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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 280 Research Studies Displayed
Miller-Rosales C, Busch SH, Meara ER
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
This study examined the extent of screening for opioid use and availability of medications for opioid use disorder (MOUD) in a national cross-section of multi-physician primary care and multispecialty practices. The authors found that a total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Offering of MOUD in a practice was associated with having advanced HIT functionality, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models.
Citation: Miller-Rosales C, Busch SH, Meara ER . Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders. Med Care Res Rev 2023 Aug; 80(4):410-22. doi: 10.1177/10775587231162681..
Keywords: Opioids, Substance Abuse, Behavioral Health, Screening, Medication, Practice Patterns
Levander XA, Carmody T, Cook RR
A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.
This study’s objective was to determine if there were gender-based differences in treatment for methamphetamine use disorder (MUD) in general comparing treatment with placebo and due to use of a hormonal method of contraception (HMC). This research was a secondary analysis of ADAPT-2, a randomized, double-blind, placebo-controlled, multicenter, two-stage sequential parallel comparison design trial. This cohort study comprised 126 women (403 total participants); average age of 40.1 years with moderate to severe MUD. At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days] and more women than men had anxiety (59.5 versus 47.6%). Of the 113 women capable of becoming pregnant, 31 used HMC. Treatment response for women was 29% in Stage 1 and 5.6% in Stage 2 compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males; with no between-gender treatment effect (0.144 females versus 0.100 males). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none).
Citation: Levander XA, Carmody T, Cook RR . A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial. Addiction 2023 Jul; 118(7):1320-28. doi: 10.1111/add.16163..
Keywords: Substance Abuse, Medication, Behavioral Health, Sex Factors
King C, Beetham T, Smith N
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.
This study is a survey of US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder (OUD). The authors posed as an aunt or uncle of a 16-year-old with a recent non-fatal fentanyl overdose to make calls to treatment facilities more plausible if they did not have all requested information about an adolescent. Four investigators called facilities included in the SAMHSA Treatment Indicator in random order and asked to speak with someone about residential treatment. They asked specific questions about buprenorphine use and open-ended questions about other available treatments. They identified 354 facilities, reached 327, and confirmed that 160 provided residential treatment to patients younger than 18 years. Of the 160 facilities identified 39 (24.4%) offered buprenorphine, including through partnerships with outside clinicians. Rates varied by US region (18% in the West to 40% in the Northeast). Among the 121 facilities that did not offer buprenorphine or were unsure, 57 indicated that adolescents who were prescribed buprenorphine by their own clinician could continue receiving it, at least temporarily, although some facilities indicated that would discontinue it before discharged, and 22.3% required adolescents to not be receiving it at admission. Of 160 facilities, 140 had someone available who could prescribe medications for psychiatric comorbidities. Overall, 124 facilities had naloxone, 24 did not, and 11 were unsure. Over half of the facilities included family members in adolescent treatment. Leading approaches for adolescent treatment included mutual help frameworks (eg, 12-step program, n = 59), cognitive behavior therapy (n = 52), community reinforcement/adolescent community approach (n = 44), art therapy (n = 40), and equine therapy (n = 40).
Citation: King C, Beetham T, Smith N . Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022. JAMA 2023 Jun 13; 329(22):1983-85. doi: 10.1001/jama.2023.6266..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Isbell LM, Chimowitz H, Huff NR
A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders.
This study’s aim was to develop a comprehensive data-driven model of the complex challenges and unique dynamics associated with caring for patients with psychiatric conditions and/or substance use disorders (SUDs) in the emergency department (ED), as well as the effect on patient care quality. The authors conducted a preplanned topical analysis of grounded theory data obtained from semistructured interviews with 86 ED physicians and nurses from 8 hospitals in the Northeastern USA. Participants described in detail their experiences and challenges in caring for patients with psychiatric conditions and/or SUDs. The authors identified themes inductively using constant comparative analysis and developed a grounded model of physicians' and nurses' perceptions of challenges, biases, and effects on patient care. Challenges identified were emotional, diagnostic, and logistical. These challenges magnified existing health care system issues and social structures, which fuel and reinforce negative attitudes, expectations, and biases. This creates a cyclical process whereby challenges and biases associated with patients with psychiatric conditions and/or SUDs can reciprocally threaten patient care quality.
Citation: Isbell LM, Chimowitz H, Huff NR . A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders. Ann Emerg Med 2023 Jun; 81(6):715-27. doi: 10.1016/j.annemergmed.2022.10.014..
Keywords: Behavioral Health, Substance Abuse, Emergency Department, Provider: Nurse, Provider: Physician
Stiles-Shields C, Archer J, Zhang J
A scoping review of associations between cannabis use and anxiety in adolescents and young adults.
This review sought to examine the association between anxiety and cannabis in adolescents and young adults. Forty-seven studies were identified that examined the relationship between anxiety and cannabis use via a database search; 23 studies found a positive association that greater anxiety was associated with greater cannabis use and 7 found a negative association. The remainder found no clear association. The authors concluded that further research is needed to understand the relationship between anxiety and cannabis use.
Citation: Stiles-Shields C, Archer J, Zhang J . A scoping review of associations between cannabis use and anxiety in adolescents and young adults. Child Psychiatry Hum Dev 2023 Jun; 54(3):639-58. doi: 10.1007/s10578-021-01280-w..
Keywords: Children/Adolescents, Anxiety, Substance Abuse, Behavioral Health
Short VL, Abatemarco DJ, Sood E
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Group-based well child care is a shared medical appointment where families join as a group to receive pediatric primary care. Prior research indicates that this method of receiving care increases patient-reported satisfaction and adherence to recommended care. There is little evidence supporting the use of group well child care for mothers with opioid use disorder. The purpose of the Child Healthcare at MATER Pediatric Study (CHAMPS) is to assess a group model of well child care for mothers with opioid use disorder and their children to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care. A total of 108 mother-child dyads will be enrolled into the study. In the intervention branch, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control branch will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study branches will be followed for 18 months, and their resulting data will be compared. Primary outcomes will include well child care quality and utilization, child health knowledge, and parenting quality.
Citation: Short VL, Abatemarco DJ, Sood E . The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children. Trials 2023 May 17; 24(1):333. doi: 10.1186/s13063-023-07357-2..
Keywords: Children/Adolescents, Opioids, Substance Abuse, Behavioral Health
Raffa BJ, Schilling S, Henry MK
Ingestion of illicit substances by young children before and during the COVID-19 pandemic.
The objectives of this retrospective cross-sectional study were to assess changes in overall illicit substance ingestion rates among children less than 6 years old before and during the COVID-19 pandemic, and to examine changes by substance type. Results showed an immediate and sustained increase in illicit substance ingestions during the pandemic; no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters was found. The authors concluded that additional studies were needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent accidental ingestions.
Citation: Raffa BJ, Schilling S, Henry MK . Ingestion of illicit substances by young children before and during the COVID-19 pandemic. JAMA Netw Open 2023 Apr 3; 6(4):e239549. doi: 10.1001/jamanetworkopen.2023.9549..
Keywords: COVID-19, Children/Adolescents, Substance Abuse
Sibley AL, Baker R, Levander XA
"I am not a junkie": social categorization and differentiation among people who use drugs.
The purpose of this qualitative study, framed by Social Identity Theory/Self-Categorization Theory, was to investigate strategies of within-group categorization and differentiation among people who use drugs (PWUD) and the roles these social categories play in shaping intragroup attitudes, perceptions, and behaviors. Data were taken from the Rural Opioid Initiative. Through interviews with participating PWUDs, researchers identified several facets of identity, behavioral and demographic, along which PWUDs perceived salient social boundaries. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder collective action in this marginalized group.
Citation: Sibley AL, Baker R, Levander XA . "I am not a junkie": social categorization and differentiation among people who use drugs. Int J Drug Policy 2023 Apr;114:103999. doi: 10.1016/j.drugpo.2023.103999.
Keywords: Substance Abuse, Behavioral Health, Social Stigma
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
Citation: Sun EC, Rishel CA, Waljee JF . Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients. Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Lee AK, Bobb JF, Richards JE
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
This study’s goal was to evaluate an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration. This stepped-wedge cluster randomized trial called the Sustained Patient-Centered Alcohol-Related Care (SPARC) trial included 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients 18 years or older with primary care visits from January 2015 to July 2018. The study included 7 waves, with practices randomly assigned launch dates. A total of 333,596 patients visited primary care (mean age, 48 years; 193,583 [58%] female; 234,764 [70%] White individuals). The proportion of patients with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10,000 patients per month). The proportion with AUD treatment engagement did not differ during intervention and usual care. However, it did increase intermediate outcomes: screening (83.2% vs 20.8%), new AUD diagnosis (33.8 vs 28.8 per 10,000), and treatment initiation (7.8 vs 6.2 per 10,000).
Citation: Lee AK, Bobb JF, Richards JE . Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial. JAMA Intern Med 2023 Apr;183(4):319-28. doi: 10.1001/jamainternmed.2022.7083.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Patient-Centered Healthcare
Short VL, Gannon M, Sood E
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
The objectives of this qualitative study were to gather in-depth information regarding maternal and clinician-reported factors that facilitate or hinder well-child care (WCC) engagement as well as information from mothers' experiences during WCC visits. Thirty mothers in treatment for parental opioid use disorder (OUD) and 13 clinicians working at a pediatric primary care clinic participated by completing one telephone session which involved a brief questionnaire followed by a semi-structured interview. Facilitators identified by mothers and clinicians, included continuity of care, addressing material needs, and clinician OUD training and knowledge. Barriers to WCC included: stigma toward mothers with OUD, gaps in basic parenting knowledge, competing specialized health care needs, and insufficient time to address concerns.
Citation: Short VL, Gannon M, Sood E . Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians. Acad Pediatr 2023 Mar;23(2):425-33. doi: 10.1016/j.acap.2022.07.013.
Keywords: Children/Adolescents, Family Health and History, Opioids, Substance Abuse, Behavioral Health, Caregiving, Patient and Family Engagement
Cook RR, Foot C, Arah OA
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
The co-use of stimulants and opioids is increasing rapidly. Medications for opioid use disorder (MOUD) have demonstrated efficacy in randomized clinical trials (RCTs), but stimulant use may decrease the likelihood of initiating MOUD treatment. Moreover, trial participants may not represent "real-world" populations who would benefit from treatment. The study analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The study found that in RCTs, stimulant use reduced the likelihood of MOUD initiation by 32%. Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment and adults entering OUD treatment. The association was more pronounced, but still non-significant among rural people injecting drugs. Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population. The researchers concluded that stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, particularly among rural people injecting drugs, who already face limited access to MOUD.
Citation: Cook RR, Foot C, Arah OA . Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addict Sci Clin Pract 2023 Feb 14; 18(1):11. doi: 10.1186/s13722-023-00364-3..
Keywords: Substance Abuse, Behavioral Health, Opioids, Medication
Alexandre W, Muhammad H, Agbalajobi O
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
The purpose of this study was to investigate the relationships between medical dialogues concerning alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality rates. The retrospective cohort study encompassed all patients diagnosed with cirrhosis and AUD receiving hepatology care within a single healthcare system in 2015. Baseline data on demographics, medical history, liver disease, and AUD treatment were examined. Information on AUD treatment discussions, initiation, alcohol cessation, and the subsequent 5-year mortality rates was gathered. Out of 436 patients with alcohol-related cirrhosis, 15% received AUD treatment at baseline, with 11% undergoing behavioral therapy, 2% receiving pharmacotherapy, and 1% obtaining both. Within the first year after the initial hepatology visit, 37 patients had AUD treatment, 51 remained in treatment, and 14 discontinued. Hepatology-documented AUD treatment recommendations were provided to 30% of patients, while 26% received primary care-documented recommendations. The majority of hepatology (86%) and primary care (88%) recommendations focused on behavioral therapy. Among patients with persistent alcohol use at baseline, AUD treatment after one year was significantly and independently associated with hepatology or primary care treatment discussions, and negatively associated with Medicaid insurance. When treatment discussions occurred in both settings, high treatment rates followed. Over five years, 35% of patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma significantly contributed to mortality in the final survival model. In patients with alcohol-related cirrhosis, AUD treatment discussions were documented in fewer than half of hepatology and primary care encounters; however, such discussions were significantly correlated with AUD treatment receipt.
Citation: Alexandre W, Muhammad H, Agbalajobi O . Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis. BMC Gastroenterol 2023 Feb 2; 23(1):29. doi: 10.1186/s12876-023-02656-z..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Clinician-Patient Communication, Communication
Ali MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
Citation: Ali MM, McClellan C, Mutter R . Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata. Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
Citation: Maclean JC, McClellan C, Pesko MF . Medicaid reimbursement rates for primary care services and behavioral health outcomes. Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
Citation: Toseef MU, Durfee J, Podewils LJ . Total cost of care associated with opioid use disorder treatment. Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Carlile N, Fuller TE, Benneyan JC
Lessons learned in implementing a chronic opioid therapy management system.
This article describes a research collaborative of health service researchers, systems engineers, and clinicians that sought to improve processes for safer chronic opioid therapy management in an academic primary care center. The authors present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization. They designed, tested, and implemented two key safe opioid use process metrics-percent for patients with recent opioid treatment agreements and urine drug tests. Focus groups were conducted after the conclusion of the implementation. They found a general lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 69% of clinicians reported largely “inheriting” (rather than initiating) their chronic opioid therapy patients. They also tracked 68 patients over a 4-year period and found although process measures improved, full adherence was not achieved for the entire population. Barriers identified included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus.
Citation: Carlile N, Fuller TE, Benneyan JC . Lessons learned in implementing a chronic opioid therapy management system. J Patient Saf 2022 Dec 1;18(8):e1142-e49. doi: 10.1097/pts.0000000000001039..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Substance Abuse, Behavioral Health, Practice Patterns
Grove LR, Rao N, Domino ME
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
This study’s goal was to inform efforts to increase prescriptions of medications for opioid use disorder (MOUD) among Medicaid beneficiaries. A retrospective study of North Carolina licensed physicians, physician assistants, and nurse practitioners was conducted to estimate Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and to estimate the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Outcomes looked for were indicators of any Medicaid professional claims and Medicaid claims data for buprenorphine and naltrexone. Licensure data from 2018 was merged with 2019 US Drug Enforcement Administration to identify clinicians who used the DEA waiver required to prescribe buprenorphine (n = 1714). Services by waivered clinicians to Medicare beneficiaries ranged from 67% of behavioral health clinicians to 82.9% of specialist physicians. Prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians.
Citation: Grove LR, Rao N, Domino ME . Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries? Addiction 2022 Nov;117(11):2855-63. doi: 10.1111/add.15854..
Keywords: Opioids, Substance Abuse, Behavioral Health, Vulnerable Populations, Medication, Access to Care, Medicaid
Rich KM, Zubiago J, Murphy M
The association of gender with receptive and distributive needle sharing among individuals who inject drugs.
The authors sought to assess the relationship between gender and needle sharing with injection drug use. Using data from the 2010-2019 National Survey on Drug Use and Health (NSDUH) datasets, they found that women were more likely in comparison with men to share needles both through receptive and distributive means. They concluded that expansion of interventions, including syringe service programs, to increase access to sterile injection equipment, is of great importance.
Citation: Rich KM, Zubiago J, Murphy M . The association of gender with receptive and distributive needle sharing among individuals who inject drugs. Harm Reduct J 2022 Sep 30;19(1):108. doi: 10.1186/s12954-022-00689-3..
Keywords: Human Immunodeficiency Virus (HIV), Substance Abuse, Behavioral Health, Sex Factors
Wei YJ, Chen C, Cheng TD
Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study’s objectives were to examine the association between incident injury after prescription opioid initiation and subsequent risk of opioid-related adverse events (ORAEs) and to assess whether the association differs by recency of injury among older patients. The researchers observed that incident diagnosis of injury following opioid initiation was associated with subsequent increased risk of ORAEs, and the risk was only significant among patients with injury in the month before the index date. They recommended regular monitoring for injury in order to identify older opioid users at high risk for ORAEs.
Citation: Wei YJ, Chen C, Cheng TD . Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study. PLoS Med 2022 Sep;19(9):e1004101. doi: 10.1371/journal.pmed.1004101..
Keywords: Opioids, Medication, Adverse Drug Events (ADE), Substance Abuse, Elderly, Adverse Events
Calcaterra SL, Martin M, Bottner R
Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine.
This paper discusses the findings of a Society of Hospital Medicine working group convened to develop a Consensus Statement on the management of opioid use disorder (OUD) and associated conditions among hospitalized adults. The statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. The first step of the working group to develop the statement was to conduct a systematic review of relevant guidelines and compose a draft statement based on extracted recommendations. In the next step the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. This iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD.
Citation: Calcaterra SL, Martin M, Bottner R . Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine. J Hosp Med 2022 Sep;17(9):744-56. doi: 10.1002/jhm.12893..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Calcaterras SL, Bottner R, Martin M
Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines.
This study evaluated the quality and content of existing guidelines for in-hospital opioid use disorder (OUD) treatment and management. A literature search was done on several databases, websites of relevant societies and advocacy organizations, and selected international search engines. Nineteen guidelines published between January 2010 and June 2020 met the selection criteria. The majority of guidelines were based on observational studies or expert consensus. They recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal.
Citation: Calcaterras SL, Bottner R, Martin M . Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines. J Hosp Med 2022 Sep;17(9):679-92. doi: 10.1002/jhm.12908..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Beetham T, Fiellin DA, Busch SH
Physician response to COVID-19-driven telehealth flexibility for opioid use disorder.
This study surveyed physicians who provide opioid use disorder (OUD) treatment on their preferences and practices regarding telehealth that have evolved during the COVID-19 pandemic. A total of 1141 physicians who were publicly listed buprenorphine-prescribing physicians were surveyed. Most respondents found telehealth to be effective, with 54% who found it more effective than expected. Overall, 85% were in favor of temporary telehealth flexibility being permanently extended, and 77% would be likely to use telehealth after the COVID-19 pandemic is over.
Citation: Beetham T, Fiellin DA, Busch SH . Physician response to COVID-19-driven telehealth flexibility for opioid use disorder. Am J Manag Care 2022 Sep;28(9):456-63. doi: 10.37765/ajmc.2022.89221..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Opioids, Substance Abuse, Behavioral Health, Medication
Khouja T, Zhou J, Gellad WF
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
This study’s objective was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with dental visit and corresponding opioid prescription from 2011 to 2017 within a nationwide commercial claims database was conducted. As per CDC guidelines, opioid overprescribing was defined as >120 morphine milligram equivalents. Of 633,387 visits, 16.6% had POU and 2.6% experienced an adverse outcome. POU was higher when opioids were overprescribed with visits associated with mild pain and those with substance use disorders having the highest risk of both outcomes.
Citation: Khouja T, Zhou J, Gellad WF . Serious opioid-related adverse outcomes associated with opioids prescribed by dentists. Pain 2022 Aug 1;163(8):1571-80. doi: 10.1097/j.pain.0000000000002545..
Keywords: Opioids, Dental and Oral Health, Substance Abuse, Behavioral Health, Practice Patterns, Pain, Medication, Adverse Drug Events (ADE), Adverse Events
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N . Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study. Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)