Journal of substance use and addiction treatment最新文献

{"title":"Trends in polysubstance use among patients in methadone maintenance treatment in Ireland: Evidence from urine drug testing 2010–2020","authors":"Louise Durand ,&nbsp;Aoife O'Kane ,&nbsp;Siobhan Stokes ,&nbsp;Kathleen E. Bennett ,&nbsp;Eamon Keenan ,&nbsp;Gráinne Cousins","doi":"10.1016/j.josat.2024.209507","DOIUrl":"10.1016/j.josat.2024.209507","url":null,"abstract":"<div><h3>Introduction</h3><p>The benefits of methadone maintenance treatment (MMT) may be compromised by the continued use of other substances during treatment. Polysubstance use has been identified as a major contributing factor to treatment discontinuation, a known risk factor for drug overdose. We examined trends in immunoassay drug positivity rates for amphetamines, benzodiazepines, cannabis, cocaine and opioids, and (2) trends in polysubstance positivity rates for drug combinations associated with increased risk of drug overdose among patients attending the national drug treatment centre in Ireland for MMT between 2010 and 2020.</p></div><div><h3>Methods</h3><p>Repeated cross-sectional study of patients attending the national drug treatment centre (NDTC) for MMT (total N = 1942) between 2010 and 2020, focused on urine drug samples provided for testing to the NDTC clinical testing laboratory (n = 221,564). Samples were analysed using immunoassay during the study period. Mixed-effects logistic regression models evaluate time trends in drug positivity. A random intercept accounts for repeat testing of individual patients. The study reports Adjusted Odds Ratios (AOR) for time (per year) with 95 % Confidence Intervals (95 % CI).</p></div><div><h3>Results</h3><p>Drug positivity rates increased over time for benzodiazepines (AOR 1.02, 95 % CI 1.01–1.03, p &lt; .0001), cannabis (AOR 1.06, 95 % CI 1.05–1.08, p &lt; .0001) and cocaine (AOR 1.28, 95 % CI 1.27–1.29, p &lt; .0001), with decreasing trends for opioids (AOR 0.91, 95 % CI 0.91–0.92, p &lt; .0001). Methadone and benzodiazepines were co-detected in over two-thirds of all samples during the study period. Co-detection of methadone and benzodiazepines with cocaine was also found to be increasing (AOR 1.24, 95 % CI 1.23–1.25, p &lt; .0001), with weighted polysubstance positivity rates reaching 29.2 % in 2020. The co-detection of methadone and benzodiazepines with opioids decreased over the study period (AOR 0.92, 95 % CI 0.91–0.92, p &lt; .0001), ranging from 36.7 % in 2010 to 26.9 % in 2020.</p></div><div><h3>Conclusion</h3><p>Interventions are needed to target the persistently high use of benzodiazepines among patients in receipt of methadone due to their synergistic effects with opioids on respiratory depression, enhancing the risk of overdose. The growing use of cocaine among people in MMT also needs to be addressed.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209507"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross sectional analysis of an addiction consultation service, substance co-use patterns, and receipt of medications for opioid use disorder during hospitalization","authors":"Riley D. Shearer ,&nbsp;Gavin Bart ,&nbsp;Timothy J. Beebe ,&nbsp;Beth A. Virnig ,&nbsp;Nathan D. Shippee ,&nbsp;Tyler N.A. Winkelman","doi":"10.1016/j.josat.2024.209505","DOIUrl":"10.1016/j.josat.2024.209505","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite effective medications for opioid use disorder (MOUD), treatment engagement remains low. As the overdose crisis is increasingly characterized by opioids co-used with other substances, it is important to understand whether existing models effectively support treatment for patients who use multiple substances. Hospital-based addiction consultation services (ACS) have shown promise at increasing MOUD initiation and treatment engagement, but the effectiveness for patients with specific co-use patterns remains unknown.</p></div><div><h3>Methods</h3><p>Using 2016–2023 admissions data from a large safety net hospital, we estimated a random-effects logistic regression model to determine whether specific co-use (methamphetamine, cocaine, alcohol, sedative, and other) moderated the effect of being seen by ACS on the receipt of MOUD. Adjusting for patient sociodemographic, health, and admission characteristics we estimated the proportion of patients who received MOUD across specific co-use groups.</p></div><div><h3>Results</h3><p>Of 7679 total admissions indicating opioid use, of which 5266 (68.6 %) indicated co-use of one or more substances and 2387 (31.1 %) were seen by the ACS. Among admissions not seen by the ACS, a smaller proportion of admissions with any co-use received MOUD (23.5 %; 95 % CI: 21.9–25.1) compared to admissions with opioid use alone (34.0 %; 95 % CI: 31.9–36.1). However, among admissions seen by the ACS a similar proportion of admissions with any co-use received MOUD (57.8 %; 95 % CI: 55.5–60.1) as admissions with opioid use alone (56.2 %; 95 % CI: 52.2–60.2). The increase in proportion of admissions receiving MOUD associated with being seen by the ACS was larger for admissions with methamphetamine (38.6 percentage points; 95 % CI: 34.6–42.6) or cannabis co-use (39.0 percentage points; 95 % CI: 32.9–45.1) compared to admissions without methamphetamine (25.7 percentage points; 95 % CI: 22.2–29.2) or cannabis co-use (29.1 percentage points; 95 % CI: 26.1–32.1).</p></div><div><h3>Conclusions</h3><p>The ACS is an effective hospital-based treatment model for increasing the proportion of admissions which receive MOUD. This study shows that ACSs are also able to support increased receipt of MOUD for patients who use other substances in addition to opioids. Future research is needed to further understand what transition strategies best support treatment linkage for patients who use multiple substances.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209505"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine discontinuation in telehealth-only treatment for opioid use disorder: A longitudinal cohort analysis","authors":"Brian Chan ,&nbsp;Ryan Cook ,&nbsp;Ximena Levander ,&nbsp;Katharina Wiest ,&nbsp;Kim Hoffman ,&nbsp;Kellie Pertl ,&nbsp;Ritwika Petluri ,&nbsp;Dennis McCarty ,&nbsp;P. Todd Korthuis ,&nbsp;Stephen A. Martin","doi":"10.1016/j.josat.2024.209511","DOIUrl":"10.1016/j.josat.2024.209511","url":null,"abstract":"<div><h3>Introduction</h3><p>At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes.</p></div><div><h3>Methods</h3><p>A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington. The intervention was a fully telehealth-only (THO) app versus treatment as usual (TAU) in office-based settings with some telehealth. We assessed self-reported buprenorphine discontinuation at 4-,12-, and 24-weeks. Generalized estimating equations (GEE) calculated unadjusted and adjusted relative risk ratios (RR) for discontinuation averaged over the study period. Secondary outcomes included change in the Brief Addiction Monitor (BAM) and the visual analogue craving scale. Generalized linear models estimated average within-group and between-group differences over time.</p></div><div><h3>Results</h3><p>Participants (<em>n</em> = 103 THO; <em>n</em> = 56 TAU) had a mean age of 37 years (SD = 9.8 years) and included 52 % women, 83 % with Medicaid insurance, 80 % identified as White, 65 % unemployed/student, and 19 % unhoused. There were differences in gender (THO = 54 % women vs. TAU = 44 %, <em>p</em> = .04), unemployed status (60 % vs 75 %, <em>p</em> <em>=</em> .02), and stable housing (84 % vs 73 %, <em>p</em> <em>=</em> .02). Rates of buprenorphine discontinuation were low in the THO (4 %) and TAU (13 %) groups across 24 weeks. In the adjusted analysis, the risk of discontinuation was 61 % lower in the THO group (aRR = 0.39, 95 % CI [0.17, 0.89], <em>p</em> <em>=</em> .026). Decreases occurred over time on the harms subscale of the BAM (within-group difference − 0.85, <em>p</em> = .0004 [THO], and − 0.68, <em>p</em> <em>=</em> .04 [TAU]<em>)</em> and cravings (within-group difference − 13.47, <em>p</em> = .0001 [THO] vs −7.65, <em>p</em> = .01 [TAU]).</p></div><div><h3>Conclusions</h3><p>A telehealth-only platform reduced the risk of buprenorphine discontinuation compared to office-based TAU. In-person evaluation to receive buprenorphine may not be necessary for treatment-seeking patients.</p></div><div><h3>Clinical trials identifier</h3><p><span><span>NCT03224858</span><svg><path></path></svg></span></p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209511"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924002236/pdfft?md5=bcc8e60081e9b40b01e561dcde83f665&pid=1-s2.0-S2949875924002236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of implementation research funded by the National Institute on Drug Abuse, 2007–2023: Progress and opportunities","authors":"Lori J. Ducharme,&nbsp;Tisha R.A. Wiley,&nbsp;Julia B. Zur,&nbsp;Jorge Andres Vizcaino-Riveros,&nbsp;Lindsey Martin","doi":"10.1016/j.josat.2024.209489","DOIUrl":"10.1016/j.josat.2024.209489","url":null,"abstract":"<div><h3>Background</h3><p>The ongoing and evolving overdose epidemic highlights the need to translate research results into routine clinical practice to address urgent service delivery needs. Implementation science is a relatively new discipline intended to develop systematic, replicable, scalable strategies to accelerate this translation. This article presents a comprehensive review of implementation research funded by the National Institute on Drug Abuse (NIDA).</p></div><div><h3>Methods</h3><p>The study identified all NIDA-funded research grants awarded in fiscal years 2007 through 2023 in treatment services or prevention research (<em>n</em> = 1111) and screened them to find those with a pre-specified implementation science component (<em>n</em> = 248). Using the text of the grant application, two reviewers independently coded the key characteristics of each study.</p></div><div><h3>Results</h3><p>The characteristics of these grants, and trends over time, are described, and priority gap areas are identified. NIDA's implementation research grants have demonstrated increasing rigor in design and measurement.</p></div><div><h3>Conclusions</h3><p>Growth in the portfolio has been driven in part by NIDA's investments in research-practice partnerships in the criminal-legal system, and by recent efforts to address the overdose epidemic.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209489"},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(24)00190-5","DOIUrl":"10.1016/S2949-8759(24)00190-5","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"165 ","pages":"Article 209478"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924001905/pdfft?md5=7c7bc6bea3ef5dc19622e52775572c6c&pid=1-s2.0-S2949875924001905-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harm reduction-focused behavioral activation for people who inject drugs: Mixed methods outcomes from a pilot open trial","authors":"Catherine Paquette ,&nbsp;Alexander Vierling ,&nbsp;Louisa Kane ,&nbsp;Paulina Linares Abrego ,&nbsp;Katherine Benson ,&nbsp;Elizabeth Jordan ,&nbsp;Donald Baucom ,&nbsp;William Zule ,&nbsp;Stacey Daughters","doi":"10.1016/j.josat.2024.209490","DOIUrl":"10.1016/j.josat.2024.209490","url":null,"abstract":"<div><h3>Introduction</h3><p>People who inject drugs (PWID) experience high rates of mental health problems and drug-related harms. Harm reduction-focused interventions aim to reduce harms associated with drug use and are an important approach for engaging people who are not seeking traditional abstinence-focused treatment. Yet, few studies to date have examined the effectiveness of harm reduction psychosocial treatment for drug use. We evaluated the outcomes of a harm reduction-focused behavioral activation (BA) intervention from pretreatment to a 1-month follow-up.</p></div><div><h3>Methods</h3><p>A total of <em>N</em> = 23 PWID (65.2 % White; 52.2 % women; mean age 35.4 ± 7.8 years) were recruited from syringe services programs and <em>n</em> <em>=</em> 19 received the intervention via teletherapy. Assessment of study outcome measures occurred at pre- and posttreatment and a one-month follow-up.</p></div><div><h3>Results</h3><p>Results reflected post-intervention increases in behavioral activation and readiness to change drug use, as well as decreases in substance use, depression, and HIV risk behaviors. There were mixed outcomes on substance-related problems with increases at follow-up, possibly reflecting increased problem recognition.</p></div><div><h3>Conclusions</h3><p>These results suggest initial promise for the harm reduction-focused treatment. Additional research with randomized designs and larger sample sizes is needed, and more intensive treatment may be required to support sustained treatment gains in this population.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209490"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cascade of care for substance use and mental health disorders for justice-involved populations","authors":"Kendra J. Clark ,&nbsp;Jill Viglione ,&nbsp;Rodlescia Sneed ,&nbsp;Niloofar Ramezani ,&nbsp;Faye S. Taxman ,&nbsp;Jennifer E. Johnson","doi":"10.1016/j.josat.2024.209488","DOIUrl":"10.1016/j.josat.2024.209488","url":null,"abstract":"<div><h3>Introduction</h3><p>Justice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade.</p></div><div><h3>Method</h3><p>Using Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment.</p></div><div><h3>Results</h3><p>The study identified four SUD/MHD treatment patterns: <em>Low Access</em>, <em>SUD-Focused</em>, <em>High Need-High Access</em>, and <em>Lower Need-High Access</em> classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures.</p></div><div><h3>Conclusion</h3><p>Focusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209488"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924002005/pdfft?md5=d0a0fd6ccdd81e9c0d0a08befc7e30ab&pid=1-s2.0-S2949875924002005-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(24)00191-7","DOIUrl":"10.1016/S2949-8759(24)00191-7","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"165 ","pages":"Article 209479"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924001917/pdfft?md5=13ff19802efc31c190c38ceee77a58a2&pid=1-s2.0-S2949875924001917-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latine perspectives on the impact of family, perceptions of medication, health systems, incarceration, and housing on accessing opioid agonist therapy: A thematic analysis","authors":"Karina Ascunce Gonzalez ,&nbsp;Natalie Swartz ,&nbsp;Miguel A. Linares ,&nbsp;Camila Gelpí-Acosta ,&nbsp;Avik Chatterjee","doi":"10.1016/j.josat.2024.209491","DOIUrl":"10.1016/j.josat.2024.209491","url":null,"abstract":"<div><h3>Introduction</h3><p>Opioid-related overdose deaths rates among Latine individuals are increasing rapidly and, in Massachusetts, have exceeded rates among non-Hispanic White individuals. Yet Latine individuals are less likely to receive opioid agonist therapies (OAT) methadone and buprenorphine, which have been demonstrated to prevent opioid deaths. Amid climbing Latine overdose rates, we lack qualitative data from Spanish-speaking people who use opioids about their views on and access to OAT. In this paper, we sought to assess variables affecting Latine individuals' initiation of OAT.</p></div><div><h3>Methods</h3><p>We conducted 21 semi-structured interviews – half in Spanish – with Latine-identifying individuals recruited from four locations–three residential treatment sites and one city shelter–in Boston offering services to people who use drugs. We utilized thematic analysis to identify barriers and facilitators to starting and continuing OAT.</p></div><div><h3>Results</h3><p>The following themes – which cut across individual-, interpersonal-, and systems-level variables – emerged as core considerations shaping Latine participants' OAT engagement: (1) family, (2) medication desirability and accessibility, (3) health care resources, (4) housing stability, and (5) incarceration. First, family members were prominent interpersonal influences on participants' treatment decisions. For some participants, family introduced participants to opioids at young ages and later supported them in recovery. Second, engagement with OAT was shaped by individual-level opinions on the medications as well as by systems-level experiences with trying to access the medications. Participants identified benefits and drawbacks of methadone versus buprenorphine, with greater access difficulties for methadone. Third, the health care setting in Boston provided notable systems-level facilitators to OAT access, including outreach workers, Medicaid, and Spanish-speaking providers. Fourth, housing instability impeded some from accessing OAT while motivating others to initiate the medications. Finally, incarceration created systems-level barriers to OAT engagement. Most participants had been incarcerated in jail or prison but did not have access to OAT during incarceration or during their transition back to the community.</p></div><div><h3>Conclusions</h3><p>Approaches to increase OAT engagement among Latine individuals should consider integrating family into recovery pathways, tailoring information in Spanish, developing bilingual/bicultural staffing, ensuring supportive insurance coverage systems, addressing housing needs, and making OAT available for individuals involved in the legal system.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209491"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina","authors":"Jennifer J. Carroll ,&nbsp;Nabarun Dasgupta ,&nbsp;Bayla Ostrach ,&nbsp;Taleed El-Sabawi ,&nbsp;Sarah Dixon ,&nbsp;Brandon Morrissey ,&nbsp;Roxanne Saucier","doi":"10.1016/j.josat.2024.209474","DOIUrl":"10.1016/j.josat.2024.209474","url":null,"abstract":"<div><h3>Introduction</h3><p>Opioid agonist treatment (OAT) is the only treatment for opioid use disorder (OUD) proven to reduce overdose mortality, yet access to this evidence-based treatment remains poor. The purpose of this cross-sectional audit study was to assess OAT availability at residential substance use services in North Carolina.</p></div><div><h3>Methods</h3><p>We conducted a state-wide inventory of residential substance use service providers in North Carolina and subsequently called all providers identified, posing as uninsured persons who use heroin, seeking treatment services. Program characteristics, as reported in phone calls, were systematically recorded. We used Fisher's exact tests to assess what program characteristics were associated with OAT availability and with staff making discouraging comments about OAT. We used unsupervised agglomerative clustering to identify facilities with similar characteristics.</p></div><div><h3>Results</h3><p>Of the 94 treatment providers identified, we successfully contacted and collected data from 66. Of those, only 7 (10.6 %) provide OAT on site; an additional 9 (13.6 %) allow OAT through an outside or community-based prescriber. Only 8 (12.1 %) providers were licensed to provide residential substance use treatment. Staff from 33 (50.0 %) providers made negative, discouraging, or stigmatizing remarks about OAT—for example, that OAT substitutes one addiction for another or does not constitute “true recovery.” OAT availability was positively associated with a provider holding a state license for any substance use-related service (41.9 % vs 8.6 %, <em>p</em> = 0.002) and offering 12-step programming (36.1 % vs. 10/0 %, <em>p</em> = 0.020). OAT availability was negatively associated with faith-based programming (6.1 % vs 42.4 %, <em>p</em> = 0.001), dress codes (5.3 % vs 50.0 %, <em>p</em> &lt; 0.001), and mandates that residents work in a provider-owned and -operated commercial enterprise (5.0 % vs 32.6 %, <em>p</em> = 0.026). Cluster analysis revealed that the most common (<em>n</em> = 21) type of service provider in North Carolina is an unlicensed, faith-based organization that prohibits OAT, imposes a dress code, and mandates that residents work, often in provider-owned and -operated commercial enterprises.</p></div><div><h3>Conclusion</h3><p>Evidence-based treatments for OUD are largely unavailable at providers of residential substance use services in North Carolina. The prohibition of OAT occurs most often among providers who are unlicensed and impose labor and/or 12-step mandates on residents. Changes to state licensure requirements and exemptions may help improve OAT availability.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"167 ","pages":"Article 209474"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924001863/pdfft?md5=3e0a80349e3d0a3c7d590b7f366b8d7e&pid=1-s2.0-S2949875924001863-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}