ABSTRACT
Sharp rises in overdose deaths nationally coincided with the arrival of the COVID-19 pandemic. Rural Appalachia, known for high rates of substance use and barriers to health care in general, was suspected to be disproportionately impacted in terms of recovery supports such as 12-step recovery meetings. This study investigated the availability of recovery meetings in South Central Appalachia before and after COVID-19 lockdowns. The number of confirmed recovery meetings was compared before and after COVID-19 lockdowns by geographic location (i.e., rural/nonrural and medium metro/small metro/micropolitan/noncore). Recovery meeting data were systematically collected through interviews with community contacts, reviewing social media and websites, making phone calls, and sending emails and surveys and updated longitudinally. There was no significant change in the number of meetings from pre- (n = 189) to post-COVID-19 (n = 178). There was no significant shift in meeting location when dichotomizing by rural/nonrural classification, chi2(1) = 2.76, p = .097, pi = -0.087. Chi-square test of independence did reveal a significant change in number of recovery meetings by location when using four location classifications, chi2(3) = 7.97, p = .047, Cramer's V = 0.147. There was a noteworthy rise in the meetings in small metro (36.5%-51.1%), with all other locations declining. The establishment and reestablishment of recovery meetings in rural communities should be prioritized to address the longstanding scarcity of recovery resources in rural locations, recent decline in such support, and the rise in overdose deaths. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This study highlights a significant barrier to recovery from problematic substance use in rural areas. Strategically establishing recovery meetings in areas with few or no meetings and facilitating access through addressing transportation is critical. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The onset of COVID-19 introduced unprecedented changes to how U.S. public health services were delivered. Many public and private agencies faced mandatory closures, social distancing mandates, and rapid transitions to telehealth interventions and treatment. Mental health clinicians witnessed disruptions in continuity of care and an increase in mental health risks overall. Although some studies have been conducted to survey clinicians' perceptions of the usefulness and ease of use of technology-based interventions, knowledge about mental health clinicians' experiences and perceptions in Virginia was sparse. The purpose of this generic qualitative study was to explore how mental health clinicians in Virginia described their experiences and perceptions of using telehealth in providing services to clients during the COVID-19 pandemic. The social-ecological systems and technology acceptance models were used to explore the experiences and perceptions of clinicians. Data analysis led to the identification of themes: (a) pre-COVID-19 treatment and services (b) adjustments to rapid implementation of telehealth, (c) convenience and flexibility to providing services following acclimation, (d) technological barriers to providing telehealth services, (e) challenges with limited understanding and exposure to technology, (f) protocols and managing expectations, (g) acceptance and aversion to telehealth service, and (h) lessons learned for future practice. The findings of this study have potential implications for positive social change by providing insight into the ease of use of telehealth models, encouraging ongoing training for clinical professionals, and informing future research and practice in the mental health field. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
INTRODUCTION: Substance use among pregnant and postpartum women (PPW) is a serious public health concern. The COVID-19 pandemic has exacerbated substance use among the general population including pregnant women, and disrupted operations for substance use treatment centers. Little is known about the outcomes of substance use treatment for PPW before and during the COVID-19 pandemic. METHOD: Data from a longitudinal program evaluation were analyzed to examine outcomes among 136 PPW participating in a residential SUD treatment program, and to explore differences in treatment outcomes for women who enrolled in services before versus during the COVID-19 pandemic. Analyses were used to test the significance of change from treatment intake to 6-month post-intake on assessments of substance use, mental health symptoms, and functioning collected to evaluate the Healthy Families Program (HFP), a comprehensive program for PPW located within a gender-specific SUD treatment facility in the United States. RESULTS: Results indicated that from treatment intake to follow-up assessment, clients self-reported statistically significant improvements in family functioning and daily functioning as well as reduced days of substance use. Notably, the rate of treatment intakes declined during the COVID-19 pandemic. In separate analyses by subgroup, mental health indicators showed improvements only for clients engaged in treatment before the COVID-19 pandemic and not for clients served during the COVID-19 pandemic, but substance use decreased significantly for both pre-pandemic and pandemic enrollees. CONCLUSION: Specialized treatment considerations and implications for PPW are discussed, including a need for added emphasis on co-occurring mental health symptoms and family system stress during a pandemic, and the role of nurses in identifying and addressing these concerns. Additionally, potential relapse prevention efforts during COVID-19 for PPW with substance use disorders are examined. CLINICAL RELEVANCE: The present research continues to highlight the importance of specialized treatment programming for PPW with SUDs as well as the potential need for additional recovery support mechanisms to be utilized during the COVID-19 pandemic.
ABSTRACT
The COVID-19 global pandemic hit the United States in early 2020. The pandemic had forced many businesses to shut their doors temporarily and permanently. The mental health and substance use population was hit harder than ever before. Due to uncontrollable factors such as homelessness, and unknown or undertreated preexisting conditions, the COVID-19 virus took an intractable hold on the treatment facilities where this population of patients turned to when they were ready for change. This Doctor of Nursing Practice (DNP) project implemented rapid COVID-19 testing for all newly admitted patients into an inpatient substance use disorder (SUD) treatment facility. Testing was implemented for six weeks utilizing the rapid antigen tests. The proposal for initiating rapid COVID-19 testing, identified the problem early in treatment, allowing for the initiation of early intervention and better patient outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The community reinforcement and family training (CRAFT) program provides group support for families affected by substance use disorders. During the COVID-19 pandemic traditional in-person support groups were limited and moved to online formats out of necessity and safety. This negatively impacted both recipients of group interventions as well as group facilitators. Research on the feasibility and effectiveness of a free, online CRAFT approach was limited at the time of this current study. This study attempted to measure the feasibility of the continued online application of CRAFT groups that utilized Zoom video conferencing software. A quasi-experimental, one-group posttest-only, mixed methods design was utilized in this study to obtain findings to answer these research questions. The sample of this study included data from a free, 12-week online group. These data included surveys from group participants (n=9) and group facilitators (n=8). Participant surveys utilized quantitative and qualitative data to measure group participant satisfaction and the effectiveness of the online group format. Group facilitator surveys utilized quantitative and qualitative items to measure group facilitator satisfaction, ease of access and feasibility of ongoing online group format. Data were analyzed using descriptive statistics (charts) in IBM SPSS as well as analyses of qualitative data conducted by the researcher. The findings concerning the effectiveness and feasibility of the ongoing application of such online groups were largely inconclusive. However, the findings of this study could inform future studies intended to measure the effectiveness and feasibility of similar ongoing, free, online CRAFT programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Symposium title: Addressing chronic pain and the opioid epidemic using auricular neuromodulation Symposium description: Our proposed symposium integrates a diverse group of scientist and clinician experts (Drs. Cunningham, Wilkes, Khodaparast, Badran) who have committed to exploring the anti-nociceptive and opioid sparing effects of auricular neuromodulation to progress toward non-opioid interventions for chronic pain and opioid use disorders. The demand for chronic pain therapies has increased at an unprecedented rate over the last several decades, contributing in part to a surge in prescription and illicit opioid demand. Countless patients were escalated to prolonged, high-dose opioid regimens over years of treatment. By 2014, 5.4% of U.S. adults were estimated to use prescription opioids on a long-term basis. As the harms of opioid proliferation became increasingly clear, a dramatic paradigm shift occurred in which these drugs are now perceived as more dangerous than beneficial for chronic pain. New clinical guidelines highlight the risks of high-dose regimens as well as the limited benefits, particularly insufficient analgesia and hyperalgesia, associated with long-term use. According to this new perspective, the preferred therapeutic modality for many patients is to safely taper, or even completely stop, using opioids. Transcutaneous auricular neurostimulation (tAN) is a novel therapeutic paradigm that includes stimulation of both the auricular branch of the vagus nerve and auriculotemporal nerve (branch of trigeminal). tAN therapy results in clinically significant reductions in opioid withdrawal symptoms associated with opioid detoxification and tapering. Either adjunctive vagal or trigeminal stimulation modulates pain transmission suggesting overlapping common effector pathways, possibly targeting the endogenous opioid system, which could lead to a synergistic therapeutic benefit for pain. This symposium will explore the scientific basis for this hypothesis across targeted and interconnected topics, including fundamental neuropharmacological mechanisms underlying pain and opioids, clinical challenges of tapering opioids, managing opioid withdrawal symptoms with tAN, and the prospects for tAN to deliver a safe alternative treatment option for pain disorders. The United States is experiencing an epidemic for prescription and non-prescription opioids, which have continued to rise since the 1990s. During 2015, approximately 2.1 million people were severely dependent on prescription opioids, and 513,000 on heroin. In 2020, the Centers for Disease Control reported 93,331 substance use overdose deaths. The continuing increase in opioid-related deaths from 2015 (18%) to 2020 (60%) is partly attributed to the mental health crisis during the Covid-19 pandemic. Aside from pain mitigation, individuals with opioid use disorder (OUD) may be motivated to continue drug-seeking by both the positive reinforcement of the euphoric effects of opioids and the negative reinforcement of opioid withdrawal symptoms due to cessation. Alternative approaches for OUD are a major priority for government agencies given the substantial impact on health, social, and economic welfare. Transcutaneous auricular neurostimulation (tAN) is a non-invasive form of vagus and trigeminal neuromodulation that was recently proven to be an efficacious non-pharmacologic based treatment for reducing opioid withdrawal symptoms. In 2021, tAN therapy received FDA clearance as an adjunctive treatment for opioid withdrawal symptoms in adults. tAN therapy was also proven safe and effective in reducing symptoms of neonatal opioid withdrawal syndrome (NOWS) in neonates. tAN as an adjuvant was safe, well-tolerated, while facilitating the successful rapid weaning of oral morphine and decreasing length of stay in the neonatal ICU. Based on these preliminary findings, tAN therapy is currently in two NIH-funded pivotal clinical trials to: 1) evaluate the long-term effects of tAN on opioid use relapse prevention and cravings in adults with OUD, and 2) determine f tAN therapy can reduce withdrawal symptoms and reduce morphine length of treatment for neonates with NOWS. Lastly, we will explore how tAN could be utilized as neuromodulatory approach for opioid sparing, and ultimately pain mitigation. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Vagus Nerve Stimulation, Opioid Use Disorder, Pain, NeurostimulationCopyright © 2023
ABSTRACT
Severe substance use disorders are characterized by chronic cycles of relapse;however, individuals who complete substance use treatment are less likely to experience relapse. Research has focused on trying to identify factors that predict treatment dropout to help improve treatment outcomes. Most of this research has focused on examining demographic and patient-specific factors, with little success in reliably predicting treatment attrition. There has been less focus on investigating transdiagnostic factors that span across discrete psychological diagnoses and demographics. The present study sought to determine if self-report and behavioral measures related to emotion regulation predicted inpatient substance use treatment dropout above and beyond demographic variables, and to determine if variables related to emotion regulation improved during substance use treatment. The present study included 69 male participants, 68 of whom completed the full baseline assessment. Nine participants dropped out of treatment prematurely. Of the 59 participants who remained in treatment, 49 completed follow-up data collection. No demographic or substance use-related factors emerged as predictors of treatment dropout, except for number of past substance use treatments. Self-report measures of emotion regulation, distress tolerance, urgency, and negative emotionality were also not significantly predictive of treatment dropout. Additionally, behavioral measures of distress tolerance and risky-decision making were not predictive of treatment attrition. Prior to accounting for multiple comparisons, self-reported emotion regulation and negative urgency improved between the baseline and follow-up sessions. This study was significantly underpowered due to factors related to COVID-19 impacting dropout rate. Measures to contain the spread of COVID-19 also likely compromised other aspects of data collection. While findings were not significant, most findings were in the expected direction and warrant further consideration with a larger sample size and data collection after the impact of COVID-19 has subsided. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The COVID-19 global pandemic hit the United States in early 2020. The pandemic had forced many businesses to shut their doors temporarily and permanently. The mental health and substance use population was hit harder than ever before. Due to uncontrollable factors such as homelessness, and unknown or undertreated preexisting conditions, the COVID-19 virus took an intractable hold on the treatment facilities where this population of patients turned to when they were ready for change. This Doctor of Nursing Practice (DNP) project implemented rapid COVID-19 testing for all newly admitted patients into an inpatient substance use disorder (SUD) treatment facility. Testing was implemented for six weeks utilizing the rapid antigen tests. The proposal for initiating rapid COVID-19 testing, identified the problem early in treatment, allowing for the initiation of early intervention and better patient outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The community reinforcement and family training (CRAFT) program provides group support for families affected by substance use disorders. During the COVID-19 pandemic traditional in-person support groups were limited and moved to online formats out of necessity and safety. This negatively impacted both recipients of group interventions as well as group facilitators. Research on the feasibility and effectiveness of a free, online CRAFT approach was limited at the time of this current study. This study attempted to measure the feasibility of the continued online application of CRAFT groups that utilized Zoom video conferencing software. A quasi-experimental, one-group posttest-only, mixed methods design was utilized in this study to obtain findings to answer these research questions. The sample of this study included data from a free, 12-week online group. These data included surveys from group participants (n=9) and group facilitators (n=8). Participant surveys utilized quantitative and qualitative data to measure group participant satisfaction and the effectiveness of the online group format. Group facilitator surveys utilized quantitative and qualitative items to measure group facilitator satisfaction, ease of access and feasibility of ongoing online group format. Data were analyzed using descriptive statistics (charts) in IBM SPSS as well as analyses of qualitative data conducted by the researcher. The findings concerning the effectiveness and feasibility of the ongoing application of such online groups were largely inconclusive. However, the findings of this study could inform future studies intended to measure the effectiveness and feasibility of similar ongoing, free, online CRAFT programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling "safe" within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
Subject(s)
Buprenorphine , COVID-19 Drug Treatment , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Female , Humans , Opiate Substitution Treatment/psychology , Opioid-Related Disorders/epidemiology , PandemicsABSTRACT
Social inequities made some sociodemographic groups - including those of older age, minoritized race/ethnicity, and low socioeconomic status - disproportionately vulnerable to morbidity and mortality associated with the opioid epidemic and COVID-19 pandemic. Given shared vulnerability to these public health crises, it is critical to understand how COVID-19 impacts substance use disorder (SUD) treatment and recovery among people with these characteristics. The current study examined COVID-19's perceived impact on treatment factors and psychosocial outcomes by sociodemographic vulnerability. Patients receiving SUD treatment with a history of opioid misuse were recruited. Participants completed self-report questionnaires regarding the impact of COVID-19 on treatment indicators and mood and substance use symptoms. Most participants reported that COVID-19 decreased their treatment access and quality. There were no sociodemographic differences in treatment factors. Those with high sociodemographic vulnerability reported greater pandemic-related increases in depression and demonstrated greater mood symptoms. Post-hoc analyses demonstrated that unmet basic needs were significantly associated with lower treatment access and quality, greater mood symptoms, and higher substance use. Findings suggest pandemic-related stressors and barriers affected those across the sociodemographic spectrum. Treatment systems must address socioeconomic barriers to care exacerbated by the pandemic and bolster integrated treatment options for opioid use and mood disorders.
Subject(s)
COVID-19 , Opioid-Related Disorders , Humans , Pandemics , Vulnerable Populations , Analgesics, Opioid/therapeutic use , Opioid-Related Disorders/drug therapyABSTRACT
BACKGROUND: People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services representing potential opportunities (i.e., 'touchpoints') where COVID-19 testing could have been offered. METHODS: Between October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression identified factors associated with COVID-19 testing including potential touchpoints, comorbidities and COVID-19 related misinformation and disinformation. RESULTS: Of 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive (30.1%), 50.3% encountered at least one touchpoint where COVID-19 testing could have been offered within the prior six months. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego, recent incarceration, receiving substance use treatment, and experiencing ≥1 chronic health condition. Homelessness, having received ≥1 dose of COVID-19 vaccine, and having a HIV or HCV test since the COVID-19 epidemic began were also independently associated with having had a prior COVID-19 test. CONCLUSION: We identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.
Subject(s)
COVID-19 , Drug Users , HIV Infections , Hepatitis C , Substance Abuse, Intravenous , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , COVID-19 Vaccines , Cross-Sectional Studies , HIV Infections/epidemiology , Hepatitis C/complications , Humans , Mexico/epidemiology , Prevalence , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiologyABSTRACT
BACKGROUND: The COVID-19 pandemic has profoundly transformed substance use disorder (SUD) treatment in the United States, with many web-based treatment services being used for this purpose. However, little is known about the long-term treatment effectiveness of SUD interventions delivered through digital technologies compared with in-person treatment, and even less is known about how patients, clinicians, and clinical characteristics may predict treatment outcomes. OBJECTIVE: This study aims to analyze baseline differences in patient demographics and clinical characteristics across traditional and telehealth settings in a sample of participants (N=3642) who received intensive outpatient program (IOP) substance use treatment from January 2020 to March 2021. METHODS: The virtual IOP (VIOP) study is a prospective longitudinal cohort design that follows adult (aged ≥18 years) patients who were discharged from IOP care for alcohol and substance use-related treatment at a large national SUD treatment provider between January 2020 and March 2021. Data were collected at baseline and up to 1 year after discharge from both in-person and VIOP services through phone- and web-based surveys to assess recent substance use and general functioning across several domains. RESULTS: Initial baseline descriptive data were collected on patient demographics and clinical inventories. No differences in IOP setting were detected by race (χ22=0.1; P=.96), ethnicity (χ22=0.8; P=.66), employment status (χ22=2.5; P=.29), education level (χ24=7.9; P=.10), or whether participants presented with multiple SUDs (χ28=11.4; P=.18). Significant differences emerged for biological sex (χ22=8.5; P=.05), age (χ26=26.8; P<.001), marital status (χ24=20.5; P<.001), length of stay (F2,3639=148.67; P<.001), and discharge against staff advice (χ22=10.6; P<.01). More differences emerged by developmental stage, with emerging adults more likely to be women (χ23=40.5; P<.001), non-White (χ23=15.8; P<.001), have multiple SUDs (χ23=453.6; P<.001), have longer lengths of stay (F3,3638=13.51; P<.001), and more likely to be discharged against staff advice (χ23=13.3; P<.01). CONCLUSIONS: The findings aim to deepen our understanding of SUD treatment efficacy across traditional and telehealth settings and its associated correlates and predictors of patient-centered outcomes. The results of this study will inform the effective development of data-driven benchmarks and protocols for routine outcome data practices in treatment settings.
ABSTRACT
Background: Extended-release buprenorphine (XRB) offers a novel approach to sustained monthly treatment for people who use opioids in criminal justice settings (CJS). This study explores the experiences of adults receiving XRB as a jail-to-community treatment. Methods and findings: In-depth qualitative interviews were conducted among adult participants with opioid use disorder (OUD;n = 16) who were recently released from NYC jails and maintained on XRB after switching from daily sublingual buprenorphine (SLB). Interviews elaborated on the acceptability and barriers and facilitators of XRB treatment pre- and post-release. Interviews were audio recorded, transcribed, and analyzed for content related to factors influencing XRB treatment uptake and community reentry. Important themes were grouped into systems, medication, and patient-level factors. Key systems-level factors influencing initiation of XRB in jail included an alternative to perceived stigmatization and privacy concerns associated with daily in-jail SLB administration and less concerns with buprenorphine diversion. In-jail peer networks positively influenced participant adoption of XRB. XRB satisfaction was attributed to reduced in-jail clinic and medication administration visits, perceived efficacy and blockade effects upon the use of heroin/fentanyl following release, and averting the risk of criminal activities to fund opioid use. Barriers to retention included post-injection withdrawal symptoms and cravings attributed to perceived suboptimal medication dosing, injection site pain, and lack of in-jail provider information about the medication. Conclusion: Participants were generally favorable to XRB initiation in jail and retention post-release. Further studies are needed to address factors influencing access to XRB in criminal justice settings, including stigma, ensuring patient privacy following initiation on XRB, and patient-, provider-, and correctional staff education pertaining to XRB. Trial Registration: ClinicalTrials.gov Identified: NCT03604159. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
BACKGROUND: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. OBJECTIVE: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. METHODS: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). RESULTS: No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one's ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). CONCLUSIONS: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.
ABSTRACT
This study reviewed the impact of telemedicine on treatment retention in Medications for Opioid Use Disorder (MOUD) with buprenorphine treatment program during the coronavirus disease 2019 (COVID-19) pandemic. Electronic health records of active patients in MOUD with buprenorphine treatment program were reviewed from July 1, 2019, to June 30, 2020. Data were divided into four groups of 3-months' time points to calculate and compare treatment retention in the baseline, pre-COVID, and in-COVID groups. The percentage of treatment retention with a 95% confidence interval was calculated using University of California San Franciso- Clinical and Translational Science Institute (UCSF-CTSI) sample size calculator tool. This study presents data suggesting that telemedicine is efficacious in retaining patients in MOUD. Telemedicine is an alternative to face-to-face treatment delivery for MOUD with buprenorphine treatment. It should be available to provide services after the pandemic as well. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement Addressing Opioid Use Disorder (OUD) is essential to reduce individual and societal harms associated with drug overdoses. Because of the need for social isolation and social distancing related to coronavirus disease 2019 (COVID-19), in-person encounters in Medications for Opioid Use Disorder (MOUD) with buprenorphine treatment programs were not feasible. This study suggests telemedicine as an alternative to in-person meetings and is efficacious in retaining patients in MOUD with buprenorphine treatment programs during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Background: Individuals with substance use disorder (SUD) may be particularly at risk during the COVID-19 pandemic. The purpose of this study was to examine attitudes to the pandemic among individuals with SUD. Methods: Survey responses from 266 patients entering a residential treatment program were analyzed. Results: Most participants were White or African American men. A third of participants reported that their substance use had increased during the pandemic (38%), and that they had stockpiled substances because of concerns about supply (30%). A majority of participants indicated more depression (60%), anxiety (61%), worry about finances (62%), and feeling worse about their substance use due to COVID-19 (67%). An exploratory factor analysis revealed five factors that measured interest in SUD treatment, psychological symptoms, adherence to health recommendations, perceptions of vulnerability to COVID-19, and substance use during COVID-19. African American participants indicated a greater interest in treatment than Whites, while White participants indicated increased symptoms and substance use during COVID-19 (p < .05). Further, African Americans were more likely to have known someone who had developed COVID-19 than whites (p < .05). Older participants indicated adhering to health recommendations more than younger participants, using substances less than younger participants, as well as feeling more vulnerable to COVID-19 (p < .05). Conclusions: This is the first study to examine patient attitudes and behaviors related to COVID-19 at a residential SUD treatment program. Treatment providers should be aware of patient attitudes and behaviors related to COVID-19 paying special attention to barriers to treatment engagement.
Subject(s)
COVID-19 , Substance-Related Disorders , Attitude , Humans , Male , Pandemics , SARS-CoV-2 , Substance-Related Disorders/complications , Substance-Related Disorders/epidemiologyABSTRACT
Those with substance use disorders living in recovery homes might be at-risk for Coronavirus disease (COVID-19) due to close living arrangements and past histories of substance use (as well as comorbid factors such as homelessness, psychiatric comorbidity, and chronic health conditions). This study compared COVID-19 infection and mortality rates for residents of self-help recovery homes versus overall state estimates. Significantly lower rates of infection and mortality were found for residents of recovery homes, and their COVID-19 mortality rates were extremely low. Given the number of people in community settings living in these recovery homes, these findings are important as they suggest that recovery homes might play a critical role in COVID-19 mitigating strategies. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement For high-risk individuals, supportive housing in community settings represents a promising ecological strategy for reducing COVID-19 infections and mortality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
ABSTRACT
BACKGROUND AND AIMS: To prevent COVID-19 transmission, some United States (US) federal regulations on substance use disorder (SUD) treatment were suspended in March 2020. This study aimed to quantify the extent of state-level policy uptake and the potential number of people with SUD affected by these policy changes across the US, as well as to assess if policy uptake correlated with rates of people with SUD already in treatment or needing treatment. DESIGN: Cross-sectional analysis of policies implemented as of April 13, 2020. SETTING AND PARTICIPANTS: A total of 50 US states and the District of Columbia MEASUREMENTS: State-level implementation of: oral schedule II controlled substances emergency prescription, extended take-home doses for medication for opioid use disorders (MOUD), home-delivery of take-home medications, telemedicine for schedule II-IV prescriptions, telemedicine for buprenorphine prescribing initiation, and waiver of out-of-state Drug Enforcement Administration (DEA) registration. Rates per 100 000 population of: adults in treatment for SUD, MOUD treatment at facilities with opioid treatment programs, SUD based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria, and needing, but not receiving treatment. FINDINGS: Half of the states (n = 24) enacted no policies, leaving ~460 955 people in treatment and 114 370 people on MOUD pre-pandemic uncovered by any policy expansion. Only telemedicine for buprenorphine initiation was marginally associated with pre-pandemic rate of SUD treatment (OR = 1.003, 95% CI = [1.001, 1.006]) and rate of MOUD therapy (OR = 1.006, 95% CI = [1.002, 1.011]) in univariable analysis, but these associations were no longer significant when controlling for state-level demographics. No policies were associated with state-wide SUD prevalence or rate of unmet treatment need (P > 0.05). CONCLUSIONS: Twenty-four United States states did not implement at least one federal policy for substance use disorder treatment expansion as of April 2020, leaving approximately half a million people in treatment pre-pandemic potentially without access to treatment or risking exposure to COVID-19 to continue in-person therapies.
Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Buprenorphine/therapeutic use , Cross-Sectional Studies , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Pharmaceutical Preparations , United StatesABSTRACT
BACKGROUND: People in substance use disorder (SUD) treatment experience disproportionate rates of tobacco use. California has prioritized smoking cessation among these individuals through the Tobacco-Free for Recovery Initiative, which includes an intervention aimed at supporting programs in implementing tobacco-free grounds. The current study examined changes in client smoking prevalence, tobacco use behaviors, and receipt of cessation services among the first seven programs participating in the initiative. METHODS: Residential treatment program clients completed cross-sectional surveys at the start of the intervention (baseline: n = 249), at an interim timepoint post-baseline (interim: n = 275), and at the end of the intervention 15 months later (post-intervention: n = 219). All participants reported smoking status. Current smokers reported tobacco use behaviors, and both current smokers and those who quit in treatment reported receipt of cessation services. Univariate analyses explored differences across the three timepoints and multivariate logistic regression assessed change from baseline to interim and baseline to post-intervention. RESULTS: Client smoking prevalence decreased from 54.2% at pre- to 26.6% at post-intervention (Adjusted Odds Ratio [AOR] = 0.25, 95% CI = 0.13, 0.45). Current smokers and those who quit while in treatment reported an increase in NRT/pharmacotherapy (11.9% vs. 25.2%; AOR = 3.02, CI = 1.24, 7.35). When comparing baseline to the interim timepoint (a timepoint before the COVID-19 pandemic), data analyses also demonstrated a significant decrease in smoking prevalence (54.2% vs. 41.8%; AOR = 0.62, CI = 0.42, 0.92) and increase in NRT/pharmacotherapy (11.9% vs. 24.5%; AOR = 3.68, CI = 1.11, 12.19). CONCLUSION: An intervention to promote tobacco-free grounds implemented in residential SUD treatment programs was associated with a significant reduction in client smoking and an increase in NRT/pharmacotherapy. These associations were observed both before the COVID-19 pandemic and in the early stages of the pandemic, suggesting that they may be due to the intervention rather than to the pandemic.