Pub Date : 2022-06-07DOI: 10.1080/08897077.2022.2074599
Kristine Ramsay-Seaner, Amber Letcher, Meagan Scott Hoffman, E. Anderson, Charlotte Heckmann
Background: In 2017, 45% of rural adults reported being directly impacted by the opioid epidemic. While research on the experiences of those using prescription opioids in rural communities is increasing, less is known about a unique sub-population who may have high rates of exposure: rural agricultural workers. The purpose of this study was to explore the prevalence and perceptions related to prescription opioids among rural producers and farmworkers. Methods: A questionnaire was mailed in spring 2019 and spring 2020 to rural residents living in one of two agricultural-based states in the Upper Midwest. Individuals were eligible to participate if any member of their family was involved in the agricultural industry. A total of 1116 questionnaires were returned for a 27.9% response rate. Results: Participants were 68.1 years old on average. The majority identified as white, male, and married. Prescription opioid use was found in 8.2% of households currently, and 15.7% in the past year. There were no gender differences in prevalence of use, but women and older individuals reported significantly more perceived risk than men and younger individuals. Nearly half used alternative pain management, and received most information about prescription opioids from the radio (65.5%) and newsletters (13.5%). Conclusions. Despite their elevated age and working in an occupation at high risk of injury and chronic pain, study participants reported few opioid prescriptions and moderate use of alternative pain management. Perceived risk of prescription opioids may explain low prevalence. Outreach efforts that increase access to healthcare services and alternative pain management treatments for agricultural workers may mitigate the experience of chronic pain that can interfere with their overall quality of life.
{"title":"Perceptions of Prescription Opioid Use among Rural Farming and Ranching Communities: Preliminary Implications for Outreach and Treatment","authors":"Kristine Ramsay-Seaner, Amber Letcher, Meagan Scott Hoffman, E. Anderson, Charlotte Heckmann","doi":"10.1080/08897077.2022.2074599","DOIUrl":"https://doi.org/10.1080/08897077.2022.2074599","url":null,"abstract":"Background: In 2017, 45% of rural adults reported being directly impacted by the opioid epidemic. While research on the experiences of those using prescription opioids in rural communities is increasing, less is known about a unique sub-population who may have high rates of exposure: rural agricultural workers. The purpose of this study was to explore the prevalence and perceptions related to prescription opioids among rural producers and farmworkers. Methods: A questionnaire was mailed in spring 2019 and spring 2020 to rural residents living in one of two agricultural-based states in the Upper Midwest. Individuals were eligible to participate if any member of their family was involved in the agricultural industry. A total of 1116 questionnaires were returned for a 27.9% response rate. Results: Participants were 68.1 years old on average. The majority identified as white, male, and married. Prescription opioid use was found in 8.2% of households currently, and 15.7% in the past year. There were no gender differences in prevalence of use, but women and older individuals reported significantly more perceived risk than men and younger individuals. Nearly half used alternative pain management, and received most information about prescription opioids from the radio (65.5%) and newsletters (13.5%). Conclusions. Despite their elevated age and working in an occupation at high risk of injury and chronic pain, study participants reported few opioid prescriptions and moderate use of alternative pain management. Perceived risk of prescription opioids may explain low prevalence. Outreach efforts that increase access to healthcare services and alternative pain management treatments for agricultural workers may mitigate the experience of chronic pain that can interfere with their overall quality of life.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1245 - 1250"},"PeriodicalIF":3.5,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46445467","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 : 2022-06-03DOI: 10.1080/08897077.2022.2074608
K. Smith, K. Dunn, D. Epstein, J. Feldman, A. Garcia-Romeu, O. Grundmann, J. Henningfield, Christopher R. McCurdy, Jeffrey M Rogers, Destiny Schriefer, Darshan Singh, S. Weiss
This Letter to the Editor is a response to Broyan and colleagues who recently published a Case Report presenting data on 28 patients in the United States who identified kratom as their primary substance of use and who were subsequently induced on buprenorphine/naloxone for a reported diagnosis of kratom use disorder. We applaud the authors for helping to advance the science on kratom and recognize the difficulties in conducting kratom-related clinical assessment and research. However, a number of inconsistences and generalizations were identified in this Case Report, which also lacked some critical context. Importantly, such inconsistencies and generalizations can be observed throughout kratom-specific case reports. We feel this is now an important opportunity to highlight these issues that are present in the Broyan and colleagues Case report but emphasize that they are not unique to it. We do this with the hope that by acknowledging these issues it can help inform editors, clinicians, and researchers who may not be familiar with kratom and, as a result of this unfamiliarity, may inadvertently present findings in a manner that could confuse readers and even misinform clinical researchers and practitioners.
{"title":"Need for Clarity and Context in Case Reports on Kratom Use, Assessment, and Intervention","authors":"K. Smith, K. Dunn, D. Epstein, J. Feldman, A. Garcia-Romeu, O. Grundmann, J. Henningfield, Christopher R. McCurdy, Jeffrey M Rogers, Destiny Schriefer, Darshan Singh, S. Weiss","doi":"10.1080/08897077.2022.2074608","DOIUrl":"https://doi.org/10.1080/08897077.2022.2074608","url":null,"abstract":"This Letter to the Editor is a response to Broyan and colleagues who recently published a Case Report presenting data on 28 patients in the United States who identified kratom as their primary substance of use and who were subsequently induced on buprenorphine/naloxone for a reported diagnosis of kratom use disorder. We applaud the authors for helping to advance the science on kratom and recognize the difficulties in conducting kratom-related clinical assessment and research. However, a number of inconsistences and generalizations were identified in this Case Report, which also lacked some critical context. Importantly, such inconsistencies and generalizations can be observed throughout kratom-specific case reports. We feel this is now an important opportunity to highlight these issues that are present in the Broyan and colleagues Case report but emphasize that they are not unique to it. We do this with the hope that by acknowledging these issues it can help inform editors, clinicians, and researchers who may not be familiar with kratom and, as a result of this unfamiliarity, may inadvertently present findings in a manner that could confuse readers and even misinform clinical researchers and practitioners.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1221 - 1224"},"PeriodicalIF":3.5,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48615816","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 : 2022-06-03DOI: 10.1080/08897077.2022.2074606
Emma T. Biegacki, Jeanette M. Tetrault, D. Fiellin
Background Addiction programs at academic medical centers must navigate complex, multidisciplinary environments as they work to advance the field and improve substance use treatment access and outcomes. Programs can employ strategic planning processes to identify goals and strategies for success. Methods: The Yale Program in Addiction Medicine began a series of strategic planning activities in February 2020 with the primary aims of (1) conducting a point-in-time needs assessment for the Program and (2) identifying goals for Program improvement and expansion. Drawing upon a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework and the Delphi method for group decision-making, these strategic planning activities were implemented in four steps involving multimodal engagement and iterative feedback amongst Program faculty and selected stakeholders. Results: Primary deliverables included four overarching programmatic goals, associated action items, strategies for success, a proposed implementation timeline, and a revised Mission, Vision, and Values statement for the Program. Conclusion: Methodologic considerations and environmental factors offer insight into the strengths, limitations, and adaptive potential of this approach as well as others described in the literature. Key outputs highlight the benefits and timeliness of strategic planning for addiction programs, as heightened interest and investment in substance use treatment, prevention, and harm reduction paves the way for opportunity and innovation.
{"title":"Commentary Article: Strategic Planning for Addiction Programs within Academic Medical Centers: Examples from the Yale Program in Addiction Medicine","authors":"Emma T. Biegacki, Jeanette M. Tetrault, D. Fiellin","doi":"10.1080/08897077.2022.2074606","DOIUrl":"https://doi.org/10.1080/08897077.2022.2074606","url":null,"abstract":"Background Addiction programs at academic medical centers must navigate complex, multidisciplinary environments as they work to advance the field and improve substance use treatment access and outcomes. Programs can employ strategic planning processes to identify goals and strategies for success. Methods: The Yale Program in Addiction Medicine began a series of strategic planning activities in February 2020 with the primary aims of (1) conducting a point-in-time needs assessment for the Program and (2) identifying goals for Program improvement and expansion. Drawing upon a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework and the Delphi method for group decision-making, these strategic planning activities were implemented in four steps involving multimodal engagement and iterative feedback amongst Program faculty and selected stakeholders. Results: Primary deliverables included four overarching programmatic goals, associated action items, strategies for success, a proposed implementation timeline, and a revised Mission, Vision, and Values statement for the Program. Conclusion: Methodologic considerations and environmental factors offer insight into the strengths, limitations, and adaptive potential of this approach as well as others described in the literature. Key outputs highlight the benefits and timeliness of strategic planning for addiction programs, as heightened interest and investment in substance use treatment, prevention, and harm reduction paves the way for opportunity and innovation.","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"43 1","pages":"1215 - 1220"},"PeriodicalIF":3.5,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48275178","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: 10.1080/08897077.2022.2074597
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 : 2022-05-02DOI: 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}
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