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1.
Subst Abus ; 43(1): 1143-1150, 2022.
Article in English | MEDLINE | ID: covidwho-1830535

ABSTRACT

Background: Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. Methods: We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. Results: Patient participants were middle-aged (median age 51 years) and were predominantly men (53%). Providers discussed clinical decision-making processes and experiences providing take-homes. Implementation of expanded take-home policies was cautious. Providers reported making individualized decisions, using patient factors to decide if benefits outweighed risks of overdose and misuse. Decision-making factors included patient drug use, overdose risk, housing status, and vulnerability to COVID-19. New patient groups started receiving take-homes and providers noted few adverse events. Patients who received take-homes reported increased autonomy and treatment flexibility, which in turn increased likelihood of treatment stabilization and engagement. Patients who remained ineligible for take-homes, usually due to ongoing non-prescribed opioid or benzodiazepine use, desired greater transparency and shared decision-making. Conclusion: Federal exemptions in response to COVID-19 led to the unprecedented expansion of access to MOUD take-homes within OTPs. Providers and patients perceived benefits to expanding access to take-homes and experienced few adverse outcomes, suggesting expanded take-home policies should remain post-COVID-19. Future studies should explore whether these findings are generalizable to other OTPs and assess larger samples to quantify patient-level outcomes resulting from expanded take-home policies.


Subject(s)
COVID-19 , Drug Overdose , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Drug Overdose/drug therapy , Female , Freedom , Humans , Male , Methadone/therapeutic use , Middle Aged , Opioid-Related Disorders/epidemiology , Pandemics , Qualitative Research , United States
2.
J Subst Abuse Treat ; : 108801, 2022 May 08.
Article in English | MEDLINE | ID: covidwho-1821395

ABSTRACT

OBJECTIVES: In March 2020, the Substance Abuse and Mental Health Services Administration permitted Opioid Treatment Programs (OTPs) to relax restrictions on take-home methadone and promoted telehealth to minimize potential exposures to COVID-19. We assessed the effects of COVID-19-related changes on take-home methadone dosing in two OTPs serving five rural Oregon counties. METHODS: We used a mixed-methods convergent design. The OTPs extracted urine drug test (UDT) results, take-home methadone regimens, and treatment retention from the electronic health record (EHR) for patients (n = 377). A mixed-effects negative binomial regression model assessed patient-level differences in take-home doses before and after the COVID-19 policy changes and the associations with treatment discontinuation, and UDT positivity. Semi-structured qualitative interviews (n = 32) explored patient reactions to increased take-home dosing and reduced clinic visits to provide context for quantitative findings. RESULTS: The number of take-home doses increased in the post-COVID-19 period for patients engaged in treatment for more than 180 days (median: 8 vs 13 take-home doses per month, p = 0.011). Take-homes did not increase for patients with fewer days of treatment. Each percentage point increase in take-home dosing above what would be expected without COVID-19 policy changes was negatively associated with the percent of UDT positive for opioids (B = -0.12, CI [-0.21, -0.04], p = 0.005) and the probability of treatment discontinuation (aOR = 0.97, CI [0.95, 0.99], p = 0.003). Qualitative analysis revealed three themes explaining how increased take-home dosing supported recovery: 1) value of feeling trusted with increased responsibility; 2) reduced travel time permitted increased employment and recreation; and 3) reduced exposure to individuals less stable in recovery and potential triggers. CONCLUSIONS: Take-home methadone dose relaxations were associated with increased methadone take-home doses, improved retention, and decreased UDT opioid positive results among clinically stable patients. Qualitative findings suggest that fewer take-home restrictions are feasible and desirable and do not pose safety or public health harms.

3.
Subst Abus ; 43(1): 1150-1157, 2022.
Article in English | MEDLINE | ID: covidwho-1819680

ABSTRACT

Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants' desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.


Subject(s)
COVID-19 , Drug Overdose , Opioid-Related Disorders , Telemedicine , Humans , Male , Opioid-Related Disorders/drug therapy , Pandemics , Patient Outcome Assessment
4.
Drug Alcohol Depend Rep ; 3: 100055, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1803862

ABSTRACT

Background: Medications such as buprenorphine are considered the gold standard for the treatment of opioid use disorders. This study aimed to determine whether less restrictive buprenorphine prescribing practices during the COVID-19 pandemic impacted retention in and adherence to buprenorphine among patients accessing treatment from 2018-2020 at a community-based syringe services program. Methods: In this retrospective cohort study, we compared retention in treatment before and during the COVID-19 pandemic. Then, with relaxed restrictions acting as the intervention in a natural experiment, we conducted a sub-analysis of "continuity participants" who accessed treatment services both before and during the COVID-19 period. Records of 418 historical control patients treated with buprenorphine before COVID-19 were compared to 88 patients enrolled during COVID-19 (n=43 remote telemedicine and n=45 remote provider with patient on-site). Cox proportional hazards regressions were used to assess risk factors for treatment discontinuation. The sub-analysis used proportion of days covered (PDC) differences before and during COVID-19 (n=164) for a paired analysis in a nonparametric bootstrap test. Results: The risk of discontinuation was 71% lower in those accessing remote telemedicine during COVID-19 (HR=0.29; CI: 0.18, 0.47) and 51% lower in those accessing their remote provider onsite during COVID-19 (HR=0.49; CI:0.31, 0.77), compared to the historical control group. The average PDC did not significantly differ before and during COVID-19 (difference=2.4%; CI:-0.6%, 5.3%). Conclusions: The risk of discontinuing treatment was lower in both COVID-19 treatment groups compared to historical controls. Less restrictive buprenorphine prescribing guidelines during COVID-19 led to improved retention in care over 6-months.

5.
Int J Drug Policy ; 104: 103680, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1783290

ABSTRACT

BACKGROUND: In March 2020, following a provincial COVID-19 emergency declaration, modifications to opioid agonist treatment (OAT) were introduced in Ontario, Canada to promote treatment access amid the pandemic and ongoing opioid overdose crisis. Modifications included federal exemptions to facilitate OAT prescription re-fills, extensions, and deliveries and interim treatment guidance emphasizing take-home (non-observed) doses and reduced urine drug screening for OAT patients. METHODS: We conducted an interrupted time series study using health administrative data from September 17th, 2019-September 21st, 2020, on 359 people who inject drugs with suspected opioid use disorder in Toronto, Ontario. We used segmented regression analyses to evaluate the joint effects of the provincial COVID-19 emergency declaration, federal OAT exemptions, and interim treatment guidance-all implemented between March 17th-23rd, 2020-on the weekly proportion of participants enrolled in OAT (i.e., ≥1 day(s) covered with methadone or buprenorphine/naloxone), with an opioid-related overdose (based on emergency department visits and hospitalizations), and who died (all-cause), and the weekly proportion of OAT-enrolled participants receiving take-home doses (i.e., ≥1 day(s) covered) and undergoing urine drug screening. RESULTS: Post-implementation, the interventions were associated with immediate absolute changes in OAT enrollment (+1.95%; 95% CI=0.04%-3.85%), receipt of take-home doses (+18.3%; 95% CI=13.2%-23.4%), and urine drug screening (-22.4%; 95% CI=[-26.9%]-[-17.9%]) and a gradual absolute increase of 0.56% in urine drug screening week-to-week (95% CI=0.27%-0.86%) beyond the pre-implementation trend. At 26 weeks post-implementation, OAT enrollment and urine drug screening approached pre-implementation levels whereas the increase in take-home doses was largely sustained (+15.0%; 95% CI=4.33%-25.6%). No post-implementation increases in opioid-related overdoses were observed. Death was not modelled (low event frequency). CONCLUSION: Changes to OAT provision following provincial COVID-19 restrictions were associated with an immediate and sustained increase in take-home dose coverage among OAT-enrolled participants, without corresponding increases in opioid-related overdoses among all participants.

6.
Front Psychiatry ; 13: 803998, 2022.
Article in English | MEDLINE | ID: covidwho-1775793

ABSTRACT

Background: The coronavirus-19 (COVID-19) pandemic was initially characterized by misinformation and fear related to transmission that has been previously shown to produce stigma toward persons perceived to be at risk for transmission. This study evaluated perceptions toward scenarios with variable levels of perceived risk for COVID-19 acquisition, and compared stigma to COVID-19 to depression and opioid use disorder. Methods: Respondents (N = 280) from the United States completed a web-based survey 6 months after pandemic declaration. Questions included demographics and COVID-19 misconceptions, expected response to hypothetical scenarios with variable risk for COVID-19, and the Attribution Questionnaire-9 for COVID-19, depression, and opioid use disorder. Results: Participants had several COVID-19 misconceptions, including that opioids increased immunity (63.6%), persons were more susceptible based upon racial/ethnic background (63.2%), and underlying health conditions did not influence risk (58.9%). Respondents were highly likely (64/100) to assume someone coughing had COVID-19 and the majority (93.5%) recommended quarantining persons with recent travel. However, the majority of respondents (>70% in all cases) also believed they would not change their COVID-19-related behavior when interacting with persons of different racial, ethnic, and age backgrounds. Finally, persons with COVID-19 engendered greater pity, less fear, less blame, less anger, and more willingness to help from respondents relative to persons with opioid use disorder. Conclusion: Stigma ratings toward persons perceived at risk of transmitting COVID-19, collected soon after the onset of the pandemic, showed less evidence of stigma relative to persons with opioid use disorder despite pronounced misconceptions regarding COVID-19 risk. Data provide a foundation for additional research in this area.

7.
Addiction Science & Clinical Practice Vol 17 2022, ArtID 4 ; 17, 2022.
Article in English | APA PsycInfo | ID: covidwho-1772359

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)

8.
Am J Health Promot ; : 8901171221082471, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1775174

ABSTRACT

The opioid overdose epidemic continues to devastate lives across the United States and has worsened during the COVID-19 pandemic. In this paper, we review 166 online-accessible opioid-related campaigns to understand the current state of the science and practice of campaigns to address the opioid crisis. The findings suggest that health promotion practitioners can have a greater impact on reducing overdose deaths if they move beyond awareness-raising messaging about opioid misuse and place a greater emphasis on driving demand for evidence-based treatments such as medications for opioid use disorder and on reducing stigma related to treatment and recovery.

9.
BMC Health Serv Res ; 22(1): 418, 2022 Mar 30.
Article in English | MEDLINE | ID: covidwho-1770536

ABSTRACT

BACKGROUND: Opioid treatment programs (OTPs) serve as daily essential services for people with opioid use disorder. This study seeks to identify modifications to operations and adoption of safety measures at Pennsylvania OTPs during the COVID-19 pandemic. METHODS: A 25-min online survey to clinical and administrative directors at all 103 state-licensed OTPs in Pennsylvania was fielded from September to November 2020. Survey domains included: 1) changes to services, client volume, hours and staffing during the COVID-19 pandemic 2) types of services modifications 3) safety protocols to reduce COVID-19 transmission 4) challenges to operations during the pandemic. RESULTS: Forty-seven directors responded, for a response rate of 45%. Almost all respondents reported making some service modification (96%, n = 43). Almost half (47%, n = 21) of respondents reported reductions in the number of clients served. OTPs were more likely to adopt safety protocols that did not require significant funding, such as limiting the number of people entering the site (100%, n = 44), posting COVID-safety information (100%, n = 44), enforcing social distancing (98%, n = 43), and increasing sanitation (100%, n = 44). Only 34% (n = 14) of OTPS provided N95 masks to most or all staff. Respondents reported that staff's stress and negative mental health (86%, n = 38) and staff caregiving responsibilities (84%, n = 37) during the pandemic were challenges to maintaining OTP operations. CONCLUSION: OTPs faced numerous challenges to operations and adoption of safety measures during the COVID-19 pandemic. Funding mechanisms and interventions to improve adoption of safety protocols, staff mental health as well as research on patient experiences and preferences can inform further OTP adaptation to the COVID-19 pandemic and future emergency planning.


Subject(s)
COVID-19 , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/prevention & control , Pandemics/prevention & control , Surveys and Questionnaires
10.
Non-conventional in English | APA PsycInfo | ID: covidwho-1766694

ABSTRACT

Unhealed trauma causes distress in the body. When the nature of the distress overrides a person's existing system for coping, or the trauma is not processed, survivors may numb themselves or seek a more pleasurable experience to escape. Such behavior is a completely natural response to unprocessed trauma. This tendency we have as human beings to dissociate, or sever from the present moment when the moment becomes unpleasant or painful, is amplified for survivors when chemicals or other reinforcing behaviors are introduced. Such chemicals and behaviors can accelerate the potency of dissociation. Eye movement desensitization and reprocessing (EMDR) therapy is a complete system of psychotherapy that can facilitate this process. This innovative book offers an investigation into therapies which can assist therapists to assess trauma and how it impacts the mind-body. It provides a clear guide to therapists in changing the way healing addiction is imagined. The book continues to challenge the existing paradigms for treating addiction and related issues. Despite the longstanding existence of professional treatment in North America, recidivism is high. People are still dying at alarming rates, not just from the opioid crisis that dominates news headlines, but also from the impact of alcohol, cocaine, nicotine, and other maladaptive behaviors. Moreover, the social isolation and collective trauma caused by the COVID-19 pandemic added fuel to an already raging fire, revealing massive cracks in a system for care that is barely functional. In assessment, no single drug, substance, or behavior is the culprit the real issue is the untreated trauma that lurks underneath, causing people to seek out the relief of these substances in the first place. EMDR therapy is a complete psychotherapy that facilitates the shifts that are required in an individual to achieve meaningful lifestyle change. Recovery, healing, and wellness require lifestyle change. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

11.
Am J Emerg Med ; 54: 221-227, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1748324

ABSTRACT

OBJECTIVES: Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED). Our secondary aim was to determine if Black and Hispanic patients were more likely to have >3 referrals. METHODS: This retrospective cohort study was conducted at a large urban safety-net hospital and included patients seen in the ED from July 2018 to September 2019 with ICD-10 codes for an opioid-related visit and who sought placement to inpatient detox. A generalized linear mixed model controlling for multiple visits, age, sex, insurance, time, day of week, and time of year was used to assess the association between race/ethnicity and hypothesized barriers to placement. The proportion of patients with >3 visits for referral to inpatient detox was compared between Black and Hispanic patients and white patients using a chi-squared test. RESULTS: We identified 1733 encounters from 782 unique patients seeking connection to inpatient detox for OUD. Of the 1733 encounters, 45% were among Black and Hispanic patients. Hispanic and Black men had significantly lower odds of having a barrier to inpatient OUD detox than white men (OR = 0.734, 95% CI 0.542-0.995). No significant difference was found for Hispanic and Black women (OR = 1.212, 95% CI 0.705-2.082). More Black and Hispanic patients experienced >3 referrals to inpatient detox compared to white patients (19.2% vs 12.9%, p = 0.016). CONCLUSIONS: This study suggests in the context of near-universal health insurance coverage, an ED-based OUD support program staffed by diverse community members can mitigate inequities in access to inpatient detox. However, the increased number of ED visits for OUD detox placement by Black and Hispanic patients suggests racial inequities in OUD treatment exist after linkage to care. Additional research should explore the causes, specifically structural and interpersonal racism, and determine solutions to address racial inequities in detox placement as well as maintenance in treatment programs.


Subject(s)
Emergency Medical Services , Opioid-Related Disorders , Female , Humans , Inpatients , Male , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Retrospective Studies , United States
12.
Subst Abuse Treat Prev Policy ; 17(1): 22, 2022 03 18.
Article in English | MEDLINE | ID: covidwho-1745438

ABSTRACT

BACKGROUND: The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS: The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS: The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS: The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.


Subject(s)
COVID-19 , Opioid-Related Disorders , Humans , Male , Opioid-Related Disorders/epidemiology , Pandemics , Public Health , Qualitative Research
13.
20th IEEE International Conference on Machine Learning and Applications, ICMLA 2021 ; : 1333-1340, 2021.
Article in English | Scopus | ID: covidwho-1741209

ABSTRACT

Opioid Use Disorder (OUD) is one of the most severe health care problems in the USA. People addicted to opioids need various treatments, including Medication-Assisted Treatment (MAT), proper counseling, and behavioral therapies. However, during the peak time of the COVID-19 pandemic, the supply of emergency medications was disrupted seriously. Patients faced severe medical care scarcity since many pharmaceutical companies, drugstores, and local pharmacies were closed. Import-export was also canceled to consent to the government emergency law, i.e., lockdown, quarantine, and isolation. These circumstances and their negative effects on OUD patient's psychology could have led them to a drop out of MAT medications and persuaded to resume illicit opioid use. This project involves collecting and analyzing a large volume of Twitter data related to MAT medications for OUD patients. We discover the Active MAT Medicine Users (AMMUs) on twitter. For this, we build a seed dictionary of words related to OUD and MAT and apply association rules to expand it. Further, AMMUs' tweet posts are studied 'before the pandemic' (BP) and 'during the pandemic' (DP) to understand how the drug behaviors and habits have changed due to COVID-19. We also perform sentiment analysis on Tweets to determine the impact of the COVID-19 pandemic on the psychology of AMMUs. Our analysis shows that the use of MAT medications has decreased around 30.54%, where the use of illicit drugs and other prescription opioids increased 18.06% and 12.12%, respectively, based on AMMUs' tweets posted during the lockdown compared with before the lockdown statistics. The COVID-19 pandemic and lockdown may result in the resumption of illegal and prescription opioid abuse by OUD patients. Necessary steps and precautions should be taken by health care providers to ensure the emergency supply of medicines and also psychological support and thus prevent patients from illicit opioid use. © 2021 IEEE.

14.
J Osteopath Med ; 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1742053

ABSTRACT

CONTEXT: The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. OBJECTIVES: This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. METHODS: The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. RESULTS: Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. CONCLUSIONS: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.

15.
Molecules ; 27(5)2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1737001

ABSTRACT

In our continuing effort to develop effective anti-heroin vaccines as potential medications for the treatment of opioid use disorder, herein we present the design and synthesis of the haptens: 1-AmidoMorHap (1), 1-AmidoMorHap epimer (2), 1 Amido-DihydroMorHap (3), and 1 Amido-DihydroMorHap epimer (4). This is the first report of hydrolytically stable haptenic surrogates of heroin with the attachment site at the C1 position in the 4,5-epoxymorophinan nucleus. We prepared respective tetanus toxoid (TT)-hapten conjugates as heroin vaccine immunogens and evaluated their efficacy in vivo. We showed that all TT-hapten conjugates induced high antibody endpoint titers against the targets but only haptens 2 and 3 can induce protective effects against heroin in vivo. The epimeric analogues of these haptens, 1 and 4, failed to protect mice from the effects of heroin. We also showed that the in vivo efficacy is consistent with the results of the in vitro drug sequestration assay. Attachment of the linker at the C1 position induced antibodies with weak binding to the target drugs. Only TT-2 and TT-3 yielded antibodies that bound heroin and 6-acetyl morphine. None of the TT-hapten conjugates induced antibodies that cross-reacted with morphine, methadone, naloxone, or naltrexone, and only TT-3 interacted weakly with buprenorphine, and that subtle structural difference, especially at the C6 position, can vastly alter the specificity of the induced antibodies. This study is an important contribution in the field of vaccine development against small-molecule targets, providing proof that the chirality at C6 in these epoxymorphinans is a vital key to their effectiveness.


Subject(s)
Heroin
16.
Journal of Rural Mental Health ; : No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-1735198

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)

17.
Clin Cardiol ; 45(5): 536-539, 2022 May.
Article in English | MEDLINE | ID: covidwho-1733857

ABSTRACT

BACKGROUND AND OBJECTIVES: Compare proportion of all-cause and cause-specific mortality among West Virginia Medicaid enrollees who were discharged from infective endocarditis (IE) hospitalization with and without opioid use disorder (OUD) diagnosis. METHODS: The proportions of cause-specific deaths among those who were discharged from IE-related hospitalizations were compared by OUD diagnosis. RESULTS: The top three underlying causes of death discharged from IE hospitalization were accidental drug poisoning, mental and behavioral disorders due to polysubstance use, and cardiovascular diseases. Of the total deaths occurring among patients discharged after IE-related hospitalization, the proportion has increased seven times from 2016 to 2019 among the OUD deaths while it doubled among the non-OUD deaths. DISCUSSION AND CONCLUSIONS: Of the total deaths occurring among patients discharged after IE-related hospitalization, the increase is higher in those with OUD diagnosis. OUD is becoming a significantly negative impactor on the survival outcome among IE patients. It is of growing importance to deliver medication for OUD treatment and harm reduction efforts to IE patients in a timely manner, especially as the COVID-19 pandemic persists.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Opioid-Related Disorders , Cause of Death , Endocarditis/diagnosis , Hospitalization , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Patient Discharge , Retrospective Studies , United States , West Virginia/epidemiology
18.
Addict Sci Clin Pract ; 17(1): 16, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731544

ABSTRACT

BACKGROUND: Morbidity and mortality related to opioid use disorder (OUD) in the U.S. is at an all-time high. Innovative approaches are needed to address gaps in retention in treatment with medications for opioid use disorder (MOUD). Mobile health (mHealth) approaches have shown improvement in engagement in care and associated clinical outcomes for a variety of chronic diseases, but mHealth tools designed specifically to support patients treated with MOUD are limited. METHODS: Following user-centered development and testing phases, a multi-feature smartphone application called HOPE (Heal. Overcome. Persist. Endure) was piloted in a small cohort of patients receiving MOUD and at high risk of disengagement in care at an office-based opioid treatment (OBOT) clinic in Central Virginia. Outcomes were tracked over a six-month period following patient enrollment. They included retention in care at the OBOT clinic, usage of various features of the application, and self-rated measures of mental health, substance use, treatment and recovery. RESULTS: Of the 25 participants in the HOPE pilot study, a majority were retained in care at 6 months (56%). Uptake of bi-directional features including messaging with providers and daily check-ins of mood, stress and medication adherence peaked at one month, and usage persisted through the sixth month. Patients who reported that distance to clinic was a problem at baseline had higher loss to follow up compared to those without distance as a reported barrier (67% vs 23%, p = 0.03). Patients lost to in-person clinic follow up continued to engage with one or more app features, indicating that mHealth approaches may bridge barriers to clinic visit attendance. Participants surveyed at baseline and 6 months (N = 16) scored higher on scales related to overall self-control and self-efficacy related to drug abstinence. CONCLUSIONS: A pilot study of a novel multi-feature smartphone application to support OUD treatment showed acceptable retention in care and patient usage at 6 months. Further study within a larger population is needed to characterize 'real world' uptake and association with outcomes related to retention in care, relapse prevention, and opioid-associated mortality.


Subject(s)
Buprenorphine , COVID-19 , Mobile Applications , Opioid-Related Disorders , Buprenorphine/therapeutic use , Communicable Disease Control , Humans , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pilot Projects , SARS-CoV-2 , Smartphone
19.
Drug Alcohol Depend ; 232: 109340, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1729685

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. METHODS: State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. RESULTS: The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). CONCLUSIONS: The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.


Subject(s)
COVID-19 , Drug Overdose , Adult , Analgesics, Opioid/therapeutic use , Drug Overdose/epidemiology , Humans , Medicaid , Pandemics , SARS-CoV-2 , United States/epidemiology
20.
Subst Abuse Treat Prev Policy ; 17(1): 16, 2022 03 05.
Article in English | MEDLINE | ID: covidwho-1724512

ABSTRACT

BACKGROUND: Timely data from official sources regarding the impact of the COVID-19 pandemic on people who use prescription and illegal opioids is lacking. We conducted a large-scale, natural language processing (NLP) analysis of conversations on opioid-related drug forums to better understand concerns among people who use opioids. METHODS: In this retrospective observational study, we analyzed posts from 14 opioid-related forums on the social network Reddit. We applied NLP to identify frequently mentioned substances and phrases, and grouped the phrases manually based on their contents into three broad key themes: (i) prescription and/or illegal opioid use; (ii) substance use disorder treatment access and care; and (iii) withdrawal. Phrases that were unmappable to any particular theme were discarded. We computed the frequencies of substance and theme mentions, and quantified their volumes over time. We compared changes in post volumes by key themes and substances between pre-COVID-19 (1/1/2019-2/29/2020) and COVID-19 (3/1/2020-11/30/2020) periods. RESULTS: Seventy-seven thousand six hundred fifty-two and 119,168 posts were collected for the pre-COVID-19 and COVID-19 periods, respectively. By theme, posts about treatment and access to care increased by 300%, from 0.631 to 2.526 per 1000 posts between the pre-COVID-19 and COVID-19 periods. Conversations about withdrawal increased by 812% between the same periods (0.026 to 0.235 per 1,000 posts). Posts about drug use did not increase (0.219 to 0.218 per 1,000 posts). By substance, among medications for opioid use disorder, methadone had the largest increase in conversations (20.751 to 56.313 per 1,000 posts; 171.4% increase). Among other medications, posts about diphenhydramine exhibited the largest increase (0.341 to 0.927 per 1,000 posts; 171.8% increase). CONCLUSIONS: Conversations on opioid-related forums among people who use opioids revealed increased concerns about treatment and access to care along with withdrawal following the emergence of COVID-19. Greater attention to social media data may help inform timely responses to the needs of people who use opioids during COVID-19.


Subject(s)
COVID-19 , Opioid-Related Disorders , Social Media , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Humans , Natural Language Processing , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , SARS-CoV-2
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