Adapting and scaling a single site DEA X-waiver training program to a statewide initiative: Implementing GetWaiveredTX.

OBJECTIVES: To address the critical need for opioid use disorder (OUD) treatment by rapidly planning and implementing a statewide DEA X-waiver training initiative expanding office-based OUD treatment in Texas by: (1) facilitating access to buprenorphine waiver trainings to targeted regions and health care providers across the state; and (2) supporting completion of DEA X-waiver requirements. METHODS: We used a transdisciplinary and theory-driven approach to adapt and rapidly scale up an existing, previously successful DEA X-waiver initiative. Pre-implementation activities included a literature review to identify OUD treatment barriers and demographic analyses to identify high-need areas of the state. We used geospatial mapping methods to identify regions with highest point prevalence of opioid-overdose mortality and low access to a buprenorphine provider. The study team used the Replicating Effective Programs (REP) framework developed by the Centers for Disease Control and Prevention to support implementation of evidence-based practices. RESULTS: In six months, we trained 451 waiver eligible providers, 133 (29%) of whom received waivers by 6 months post-training. Of the 163 (36.1%) providers who completed the post-waiver evaluation, 97% reported that they were satisfied or very satisfied with the training. Our initiative delivered high quality education to providers and increased the number of waiver trainers in Texas from eight to thirteen. CONCLUSIONS: Despite recent changes to the DEA X-waiver process, barriers to treating OUD with buprenorphine remain. Lack of education and experience treating substance use disorders remains a significant factor in limiting clinician comfort in prescribing buprenorphine. The research team successfully adapted a Texas-wide initiative to increase the number of office-based providers eligible to prescribe buprenorphine for OUD from an existing single-site initiative. Attentiveness to barriers pre-implementation and to adaptations during implementation enabled moderate impact across a large network in a short time and facilitated program sustainment.

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI).

INTRODUCTION: Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE: We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD: CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION: As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pain, psychological flexibility, and continued substance use in a predominantly hispanic adult sample receiving methadone treatment for opioid use disorder.

BACKGROUND: We explored pain, psychological flexibility, and continued substance use among 100 adults treated with methadone for opioid use disorder (OUD). All participants had co-occurring chronic pain. METHODS: Participants recruited from a community treatment center between 2009 and 2010 completed an interviewer-facilitated assessment. Chronic pain severity and interference, psychological flexibility (mindfulness, acceptance, values success), past 30-day substance use, and demographics were reported. We modeled a zero-inflated negative binomial regression to examine 1) the probability that an individual does not use illicit substances and 2) illicit substance use frequency among those expected to use. Pain severity and mindfulness were included as predictors in the logit (zero inflated) model. Pain interference, acceptance, and values success were included as predictors in the negative binomial (count) model. We controlled for age and gender in both models. RESULTS: Participants were predominantly (84%) Hispanic, and 64% used an illicit substance least once in the past 30 days. Greater degree of mindfulness significantly predicted the probability that an individual does not continue to use illicit substances (OR = 1.59, p < 0.05). Lower degree of values success significantly predicted greater illicit substance use frequency among those likely to use (IRR = 0.72, p < 0.01). No other variables were associated with continued substance use. CONCLUSIONS: Findings suggest psychological flexibility is associated with continued substance use in this predominantly Hispanic sample of adults treated for OUD with co-occurring chronic pain. Study findings may have implications for how to address the treatment needs of this complex population.

Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training.

OBJECTIVE: The primary objective was to evaluate the efficacy of commercially available mobile app-delivered mindfulness training (AMT), compared with waitlist control (WC), on quality of life (QOL) among women diagnosed with breast cancer. The secondary outcome was dispositional mindfulness. Enrollment, app utilization, and study completion are reported as feasibility objectives. METHODS: Women diagnosed with breast cancer ≤5 years (n = 112) were randomized to AMT (n = 57) or WC (n = 55), over 8 weeks, with 4 weeks of follow-up. We conducted linear mixed effects models to examine group by observation interactions on QOL and dispositional mindfulness at baseline, during intervention (5-weeks), post-intervention (9-weeks), and follow-up (12-weeks post-baseline). RESULTS: Participants assigned to AMT reported higher QOL, compared with those assigned to WC, from baseline through follow-up t(258.40) = 3.09, P < 0.01, 95% CI [2.71, 11.90]. Participants assigned to AMT also reported higher dispositional mindfulness, compared with those assigned to WC, from baseline through follow-up t(268.44) = 2.04, P = 0.04, 95% CI [0.01, 0.57]. App utilization data was obtained from 34 participants. Fewer participants assigned to AMT completed all study assessments, compared with participants assigned to WC, (χ21  = 7.07, P = 0.008). CONCLUSIONS: Findings suggest commercially available AMT may proffer some benefit to women seeking to enhance their QOL following breast cancer diagnosis.

Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain.

The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.

Impulsivity but not sensation seeking is associated with opioid analgesic misuse risk in patients with chronic pain.

Impulsivity and sensation seeking have been associated with substance use disorders, including opioid use disorders. This pilot study sought to examine whether impulsivity and sensation seeking, as measured by the Barratt Impulsiveness Scale (BIS) and Sensation Seeking Scale (SSS), were associated with opioid analgesic misuse risk in chronic, low-back pain patients prescribed opioid analgesics. Participants were 42 chronic, low-back pain patients enrolled in a larger study examining problematic opioid analgesic use. Impulsivity was assessed using the BIS, sensation seeking was measured using the SSS, and opioid analgesic misuse risk was assessed using the Current Opioid Misuse Measure (COMM). Significant bivariate associations were found between the COMM and the following predictor variables: age and the three BIS subscales: Attentional Impulsiveness, Non-planning Impulsiveness, and Motor Impulsiveness. Using a multivariate linear regression, after controlling for age, the BIS subscales accounted for 29.0% of the variance in the COMM. Attentional Impulsiveness was the only significant BIS subscale. These results suggest a potential relationship between impulsivity, but not sensation seeking, and risk for opioid analgesic misuse. Impulsivity is not a prominent trait observed in chronic pain patients; however, it may be an important risk factor for opioid analgesic misuse for a subset of individuals with chronic pain. As such, these findings suggest that additional exploration of this potential risk factor is warranted.