Pub Date : 2022-05-26DOI: 10.1080/08897077.2022.2074597
A. Rivera, Michelle L. Nolan, D. Paone, Sidney A. Carrillo, S. Braunstein
Background: Community distribution of naloxone, a medication that reverses opioid overdose, is an effective public health strategy to prevent overdose deaths. However, data are limited on who has naloxone during the current fentanyl wave of the opioid overdose epidemic in the United States. We aim to determine correlates of naloxone ownership among a community sample of people who inject drugs (PWID) from New York City (NYC). Methods: Data were drawn from the National HIV Behavioral Surveillance Study among PWID. Participants were recruited via respondent-driven sampling. Eligible participants completed an interviewer-administered survey. Log-linked Poisson regression was used to determine adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) current naloxone ownership. Results: Of 503 PWID, 60% currently owned naloxone. In the past 12 months, 74% witnessed an opioid overdose and 25% experienced one. Those who experienced current homelessness were less likely to own naloxone (aPR: 0.79; 95% CI: 0.68, 0.91), as were those who had been recently incarcerated (aPR: 0.83; 95% CI: 0.71, 0.97). Respondents who reported recent known or possible fentanyl use were more likely to own naloxone (aPR: 1.23; 95% CI: 1.07, 1.43) as were those who experienced an opioid overdose in the past 12 months (aPR: 1.33; 95% CI: 1.15, 1.53). Conclusions: The prevalence of naloxone ownership among PWID in NYC was high, potentially due to widespread community naloxone distribution programs; however, gaps in naloxone ownership existed. Interventions that further ease access to naloxone, such as reclassifying naloxone as an over-the-counter medication and making it available “off the shelf,” should be considered. More research is needed to identify barriers to access, uptake, and sustained possession within this group to maximize the impact of naloxone distribution during the ongoing fentanyl wave of the opioid overdose epidemic.
{"title":"Gaps in Naloxone Ownership among People who Inject Drugs during the Fentanyl Wave of the Opioid Overdose Epidemic in New York City, 2018","authors":"A. Rivera, Michelle L. Nolan, D. Paone, Sidney A. Carrillo, S. Braunstein","doi":"10.1080/08897077.2022.2074597","DOIUrl":"https://doi.org/10.1080/08897077.2022.2074597","url":null,"abstract":"Background: Community distribution of naloxone, a medication that reverses opioid overdose, is an effective public health strategy to prevent overdose deaths. However, data are limited on who has naloxone during the current fentanyl wave of the opioid overdose epidemic in the United States. We aim to determine correlates of naloxone ownership among a community sample of people who inject drugs (PWID) from New York City (NYC). Methods: Data were drawn from the National HIV Behavioral Surveillance Study among PWID. Participants were recruited via respondent-driven sampling. Eligible participants completed an interviewer-administered survey. Log-linked Poisson regression was used to determine adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) current naloxone ownership. Results: Of 503 PWID, 60% currently owned naloxone. In the past 12 months, 74% witnessed an opioid overdose and 25% experienced one. Those who experienced current homelessness were less likely to own naloxone (aPR: 0.79; 95% CI: 0.68, 0.91), as were those who had been recently incarcerated (aPR: 0.83; 95% CI: 0.71, 0.97). Respondents who reported recent known or possible fentanyl use were more likely to own naloxone (aPR: 1.23; 95% CI: 1.07, 1.43) as were those who experienced an opioid overdose in the past 12 months (aPR: 1.33; 95% CI: 1.15, 1.53). Conclusions: The prevalence of naloxone ownership among PWID in NYC was high, potentially due to widespread community naloxone distribution programs; however, gaps in naloxone ownership existed. Interventions that further ease access to naloxone, such as reclassifying naloxone as an over-the-counter medication and making it available “off the shelf,” should be considered. More research is needed to identify barriers to access, uptake, and sustained possession within this group to maximize the impact of naloxone distribution during the ongoing fentanyl wave of the opioid overdose epidemic.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1172 - 1179"},"PeriodicalIF":3.5,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44503278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-26DOI: 10.1080/08897077.2022.2074600
S. Sanatkar, M. Heinsch, Campbell Tickner, S. Hunt, M. Teesson, Jenny Geddes, Jayden Gilbert, Lauren Pedemont, R. Mcketin, F. Kay-Lambkin
Background: Methamphetamine is a highly addictive central nervous stimulant associated with numerous adverse health, psychological, and social impacts. Family and friends of people who use methamphetamine often take on a crucial caregiving role in supporting their loved one. Consequently, they can experience a range of psychosocial challenges themselves. This review aimed to identify and assess the effectiveness of interventions designed to support caregivers of people who use methamphetamine. Methods: A systematic search of relevant literature published in the English language was conducted. Of 2257 records identified, only 2 evaluation studies examined interventions specifically designed for caregivers of people who use methamphetamine. Additionally, four qualitative accounts described experiences of caring for people who use methamphetamine. These accounts were summarized narratively to provide a more complete picture of family and caregiver experiences and coping strategies. Results: Effective treatment components included tending to caregiver concerns and providing training to enhance informational support and problem-solving skills. Qualitative accounts uncovered a range of challenges experienced by caregivers, such as emotional distress, concern for the person using methamphetamine, disrupted family structures, and financial difficulties. Coping strategies included attempts at managing and supporting the person using methamphetamine while protecting the overall cohesion and wellbeing of the family unit. Conclusions: This review highlighted a lack of evidence-based interventions for caregivers of people who use methamphetamine. More research is needed to clarify concerns that may be particularly relevant for those in a caregiving role.
{"title":"A Systematic Literature Review and Narrative Synthesis of Effective Interventions for Family and Caregivers of People who Use Methamphetamine","authors":"S. Sanatkar, M. Heinsch, Campbell Tickner, S. Hunt, M. Teesson, Jenny Geddes, Jayden Gilbert, Lauren Pedemont, R. Mcketin, F. Kay-Lambkin","doi":"10.1080/08897077.2022.2074600","DOIUrl":"https://doi.org/10.1080/08897077.2022.2074600","url":null,"abstract":"Background: Methamphetamine is a highly addictive central nervous stimulant associated with numerous adverse health, psychological, and social impacts. Family and friends of people who use methamphetamine often take on a crucial caregiving role in supporting their loved one. Consequently, they can experience a range of psychosocial challenges themselves. This review aimed to identify and assess the effectiveness of interventions designed to support caregivers of people who use methamphetamine. Methods: A systematic search of relevant literature published in the English language was conducted. Of 2257 records identified, only 2 evaluation studies examined interventions specifically designed for caregivers of people who use methamphetamine. Additionally, four qualitative accounts described experiences of caring for people who use methamphetamine. These accounts were summarized narratively to provide a more complete picture of family and caregiver experiences and coping strategies. Results: Effective treatment components included tending to caregiver concerns and providing training to enhance informational support and problem-solving skills. Qualitative accounts uncovered a range of challenges experienced by caregivers, such as emotional distress, concern for the person using methamphetamine, disrupted family structures, and financial difficulties. Coping strategies included attempts at managing and supporting the person using methamphetamine while protecting the overall cohesion and wellbeing of the family unit. Conclusions: This review highlighted a lack of evidence-based interventions for caregivers of people who use methamphetamine. More research is needed to clarify concerns that may be particularly relevant for those in a caregiving role.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1190 - 1196"},"PeriodicalIF":3.5,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42547342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.1080/08897077.2022.2060434
P. Ling, Eric Crosbie, Louisa M. Holmes, Christine Hoang, Samantha Hoeper
Background: The COVID-19 pandemic has been accompanied by increases in cannabis consumption, which might relate to dispensary marketing activities. As part of an ongoing project monitoring cannabis dispensary websites in Northern California and Reno, Nevada, we noticed many websites added announcements and “pop-up” communications in response to lockdowns. This brief report describes the cannabis dispensary website communications related to COVID-19 with the aim to provide insight into emerging marketing messages that may increase cannabis consumption in times of crisis. Methods: Content analysis of COVID-19 announcements present on cannabis dispensary websites in San Francisco/Alameda Counties (n = 32), and the Reno area (n = 15) in April-May 2020 shortly after lockdowns were implemented. Results: COVID-19 announcements were present on 25/32 (78%) of dispensary websites in San Francisco/Alameda and 9/15 (60%) of websites in the Reno area. Almost all COVID-19 announcements (88% San Francisco/Alameda, 89% Reno) announced operational changes such as delivery or curbside pickup services, 72% and 56% respectively announced patron/employee safety measures. Health related messages were present; about half of website announcements referred to government/health authorities, 44% of Reno area announcements used healthcare rhetoric, and some San Francisco/Alameda announcements included suggestions for using cannabis to mitigate infection risk or manage anxiety. Conclusions: Most cannabis dispensaries in the study region implemented COVID-19 pandemic operational changes to maintain product availability, and many positioned their identity with health – either by referring to health authorities, or using health rhetoric, and a minority gave health advice. Cannabis dispensary websites provide a timely snapshot of marketing practices that may contribute to increases in cannabis use during stressful events.
{"title":"Cannabis Dispensary Online Marketing Practices in Response to Covid-19 Lockdowns","authors":"P. Ling, Eric Crosbie, Louisa M. Holmes, Christine Hoang, Samantha Hoeper","doi":"10.1080/08897077.2022.2060434","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060434","url":null,"abstract":"Background: The COVID-19 pandemic has been accompanied by increases in cannabis consumption, which might relate to dispensary marketing activities. As part of an ongoing project monitoring cannabis dispensary websites in Northern California and Reno, Nevada, we noticed many websites added announcements and “pop-up” communications in response to lockdowns. This brief report describes the cannabis dispensary website communications related to COVID-19 with the aim to provide insight into emerging marketing messages that may increase cannabis consumption in times of crisis. Methods: Content analysis of COVID-19 announcements present on cannabis dispensary websites in San Francisco/Alameda Counties (n = 32), and the Reno area (n = 15) in April-May 2020 shortly after lockdowns were implemented. Results: COVID-19 announcements were present on 25/32 (78%) of dispensary websites in San Francisco/Alameda and 9/15 (60%) of websites in the Reno area. Almost all COVID-19 announcements (88% San Francisco/Alameda, 89% Reno) announced operational changes such as delivery or curbside pickup services, 72% and 56% respectively announced patron/employee safety measures. Health related messages were present; about half of website announcements referred to government/health authorities, 44% of Reno area announcements used healthcare rhetoric, and some San Francisco/Alameda announcements included suggestions for using cannabis to mitigate infection risk or manage anxiety. Conclusions: Most cannabis dispensaries in the study region implemented COVID-19 pandemic operational changes to maintain product availability, and many positioned their identity with health – either by referring to health authorities, or using health rhetoric, and a minority gave health advice. Cannabis dispensary websites provide a timely snapshot of marketing practices that may contribute to increases in cannabis use during stressful events.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1116 - 1119"},"PeriodicalIF":3.5,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46992495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.1080/08897077.2022.2060445
Ruth Yoo, N. Krawczyk, Eileen L. Johns, R. McCormack, J. Rotrosen, T. Mijanovich, L. Gelberg, K. Doran
Background: Homelessness and substance use are intricately related, and both are prevalent among emergency department (ED) patients. This study examined the longitudinal association of substance use characteristics with future homeless shelter entry among ED patients with any drug use or unhealthy alcohol use. Methods: We present results from a longitudinal cohort study of public hospital ED patients who screened positive for drug use or unhealthy alcohol use and who were not homeless at their baseline (index) ED visit. The primary outcome was homeless shelter entry within 12 months of baseline, ascertained in city homeless shelter administrative data. Primary independent variables of interest were alcohol use severity (AUDIT), drug use severity (DAST-10), and types of drugs used, as reported on baseline survey questionnaires. Results:Analyses included 1,210 ED patients. By 12 months following the baseline ED visit, 114 (9.4%) had entered a homeless shelter. Among patients with the most severe problems related to drug use (DAST-10 score 9–10), 40.9% entered a shelter within 12 months. Past shelter use was the strongest predictor of future shelter entry; once adjusting for historic shelter use the relationship of AUDIT and DAST-10 scores with future shelter entry was no longer statistically significant in multivariable models. Conclusions: ED patients with past year drug use or unhealthy alcohol use had relatively high likelihood of future shelter entry. Risk for homelessness should be addressed in future interventions with this population. Findings illustrate the complexity of relationships between substance use and homelessness.
{"title":"Association of Substance Use Characteristics and Future Homelessness among Emergency Department Patients with Drug Use Or Unhealthy Alcohol Use: Results from A Linked Data Longitudinal Cohort Analysis","authors":"Ruth Yoo, N. Krawczyk, Eileen L. Johns, R. McCormack, J. Rotrosen, T. Mijanovich, L. Gelberg, K. Doran","doi":"10.1080/08897077.2022.2060445","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060445","url":null,"abstract":"Background: Homelessness and substance use are intricately related, and both are prevalent among emergency department (ED) patients. This study examined the longitudinal association of substance use characteristics with future homeless shelter entry among ED patients with any drug use or unhealthy alcohol use. Methods: We present results from a longitudinal cohort study of public hospital ED patients who screened positive for drug use or unhealthy alcohol use and who were not homeless at their baseline (index) ED visit. The primary outcome was homeless shelter entry within 12 months of baseline, ascertained in city homeless shelter administrative data. Primary independent variables of interest were alcohol use severity (AUDIT), drug use severity (DAST-10), and types of drugs used, as reported on baseline survey questionnaires. Results:Analyses included 1,210 ED patients. By 12 months following the baseline ED visit, 114 (9.4%) had entered a homeless shelter. Among patients with the most severe problems related to drug use (DAST-10 score 9–10), 40.9% entered a shelter within 12 months. Past shelter use was the strongest predictor of future shelter entry; once adjusting for historic shelter use the relationship of AUDIT and DAST-10 scores with future shelter entry was no longer statistically significant in multivariable models. Conclusions: ED patients with past year drug use or unhealthy alcohol use had relatively high likelihood of future shelter entry. Risk for homelessness should be addressed in future interventions with this population. Findings illustrate the complexity of relationships between substance use and homelessness.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1100 - 1109"},"PeriodicalIF":3.5,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43220877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.1080/08897077.2022.2060447
Rachel Lockard, K. Priest, J. Gregg, Bradley M Buchheit
Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants’ desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.
{"title":"A Qualitative Study of Patient Experiences with Telemedicine Opioid Use Disorder Treatment during Covid-19","authors":"Rachel Lockard, K. Priest, J. Gregg, Bradley M Buchheit","doi":"10.1080/08897077.2022.2060447","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060447","url":null,"abstract":"Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants’ desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1155 - 1162"},"PeriodicalIF":3.5,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48090006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.1080/08897077.2022.2060427
Jingxiang Zhang, Siyu Qian, Guoxin Su, Chao Deng, D. Reid, K. Curtis, Barbara L. Sinclair, Ping Yu
Background: This study aimed to investigate the longitudinal changes in emergency department (ED) presentations incurred by patients with alcohol use disorders. Methods: A retrospective quantitative analysis was conducted on patients’ ED presentations between December 2011 and January 2019 in an Australian regional health district. The health district has five EDs serving rural, regional, and metropolitan areas. Patients with alcohol use disorders were divided into two groups for comparison: those who had interactions with the community-based Drug and Alcohol (D&A) services and those who did not. Results: A total of 2,519 individual patients with alcohol use disorders made 21,715 ED presentations. Among these patients, 75.4% did not have interactions with the community-based D&A services. Compared with those who had, these patients were older, more likely to be diagnosed with abdominal pain (26.9% vs 12.0%, p < 0.001) and chest pain (16.2% vs 8.6%, p < 0.001), and had longer mean length of ED stay (7 hours and 41.7 minutes vs 6 hours and 25.6 minutes, p < 0.001). For the patients who had interactions with the community-based D&A services, their 28-day re-presentation rates decreased from 55.5% (2013–14) to 45.1% (2017–18); however, were higher than that of those who had no interactions (41.1% to 32.8%). Overall, 21.9%−24.5% of the patients were frequent ED presenters (i.e., ≥4 visits per year). Frequent ED presenters were proportionately higher among the patients who had interactions with the community-based D&A services, consistently over the relevant years. Although patients with alcohol use disorders frequently presented to EDs, their alcohol use disorders were only identified in 8.9% of their presentations. Conclusions: Patients with alcohol use disorders were often unidentified in EDs. Those who did not have interactions with the community-based D&A services were less likely to be diagnosed with alcohol use disorders when presenting to EDs.
{"title":"Emergency Department Presentations of Patients with Alcohol Use Disorders in An Australian Regional Health District","authors":"Jingxiang Zhang, Siyu Qian, Guoxin Su, Chao Deng, D. Reid, K. Curtis, Barbara L. Sinclair, Ping Yu","doi":"10.1080/08897077.2022.2060427","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060427","url":null,"abstract":"Background: This study aimed to investigate the longitudinal changes in emergency department (ED) presentations incurred by patients with alcohol use disorders. Methods: A retrospective quantitative analysis was conducted on patients’ ED presentations between December 2011 and January 2019 in an Australian regional health district. The health district has five EDs serving rural, regional, and metropolitan areas. Patients with alcohol use disorders were divided into two groups for comparison: those who had interactions with the community-based Drug and Alcohol (D&A) services and those who did not. Results: A total of 2,519 individual patients with alcohol use disorders made 21,715 ED presentations. Among these patients, 75.4% did not have interactions with the community-based D&A services. Compared with those who had, these patients were older, more likely to be diagnosed with abdominal pain (26.9% vs 12.0%, p < 0.001) and chest pain (16.2% vs 8.6%, p < 0.001), and had longer mean length of ED stay (7 hours and 41.7 minutes vs 6 hours and 25.6 minutes, p < 0.001). For the patients who had interactions with the community-based D&A services, their 28-day re-presentation rates decreased from 55.5% (2013–14) to 45.1% (2017–18); however, were higher than that of those who had no interactions (41.1% to 32.8%). Overall, 21.9%−24.5% of the patients were frequent ED presenters (i.e., ≥4 visits per year). Frequent ED presenters were proportionately higher among the patients who had interactions with the community-based D&A services, consistently over the relevant years. Although patients with alcohol use disorders frequently presented to EDs, their alcohol use disorders were only identified in 8.9% of their presentations. Conclusions: Patients with alcohol use disorders were often unidentified in EDs. Those who did not have interactions with the community-based D&A services were less likely to be diagnosed with alcohol use disorders when presenting to EDs.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1128 - 1140"},"PeriodicalIF":3.5,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44444040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-25DOI: 10.1080/08897077.2022.2060444
H. Hagedorn, J. Wisdom, Heather Gerould, E. Pinsker, Randall T Brown, Michael Dawes, E. Dieperink, D. Myrick, Elizabeth M Oliva, T. Wagner, Alex H. S. Harris
Background: A minority of individuals meeting diagnostic criteria for alcohol use disorders (AUD) receive any type of formal treatment. Developing options for AUD treatment within primary care settings is imperative to increase treatment access. A multi-faceted implementation intervention including provider and patient education, clinician reminders, development of local champions and ongoing facilitation was designed to enhance access to AUD pharmacotherapy in primary care settings at three large Veterans Health Administration (VHA) facilities. This qualitative study compared pre-implementation barriers to post-implementation barriers identified via provider interviews to identify those barriers addressed and not addressed by the intervention to better understand the limited impact of the intervention. Methods: Following the nine-month implementation period, primary care providers at the three participating facilities took part in qualitative interviews to collect perceptions regarding which pre-implementation barriers had and had not been successfully addressed by the intervention. Participants included 20 primary care providers from three large VHA facilities. Interviews were coded using common coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Summary reports were created for each CFIR construct for each facility and the impact of each CFIR construct on implementation was coded as positive, neutral, or negative. Results: Some barriers identified during pre-implementation interviews were no longer identified as barriers in the post-implementation interviews. These included Relative Advantage, Relative Priority, and Knowledge & Beliefs about the Innovation. However, Compatibility, Design Quality & Packaging, and Available Resources remained barriers at the end of the implementation period. No substantial new barriers were identified. Conclusions: The implementation intervention appears to have been successful at addressing barriers that could be mitigated with traditional educational approaches. However, the intervention did not adequately address structural and organizational barriers to implementation. Recommendations for enhancing future interventions are provided.
{"title":"Alcohol Use Disorder Pharmacotherapy and Treatment in Primary Care (Adapt-Pc) Trial: Impact on Identified Barriers to Implementation","authors":"H. Hagedorn, J. Wisdom, Heather Gerould, E. Pinsker, Randall T Brown, Michael Dawes, E. Dieperink, D. Myrick, Elizabeth M Oliva, T. Wagner, Alex H. S. Harris","doi":"10.1080/08897077.2022.2060444","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060444","url":null,"abstract":"Background: A minority of individuals meeting diagnostic criteria for alcohol use disorders (AUD) receive any type of formal treatment. Developing options for AUD treatment within primary care settings is imperative to increase treatment access. A multi-faceted implementation intervention including provider and patient education, clinician reminders, development of local champions and ongoing facilitation was designed to enhance access to AUD pharmacotherapy in primary care settings at three large Veterans Health Administration (VHA) facilities. This qualitative study compared pre-implementation barriers to post-implementation barriers identified via provider interviews to identify those barriers addressed and not addressed by the intervention to better understand the limited impact of the intervention. Methods: Following the nine-month implementation period, primary care providers at the three participating facilities took part in qualitative interviews to collect perceptions regarding which pre-implementation barriers had and had not been successfully addressed by the intervention. Participants included 20 primary care providers from three large VHA facilities. Interviews were coded using common coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Summary reports were created for each CFIR construct for each facility and the impact of each CFIR construct on implementation was coded as positive, neutral, or negative. Results: Some barriers identified during pre-implementation interviews were no longer identified as barriers in the post-implementation interviews. These included Relative Advantage, Relative Priority, and Knowledge & Beliefs about the Innovation. However, Compatibility, Design Quality & Packaging, and Available Resources remained barriers at the end of the implementation period. No substantial new barriers were identified. Conclusions: The implementation intervention appears to have been successful at addressing barriers that could be mitigated with traditional educational approaches. However, the intervention did not adequately address structural and organizational barriers to implementation. Recommendations for enhancing future interventions are provided.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1043 - 1050"},"PeriodicalIF":3.5,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44606651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-20DOI: 10.1080/08897077.2022.2060428
Maria X Sanmartin, M. M. Ali, D. Dwyer
Background: The federal government has made several efforts to increase access to buprenorphine for the treatment of opioid use disorder (OUD). However, patients continue to face challenges in access to treatment for OUD. Objectives: This study seeks to examine the trends in the prevalence of buprenorphine-waivered practitioners who opt to be publicly listed on the Buprenorphine Treatment Practitioner Locator tool maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and how this varies between Medicaid expansion and non-expansion states. Methods: Administrative records of all the DATA-waivered providers collected by SAMHSA were utilized to identify the trends in the number of waivered practitioners by their public listing status from 2002–2017. We further examine how that trend varied between Medicaid expansion and non-expansion states. Results: The total number of waivered providers increased steadily from 300 in 2002 to 41,960 in 2017. In 2015, the number of waivered providers began to increase rapidly, with the number in Medicaid expansion states increasing faster than in non-expansion states from 2014–2017 (136% vs. 59%). Even though a greater proportion of waivered providers listed their names publicly in non-expansion states than in expansion states from 2014–2017, the rate of public listing of names increased more rapidly in Medicaid expansion states than in non-expansion states (170% vs. 85%) during the same period. Conclusions: This finding suggests that even though there has been an increase in waivered providers to prescribe buprenorphine in Medicaid expansion and non-expansion states, barriers to access treatment still persist. Policy initiatives that seek to expand access to substance-use treatment are warranted.
{"title":"Trends in Buprenorphine-Waivered Providers in Medicaid Expansion and Non-Expansion States by Their Public Listing Status","authors":"Maria X Sanmartin, M. M. Ali, D. Dwyer","doi":"10.1080/08897077.2022.2060428","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060428","url":null,"abstract":"Background: The federal government has made several efforts to increase access to buprenorphine for the treatment of opioid use disorder (OUD). However, patients continue to face challenges in access to treatment for OUD. Objectives: This study seeks to examine the trends in the prevalence of buprenorphine-waivered practitioners who opt to be publicly listed on the Buprenorphine Treatment Practitioner Locator tool maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and how this varies between Medicaid expansion and non-expansion states. Methods: Administrative records of all the DATA-waivered providers collected by SAMHSA were utilized to identify the trends in the number of waivered practitioners by their public listing status from 2002–2017. We further examine how that trend varied between Medicaid expansion and non-expansion states. Results: The total number of waivered providers increased steadily from 300 in 2002 to 41,960 in 2017. In 2015, the number of waivered providers began to increase rapidly, with the number in Medicaid expansion states increasing faster than in non-expansion states from 2014–2017 (136% vs. 59%). Even though a greater proportion of waivered providers listed their names publicly in non-expansion states than in expansion states from 2014–2017, the rate of public listing of names increased more rapidly in Medicaid expansion states than in non-expansion states (170% vs. 85%) during the same period. Conclusions: This finding suggests that even though there has been an increase in waivered providers to prescribe buprenorphine in Medicaid expansion and non-expansion states, barriers to access treatment still persist. Policy initiatives that seek to expand access to substance-use treatment are warranted.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1072 - 1074"},"PeriodicalIF":3.5,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47787151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-20DOI: 10.1080/08897077.2022.2060443
A. Soberay, Sharona T. Levy, Francis Cheung, Pamela B Pietruszewski, Lindsi DeSorrento, Stuart Garney, Crystal Luce, Christy Bame
Background: Screening for substance use within pediatric primary care provides a unique opportunity to identify adolescents in need of intervention. Methods: This study analyzed screening data collected across 13 Federally Qualified Health Centers over the course of an 18-month project designed to implement Screening Brief Intervention Referral to Treatment (SBIRT) for adolescents aged 12–21. A mixed-effects modeling strategy was used to describe associations between demographic, procedural, and clinical factors and adolescent reports of substance use. Results: In total, 10,813 adolescents were screened between December 2017 and May 2019, with 17% reporting past year use, including 11% at lower risk and 6% at high risk of a substance use disorder. Females, Hispanic, Black/African American, heterosexual, non-primary English speakers, and patients who did not have a co-occurring mental health disorder were all less likely to report past year substance use. While rates of disclosing any past year substance use were equivalent between patients screened by a staff member and those who completed self-administered screens, patients who were screened by a staff member were associated with reporting overall greater frequencies of use. Patients who were screened by a staff member with a parent present were less likely to disclose any past year substance use. Conclusion: While overall rates of disclosure of any past year substance use (17.2%) were lower than reported in research settings, a substantial proportion (6.3%) had screen results indicating a high risk for substance use disorder.
{"title":"Rates and Predictors of Substance Use in Pediatric Primary Care Clinics","authors":"A. Soberay, Sharona T. Levy, Francis Cheung, Pamela B Pietruszewski, Lindsi DeSorrento, Stuart Garney, Crystal Luce, Christy Bame","doi":"10.1080/08897077.2022.2060443","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060443","url":null,"abstract":"Background: Screening for substance use within pediatric primary care provides a unique opportunity to identify adolescents in need of intervention. Methods: This study analyzed screening data collected across 13 Federally Qualified Health Centers over the course of an 18-month project designed to implement Screening Brief Intervention Referral to Treatment (SBIRT) for adolescents aged 12–21. A mixed-effects modeling strategy was used to describe associations between demographic, procedural, and clinical factors and adolescent reports of substance use. Results: In total, 10,813 adolescents were screened between December 2017 and May 2019, with 17% reporting past year use, including 11% at lower risk and 6% at high risk of a substance use disorder. Females, Hispanic, Black/African American, heterosexual, non-primary English speakers, and patients who did not have a co-occurring mental health disorder were all less likely to report past year substance use. While rates of disclosing any past year substance use were equivalent between patients screened by a staff member and those who completed self-administered screens, patients who were screened by a staff member were associated with reporting overall greater frequencies of use. Patients who were screened by a staff member with a parent present were less likely to disclose any past year substance use. Conclusion: While overall rates of disclosure of any past year substance use (17.2%) were lower than reported in research settings, a substantial proportion (6.3%) had screen results indicating a high risk for substance use disorder.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1094 - 1099"},"PeriodicalIF":3.5,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42644299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-20DOI: 10.1080/08897077.2022.2060433
Randa Abdelal, A. Banerjee, Suzanne Carlberg-Racich, Chris Cebollero, Neyla Darwaza, Chong Kim, D. Ito, J. Epstein
Background: The increasing rates of highly potent, illicit synthetic opioids (i.e., fentanyl) in the US is exacerbating the ongoing opioid epidemic. Multiple naloxone administrations (MNA) may be required to successfully reverse opioid overdoses. We conducted a real-world study to assess the rate of MNA for opioid overdose and identify factors associated with MNA. Methods: Data from the 2015–2020 National Emergency Medical Services Information System was examined to determine trends in events requiring MNA. Logistic regression analysis was performed to determine factors associated with MNA. Results: The percentage of individuals receiving MNA increased from 18.4% in 2015 to 28.4% in 2020. The odds of an event requiring MNA significantly increased by 11% annually. The adjusted odds ratio (aOR) for MNA were greatest among males, when advanced life support (ALS) was provided, and when the dispatch complaint indicated there was a drug poisoning event. Conclusions: The 54% increase in MNA since 2015 parallels the rise in overdose deaths attributable to synthetic opioids. This growth is visible in all regions of the country, including the West, where the prevalence of illicitly manufactured synthetic opioids is intensifying. Given this phenomenon, higher naloxone formulations may fulfill an unmet need in addressing the opioid overdose crisis.
{"title":"Real-World Study of Multiple Naloxone Administrations for Opioid Overdose Reversal among Emergency Medical Service Providers","authors":"Randa Abdelal, A. Banerjee, Suzanne Carlberg-Racich, Chris Cebollero, Neyla Darwaza, Chong Kim, D. Ito, J. Epstein","doi":"10.1080/08897077.2022.2060433","DOIUrl":"https://doi.org/10.1080/08897077.2022.2060433","url":null,"abstract":"Background: The increasing rates of highly potent, illicit synthetic opioids (i.e., fentanyl) in the US is exacerbating the ongoing opioid epidemic. Multiple naloxone administrations (MNA) may be required to successfully reverse opioid overdoses. We conducted a real-world study to assess the rate of MNA for opioid overdose and identify factors associated with MNA. Methods: Data from the 2015–2020 National Emergency Medical Services Information System was examined to determine trends in events requiring MNA. Logistic regression analysis was performed to determine factors associated with MNA. Results: The percentage of individuals receiving MNA increased from 18.4% in 2015 to 28.4% in 2020. The odds of an event requiring MNA significantly increased by 11% annually. The adjusted odds ratio (aOR) for MNA were greatest among males, when advanced life support (ALS) was provided, and when the dispatch complaint indicated there was a drug poisoning event. Conclusions: The 54% increase in MNA since 2015 parallels the rise in overdose deaths attributable to synthetic opioids. This growth is visible in all regions of the country, including the West, where the prevalence of illicitly manufactured synthetic opioids is intensifying. Given this phenomenon, higher naloxone formulations may fulfill an unmet need in addressing the opioid overdose crisis.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1075 - 1084"},"PeriodicalIF":3.5,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48510336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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