francisco, CA, United States AU - Sedillo, R. AU - Chu, C. AU - Gasper, J. AU - Lutes, E. AU - Smith, B. R. AU - Tulsky, J. P. AU - Steiger, S. DB - Embase KW - alcohol buprenorphine hypnotic agent opiate sedative agent addiction burnout chronic pain clinical study clinical trial comorbidity controlled study data base decision support system diagnosis doctor patient relationship drug megadose drug therapy drug withdrawal expert nurse frustration general practitioner human Human immunodeficiency virus human tissue internist nonhuman outpatient pharmacist prescription prevention public health quantitative study safety satisfaction screening skill substance use teleconsultation toxicology urine LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2017 SN - 0884-8734 SP - S802-S803 ST - The substance use warm line: A new resource for primary care T2 - Journal of General Internal Medicine TI - The substance use warm line: A new resource for primary care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615581968&from=export VL - 32 ID - 931171 ER - TY - JOUR AB - Physicians who want to prescribe buprenorphine to treat opioid use disorder require a waiver established by the Drug Addiction Treatment Act (DATA) of 2000, often through completion of an eight-hour training course. This is an issue for a number of reasons, including that opioid overdose deaths continue to rise nationally. However, on October 24, 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act was signed into law. This bill allows any physician who graduates in good standing from an allopathic or osteopathic medical school in the United States that incorporates necessary material around opioid misuse in their standard curriculum, without need for any additional training, to prescribe buprenorphine. This perspective piece describes why this is an important first step and what more needs to be done within medical education to combat the opioid epidemic. AD - The Warren Alpert Medical School of Brown University , Providence, RI, USA. Division of Public Health Preparedness, Arizona Department of Health Services , Phoenix, AZ, USA. Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA. Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, RI, USA. AN - 31447600 AU - Shapiro, A. AU - Villarroel, L. R. AU - George, P. C2 - Pmc6683946 DO - 10.2147/amep.s205946 DP - NLM ET - 2019/08/27 J2 - Advances in medical education and practice KW - buprenorphine waiver medical education opioid use disorder Foundation in support of this work. The authors report no other conflicts of interest in this work.  LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1179-7258 (Print) 1179-7258 SP - 581-583 ST - A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools T2 - Adv Med Educ Pract TI - A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools VL - 10 ID - 930928 ER - TY - JOUR AB - The 2017 declaration of the opioid overdose epidemic as a public health emergency in the United States enhanced a national focus on effective and sustainable treatments for opioid use disorder (OUD), including multiple options utilizing medication. Despite clinical studies demonstrating efficacy, numerous reports suggest that medication for opioid use disorder (MOUD) has been underutilized, leaving many questions about specific barriers and facilitators. This study examines factors impacting attitudes and perspectives related to MOUD that influence its utilization and acceptance in a state where support for harm reduction and treatment policy has been limited. With consideration for the contextual cultural factors of this region, we conducted twelve individual interviews with people seeking treatment for OUD at a detoxification facility in Tampa, Florida. This study called attention to the perspectives of patients regarding their unique self-identified needs and beliefs around MOUD as it relates to their addiction treatment. We evaluated the perspectives collected in the interviews (N = 12) based on three main themes: 1) positive perceptions of MOUD; 2) negative perceptions of MOUD; and 3) overall perceptions of treatment and recovery. Findings suggest that participants' varying levels of positive and negative perspectives about MOUD are informed by nuances in their social networks and varying levels of exposure or education. For example, participants held more negative opinions of MOUD than positive, accounting mostly for a view that it serves as a direct substitute for illicit opioids rather than a sustainable or supportive solution addressing the underlying causes of addiction. These opinions may be largely dependent on geographic location that dictates policy, practice, funding, and, in turn, cultural acceptance of MOUD. The findings in this qualitative study may help to inform future education efforts, initiatives addressing patient-level concerns, and provide decision-makers with meaningful information to tailor programmatic policy and procedures specific to local area social inputs and resource exposure. AD - University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States. Electronic address: amandasharp@health.usf.edu. University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States. Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA 02115, United States. AN - 33612190 AU - Sharp, A. AU - Carlson, M. AU - Howell, V. AU - Moore, K. AU - Schuman-Olivier, Z. DA - Apr DO - 10.1016/j.jsat.2020.108247 DP - NLM ET - 2021/02/23 J2 - Journal of substance abuse treatment KW - Detoxification Medication for opioid use disorder (MOUD) Medication-assisted treatment (MAT) Opioid use disorder Patient perspectives LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0740-5472 SP - 108247 ST - Letting the sun shine on patient voices: Perspectives about medications for opioid use disorder in Florida T2 - J Subst Abuse Treat TI - Letting the sun shine on patient voices: Perspectives about medications for opioid use disorder in Florida VL - 123 ID - 930956 ER - TY - JOUR AB - Study Objectives: COVID-19 has created numerous challenges for the United States’ health care system. Restrictions on in-person gatherings have impacted access to care for patients with opioid use disorder (OUD) by making it more difficult for clinicians to learn about evidence-based prescribing practices. Many educational conferences, previously delivered in-person, have moved to remote formats but national training sessions are not always filled. While virtual conferences have been described in other academic settings, there have been no interactive, virtually delivered, real-time, large scale courses offering a Drug Enforcement Administration (DEA) Buprenorphine Waiver. This paper describes a nationwide, digitally delivered, interactive DEA X-Waiver educational conference and provides guidance to Emergency Medicine organizations seeking to increase attendance at and engagement in remote courses. Aim 1: Describe the implementation of the Get Waivered Remote Course. Aim 2: Use the RE-AIM framework to evaluate our program outcomes. Aim 3: Suggest potential opportunities for future improvement. Methods: Our team delivered a virtual educational course to allow clinician participants to obtain their DEA-X-waiver. Using a novel approach, we aimed to offset the additional barriers COVID-19 has created for clinicians to assess evidence-based practices to treat patients with Opioid Use Disorder (OUD). Our previous work has identified behavioral patterns that were found to act as barriers and restrict the number of clinicians who completed the “X” waiver process. Physicians, residents, nurse practitioners and physician assistants, including those in training, were eligible for the course. The didactics were delivered via the Zoom platform on May 20, 2020 from 10 AM to 6 PM Eastern Standard Time. Utilizing the RE-AIM model we evaluated our training session’s outcomes in terms of course enrollment, delivery, reception, and overall efficacy. Results: The DEA-X waiver course had 1,179 people enrolled, of which 799 attendees remained in the course for the necessary time to qualify for the X waiver. 814 attendees completed the pre-survey and 103 completed the post-survey. The majority of students (59.5%) heard about this course through emails sent out via medical association newsletters. Most (52.4%) participants chose to enroll due to the Zoom webinar format making this training more convenient than other options. Participants indicated that the largest barriers to receiving their waivers previously had been the time and hassle (44.7%) and lack of knowledge about the process (29%). The course was well-received, with 92.2% of attendees rating it as neutral or better compared to in-person classes and 94.2% indicating that they would recommend the course to a friend (measured by 6 or higher on a scale of 10). Prior to taking the course, 65% participants said they were at least somewhat familiar with the practice of opioid dependency treatment with approved buprenorphine medications, after the course, 98% of participants were at least somewhat familiar. Conclusion: Results show that moving to a ZoomTM webinar training format in response to COVID-19 increased the number of waivered physicians by providing a convenient, hassle-free waiver course option. This indicates that completion of non-mandatory training courses, including future DEA X-waiver courses, can be improved through the use of remote educational technologies. AU - Shayer, D. AU - Raber, J. P. AU - He, S. AU - Raja, A. AU - Martin, A. DB - Embase DO - 10.1016/j.annemergmed.2020.09.201 KW - buprenorphine opiate adult conference abstract controlled study coronavirus disease 2019 drug therapy e-mail educational technology emergency medicine friend government human nurse practitioner opiate addiction organization outcome assessment physician assistant resident training LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1097-6760 0196-0644 SP - S73 ST - 189 Get Waivered Remote: A Nationwide, Remote, and Interactive Educational Conference Designed in Response to COVID-19 T2 - Annals of Emergency Medicine TI - 189 Get Waivered Remote: A Nationwide, Remote, and Interactive Educational Conference Designed in Response to COVID-19 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008409745&from=export http://dx.doi.org/10.1016/j.annemergmed.2020.09.201 VL - 76 ID - 931057 ER - TY - JOUR AB - Medication treatment for opioid use disorder (M-OUD) is underutilized, despite research demonstrating its effectiveness in treating opioid use disorder (OUD). The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) project was designed to evaluate interventions for reducing barriers to delivery of M-OUD by rural primary care providers in North Carolina. A key element was tele-conferenced sessions based on the University of New Mexico Project ECHO model, comprised of case discussions and didactic presentations using a "hub and spoke" model, with expert team members at the hub site and community-based providers participating from their offices (i.e., spoke sites). Although federal funders have promoted use of the model, barriers for providers to participate in ECHO sessions are not well documented. Methods: UNC ECHO for MAT included ECHO sessions, provider-to-provider consultations, and practice coaching. We conducted 20 semi-structured interviews to assess perceived usefulness of the UNC ECHO for MAT intervention, barriers to participation in the intervention, and persistent barriers to prescribing M-OUD. Results: Participants were generally satisfied with ECHO sessions and provider-to-provider consultations; however, perceived value of practice support was less clear. Primary barriers to participating in ECHO sessions were timing and length of sessions. Participants recommended recording ECHO sessions for viewing later, and some thought incentives for either the practice or provider could facilitate participation. Providers who had participated in ECHO sessions valued the expertise on the expert team; the team's ability to develop a supportive, collegial environment; and the value of a community of providers interested in learning from each other, particularly through case discussions. Conclusions: Despite the perceived value of ECHO, barriers may prevent consistent participation. Also, barriers to M-OUD delivery remain, including some that ECHO alone cannot address, such as Medicaid and private-insurer policies and availability of psychosocial resources. AD - University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. AN - 31809679 AU - Shea, C. M. AU - Gertner, A. K. AU - Green, S. L. C2 - Pmc7274853 C6 - Nihms1546376 DO - 10.1080/08897077.2019.1694617 DP - NLM ET - 2019/12/07 J2 - Substance abuse KW - Echo Primary health care implementation barriers medication assisted treatment opioid use disorder LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 0889-7077 (Print) 0889-7077 SP - 54-64 ST - Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: A qualitative study T2 - Subst Abus TI - Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: A qualitative study VL - 42 ID - 930910 ER - TY - JOUR AB - OBJECTIVE: To determine internal medicine (IM) residents' knowledge of, attitudes towards, and barriers to prescribing buprenorphine for opioid use disorder (OUD). METHODS: We conducted a cross-sectional study of IM residents across all 35 Accreditation Council for Graduate Medical Education (ACGME) accredited Florida IM residency programs. We used an online survey to collect information about resident demographics, substance use curriculums, career interests, content knowledge about diagnosing and managing OUD, and attitudes about and barriers to prescribing buprenorphine for OUD. We used Chi-square test to explore differences in interest in prescribing buprenorphine. We created a composite knowledge score and investigated distribution of knowledge among characteristics via Mann-Whitney U test. RESULTS: There were 161 participants (response rate 16.0%, n = 1008) across 35 programs Seventy-seven percent of residents provided care for patients with OUD more than once per month. Seventy-four percent report no buprenorphine prescribing training. Higher knowledge scores, interest in primary care, being an intern, and caring for patients with OUD more than monthly were associated with interest in obtaining a buprenorphine waiver (P < 0.05). Limited knowledge about OUD was the most important barrier to prescribing buprenorphine. Eighty-nine percent support legislation to deregulate buprenorphine. CONCLUSIONS: Knowledge about managing OUD was poor and represented the most commonly cited barrier to prescribing buprenorphine. Residents want to expand their role in treating OUD. Our findings warrant incorporating addiction medicine into residency curriculum standards. Legislation removing the buprenorphine waiver requirement may increase the number of resident buprenorphine prescribers and improve treatment options for patients with opioid addiction. AD - Department of Internal Medicine, University of South Florida, 17 Davis Blvd, Suite 308, Tampa, FL 33606 (BS, DL, CB, RM, AO); Department of Internal Medicine, Mount Sinai Medical Center, Miami, 4300 Alton Road, Miami Beach, FL 33140 (IU); Department of Internal Medicine, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827 (SB, MQ). AN - 33079729 AU - Shuey, B. AU - Lee, D. AU - Ugalde, I. AU - Borgan, S. AU - Bresnan, C. AU - Qureshi, M. AU - Mhaskar, R. AU - Oxner, A. DA - Oct 19 DO - 10.1097/adm.0000000000000750 DP - NLM ET - 2020/10/21 J2 - Journal of addiction medicine LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 1932-0620 ST - Evaluation of Resident Physicians' Knowledge Of and Attitudes Towards Prescribing Buprenorphine for Patients with Opioid Use Disorder T2 - J Addict Med TI - Evaluation of Resident Physicians' Knowledge Of and Attitudes Towards Prescribing Buprenorphine for Patients with Opioid Use Disorder ID - 930913 ER - TY - JOUR AB - The current opioid crisis in Alaska and the USA will negatively affect the health and wellbeing of future generations. The increasing number of infants born with neonatal opioid withdrawal syndrome (NOWS) has had a profound impact on families, health care providers and the child welfare system. This manuscript summarises the main themes of a Symposium held in Anchorage, Alaska with health care providers, researchers, elders and public health officials that focused on identifying emerging challenges, trends and potential solutions to address the increasing number of infants and children affected by maternal opioid use. Five areas of importance for research and policy development that would direct improvement in the care of infants with NOWS in Alaska are outlined with the goal of supporting a research agenda on opioid misuse and child health across the circumpolar north. Abbreviations: NOWS - neonatal opioid withdrawal syndrome; NAS - neonatal abstinence syndrome; MAT - medication-assisted treatment; NICU - neonatal intensive care unit; OATs - opioid agonist treatments; OCS - office of children's services; ANTHC - Alaska Native Tribal Health Consortium; OUD - opioid use disorder; SBIRT - screening, brief intervention and referral to treatment; ISPCTN - IDeA States Pediatric Clinical Trials Network; NIH - National Institutes of Health; ANMC - Alaska Native Medical Center; DHSS - Department of Health and Social Services; AAPP - All Alaska Pediatric Partnership. AD - a Alaska Native Tribal Health Consortium , Anchorage , AK , USA. b British Columbia Centre for Disease Control , Vancouver , Canada. c Southcentral Foundation , Anchorage , AK , USA. d Fairbanks Memorial Hospital , Fairbanks , AK , USA. e Division of Public Health , Department of Health and Social Services, State of Alaska , Anchorage , AK , USA. f Alaska Neonatology Associates. AN - 31020919 AU - Singleton, R. AU - Slaunwhite, A. AU - Herrick, M. AU - Hirschfeld, M. AU - Brunner, L. AU - Hallas, C. AU - Truit, S. AU - Hanson, S. AU - Young, M. AU - Rider, E. C2 - Pmc6493296 DA - Dec DO - 10.1080/22423982.2019.1599275 DP - NLM ET - 2019/04/26 J2 - International journal of circumpolar health KW - Alaska Analgesics, Opioid/*toxicity Attitude of Health Personnel *Biomedical Research Female Humans Inservice Training/organization & administration Mass Screening/organization & administration Neonatal Abstinence Syndrome/*ethnology/prevention & control/therapy Opioid-Related Disorders/*ethnology/prevention & control *Policy Pregnancy Pregnancy Complications Prenatal Exposure Delayed Effects/*ethnology/prevention & control/therapy *Opioids *maternal health *neonatal *neonatal abstinence syndrome *substance abuse LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 1239-9736 (Print) 1239-9736 SP - 1599275 ST - Research and policy priorities for addressing prenatal exposure to opioids in Alaska T2 - Int J Circumpolar Health TI - Research and policy priorities for addressing prenatal exposure to opioids in Alaska VL - 78 ID - 930838 ER - TY - JOUR AB - OBJECTIVE: Guidelines for treatment of opioid use disorder stipulate for mental health assessment and the option for treatment alongside medication for opioid use disorder (MOUD). Yet efforts to expand MOUD treatment capacity have focused on expanding the workforce of buprenorphine providers. This article aims to describe the processes facilitating and impeding integrated care for rural patients with co-occurring opioid use disorder and mental health conditions. METHODS: Qualitative interviews were conducted with primary care and specialty providers (N=26) involved in integrated care through the state's hub-and-spoke system and with system-level stakeholders (N=16) responsible for expanding access to MOUD in rural California. RESULTS: Rural primary care providers struggled to offer adequate mental health resources to patients with co-occurring conditions because of personnel shortages and inadequate availability of telehealth. Efforts to intensify care through referral to county mental health systems and private community providers were thwarted by access barriers. The bifurcated nature of treatment systems resulted in inadequate training in integrated care and the deprioritization of mental health in patient evaluations. CONCLUSIONS: Significant system-level barriers undermine the implementation of integrated MOUD in rural areas, potentially increasing the suffering of residents with co-occurring conditions and intensifying burnout among providers. AD - School of Public Health, University of California, Berkeley (Snell-Rood); School of Public Health, West Virginia University, Morgantown (Pollini); Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico (Willging). AN - 33530734 AU - Snell-Rood, C. AU - Pollini, R. A. AU - Willging, C. DA - Feb 3 DO - 10.1176/appi.ps.202000312 DP - NLM ET - 2021/02/04 J2 - Psychiatric services (Washington, D.C.) KW - Moud Mental illness and alcohol/drug abuse Primary care Rural psychiatric services Service delivery systems Stepped care LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2021 SN - 1075-2730 SP - appips202000312 ST - Barriers to Integrated Medication-Assisted Treatment for Rural Patients With Co-Occurring Disorders: The Gap in Managing Addiction T2 - Psychiatr Serv TI - Barriers to Integrated Medication-Assisted Treatment for Rural Patients With Co-Occurring Disorders: The Gap in Managing Addiction ID - 931010 ER - TY - JOUR AB - Needs and Objectives: Using the Kern model of curriculular devel-opment, we developed a medication assisted treatment (MAT) curriculum within a Primary care Internal Medicine (PCIM) residency clinic to better train our residents. Objectives: 1. To teach PCIM residents to actively care for patients receiving outpatient-based opioid treatment in their continuity clinic 2.To provide Buprenorphine/naloxone waiver training to PCIM residents 3. To Integrate the MAT team (Nurse and Licensed alcohol/drug counselor) into the PCIM ambulatory curriculum 4. To understand the dosing of Buprenorphine/naloxone 5. To review the interpretation of Urine Drug Screening (UDS) results 6. To discuss the language of addiction, recovery and the stigma which occurs in this patient population Setting and Participants: Starting in the 2017-18 academic year, through the framework of experiential learning, PCIM residents assumed care for patients receiving MAT in their clinic. PCIM residents are assigned a cap of 3 patients on buprenorphine/naloxone and serve both as their primary care physician (PCP) and MAT prescriber under the supervision of their waivered faculty preceptor. Interested categorical resdients are also allowed to participate in the curriculum. Description: Thus far, We are providing care for 17 patients in the PCIM resident clinic and are not yet at capacity for more PCIM residents to assume patient care. Each PCIM resident has 1.6 patients. Thus far, three residents have completed the ATP elective. The pre-survey of comfort with providing MAT and post-survey of providing MAT (collected 1-2 weeks after the ATP elective) will be available at the end of this academic year. Preliminary feedback has been that the experience has been positive, rewarding and educational for the residents. Evaluation: To date, post-survey results of PCIM residents completing the ATP elective have shown improved confidence in caring for patients receiving OBOT. One resident commented on the overall experience on the curriculum: “While on the inpatient wards, I was seeing a patient presenting with major complications from their substance use disorders, and I felt uniquely equipped with experiences from my ATP elective to help facilitate connecting these patients with community support, resources, and starting MAT inpatient to help support their recovery at discharge. In three weeks, I started three patients on suboxone inpatient to initiate their outpatient management plan.” Discussion/Reflection/Lessons Learned: The integration of MAT into an ambulatory IM resident clinic has been successful. Our PCIM residents have had increased exposure to providing care for patients receiving MATwith buprenorphine/naloxone in their clinic. The team model of having a MAT RN and LIADC complement care fully integrates care for the patient by having psychosocial issues and outreach more easily achieved than if just the provider alone was managing the patient. By expanding the resident clinic to care for patients receiving OBOT, this has increased access in our community for patients needing OBOT treatment. AD - H.G. Sobel, University of Vermont Medical Center, Burlington, VT, United States AU - Sobel, H. G. AU - Strout, E. H. AU - Greenberg, C. AU - Wahlberg, E. AU - Whitbread, K. AU - Maruti, S. AU - Goedde, M. DB - Embase KW - adenosine triphosphate alcohol buprenorphine plus naloxone opiate adult clinical article comfort complication conference abstract controlled study counselor curriculum drug dependence drug screening drug therapy experiential learning female general practitioner hospital patient human human tissue internal medicine language male nurse outpatient patient care remission resident stigma urine LA - English M1 - 2 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2018 SN - 1525-1497 SP - 733-734 ST - Primary care internal medicine residents are be-hind the wheel: Integration ofa hub and spoke model for office-based opioid therapy (OBOT) into a pri-mary care internal medicine residency curriculum T2 - Journal of General Internal Medicine TI - Primary care internal medicine residents are be-hind the wheel: Integration ofa hub and spoke model for office-based opioid therapy (OBOT) into a pri-mary care internal medicine residency curriculum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622331181&from=export VL - 33 ID - 931160 ER - TY - JOUR AB - Medication for opioid use disorder (MOUD) is an important approach to address the opioid crisis, but rural areas have limited access to MOUD. In 2016, Nurse Practitioners (NPs) and Physician Assistants (PAs) became eligible to prescribe buprenorphine. Local and state stakeholders in Colorado, including clinicians, policymakers, law enforcement, and patient advocates, formed a collaborative to develop legislative policy and programs for the opioid epidemic. A pilot MOUD program was developed in 2017 to increase the number of NPs and PAs providing MOUD and to increase access to MOUD in 2 counties with high opioid overdose rates. A central coordinating site selected 3 clinical agencies through an open call for proposals, with review of applications by nursing faculty experts and a community advisory board. We then monitored the number of waivered providers and patients served in targeted counties. Providers at pilot program sites tracked costs, community-level barriers, facilitators of success via monthly reports. Sites were funded for 18 months. Seven MOUD providers were added in County 1, a 350% increase compared to the prior year, and there are now 8 MOUD providers in County 2 where there were previously none. County 1 increased MOUD services from 99 clients in 2017 to 582 in 2018 and 317 during the first half of 2019. County 2 provided MOUD services for 60 new clients in 2018 and 46 in the first half of 2019. Cognitive-behavioral therapy, family therapy, and other approaches were used to increase patient engagement and days without opioid use. Successes included community outreach, referral networks, and provider education to reduce stigma. Barriers to sustainability included 1) reimbursement, 2) stigma, and 3) coordination with hospitals. Policy efforts, legislation, and academic-community collaboration led to an increase in MOUD providers and patients served in rural counties severely affected by the opioid crisis. AD - University of Colorado College of Nursing, 13120 E. 19(th) Ave., Aurora, CO 80045, USA. Health Solutions Inc., 41 Montebello Rd., Pueblo, CO 81001, USA. Mountain Medical: Road to Recovery, PO Box 773705, Steamboat Springs, CO 80477, USA. Colorado Treatment Services, 511 W. 29th St., Pueblo, CO 91008, USA. University of Colorado College of Nursing, 13120 E. 19(th) Ave., Aurora, CO 80045, USA. Electronic address: paul.cook@cuanschutz.edu. AN - 32527514 AU - Sorrell, T. R. AU - Weber, M. AU - Alvarez, A. AU - Beste, N. AU - Hollins, U. AU - Amura, C. R. AU - Cook, P. F. C2 - Pmc7292886 C6 - Nihms1595199 DA - Jul DO - 10.1016/j.jsat.2020.108027 DP - NLM ET - 2020/06/13 J2 - Journal of substance abuse treatment KW - *Medication-assisted treatment *Nurse practitioner *Opioid *Physician assistant *Policy *Rural LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0740-5472 (Print) 0740-5472 SP - 108027 ST - From policy to practice: Pilot program increases access to medication for opioid use disorder in rural Colorado T2 - J Subst Abuse Treat TI - From policy to practice: Pilot program increases access to medication for opioid use disorder in rural Colorado VL - 114 ID - 930909 ER - TY - JOUR AB - INTRODUCTION: In light of the opioid overdose epidemic in the US and the necessity of developing training to conduct difficult conversations around opioid dependence, three case-based videos were created to demonstrate providers using motivational interviewing (MI) with patients who have opioid use disorder (OUD). These vignettes displayed a primary care provider interacting with a patient seeking opioids. METHODS: Learners-including third-year medical and physician assistant (PA) students, and family medicine residents-viewed three videos set in a family medicine clinic and assessed clinician use of MI when interacting with patients with OUD. The patients were at different levels of acknowledging their need to change their opioid use behaviors and/or pursue treatment. Learners rated each video with an MI rating scale, and a facilitator debriefed strengths, weaknesses, and omissions regarding MI. RESULTS: Medical and PA students, and resident family physicians provided 572 ratings. Analysis of variance of mean percent incorrect was lower in residents than in all groups combined, but failed to reach statistical significance (47% + 12.0 vs 53% + 15.0, p = .43). DISCUSSION: These case-based videos with MI ratings afforded students and residents the opportunity to assess clinician use of MI techniques with patients with OUD. The MI rating scale had clinical significance (residents scored +5 points and had more training) despite lacking statistical significance. These scenarios allowed learners to recognize how to use MI when having a difficult conversation with patients who misuse opioids. We envision individual use or use for group discussion. AD - Professor, Wake Forest School of Medicine, Department of Family & Community Medicine. Assistant Professor, Wake Forest School of Medicine, Departments of PA Studies, Family & Community Medicine. Academic Curriculum Coordinator, Wake Forest School of Medicine, Department of PA Studies. Assistant Professor, Wake Forest School of Medicine, Department of Family & Community Medicine. Instructional Technologist, Northwest Area Health Education Center. AN - 33204836 AU - Spangler, J. G. AU - Shull, C. N. AU - Hildebrandt, C. A. AU - Jones, K. B. AU - Brewer, A. L. AU - Knudson, M. P. AU - Marion, G. S. AU - Kirk, J. K. C2 - Pmc7666834 DA - Nov 12 DO - 10.15766/mep_2374-8265.11012 DP - NLM ET - 2020/11/19 J2 - MedEdPORTAL : the journal of teaching and learning resources KW - *Addiction *Case-Based Learning *Clinical Teaching/Bedside Teaching *Curriculum *Drug Dependence *Medical Learners *Medication Assisted Treatment *Nurse/Nurse Practitioner *Opioid Use Disorder *Opioids *Pharmacist *Physician *Physician Assistant *Problem-Based Learning *Psychologist *Self-Assessment *Substance Abuse/Addiction *Video Review LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 2374-8265 SP - 11012 ST - Opioid Use Disorder and Assessment of Patient Interactions Among Family Medicine Residents, Medical Students, and Physician Assistant Students T2 - MedEdPORTAL TI - Opioid Use Disorder and Assessment of Patient Interactions Among Family Medicine Residents, Medical Students, and Physician Assistant Students VL - 16 ID - 930929 ER - TY - JOUR AB - This study uses SAMHSA data to describe the proportions of nurse practitioners and physician assistants with waivers to prescribe buprenorphine for treating opioid use disorder and associations with state regulations restricting their scope of practice. AD - Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Department of Social and Behavioral Sciences, University of California, San Francisco. Department of Community Health Systems, University of California, San Francisco. AN - 30964519 AU - Spetz, J. AU - Toretsky, C. AU - Chapman, S. AU - Phoenix, B. AU - Tierney, M. C2 - PMC6459110 National Council of State Boards of Nursing during the conduct of the study and personal fees from the Center to Champion Nursing in America (American Association of Retired Persons) and grants from the Robert Wood Johnson Foundation, National Council of State Boards of Nursing, and California Health Care Foundation outside the submitted work. Dr Tierney reported receiving grants from the National Council of State Boards of Nursing’s Center for Regulatory Excellence during the conduct of the study and honoraria from Contemporary Forums, the American Society of Addiction Medicine, Cabezon Group, and the American Psychiatric Nurses Association; grants from the Substance Abuse and Mental Health Services Administration; and honorarium from Johnson & Johnson outside the submitted work. No other disclosures were reported. DA - Apr 9 DO - 10.1001/jama.2019.0834 DP - NLM ET - 2019/04/10 J2 - Jama KW - Buprenorphine/*therapeutic use *Drug Prescriptions/nursing Drug and Narcotic Control *Government Regulation Humans Narcotic Antagonists/*therapeutic use *Nurse Practitioners Opioid-Related Disorders/*drug therapy *Physician Assistants State Government United States United States Substance Abuse and Mental Health Services Administration LA - eng M1 - 14 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0098-7484 (Print) 0098-7484 SP - 1407-1408 ST - Nurse Practitioner and Physician Assistant Waivers to Prescribe Buprenorphine and State Scope of Practice Restrictions T2 - Jama TI - Nurse Practitioner and Physician Assistant Waivers to Prescribe Buprenorphine and State Scope of Practice Restrictions VL - 321 ID - 930859 ER - TY - JOUR AB - BACKGROUND/AIMS: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. DESIGN: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups. SETTING: Oregon. PARTICIPANTS: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014-15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12-month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. MEASUREMENTS: Any opioid-dispensed, chronic (> 90-days) and high-dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. FINDINGS: Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0-42.7%; returning: 49.3%, 95% CI = 48.8-49.7%; continuously: 52.5%, 95% CI = 52.0-53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4-13.1%; returning: 11.9%, 95% CI = 11.5-12.3%, continuously: 15.8%, 95% CI = 15.4-16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4-3.7%; returning: 3.9%, 95% CI = 3.8-4.1%, continuously: 4.7%, 95% CI = 4.5-4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53-0.61; hazard ratio returning: 0.60, 95% CI = 0.56-0.65 (ref: continuously)]. CONCLUSIONS: Residents of Oregon, United States who enrolled or re-enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication-assisted treatment for opioid use disorder. AD - Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA. School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA. OCHIN, Portland, OR, USA. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, USA. AN - 31106483 AU - Springer, R. AU - Marino, M. AU - Bailey, S. R. AU - Angier, H. AU - O'Malley, J. P. AU - Hoopes, M. AU - Lindner, S. AU - DeVoe, J. E. AU - Huguet, N. C2 - Pmc6731997 C6 - Nihms1030969 DA - Oct DO - 10.1111/add.14667 DP - NLM ET - 2019/05/21 J2 - Addiction (Abingdon, England) KW - Adult Analgesics, Opioid/*therapeutic use Cross-Sectional Studies Female Humans Insurance Coverage/legislation & jurisprudence Male Medicaid/*legislation & jurisprudence Middle Aged Opiate Substitution Treatment/*statistics & numerical data Opioid-Related Disorders/*drug therapy Oregon *Patient Protection and Affordable Care Act Practice Patterns, Physicians'/*statistics & numerical data Prevalence United States *Affordable care act *Medicaid *medication-assisted treatment *opioid epidemic *opioid use disorder *prescribed opioid use LA - eng M1 - 10 N1 - PubMed NLM literature search May 7, 2021 PY - 2019 SN - 0965-2140 (Print) 0965-2140 SP - 1775-1784 ST - Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon T2 - Addiction TI - Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon VL - 114 ID - 930835 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: As the opioid crisis worsens across the United States, the factors that impact physician training in management of substance use disorders become more relevant. A thorough understanding of these factors is necessary for family medicine residency programs to inform their own residency curricula. The objective of our study was to identify factors that correlate with increased residency training in addiction medicine across a broad sample of family medicine residencies. METHODS: We performed secondary analysis of a national family medicine residency program director survey conducted in 2015-2016 (CERA Survey PD8). We obtained data from the Council of Academic Family Medicine Educational Research Alliance (CERA) Data Clearinghouse. We analyzed residency clinic site designation as a patient-centered medical home (PCMH), federally-qualified health center (FQHC), or both, for their correlation with faculty member possession of DEA-X buprenorphine waiver license, as well as required residency curriculum in addiction medicine. RESULTS: Residency programs situated in an FQHC were more likely to have faculty members who possessed DEA-X buprenorphine waiver licenses (P=.025). Residency clinics that were both a PCMH as well as an FQHC also correlated strongly (P=.001). Furthermore, residencies with faculty who possessed a DEA-X license were significantly more likely to have a required curriculum in addiction medicine (P=.002). CONCLUSIONS: Our quantitative secondary analysis of CERA survey data of family medicine residency program directors revealed that resident training in addiction medicine is strongly correlated with both residency clinic setting (FQHC or FQHC/PCMH) as well as residency faculty possession of DEA-X licenses. AD - [St Louis, Joshua; Barr, Wendy] Lawrenoe Family Med Residency, Lawrence, MA USA. [St Louis, Joshua; Barr, Wendy] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Worringer, Emma] Community Wellness Ctr, Oak Pk, IL USA. St Louis, J (corresponding author), 34 Haverhill St, Lawrence, MA 01840 USA. Joshua.stlouis@glfhc.org AN - WOS:000519529900007 AU - St Louis, J. AU - Worringer, E. AU - Barr, W. DA - Mar DO - 10.22454/FamMed.2020.373152 J2 - Fam. Med. KW - CARE Primary Health Care Medicine, General & Internal LA - English M1 - 3 M3 - Article; Proceedings Paper N1 - Web of Science Clarivate Analytics literature search May 7, 2021 PY - 2020 SN - 0742-3225 SP - 198-201 ST - Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis T2 - Family Medicine TI - Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis UR - ://WOS:000519529900007 VL - 52 ID - 931248 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: As the opioid crisis worsens across the United States, the factors that impact physician training in management of substance use disorders become more relevant. A thorough understanding of these factors is necessary for family medicine residency programs to inform their own residency curricula. The objective of our study was to identify factors that correlate with increased residency training in addiction medicine across a broad sample of family medicine residencies. METHODS: We performed secondary analysis of a national family medicine residency program director survey conducted in 2015-2016 (CERA Survey PD-8). We obtained data from the Council of Academic Family Medicine Educational Research Alliance (CERA) Data Clearinghouse. We analyzed residency clinic site designation as a patient-centered medical home (PCMH), federally-qualified health center (FQHC), or both, for their correlation with faculty member possession of DEA-X buprenorphine waiver license, as well as required residency curriculum in addiction medicine. RESULTS: Residency programs situated in an FQHC were more likely to have faculty members who possessed DEA-X buprenorphine waiver licenses (P=.025). Residency clinics that were both a PCMH as well as an FQHC also correlated strongly (P=.001). Furthermore, residencies with faculty who possessed a DEA-X license were significantly more likely to have a required curriculum in addiction medicine (P=.002). CONCLUSIONS: Our quantitative secondary analysis of CERA survey data of family medicine residency program directors revealed that resident training in addiction medicine is strongly correlated with both residency clinic setting (FQHC or FQHC/PCMH) as well as residency faculty possession of DEA-X licenses. AD - Lawrence Family Medicine Residency, Lawrence, MA. Community Wellness Center, Oak Park, IL. Lawrence Family Medicine Residency and the Tufts University School of Medicine. AN - 32159830 AU - St Louis, J. AU - Worringer, E. AU - Barr, W. B. DA - Mar DO - 10.22454/FamMed.2020.373152 DP - NLM ET - 2020/03/12 J2 - Family medicine LA - eng M1 - 3 N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0742-3225 SP - 198-201 ST - Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis T2 - Fam Med TI - Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis VL - 52 ID - 930889 ER - TY - JOUR AB - BACKGROUND: The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. METHODS: Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission. RESULTS: Only 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting). CONCLUSION: This study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes. AD - Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States. Electronic address: jstahler@temple.edu. Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States. Electronic address: jeremy.mennis@temple.edu. AN - 30041092 AU - Stahler, G. J. AU - Mennis, J. DA - Sep 1 DO - 10.1016/j.drugalcdep.2018.06.006 DP - NLM ET - 2018/07/25 J2 - Drug and alcohol dependence KW - Adolescent Adult Aged Continental Population Groups/ethnology Databases, Factual/trends Ethnic Groups Female Healthcare Disparities/*ethnology/*trends Humans Male Middle Aged Opioid-Related Disorders/diagnosis/*ethnology/*therapy Residential Treatment/trends Treatment Outcome United States/ethnology Urban Population/*trends Young Adult *Disparities *Metropolitan areas *Opioid users *Treatment completion *Treatment outcomes LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2018 SN - 0376-8716 SP - 170-178 ST - Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas? T2 - Drug Alcohol Depend TI - Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas? VL - 190 ID - 930885 ER - TY - JOUR AB - BACKGROUND: This study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. METHODS: Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. RESULTS: Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. CONCLUSIONS: Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program. AD - Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jstahler@temple.edu. Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jeremy.mennis@temple.edu. AN - 32445926 AU - Stahler, G. J. AU - Mennis, J. DA - Jul 1 DO - 10.1016/j.drugalcdep.2020.108067 DP - NLM ET - 2020/05/24 J2 - Drug and alcohol dependence KW - Adolescent Adult Aged Female Humans Male Middle Aged Narcotic Antagonists/therapeutic use Opioid-Related Disorders/*drug therapy/epidemiology/*psychology Residential Treatment/methods/*trends Retention in Care/*trends Substance Abuse Treatment Centers/methods/*trends United States/epidemiology Young Adult *Mat *Moud *Medication-Assisted treatment *Medications for opioid use disorder *Oud *Opioid use disorder *Residential treatment *Treatment completion *Treatment retention LA - eng N1 - PubMed NLM literature search May 7, 2021 PY - 2020 SN - 0376-8716 SP - 108067 ST - The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US T2 - Drug Alcohol Depend TI - The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US VL - 212 ID - 930807 ER - TY - JOUR AB - Background: In 2017, the number of overdose deaths involving opioids were found to be six times higher than in 1999. According to National Institute on Drug Abuse, more than 130 people in the United States die after overdosing on opioids every day. There are two medications that are approved for opioid maintenance treatment for opioid use disorder (OUD)-methadone and buprenorphine (generally dispensed as buprenorphine/naloxone). Buprenorphine/naloxone has been shown to be a long term and effective solution to treat OUD. Although effective treatments are available, these treatments are underutilized in the setting of the Opioid epidemic. People who have OUDoften go to the emergency department (ED) for evaluation of medical concerns. Therefore, the ED has an opportunity to screen for this disorder and initiate the appropriate treatment. The ED can effectively diagnose and begin the treatment of OUD. D'Onofrio et al, did a study that randomized OUD patients into one of three groups: referral, brief intervention or ED-initiated buprenorphine followed by 10 weeks of continued buprenorphine treatment in a primary care setting. Patients that received ED-initiated buprenorphine with continuation in primary care were more likely to still be engaged in treatment thirty days after being started on it than those in the brief intervention or referral group. There is a clear benefit to diagnosing OUD and facilitating treatment with buprenorphine/naloxone right from the ED. It is hoped that by analyzing our local hospital emergency room barriers to prescribing buprenorphine/naloxone, we can identify opportunities for education and stewardship in an effort to combat the opioid epidemic. Methods: A brief survey was provided to the ED providers at our local EDs. The survey collected demographics such as sex, years as a practicing provider and if they are waivered or not. The survey then provided a number of possible barriers to prescribing buprenorphine-naloxone and the provider was asked to put a check mark next to the barrier they identified with. A space was provided for providers to list barriers not included in the survey. Results: We provided a survey to 25 providers in the ED at Freeman Hospital in Joplin and Neosho Missouri. Of the 18 providers that responded to the survey, none were buprenorphine-naloxone waivered. Of the providers, nine were male and nine were female. The number of years as a practicing provider was charted and it varied between 2 and 22 years. The number one barrier identified by providers in the ED was lack of training on how to initiate buprenorphinenaloxone. The next most common barrier identified by providers was lack of confidence in the ability to manage OUD. The third-most common barrier identified was lack of education about buprenorphine-naloxone as a method of treatment. Providers also often cited the barriers of constraints on caring for OUD patients and concerns about diversion/patient reselling the drug. Conclusions: The study found that there are many barriers keeping providers from initiating buprenorphine-naloxone treatment for OUD. Most barriers that were identified can likely be addressed with provider education. Creation of a guideline for initiating buprenorphine-naloxone treatment written specifically for the ED could help overcome the majority of the identified barriers. Guidelines for prescribing as well as resources of outpatient follow-up could provide further help to overcome these barriers. None of the providers that participated in the survey were waivered to prescribe buprenorphine-naloxone for OUD. Future studies could investigate whether buprenorphine-naloxone waivered providers identify the same barriers to buprenorphinenaloxone prescribing in the ED. Summary: This study has identified barriers current providers face when prescribing buprenorphine-naloxone. Identifying these barriers has aided in recognizing gaps in current care for OUD. This data will be used to create a guideline to provide better care of OUD patients moving forward as well as to identify areas of opportu ity for further education. Further education will include a presentation to the Emergency Department staff to encourage providers to seek out buprenorphine-naloxone waiver training as well as education regarding accurate diagnosis of OUD in the ED setting and utilization of our Emergency Department Management of Opiate Use Disorder guideline to improve care of this patient population. AD - J. Stanton, Ozark Center Psychiatry Residency Program AU - Stanton, J. AU - Ashraf, N. AU - Cesarz, B. DB - Embase DO - 10.1111/ajad.13032 KW - buprenorphine buprenorphine plus naloxone methadone opiate adolescent adult care behavior child conference abstract controlled study demography drug overdose drug therapy education emergency ward female follow up human maintenance therapy male Missouri national health organization opiate addiction outpatient patient referral practice guideline prescription primary medical care randomized controlled trial LA - English M1 - 3 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2020 SN - 1521-0391 SP - 220-221 ST - Survey of the barriers to buprenorphine/ naloxone prescribing in our emergency department at freeman health system T2 - American Journal on Addictions TI - Survey of the barriers to buprenorphine/ naloxone prescribing in our emergency department at freeman health system UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633285066&from=export http://dx.doi.org/10.1111/ajad.13032 VL - 29 ID - 931085 ER - TY - JOUR AB - Study Objectives: Painful extremityinjuries account for the majorityofvisits to clinics serving winter resorts. Intranasal opiate administration may serve as a rapid, non-invasive means of pain control in this setting. Previous studies have evaluated the use of intranasal fentanyl administration in pediatric populations, but the larger dosing requirement in adults, and the associated larger volume, has served as a barrier to adoption of intranasal opiates in this population. Sufentanil is a synthetic opiate similar to fentanyl but with 5 to 8 times the potency, and twice the lipophilicity. Given the smaller volume required, we hypothesized that intranasal sufentanil could provide rapid, non-invasive, effective pain relief to patients presenting with an acute injury in a winter resort clinic. Methods: We evaluated a convenience sample of patients presenting to a local University affiliated ski clinic, staffed by emergency medicine residents, between January 1 and April 17, 2011. Patients were included if they presented with moderate to severe pain associated with an acute, traumatic injury. Major exclusion criteria consisted of allergies to sufentanil or its components, hypoxia (oxygen saturation <88%), significant head injury requiring mental status monitoring, or hypotension (sBP <90mm Hg). Nurses administered intranasal sufentanil at a dose of 0.5 mcg/kg using an intranasal atomizer device while under physician supervision. The administering nurse recorded pain scores (0-10 scale) on arrival and at 10, 20 and 30 minutes after administration of sufentanil. Patients were monitored for adverse events (sedation, respiratory depression, hypotension) during the 30 minutes following medication administration. Data was retrospectively reviewed from prospectively collected quality assurance data. Formal review was waived by our IRB. Results: 40 patients were enrolled during the 3.5-month study period. 75% of patients were male, and average age for the study group was 32 years (range: 16-60 years). The most frequent injury treated was upper extremity dislocations (55%) and the most frequent procedure performed was shoulder dislocation reduction (40%). The average dose of sufentanil was 37.7 mcg. Five patients (12.5%) were given additional analgesia. Pain scores were significantly lower at the 10, 20 and 30 minutes intervals, when compared to the initial pain scores: average initial pain score was 9, with scores of 4.3 at 10 minutes, 3.3 at 20 minutes, and 3.3 at 30 minutes (p<0.001). The most common complication was dizziness (7.5%). hypoxia occurred in 1 patient (2.5%), who had received a second dose of sufentanil. There were no episodes of hypotension or apnea. Conclusions: Intranasal sufentanil provided rapid, adequate pain control in patients presenting with acute, traumatic extremity injuries. Given the ease of administration, this may serve as a viable option for use in similar settings including out-of-hospital, emergency department triage and urgent care settings. Additional experience with the use of intranasal sufentanil in these settings may further aid in appropriate patient selection and medication dosing. AD - J. Steenblik, University of Utah, Salt Lake City, UT, United States AU - Steenblik, J. AU - Goodman, M. AU - Davis, V. AU - Hopkins, C. AU - Stephen, R. AU - Gee, C. A. AU - Madsen, T. DB - Embase DO - 10.1016/j.annemergmed.2011.06.259 KW - sufentanil opiate fentanyl human winter pain intranasal drug administration emergency physician hospital college patient injury hypotension population hypoxia nurse drug therapy analgesia head injury mental health monitoring nebulizer devices physician respiration depression quality control male arm shoulder dislocation dizziness apnea limb injury emergency ward emergency health service patient selection adult lipophilicity convenience sample university skiing emergency medicine allergy oxygen saturation sedation LA - English M1 - 4 M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2011 SN - 0196-0644 SP - S254 ST - Intranasal sufentanil for the treatment of acute pain in a winter resort clinic T2 - Annals of Emergency Medicine TI - Intranasal sufentanil for the treatment of acute pain in a winter resort clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70551488&from=export http://dx.doi.org/10.1016/j.annemergmed.2011.06.259 VL - 58 ID - 931210 ER - TY - JOUR AB - Aims: Buprenorphine is an effective opioid use disorder treatment that can be prescribed in offices only by buprenorphinewaivered physicians. We examined the association between buprenorphine-waivered physician supply, state policies, and community characteristics. Methods: US Census and Buprenorphine Waiver Notification System data were used to calculate the number of buprenorphinewaivered physicians per 100,000 county residents. State efforts to promote buprenorphine use and state policies supporting buprenorphine use were obtained from state Medicaid office surveys. Multivariate regression models were used to predict the number of buprenorphine-waivered physicians per 100,000 residents at the county level as a function of county characteristics and state policies. Results: Approximately half of US counties have no buprenorphine-waivered physicians; only 5% of counties have 20 or more waivered physicians. Medicaid reimbursement and other state policies reimbursing for office-based buprenorphine were associated with more buprenorphine-waivered physicians, as was specific state guidance to providers regarding buprenorphine use. Less specific efforts, such as clinical guideline distribution and encouraging methadone programs to advise patients of buprenorphine availability, had no significant impact. Conclusions: We found a substantial difference in buprenorphine-waivered physicians, with public sector reimbursement and targeted efforts associated with more physicians per capita. State efforts to increase the number of waivered physicians may be an important response to an anticipated increase in demand for effective treatment. AD - B.D. Stein, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States AU - Stein, B. D. AU - Gordon, A. J. AU - Dick, A. AU - Burns, R. M. AU - Pacula, R. AU - Farmer, C. AU - Leslie, D. DB - Embase DO - 10.1016/j.drugalcdep.2014.09.660 KW - opiate buprenorphine methadone physician human diseases policy college drug dependence medicaid reimbursement model therapy cardiac resynchronization therapy device population research patient organization and management community LA - English M3 - Conference Abstract N1 - Embase Elsevier literature search May 7, 2021 PY - 2015 SN - 0376-8716 SP - e107-e108 ST - Physician supply for the treatment of opioid use disorders: The influence of state policies T2 - Drug and Alcohol Dependence TI - Physician supply for the treatment of opioid use disorders: The influence of state policies UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71802198&from=export http://dx.doi.org/10.1016/j.drugalcdep.2014.09.660 VL - 146 ID - 931192 ER - TY - JOUR AB - Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008-11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine. AD - RAND Corporation, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213. Electronic address: stein@rand.org. University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15261. RAND Corporation, Pittsburgh, PA, USA. Penn State College of Medicine, 90 Hope Drive, Hershey, PA 17033. AN - 25218919 AU - Stein, B. D. AU - Gordon, A. J. AU - Dick, A. W. AU - Burns, R. M. AU - Pacula, R. L. AU - Farmer, C. M. AU - Leslie, D. L. AU - Sorbero, M. C2 - Pmc4420477 C6 - Nihms618802 DA - Jan DO - 10.1016/j.jsat.2014.07.010 DP - NLM ET - 2014/09/15 J2 - Journal of substance abuse treatment KW - Analgesics, Opioid/*therapeutic use Buprenorphine/*therapeutic use Drug Prescriptions/*statistics & numerical data Humans Medicaid/statistics & numerical data Methadone/*therapeutic use Opiate Substitution Treatment/*statistics & numerical data Physicians/legislation & jurisprudence/*statistics & numerical data Public Policy/*legislation & jurisprudence United States Buprenorphine Medicaid Medication assisted treatment Opioid use disorder State policy LA - eng M1 - 1 N1 - PubMed NLM literature search May 7, 2021 PY - 2015 SN - 0740-5472 (Print) 0740-5472 SP - 104-11 ST - Supply of buprenorphine waivered physicians: the influence of state policies T2 - J Subst Abuse Treat TI - Supply of buprenorphine waivered physicians: the influence of state policies VL - 48 ID - 930984 ER - TY - JOUR AB - Without aftercare treatment, the period following discharge from short-term inpatient detoxification for opioid dependence presents a high risk of relapse. Yet the role of patient preference in treatment selection is rarely discussed in the substance-abuse literature. We surveyed 485 persons initiating inpatient opioid detoxification who were predominantly male (71.3%) and had detoxed in the past (73.2%). When asked to choose the one treatment that would work best for them after discharge, 43% of participants selected medication-assisted treatment (MAT), 29% preferred residential, 12% selected drug-free counseling, 12% NA/AA meetings only, and 4% preferred no additional treatment. Residential treatment preference was significantly associated with homelessness, having been in a detox program within the past year, and having pending legal problems, indicating that there is a distinct profile of detox patients who prefer residential treatment despite its limited availability. Detox program staff should work with patients to understand reasons for treatment preferences to optimize aftercare services. AD - General Med