Pub Date : 2024-10-21DOI: 10.1016/j.josat.2024.209545
Kenneth A. Feder , Yuzhong Li , Kathryn N. Burke , Lauren Byrne , Isha K. Desai , Brendan Saloner , Noa Krawczyk
Background
Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD).
Methods
We linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021–June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix.
Results
Of 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30–49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary “drug of abuse,” stimulant use, and not working but actively looking for work.
Conclusion
Findings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication.
{"title":"Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data","authors":"Kenneth A. Feder , Yuzhong Li , Kathryn N. Burke , Lauren Byrne , Isha K. Desai , Brendan Saloner , Noa Krawczyk","doi":"10.1016/j.josat.2024.209545","DOIUrl":"10.1016/j.josat.2024.209545","url":null,"abstract":"<div><h3>Background</h3><div>Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD).</div></div><div><h3>Methods</h3><div>We linked results from a survey of non-OTP treatment program directors in New Jersey (<em>n</em> = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021–June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix.</div></div><div><h3>Results</h3><div>Of 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30–49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary “drug of abuse,” stimulant use, and not working but actively looking for work.</div></div><div><h3>Conclusion</h3><div>Findings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209545"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514245","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}
Pub Date : 2024-10-21DOI: 10.1016/j.josat.2024.209546
Margo C. Hurlocker , Hannah A. Carlon , Alexandra Hernandez-Vallant
Introduction
The initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process.
Methods
Personnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process.
Results
Participants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs).
Conclusions
Findings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.
{"title":"It takes a village: Feedback from personnel in addiction treatment programs indicates support for changing the intake process","authors":"Margo C. Hurlocker , Hannah A. Carlon , Alexandra Hernandez-Vallant","doi":"10.1016/j.josat.2024.209546","DOIUrl":"10.1016/j.josat.2024.209546","url":null,"abstract":"<div><h3>Introduction</h3><div>The initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be <em>what</em>, but <em>how</em> services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process.</div></div><div><h3>Methods</h3><div>Personnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs <em>(N</em> = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process.</div></div><div><h3>Results</h3><div>Participants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs).</div></div><div><h3>Conclusions</h3><div>Findings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209546"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514247","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}
Pub Date : 2024-10-21DOI: 10.1016/j.josat.2024.209542
Leah A. Goldberg , Tingyee E. Chang , Robin Freeman , Alice E. Welch , Angela Jeffers , Kelsey L. Kepler , Dominique Chambless , Ian Wittman , Ethan Cowan , Donna Shelley , Jennifer McNeely , Kelly M. Doran
Background
Emergency departments (EDs) are critical touchpoints for overdose prevention efforts. In New York City (NYC), the Health Department's Relay initiative dispatches trained peer “Wellness Advocates” (WAs) to engage with patients in EDs after an overdose and for up to 90 days subsequently. Interest in peer-delivered interventions for patients at risk for overdose has grown nationally, but few studies have explored challenges and opportunities related to implementing such interventions in EDs.
Methods
We conducted in-depth interviews with Relay WAs, ED patients, and ED providers across 4 diverse NYC EDs. Sampling was purposeful and continued until theoretical saturation was reached. Interviews followed a semi-structured interview guide based on key domains from the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by telephone or web conferencing; audio recordings were professionally transcribed. The study utilized rapid qualitative analysis using template summaries and summary matrices followed by line-by-line coding conducted independently by 3 researchers, then discussed and harmonized at group coding meetings. Coding was both inductive (using an a priori code list based on CFIR domains and study goals) and deductive (new codes allowed to emerge from transcripts). Dedoose software was used for data organization.
Results
We conducted 32 in-depth interviews (10 WAs, 12 patients, 10 ED providers). Four overarching themes emerged: 1) EDs are characterized by multiple competing demands (e.g., related to provider time and physical space), underscoring the utility of Relay and leading to some practical challenges for its delivery; 2) There is a strong role distinction of WAs as peers with lived experience; 3) ED providers value Relay, even though they have a limited understanding of its full scope and outcomes; 4) While the role of structural factors (e.g., homelessness and unstable housing) is recognized, responsibility is often placed on patients for controlling their own success.
Conclusions
We identified four themes that shed new light on the implementation of peer-based overdose prevention programs in EDs. Our findings highlight unique ED inner and outer setting factors that may impact program implementation and effectiveness. The findings provide actionable information to inform implementation of similar programs nationally.
{"title":"Implementation of a peer-delivered opioid overdose response initiative in New York City emergency departments: Insight from multi-stakeholder qualitative interviews","authors":"Leah A. Goldberg , Tingyee E. Chang , Robin Freeman , Alice E. Welch , Angela Jeffers , Kelsey L. Kepler , Dominique Chambless , Ian Wittman , Ethan Cowan , Donna Shelley , Jennifer McNeely , Kelly M. Doran","doi":"10.1016/j.josat.2024.209542","DOIUrl":"10.1016/j.josat.2024.209542","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) are critical touchpoints for overdose prevention efforts. In New York City (NYC), the Health Department's Relay initiative dispatches trained peer “Wellness Advocates” (WAs) to engage with patients in EDs after an overdose and for up to 90 days subsequently. Interest in peer-delivered interventions for patients at risk for overdose has grown nationally, but few studies have explored challenges and opportunities related to implementing such interventions in EDs.</div></div><div><h3>Methods</h3><div>We conducted in-depth interviews with Relay WAs, ED patients, and ED providers across 4 diverse NYC EDs. Sampling was purposeful and continued until theoretical saturation was reached. Interviews followed a semi-structured interview guide based on key domains from the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by telephone or web conferencing; audio recordings were professionally transcribed. The study utilized rapid qualitative analysis using template summaries and summary matrices followed by line-by-line coding conducted independently by 3 researchers, then discussed and harmonized at group coding meetings. Coding was both inductive (using an a priori code list based on CFIR domains and study goals) and deductive (new codes allowed to emerge from transcripts). Dedoose software was used for data organization.</div></div><div><h3>Results</h3><div>We conducted 32 in-depth interviews (10 WAs, 12 patients, 10 ED providers). Four overarching themes emerged: 1) EDs are characterized by multiple competing demands (e.g., related to provider time and physical space), underscoring the utility of Relay and leading to some practical challenges for its delivery; 2) There is a strong role distinction of WAs as peers with lived experience; 3) ED providers value Relay, even though they have a limited understanding of its full scope and outcomes; 4) While the role of structural factors (e.g., homelessness and unstable housing) is recognized, responsibility is often placed on patients for controlling their own success.</div></div><div><h3>Conclusions</h3><div>We identified four themes that shed new light on the implementation of peer-based overdose prevention programs in EDs. Our findings highlight unique ED inner and outer setting factors that may impact program implementation and effectiveness. The findings provide actionable information to inform implementation of similar programs nationally.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209542"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514246","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}
Pub Date : 2024-10-21DOI: 10.1016/j.josat.2024.209541
Monica C. Skewes , Vivian M. Gonzalez , Amy Stix
Introduction
Although American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP.
Method
The study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol.
Results
The initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream.
Conclusion
The open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.
导言：尽管美国印第安人和阿拉斯加原住民（AI/AN）的酒精和其他药物戒断率很高，但也有证据表明原住民社区的药物使用失调（SUDs）率较高。由于无法获得充分的循证治疗 (EBT)，与药物使用相关的健康差异变得更加严重。缺乏心理健康服务提供者是农村 AI 保留地社区实施 EBT 的一个明显障碍。我们的 "原住民康复规划"（IRP）干预措施融合了文化教训和文化适应性复发预防策略，以促进保留地环境中的 SUD 康复。一个关键的实施策略是培训非专业的社区促进者来实施 IRP，从而提高其可接受性和可持续性。本手稿报告了我们正在进行的 IRP 临床试验中使用的促进者培训、监督和忠诚度监控程序：该研究从社区招募了四名人工智能非专业提供者担任 IRP 促进者。最初的培训包括动机访谈入门讲习班，然后是为期两天的 IRP 课程讲习班。然后，我们对为期 6 周的干预措施进行了公开试验，并将每周的督导会议作为引导者培训过程的一部分。在公开试验期间，我们还评估了参与者和促进者对 IRP 干预的接受程度，并对我们的忠实度监控协议进行了试点测试：最初的培训研讨会为促进者提供了所需的信息，帮助他们理解 IRP 背后的原理，并确定促进者的角色是否适合；但是，在公开试验期间，还需要额外的培训和监督，以确保治疗的正确实施。虽然参与者和引导者的反馈评价都很积极，但公开试验帮助我们确定了改进引导者培训、监督和忠实度监控方法所需的修订。我们修订了这些程序，还制定了一份协议，用于培训中途加入研究的新主持人：公开试验是主持人培训过程中的一个重要环节，它帮助我们的团队确定了需要改进的几个方面。我们培训、指导和监督社区成员主持人的方法可以作为一个范例，说明如何克服障碍，在心理健康专业人员很少的农村保留地社区实施循证 SUD 治疗。
{"title":"Training community members to deliver an intervention for substance use disorder: Overcoming implementation barriers in American Indian communities","authors":"Monica C. Skewes , Vivian M. Gonzalez , Amy Stix","doi":"10.1016/j.josat.2024.209541","DOIUrl":"10.1016/j.josat.2024.209541","url":null,"abstract":"<div><h3>Introduction</h3><div>Although American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our <em>Indigenous Recovery Planning</em> (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP.</div></div><div><h3>Method</h3><div>The study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol.</div></div><div><h3>Results</h3><div>The initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream.</div></div><div><h3>Conclusion</h3><div>The open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209541"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514244","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}
Pub Date : 2024-10-20DOI: 10.1016/j.josat.2024.209547
Yuhua Bao , Megan A. O'Grady , Kayla Hutchings , Ju-Chen Hu , Kristen Campbell , Elizabeth Knopf , Shazia Hussain , Lesley Puryear , Pat Lincourt , Ashly E. Jordan , Charles J. Neighbors
Introduction
Recent federal regulatory changes governing the delivery of methadone treatment for opioid use disorder at Opioid Treatment Programs (OTPs) support continued practice changes towards greater and flexible methadone take-home medication. Existing payment models for OTPs were closely tied with onsite medication administration and thus misaligned with the need to conduct more and flexible take-homes. This study aims to understand OTP organizations' experience with the newly created OTP bundled payment model in New York State as an alternative to the pre-existing per-service payment model during 2020–2023 to inform financing strategies to support and sustain practice changes.
Methods
The study conducted semi-structured interviews with financial leaders and staff from OTP organizations in New York State. Purposeful sampling of OTP organizations based on their billing practices was supplemented by snowball sampling. Qualitative data from 12 interviews (with 11 OTP organizations and 1 trade organization) were analyzed with an integrated (inductive and deductive) approach to derive themes.
Results
Study informants recognized that the bundled payment model served to protect revenue in a time when OTPs had to pivot quickly to increase take-home medication to patients. Informants described a wide spectrum of practices to operationalize billing in the alternative payment systems, revealing confusion with the billing rules and significant logistical and technical challenges. Informants expressed concerns regarding the substantial difference between the full bundled rate, paid in weeks with one or more qualifying services, and the medication-only rate, reporting that extended (2 weeks or more) take-homes might not be sustainable under the two-tiered model with the low medication-only rate and advocating for a single bundled rate. Informants believed that increased take-home medication and federal regulatory changes had profound implications for the delivery of counseling services, the counselor workforce, and financial viability for OTPs.
Conclusions
Our study of OTP organization experience in New York State provided data on OTP organization perspectives regarding the potential revenue-protecting effects of bundled payments and generated insights to inform future research and policy experimentation to support flexible take-home medication. Future implementation studies are needed to better understand the roles of financing strategies at large in supporting clinical practice changes in substance use disorder treatment.
{"title":"Payment and billing strategies to support methadone take-home medication: Perspectives of financial leaders of opioid treatment program organizations in New York State","authors":"Yuhua Bao , Megan A. O'Grady , Kayla Hutchings , Ju-Chen Hu , Kristen Campbell , Elizabeth Knopf , Shazia Hussain , Lesley Puryear , Pat Lincourt , Ashly E. Jordan , Charles J. Neighbors","doi":"10.1016/j.josat.2024.209547","DOIUrl":"10.1016/j.josat.2024.209547","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent federal regulatory changes governing the delivery of methadone treatment for opioid use disorder at Opioid Treatment Programs (OTPs) support continued practice changes towards greater and flexible methadone take-home medication. Existing payment models for OTPs were closely tied with onsite medication administration and thus misaligned with the need to conduct more and flexible take-homes. This study aims to understand OTP organizations' experience with the newly created OTP bundled payment model in New York State as an alternative to the pre-existing per-service payment model during 2020–2023 to inform financing strategies to support and sustain practice changes.</div></div><div><h3>Methods</h3><div>The study conducted semi-structured interviews with financial leaders and staff from OTP organizations in New York State. Purposeful sampling of OTP organizations based on their billing practices was supplemented by snowball sampling. Qualitative data from 12 interviews (with 11 OTP organizations and 1 trade organization) were analyzed with an integrated (inductive and deductive) approach to derive themes.</div></div><div><h3>Results</h3><div>Study informants recognized that the bundled payment model served to protect revenue in a time when OTPs had to pivot quickly to increase take-home medication to patients. Informants described a wide spectrum of practices to operationalize billing in the alternative payment systems, revealing confusion with the billing rules and significant logistical and technical challenges. Informants expressed concerns regarding the substantial difference between the full bundled rate, paid in weeks with one or more qualifying services, and the medication-only rate, reporting that extended (2 weeks or more) take-homes might not be sustainable under the two-tiered model with the low medication-only rate and advocating for a single bundled rate. Informants believed that increased take-home medication and federal regulatory changes had profound implications for the delivery of counseling services, the counselor workforce, and financial viability for OTPs.</div></div><div><h3>Conclusions</h3><div>Our study of OTP organization experience in New York State provided data on OTP organization perspectives regarding the potential revenue-protecting effects of bundled payments and generated insights to inform future research and policy experimentation to support flexible take-home medication. Future implementation studies are needed to better understand the roles of financing strategies at large in supporting clinical practice changes in substance use disorder treatment.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209547"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514242","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}
Pub Date : 2024-10-20DOI: 10.1016/j.josat.2024.209544
Sharon Reif , Maureen T. Stewart , Shay M. Daily , Mary F. Brolin , Margaret T. Lee , Lee Panas , Grant Ritter , Morgan C. Shields , Shayna B. Mazel , Jennifer J. Wicks
Introduction
Washington State's Hub and Spoke (HS) approach aims to improve availability of opioid use disorder (OUD) treatment. Washington initially funded six hubs with expertise in medications for opioid use disorder (MOUD) that built care networks with referral and treatment partners (spokes). We assessed outcomes for the initial HS cohort, considering the role of HS and treatment characteristics.
Methods
We conducted a cohort-based observational study using 2017–2019 Medicaid claims data for 2841 HS participants aged 18–64, excluding those with past-month MOUD, in an intent-to-treat analysis. We describe treatment characteristics (MOUD type, treatment setting, and hub type at the initial HS visit, number of outpatient services in their first HS month), and six-month outcomes (MOUD continuity, emergency department (ED) utilization, hospitalization, and intensive SUD treatment). We used multivariable regressions to assess associations with six-month outcomes, adjusting for client characteristics.
Results
Two-thirds (68 %) of participants received buprenorphine, 22 % methadone, 5 % naltrexone, and 5 % outpatient without MOUD for their initial visit. Within six months, 45 % had an ED visit, 14 % any hospitalization, and 18 % entered intensive SUD treatment. Only 24 % remained on MOUD for six months. Compared to buprenorphine, the methadone sample had higher odds of MOUD continuity (aOR = 2.81, 95%CI 2.21–3.55), and the naltrexone sample had lower odds (aOR = 0.36, 95%CI 0.19–0.66). FQHC/public health treatment settings had higher odds of MOUD continuity (aOR = 1.70, 95%CI 1.17–2.47) but hub type was not significant. MOUD continuity increased with 2+ outpatient services for the buprenorphine sample (aOR range 2.55–4.73). Odds of intensive SUD treatment were lower for the methadone sample, compared to buprenorphine (aOR = 0.16, 95%CI 0.11–0.23), all settings compared to SUD settings (aOR range 0.32–0.58), and SUD + MH and medical/hospital hubs compared to SUD only hubs (aOR range 0.28–0.41).
Conclusions
Most participants did not attain six-month MOUD continuity, despite the HS approach, with variations by MOUD type and treatment setting. The number of outpatient services in the first month for buprenorphine clients was associated with greater odds of MOUD continuity and reduced odds of intensive SUD treatment. More work is needed to improve MOUD continuity for people with OUD within the HS model.
{"title":"Relationship of hub and treatment characteristics with client outcomes in the initial Washington State hub and spoke cohort","authors":"Sharon Reif , Maureen T. Stewart , Shay M. Daily , Mary F. Brolin , Margaret T. Lee , Lee Panas , Grant Ritter , Morgan C. Shields , Shayna B. Mazel , Jennifer J. Wicks","doi":"10.1016/j.josat.2024.209544","DOIUrl":"10.1016/j.josat.2024.209544","url":null,"abstract":"<div><h3>Introduction</h3><div>Washington State's Hub and Spoke (HS) approach aims to improve availability of opioid use disorder (OUD) treatment. Washington initially funded six hubs with expertise in medications for opioid use disorder (MOUD) that built care networks with referral and treatment partners (spokes). We assessed outcomes for the initial HS cohort, considering the role of HS and treatment characteristics.</div></div><div><h3>Methods</h3><div>We conducted a cohort-based observational study using 2017–2019 Medicaid claims data for 2841 HS participants aged 18–64, excluding those with past-month MOUD, in an intent-to-treat analysis. We describe treatment characteristics (MOUD type, treatment setting, and hub type at the initial HS visit, number of outpatient services in their first HS month), and six-month outcomes (MOUD continuity, emergency department (ED) utilization, hospitalization, and intensive SUD treatment). We used multivariable regressions to assess associations with six-month outcomes, adjusting for client characteristics.</div></div><div><h3>Results</h3><div>Two-thirds (68 %) of participants received buprenorphine, 22 % methadone, 5 % naltrexone, and 5 % outpatient without MOUD for their initial visit. Within six months, 45 % had an ED visit, 14 % any hospitalization, and 18 % entered intensive SUD treatment. Only 24 % remained on MOUD for six months. Compared to buprenorphine, the methadone sample had higher odds of MOUD continuity (aOR = 2.81, 95%CI 2.21–3.55), and the naltrexone sample had lower odds (aOR = 0.36, 95%CI 0.19–0.66). FQHC/public health treatment settings had higher odds of MOUD continuity (aOR = 1.70, 95%CI 1.17–2.47) but hub type was not significant. MOUD continuity increased with 2+ outpatient services for the buprenorphine sample (aOR range 2.55–4.73). Odds of intensive SUD treatment were lower for the methadone sample, compared to buprenorphine (aOR = 0.16, 95%CI 0.11–0.23), all settings compared to SUD settings (aOR range 0.32–0.58), and SUD + MH and medical/hospital hubs compared to SUD only hubs (aOR range 0.28–0.41).</div></div><div><h3>Conclusions</h3><div>Most participants did not attain six-month MOUD continuity, despite the HS approach, with variations by MOUD type and treatment setting. The number of outpatient services in the first month for buprenorphine clients was associated with greater odds of MOUD continuity and reduced odds of intensive SUD treatment. More work is needed to improve MOUD continuity for people with OUD within the HS model.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209544"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514243","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}
Pub Date : 2024-10-20DOI: 10.1016/j.josat.2024.209540
Monte D. Staton , Justin S. Bell , Alan B. McGuire , Lisa D. Taylor , Dennis P. Watson
Introduction: In 2017, funding disseminated through the US Substance Abuse and Mental Health Services Administration's Opioid State Targeted Response (STR) program accelerated the expansion of peer recovery support services across several states to engage emergency department patients presenting with opioid use disorder. While there is some literature on the initial implementation of these programs, little is known about their sustainability after the STR funding's end. Identifying what happened to these programs is a key component of understanding their ultimate impact and can inform future activities to develop, fund, or sustain similar efforts. Methods: We collected qualitative data from six organizations that participated in Indiana's STR-funded Recovery Coaching and Peer Support Initiative (RCPSI). The semi-structured interview guide was designed to gather data related to eight domains of sustainability (i.e., environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, program evaluation, communications, and strategic planning). The analysts followed a deductive-inductive analysis approach, using the eight domains as an a priori coding structure and developing higher-level inductive themes. Results: A total of ten individuals (roles included 4 Program Supervisors, 2 Nurse Administrators, a Psychiatric Social Worker, a Mobile Treatment Manager, a Grant Coordinator, and a Vice President of Planning) participated in six interviews. Two programs did not sustain services, primarily because they lacked a sufficient volume of eligible patients to justify services. Factors identified as supporting sustainability in the other four programs included (1) identification of alternate funding sources, (2) evolving internal support for ED-based opioid use disorder treatment, and (3) investment in internal and external relationships. Furthermore, these themes operated across multiple sustainability domains. Conclusions: The findings illustrate a dynamic interplay between program context and multiple theorized sustainability domains that impacted the viability of RCPSI programs after the end of STR funding. Results indicate a need for a better understanding of the factors influencing the sustainability of programs supported by federal funding to mitigate the opioid crisis, and such findings will likely apply to a broader range of grant-supported programs.
{"title":"What happens after the funding ends?: A qualitative sustainability investigation of emergency department-based peer support programs implemented as part of Indiana's opioid state targeted response initiative","authors":"Monte D. Staton , Justin S. Bell , Alan B. McGuire , Lisa D. Taylor , Dennis P. Watson","doi":"10.1016/j.josat.2024.209540","DOIUrl":"10.1016/j.josat.2024.209540","url":null,"abstract":"<div><div>Introduction: In 2017, funding disseminated through the US Substance Abuse and Mental Health Services Administration's Opioid State Targeted Response (STR) program accelerated the expansion of peer recovery support services across several states to engage emergency department patients presenting with opioid use disorder. While there is some literature on the initial implementation of these programs, little is known about their sustainability after the STR funding's end. Identifying what happened to these programs is a key component of understanding their ultimate impact and can inform future activities to develop, fund, or sustain similar efforts. Methods: We collected qualitative data from six organizations that participated in Indiana's STR-funded Recovery Coaching and Peer Support Initiative (RCPSI). The semi-structured interview guide was designed to gather data related to eight domains of sustainability (i.e., environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, program evaluation, communications, and strategic planning). The analysts followed a deductive-inductive analysis approach, using the eight domains as an a priori coding structure and developing higher-level inductive themes. Results: A total of ten individuals (roles included 4 Program Supervisors, 2 Nurse Administrators, a Psychiatric Social Worker, a Mobile Treatment Manager, a Grant Coordinator, and a Vice President of Planning) participated in six interviews. Two programs did not sustain services, primarily because they lacked a sufficient volume of eligible patients to justify services. Factors identified as supporting sustainability in the other four programs included (1) identification of alternate funding sources, (2) evolving internal support for ED-based opioid use disorder treatment, and (3) investment in internal and external relationships. Furthermore, these themes operated across multiple sustainability domains. Conclusions: The findings illustrate a dynamic interplay between program context and multiple theorized sustainability domains that impacted the viability of RCPSI programs after the end of STR funding. Results indicate a need for a better understanding of the factors influencing the sustainability of programs supported by federal funding to mitigate the opioid crisis, and such findings will likely apply to a broader range of grant-supported programs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209540"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514248","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}
Pub Date : 2024-10-18DOI: 10.1016/j.josat.2024.209534
Adam Viera , Elizabeth Jadovich , Carolyn Lauckner , Jessica Muilenburg , Trace Kershaw
Introduction
Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers.
Methods
We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences.
Results
We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified ‘home’ as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of ‘home’ while recovery was associated with limited travel and more time spent at home.
Conclusions
Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of ‘home’ as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.
{"title":"Responding to location-based triggers of cravings to return to substance use: A qualitative study","authors":"Adam Viera , Elizabeth Jadovich , Carolyn Lauckner , Jessica Muilenburg , Trace Kershaw","doi":"10.1016/j.josat.2024.209534","DOIUrl":"10.1016/j.josat.2024.209534","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers.</div></div><div><h3>Methods</h3><div>We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences.</div></div><div><h3>Results</h3><div>We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified ‘home’ as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of ‘home’ while recovery was associated with limited travel and more time spent at home.</div></div><div><h3>Conclusions</h3><div>Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of ‘home’ as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209534"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482478","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}
Pub Date : 2024-10-11DOI: 10.1016/j.josat.2024.209539
Christopher Moriates , Alanna Boulton , Richard Bottner , John Weems , Nicholaus Christian , Taylor Bazajou , Daniela I. Olmos , Carma Deem Bolton , Tara E. Karns-Wright , Holly J. Lanham , Erin P. Finley , Jennifer S. Potter
Introduction
In 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program.
Methods
This is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes.
Results
Between 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity.
Conclusions
Implementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.
{"title":"The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder","authors":"Christopher Moriates , Alanna Boulton , Richard Bottner , John Weems , Nicholaus Christian , Taylor Bazajou , Daniela I. Olmos , Carma Deem Bolton , Tara E. Karns-Wright , Holly J. Lanham , Erin P. Finley , Jennifer S. Potter","doi":"10.1016/j.josat.2024.209539","DOIUrl":"10.1016/j.josat.2024.209539","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program.</div></div><div><h3>Methods</h3><div>This is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes.</div></div><div><h3>Results</h3><div>Between 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity.</div></div><div><h3>Conclusions</h3><div>Implementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209539"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482479","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}
Pub Date : 2024-10-10DOI: 10.1016/j.josat.2024.209538
Justin Berk , Cameron Miller , Michael-Evans James , Megan Martin , Josiah Rich , Eliana Kaplowitz , Lauren Brinkley-Rubinstein
Introduction
Individuals impacted by the criminal-legal system face increased risk of opioid overdose. Medications for opioid use disorder (MOUD) provide a life-saving intervention. Multiple barriers prevent access to MOUD, including federal policies regulating opioid treatment programs (OTPs). This study aims to identify how federal policy affects anticipated barriers to methadone treatment access at a high-risk time for opioid mortality: community re-entry after incarceration.
Methods
The study used standard qualitative methods to conduct 40 in-depth-interviews with incarcerated individuals enrolled in the Rhode Island Department of Corrections MOUD treatment program. Semi-structured interviews took place between June and August 2018 and focused on participants' experiences with MOUD and anticipated treatment barriers upon re-entry. A deductive coding framework incorporating the SAMHSA “8-point” criteria for take-home methadone as the a priori codebook and additional identified barriers informed further inductive analysis.
Results
Four themes emerged: (1) logistical hurdles such as transportation and clinic location impeded clinic access; (2) punitive measures within clinics, like dose reduction for rule infractions, discouraged treatment continuation; (3) the environment of methadone clinics often tempted return to use; (4) while the structured nature of methadone treatment provided accountability, it also posed challenges. Federal policies, particularly around daily dosing and “take-home” regulations, exacerbated barriers for those re-entering the community. State and clinic level policies, however, were also identified as direct or exacerbating barriers to treatment access.
Conclusion
Significant hurdles persist for methadone access among individuals released from incarceration. Though the federal 8-point criteria have now been replaced with more flexible take-home policies, our findings highlight critical treatment barriers for individuals during the high-risk period of community re-entry. State and clinic level policies also exacerbate many of the barrier-driven themes identified in this analysis. Future work can explore how to best implement the identified benefits of a structured program without forcing the punitive measures that discourage treatment retention. Additional policy reform can help mitigate the effects of other social determinants of health (including transportation access). Ultimately, the many barriers to community methadone treatment retention also apply to individuals involved in the criminal legal system; they can be exacerbated at the federal, state, and clinic policy level.
{"title":"“Yeah, this is not going to work for me”–The impact of federal policy restrictions on methadone continuation upon release from jail or prison","authors":"Justin Berk , Cameron Miller , Michael-Evans James , Megan Martin , Josiah Rich , Eliana Kaplowitz , Lauren Brinkley-Rubinstein","doi":"10.1016/j.josat.2024.209538","DOIUrl":"10.1016/j.josat.2024.209538","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals impacted by the criminal-legal system face increased risk of opioid overdose. Medications for opioid use disorder (MOUD) provide a life-saving intervention. Multiple barriers prevent access to MOUD, including federal policies regulating opioid treatment programs (OTPs). This study aims to identify how federal policy affects anticipated barriers to methadone treatment access at a high-risk time for opioid mortality: community re-entry after incarceration.</div></div><div><h3>Methods</h3><div>The study used standard qualitative methods to conduct 40 in-depth-interviews with incarcerated individuals enrolled in the Rhode Island Department of Corrections MOUD treatment program. Semi-structured interviews took place between June and August 2018 and focused on participants' experiences with MOUD and anticipated treatment barriers upon re-entry. A deductive coding framework incorporating the SAMHSA “8-point” criteria for take-home methadone as the <em>a priori</em> codebook and additional identified barriers informed further inductive analysis.</div></div><div><h3>Results</h3><div>Four themes emerged: (1) logistical hurdles such as transportation and clinic location impeded clinic access; (2) punitive measures within clinics, like dose reduction for rule infractions, discouraged treatment continuation; (3) the environment of methadone clinics often tempted return to use; (4) while the structured nature of methadone treatment provided accountability, it also posed challenges. Federal policies, particularly around daily dosing and “take-home” regulations, exacerbated barriers for those re-entering the community. State and clinic level policies, however, were also identified as direct or exacerbating barriers to treatment access.</div></div><div><h3>Conclusion</h3><div>Significant hurdles persist for methadone access among individuals released from incarceration. Though the federal 8-point criteria have now been replaced with more flexible take-home policies, our findings highlight critical treatment barriers for individuals during the high-risk period of community re-entry. State and clinic level policies also exacerbate many of the barrier-driven themes identified in this analysis. Future work can explore how to best implement the identified benefits of a structured program without forcing the punitive measures that discourage treatment retention. Additional policy reform can help mitigate the effects of other social determinants of health (including transportation access). Ultimately, the many barriers to community methadone treatment retention also apply to individuals involved in the criminal legal system; they can be exacerbated at the federal, state, and clinic policy level.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209538"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407282","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}
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