Browsing by Subject "Buprenorphine"
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Item The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder(medRxiv, 2020) Zhang, Pengyue; Chiang, Chien-Wei; Quinney, Sara; Donneyong, Macarius; Lu, Bo; Huang, Lei Frank; Cheng, Feixiong; Obstetrics and Gynecology, School of MedicineIntroduction Retention in buprenorphine treatment for opioid use disorder (OUD) yields better opioid abstinence and reduces all-cause mortality for patients with OUD. Despite significant efforts have been made to expand the availability and use of buprenorphine in the United States, its retention rates remain on a low level. The current study examines discontinuation of buprenorphine with respect to concurrent initiation of other medications using real-world evidence. Methods Case-crossover study was conducted to examine discontinuation of buprenorphine using a large-scale longitudinal health dataset including 148,306 commercially-insured individuals initiated on medications for opioid use disorder (MOUD). Odds ratios and Bonferroni adjusted p-values were calculated for medications and therapeutic classes of medications. Results Clonidine was associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone (OR = 1.583 and adjusted p-value = 1.22 × 10−6) and using naltrexone as a comparison drug (OR = 2.706 and adjusted p-value = 4.11 × 10−5). Opioid medications (oxycodone, morphine and fentanyl) and methocarbamol were associated with increased discontinuation risk of buprenorphine using the buprenorphine dataset alone (adjusted p-value < 0.05), but not significant using naltrexone as a comparison drug. 6 drug therapeutic classes were associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone and using naltrexone as a comparison drug (adjusted p-value < 0.05). Conclusion Concurrent initiation of medications is associated with increased discontinuation risk of buprenorphine. Opioid medications are prescribed among patients on MOUD and associated with increased discontinuation risk of buprenorphine. Analgesics is associated with increased discontinuation risk of buprenorphine for patients without previous exposure of pain medications.Item Expanding Buprenorphine Use in Primary Care: Changing the Culture(The Permanente Federation, 2022) Leiser, Abraham; Robles, Maria; Medicine, School of MedicineItem Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis(Springer, 2022-10-04) Adams , K. K.; Miech, E. J.; Sobieraj, D. M.; Emergency Medicine, School of MedicineBackground: Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following question: when patients received a buprenorphine initiation strategy aimed to eliminate prerequisite withdrawal, what factors consistently distinguished patients that experienced withdrawal during the initiation process from patients that did not? Methods: From the 24 cases identified by our systematic review, we included cases that were treated using buprenorphine microdosing strategies (oral or transdermal), cases with opioid use disorder, and cases that fully transitioned to buprenorphine without continuing the full opioid agonist. Configurational analysis was used to identify combinations of patient and regimen level factors that uniquely distinguished cases experiencing withdrawal during induction. Result: Fourteen cases were included in our analysis, of which 9 experienced opioid withdrawal symptoms. Three factors were involved in explaining both the presence and absence of withdrawal symptoms: history of heroin use, history of methadone use, and duration of overlap between buprenorphine and the full opioid agonist during induction. For the presence of withdrawal symptoms, the addition of a fourth factor "buprenorphine starting dose" resulted in a model with perfect consistency and coverage; for the absence of withdrawal symptoms, the addition of a fourth factor "induction duration" similarly resulted in a model with perfect consistency and 80% coverage. Conclusion: Application of configurational methods allowed synthesis of case reports identified through a systematic review.Item Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions(Department of Emergency Medicine, School of Medicine, University of California, Irvine, 2022-07-11) Kelly, Timothy D.; Hawk, Kathryn F.; Samuels, Elizabeth A.; Strayer, Reuben J.; Hoppe, Jason A.; Emergency Medicine, School of MedicineEmergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.Item Medicated-Assisted Treatment in Indiana(The Center for Health Policy, 2019-03-01) Kooreman, HaroldOpioid misuse and addiction continues to affect many Americans. Medication-assisted treatment (MAT) using methadone, buprenorphine, or extended-release naltrexone in combination with behavioral therapy is the most effective intervention for opioid use disorders (OUDs). Despite its effectiveness, methadone to treat OUDs is not widely available. Buprenorphine is more accessible, as it can be prescribed by medical doctors, nurse practitioners, and physician assistants who have received specialized training and obtained a waiver from the DEA. Naltrexone is a non-narcotic and can be prescribed by any healthcare professional who has prescription privileges.Item Medication for Adolescents and Young Adults with Opioid Use Disorder(Elsevier, 2021) Hadland, Scott E.; Aalsma, Matthew C.; Akgül, Sinem; Alinsky, Rachel H.; Bruner, Ann; Chadi, Nicholas; Galagali, Preeti M.; Kreida, Ellen C.; Robinson, Camille A.; Wilson, J. Deanna; Pediatrics, School of MedicineOpioid-related morbidity and mortality have risen in many settings globally. It is critical that practitioners who work with adolescents and young adults (AYAs) provide timely, evidence-based treatment for opioid use disorder (OUD). Such treatment should include medications for opioid use disorder (MOUD), including buprenorphine, naltrexone, and methadone. Medication treatment is associated with reduced mortality, fewer relapses to opioid use, and enhanced recovery and retention in addiction care, among other positive health outcomes. Unfortunately, the vast majority of AYAs with OUD do not receive medication. The Society for Adolescent Health and Medicine recommends that AYAs be offered MOUD as a critical component of an integrated treatment approach. Barriers to receipt of medications are widespread; many are common to high-, middle-, and low-income countries alike, whereas others differ. Such barriers should be minimized to ensure equitable access to youth-friendly, affirming, and confidential addiction treatment that includes MOUD. Robust education on OUD and medication treatment should be provided to all practitioners who work with AYAs. Strategies to reduce stigma surrounding medication-and stigma experienced by individuals with substance use disorders more generally-should be widely implemented. A broad research agenda is proposed with the goal of expanding the evidence base for the use and delivery of MOUD for AYAs.Item Patients with Mood Disorders Require Higher Doses of Buprenorphine for Management of Opioid Use Disorder But Have No Increased Risk of Neonatal Abstinence Syndrome(Metrodora, 2021) Tonismae, Tiffany; McDowell, Misty; Torres, Loraine; Slaven, James E.; Quinney, Sara K.; Schubert, Frank; Pell Abernathy, Mary; Obstetrics and Gynecology, School of MedicineObjective: This study compared differences in buprenorphine doses needed to treat opioid use disorder in pregnant women with and without mood disorders and to compare the development of neonatal abstinence syndrome in infants delivered to mothers treated with buprenorphine in patients with history of mood disorders versus those without mood disorder. Methods: This retrospective cohort study included women with opioid use disorder prescribed buprenorphine who had at least one outpatient visit at with the Indiana University Department of Maternal Fetal Medicine during pregnancy and delivered within the Indiana University Health system. Charts were reviewed for maternal demographics, medical history and medication use, and neonatal outcomes. Cases included those patients with history of mood disorder including depression, anxiety, or post-traumatic stress disorder based on initial appointment intake forms. Starting and maximum doses of buprenorphine during pregnancy were recorded. Outcomes were compared using Student’s t-tests and Analysis of Variance models for continuous variables and chi-square tests for categorical variables. All analytic assumptions were verified, with non-parametric tests being performed where necessary. Results: A total of 266 women were treated with opioids, of which 171 were diagnosed with a mood disorder: 148 depression, 130 anxiety, and 19 post-traumatic stress disorder. Over 40% of the patients had a history of dual diagnoses. Patients with a history of depression or anxiety required a higher dose of buprenorphine during pregnancy (p=0.0217, p=0.0165) compared to those without a history of mood disorder. There was no significant difference in the doses in patients with post-traumatic stress disorder versus controls. In those with a diagnosis of mood disorder, there was no difference in buprenorphine dose between women on medication versus those not on medication for depression, anxiety, and Post Traumatic Stress Disorder. There was no statistical difference between patients with or without mood disorder and the development of neonatal abstinence syndrome. For those that developed neonatal abstinence syndrome, infants whose mothers had anxiety or post-traumatic stress disorder required 2-6 extra days of morphine treatment compared to those infants of mothers without mood disorder (p=0.0088, p=0.0291), no difference seen for depression or a combination of mood disorders. Development of neonatal abstinence syndrome or length of treatment did not vary if the mother was on medication for treatment of her mood disorder. Conclusion: Pregnant women with a mood disorder require higher doses of buprenorphine compared to patients without a mood disorder. In women with mood disorders, there was no difference in buprenorphine dose in women treated with medication compared to those not taking medication for mood disorders. While, there was no difference in the incidence of neonatal abstinence syndrome in infants whose mothers also had a mood disorder, infants born of women with anxiety or post-traumatic stress disorder had longer stays at the Neonatal Intensive Care Unit as they needed 2-6 extra days of morphine treatment. These findings may help guide provider counseling of these women in discussion of post-delivery expectations.Item Postpartum medication for opioid use disorder outcomes associated with prenatal treatment and neighborhood-level social determinants(Elsevier, 2023) Martin, Caitlin E.; Britton, Erin; Shadowen, Hannah; Johnson, Jasmine; Sabo, Roy; Cunningham, Peter; Obstetrics and Gynecology, School of MedicineBackground: Opioid use disorder is a leading cause of death through the year postpartum. Objective: This study aimed to identify the association of neighborhood-level social determinants of health and prenatal opioid use disorder treatment receipt with the outcomes of medication treatment for opioid use disorder through the year postpartum among a cohort of birthing people. Study design: This was a population-based retrospective cohort study that used state Medicaid claims and enrollment data for the 1690 individuals who delivered a live infant between July 1, 2016 and December 31, 2020 and received medication for opioid use disorder at delivery. The primary exposure was the state Health Opportunity Index, a composite measure of social determinants of health linked at the census-tract level. Secondary exposures included comprehensiveness of opioid use disorder treatment and duration of medication treatment for opioid use disorder received prenatally. Outcomes included the duration and continuity of postpartum medication treatment for opioid use disorder, operationalized as the time from delivery to the discontinuation of medication treatment for opioid use disorder, and percentage of days covered by medication treatment for opioid use disorder within the 12 months after delivery, respectively. Results: Within the study sample, 711 deliveries were to birthing people in the lowest state Health Opportunity Index tercile (indicating high burden of negative social determinants of health), 647 in the middle state Health Opportunity Index tercile, and 332 in the highest state Health Opportunity Index tercile. Using stepwise multivariable regression (Cox proportional hazards and negative binomial models) guided by a socioecological framework, prenatal receipt of more comprehensive opioid use disorder treatment and/or longer duration of prenatal medication treatment for opioid use disorder was associated with improved 1-year postpartum opioid use disorder treatment outcomes (duration and continuity of medication treatment for opioid use disorder). When the state Health Opportunity Index was added to the models, these significant associations remained stable, with the state Health Opportunity Index not demonstrating an association with the outcomes (duration hazard ratio, 1.39; 95% confidence interval, 0.551-3.512; continuity relative risk, 1.024; 95% confidence interval, 0.323-3.247). Conclusion: Targeted efforts at expanding access to and quality of evidence-based opioid use disorder treatments for reproductive-age people across the life course should be prioritized within the spectrum of work aimed at eradicating disparities in pregnancy-related mortality.Item Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic(American Medical Association, 2022) Nguyen, Thuy; Ziedan, Engy; Simon, Kosali; Miles, Jennifer; Crystal, Stephen; Samples, Hillary; Gupta, Sumedha; Economics, School of Liberal ArtsImportance: COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown. Objective: To investigate whether disruptions in filled buprenorphine and naltrexone prescriptions differed by race and ethnicity and insurance status or payer type. Design, setting, and participants: This cross-sectional study used retail pharmacy claims from May 2019 to June 2021 from the Symphony Health database, which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories. Interrupted time series were used to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. Included individuals were those who filled buprenorphine and extended-release naltrexone prescriptions. Data were analyzed from July 2021 through March 2022. Main outcomes and measures: Weekly rates of dispensed buprenorphine and extended-release naltrexone prescription fills per 1000 patients and proportion of longer (ie, ≥14 days' supply) buprenorphine prescription fills were calculated. Analyses were stratified by patient race and ethnicity and further by insurance status and payer type for White and Black patients. Results: A total of 1 556 860 individuals who filled buprenorphine prescriptions (4359 Asian [0.3%], 94 657 Black [6.1%], 55 369 Hispanic [3.6%], and 664 779 White [42.7%]) and 127 506 individuals who filled extended-release naltrexone prescriptions (344 Asian [0.3%], 8186 Black [6.4%], 5343 Hispanic [4.2%], and 53 068 White [41.6%]) from May 6, 2019, to June 5, 2021, were analyzed. Prepandemic increases in buprenorphine fill rate flattened for all groups after COVID-19 onset (30.5 percentage point difference in trend; P < .001) compared with prepandemic trends. Significant level decreases in buprenorphine fills (ranging from 2.5% for Black patients; P = .009 to 4.0% for Hispanic patients; P = .009) at pandemic onset were observed for members of racial and ethnic minority groups but not White patients. At pandemic onset, rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001). No decreases were found among Medicaid patients. Unlike buprenorphine, extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups. Conclusions and relevance: This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals. These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.