IU Indianapolis ScholarWorks :: Browsing by Subject "opioid use disorder"

Browsing by Subject "opioid use disorder"

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Assessment of Filled Buprenorphine Prescriptions for Opioid Use Disorder During the Coronavirus Disease 2019 Pandemic
(AMA, 2020-12) Nguyen, Thuy D.; Gupta, Sumedha; Ziedan, Engy; Simon, Kosali I.; Alexander, Caleb; Saloner, Brendan; Stein, Bradley D.; Economics, School of Liberal Arts
The coronavirus disease 2019 (COVID-19) pandemic has profoundly disrupted health care delivery in the US.1 The Centers for Disease Control and Prevention noted a 9.1% increase in reported 12-month counts of drug overdose deaths from March 2019 to March 2020, from 67 726 to 73 860.2 On March 13, 2020, a COVID-19 national emergency was declared. To diminish potential barriers to treatment access, 3 days later, federal guidelines on telemedicine use were released, providing authorized practitioners increased flexibility to prescribe buprenorphine to patients with opioid use disorder (OUD) during this public health emergency.3 Other local, state, and federal policy initiatives have also attempted to preserve access to medication treatment for OUD, yet the cumulative outcome of these undertakings is not clear.
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 Medicine
Introduction 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.
Court personnel attitudes towards medication-assisted treatment: A state-wide survey
(Elsevier, 2019-09) Andraka-Christou, Barbara; Gabriel, Meghan; Madeira, Jody; Silverman, Ross D.; Health Policy and Management, School of Public Health
Background Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system. Methods We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods. Results 231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications ( p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone ( p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone ( p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications ( p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone ( p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes. Conclusion As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel.
Emergency department-based peer support for opioid use disorder: Emergent functions and forms
(Elsevier, 2019) McGuire, Alan B.; Gilmore Powell, Kristen; Treitler, Peter C.; Wagner, Karla D.; Smith, Krysti P.; Cooperman, Nina; Robinson, Lisa; Carter, Jessica; Ray, Bradley; Watson, Dennis P.; School of Public and Environmental Affairs
Emergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.
Patient Activation of Persons With Opioid Use Disorder in Intensive Outpatient Treatment
(Sage, 2022-05-17) Keen, Alyson; Lu, Yvonne; Oruche, Ukamaka M.; Mazurenko, Olena; Burke Draucker, Claire; School of Nursing
Background High patient activation is associated with a variety of positive health outcomes. Although increasing patient activation in persons with opioid use disorder (OUD) in intensive outpatient treatment (IOT) programs may increase engagement and improve outcomes, little is known about how patient activation is manifested in these programs. Aims To describe types of instances in which persons play an active role in their IOT or show self-determination in their recovery generally (patient activation) and types of instances in which they play a passive role in their IOT or have recovery directed by others (patient nonactivation). Methods A qualitative descriptive study using data from a larger grounded theory study was conducted. Interviews were completed with 14 persons with OUD who attended an IOT program within a large health care system in the Midwest. Content analysis was used to create a typology of instances of patient activation or nonactivation in participants’ IOT experiences. Results Six types of instances were identified: (1) making and enacting one’s own treatment decisions, (2) actively collaborating with staff, (3) self-determining one’s disclosure in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s recovery, and (6) taking actions to avoid return to use. Conclusions Patient activation is multidimensional and plays a salient role in IOT experiences. IOT staff should engage patients as active participants in their treatment and encourage mutual goal-setting and shared-decision but should be aware that some approaches used too early in treatment may impede recovery.
Policy perceptions of US state public health and child and family services regarding maternal opioid use and neonatal exposure
(Elsevier, 2019) Scott, Lisa Fath; Stone, Cynthia; Duwve, Joan; Health Policy and Management, School of Public Health
Objective To explore how state legislatures and departments of health are responding to the public health and economic issues of increases in opioid use disorder and the impact on pregnant women and infants. Design The design was a non-experimental descriptive study using a mixed methods survey research approach. Setting Electronic and telephone survey of individuals from state departments of health associated with departments of behavioral health and substance use, or child and family services. Participants Fifty-two respondents employed by individual state departments of health and child and family services. Methods Univariate analysis and frequency distribution of ordinal variables was completed. Thematic analysis was used to analyze free text questions and identify themes. Results All states reported recent changes or plans to address the problem of opioid misuse in their state. Many respondents feel their state continues to lack adequate services for treatment. Some states are exploring unique methods for addressing this in a safe and timely fashion, such as moving medication-assisted treatment to primary care and expanding licensure to Primary Care Physicians (PCPs) and nurse practitioners. Conclusions Our findings demonstrate an increased commitment throughout the United States to enhance access to clinically appropriate treatment of substance use disorder particularly during pregnancy, consider unique methods for addressing the problem of opioid dependency, and increase education and primary prevention programs.
Provider engagement in Indiana’s opioid use disorder ECHO programme: there is a will but not always a way
(BMJ, 2021) Agley, Jon; Henderson, Cris; Adams, Zachary; Hulvershorn, Leslie; Psychiatry, School of Medicine
Stereoselective Analysis of Methadone and EDDP in Laboring Women and Neonates in Plasma and Dried Blood Spots and Association with Neonatal Abstinence Syndrome
(Thieme, 2021) Metzger, Ingrid F.; Thomas, Anna E.; Evrard, Cindy A.; Jones, David R.; Masters, Andrea R.; Haas, David M.; Haneline, Laura S.; Quinney, Sara K.; Obstetrics and Gynecology, School of Medicine
Objective This pilot study evaluated the relationship between maternal and neonatal R- and S-methadone and R- and S-2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) exposure and the severity of neonatal abstinence syndrome (NAS). The use of dried blood spots (DBS) as an alternative for plasma in assessing methadone and EDDP was also assessed. Study Design Women receiving methadone for medication assisted treatment of opioid use disorder during pregnancy were eligible for recruitment. Plasma and DBS samples were collected from mothers during labor, from cord blood, and from newborns during genetic screen. R-/S-methadone and EDDP were measured by high-performance liquid chromatography tandem mass spectrometry (HPLC/MS/MS). Associations between methadone exposure, neonatal morphine requirements, and severity of NAS were examined. Results Twenty women and infants completed the study. Maternal methadone dose at delivery was 112 mg/day (range = 60–180 mg/day). Sixteen neonates experienced NAS requiring morphine; three also required phenobarbital. Higher cord blood concentrations of R-methadone, R- and S-EDDP were associated with higher maximum doses of morphine (p < 0.05). Conclusion Maternal methadone and cord blood concentration at delivery are variable and may be potential markers of neonatal abstinence syndrome.
Treatment of Opioid Use Disorder During Pregnancy: Buprenorphine or Methadone?
(2020-03) Davis, Elizabeth; Owusu, Raiven; Vinze, Sanjna; Arnaduo, Camilla
BACKGROUND: In 2011, 5% of pregnant women 15 to 44 yo reported opioid/illicit drug use during pregnancy, and this percentage is rising. Opioid use disorder (OUD) is a chronic disease associated with adverse effects on maternal and fetal health, such as physiologic withdrawal at birth, low birth weight, congenital abnormalities, and higher relapse rates. Pregnant women treated for OUD with medication-assisted-treatment (MAT) have significantly reduced adverse effects. MAT is the standard treatment of OUD in along with counseling/therapy. Opioid agonists, namely buprenorphine and methadone, are common treatments, as they prevent opioid withdrawal symptoms, improve adherence to prenatal care, and reduce the risk of relapse. CASE: Patient is a 26 year old G2P1 female presenting with buprenorphine, heroin, and methamphetamine use during pregnancy. She had a vaginal delivery of a healthy baby girl at 40+2 weeks (APGARs 8 and 9). She used heroin during the first trimester of pregnancy and started buprenorphine treatment at 5 months’ gestation. Pregnancy complicated by a 3 weeks in a rehab center at 8 months following relapse on methamphetamine. CLINICAL SIGNIFICANCE: Research is being conducted on the risks and benefits of buprenorphine vs methadone as MAT. Buprenorphine overall has better maternal and neonatal outcomes when compared to methadone. Mothers taking buprenorphine during their pregnancy were more likely to start MAT prior to or earlier in pregnancy and had longer gestations compared to methadone. In regards to neonatal outcomes, methadone has been associated with higher rates of neonatal mortality and congenital anomalies when compared to buprenorphine. NAS generally is less severe with buprenorphine, and newborns require treatment significantly less often and for a shorter duration. Newborns exposed to buprenorphine are associated with greater birth weight but more gastrointestinal abnormalities. With the increase in OUD during pregnancy, research regarding the most effective MAT is timely and critical.
Understanding Pregnant Women with Opioid Use Disorder
(Masters Program in Public Health, Universitas Sebelas Maret, 2019-11-19) Stiffler, Deborah; Amundson, Mia; Hapke, Lauren; Harvey, Emilie; Sizemore, Samantha; Smith, Savannah; School of Nursing
Background: Pregnant women with opioid use disorder are a major concern to the healthcare industry. They are not only one of the most stigmatized groups but are in need of outreach. Women who are afflicted by opioid addiction are a highly vulnerable group who are at risk of adverse pregnancy outcomes and perinatal complications. The purpose of this study was to do a meta-synthesis of the literature to gain a better understanding of the women’s perspective who are addicted to opioid during pregnancy. Subjects and Method: We conducted an exhaustive literature search for qualitative studies that focused on women with opioid used disorder during pregnancy and postpartum. After conducting a rigorous methodological protocol for meta-synthesis described by Joanna Briggs Institute, ten studies met the criteria for inclusion into this study. We used the Qualitative Assessment and Review Instrument (QARI) from the Joanna Briggs Institute to assist with data management. We extracted the representative quotations and categorized them into like themes. Results: There were three themes formulated from this meta-synthesis: overarching fear, trust, and educational deficits. This meta-synthesis of qualitative studies leads to a greater understanding of how pregnant women with opioid use disorder perceive the consequences of their actions. Conclusion: Implications from this meta-synthesis will inform those working with opioid-addicted pregnant women and aid in establishing best practices for them and their infants by revealing their addiction experiences and narratives.

Browsing by Subject "opioid use disorder"

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