Characterizing Opioid Use Disorder Encounters in the Midwest Region, USA.

INTRODUCTION: The opioid epidemic has taken its toll on the Midwest, a census region of the USA. The Midwest includes two census divisions: East North Central and West North Central. This study aimed (1) to characterize patient encounters of opioid use disorder (OUD) in the Midwest using the Health Facts® database; and (2) to compare selected patient and facility characteristics between the two census divisions. METHODS: This study was a sub-analysis of a retrospective analysis of the Health Facts® database. For the first objective, the unit of analysis was a patient encounter. Selected patient characteristics were age, gender, marital status, race, length of stay, and patient type. Selected facility characteristics were census division and urban versus rural areas. Descriptive statistics were conducted, and population-based rates of OUD were calculated for categorical variables. For the second objective, t tests were performed for age and length of stay, and chi-square tests for categorical variables. RESULTS: A total of 13,129 (23.7%) encounters were in East North Central, and 42,271 (76.3%) in West North Central. Patient characteristics that were associated with the highest frequency of encounters were Caucasian, male, single, and other patient types. In addition, rural areas had a higher number of encounters than urban areas. Compared with East North Central, West North Central had a greater average age and a longer average length of stay (p < 0.001). West North Central had a significantly higher proportion of patient encounters associated with patients being male, African American, single, and facilities being in rural areas (p < 0.001). CONCLUSION: Compared to East North Central, patient encounters of OUD were more frequent and the average length of stay was longer than in West North Central. A significantly higher proportion of patient encounters in West North Central were associated with patients being male, African American, and single, and facilities being in rural areas.

Examining Geographic Variation of Opioid Use Disorder Encounters in the USA.

OBJECTIVES: The objectives were (1) to characterize patient encounters of opioid use disorder (OUD) using Health Facts® database; and (2) to identify geographic variation, patient characteristics, and facility characteristics impacting patients' reduced OUD encounters over time. METHODS: Patient encounters were included if the patient (1) was 18 years old or greater; (2) had an index encounter; (3) survived at least 30 days after the discharge. The OUD encounter was based on ICD-10 codes. The date at which a patient first had an OUD encounter was the index date. For the first objective, OUD encounters were described according to patient characteristics, facility characteristics, and geographic variation. Patient characteristics were age, gender, marital status, race, health insurance coverage, discharge disposition, and patient type. Facility characteristics were care setting, medical specialty, census region, census division, urban vs. rural, acute vs. non-acute, and teaching hospital status. For the second objective, patients were examined 1 year prior to through 1 year after the index date. A logistic regression was used to determine the likelihood of reduced OUD encounters over time, conditional upon geographic variation, patient characteristics, and facility characteristics. RESULTS: A total of 265,643 OUD encounters were identified. East South Central was associated with the highest population-based rate of OUD among nine census divisions. In the logistic regression (n = 10,762), discharged to home, outpatient, emergency room, psychiatry, East North Central, West North Central, and urban areas were significant positive predictors for reduced OUD encounters over time, whereas age and Mountain were significant negative predictors. CONCLUSIONS: East South Central was associated with the highest population-based rate of OUD. Compared with East South Central, East North Central and West North Central had a significantly positive impact on fewer encounters of OUD over time.

Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions.

BACKGROUND: To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD: Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS: Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS: Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.

Dismantling racism against Black, Indigenous, and people of color across the substance use continuum: A position statement of the association for multidisciplinary education and research in substance use and addiction.

The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) acknowledges that racism profoundly affects persons who use alcohol and other drugs. Racism's deadly effects compounded with other social determinants of health result in a cascade of negative impacts. The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Through these strategies, AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has permeated the United States for centuries.