Pub Date : 2024-07-01DOI: 10.1016/j.josat.2024.209451
Scott G. Weiner , Amelia Burgess , Herman Singh , Emily N. Miller , Colleen Murphy , Elizabeth Chehregosha , Brian Clear
Introduction
Telehealth-only provision of buprenorphine for the treatment of opioid use disorder (OUD) was first made possible during the COVID-19 pandemic. However, Alabama instituted a law in July 2022 that mandated an annual in-person visit in order to receive this treatment. In July 2023, our usually telehealth-only group established a temporary clinic in Birmingham to meet this requirement.
Methods
The study administered a survey instrument to patients at the time of clinic check-in.
Results
158 of 160 (98.8 %) patients completed the survey. Mean distance traveled was 86.4 (standard deviation (SD) 53.7) miles; time required for travel was mean 1.6 (SD 1.0) hours. Twenty-five patients (15.8 %) reported needing to find childcare to attend the visit and 40 patients (25.3 %) reported missing work to attend. Patients disagreed (median 2 on 1–5 Likert scale, interquartile range (IQR) <1–3>) that it is important to see their provider in-person, that seeing their provider in-person improves care or improves their ability to succeed in treatment, and that they have other OUD treatment resources in their community. Patients strongly agreed (median 5, IQR <5–5>) that OUD can be treated by telehealth without the need for an in-person visit.
Conclusions
An annual in-person visits requirement to receive telehealth OUD services imposed a significant burden on patients, was not desired by patients, and may be associated with harm.
{"title":"Patient experiences with telehealth treatment for opioid use disorder in Alabama","authors":"Scott G. Weiner , Amelia Burgess , Herman Singh , Emily N. Miller , Colleen Murphy , Elizabeth Chehregosha , Brian Clear","doi":"10.1016/j.josat.2024.209451","DOIUrl":"10.1016/j.josat.2024.209451","url":null,"abstract":"<div><h3>Introduction</h3><p>Telehealth-only provision of buprenorphine for the treatment of opioid use disorder (OUD) was first made possible during the COVID-19 pandemic. However, Alabama instituted a law in July 2022 that mandated an annual in-person visit in order to receive this treatment. In July 2023, our usually telehealth-only group established a temporary clinic in Birmingham to meet this requirement.</p></div><div><h3>Methods</h3><p>The study administered a survey instrument to patients at the time of clinic check-in.</p></div><div><h3>Results</h3><p>158 of 160 (98.8 %) patients completed the survey. Mean distance traveled was 86.4 (standard deviation (SD) 53.7) miles; time required for travel was mean 1.6 (SD 1.0) hours. Twenty-five patients (15.8 %) reported needing to find childcare to attend the visit and 40 patients (25.3 %) reported missing work to attend. Patients disagreed (median 2 on 1–5 Likert scale, interquartile range (IQR) <1–3>) that it is important to see their provider in-person, that seeing their provider in-person improves care or improves their ability to succeed in treatment, and that they have other OUD treatment resources in their community. Patients strongly agreed (median 5, IQR <5–5>) that OUD can be treated by telehealth without the need for an in-person visit.</p></div><div><h3>Conclusions</h3><p>An annual in-person visits requirement to receive telehealth OUD services imposed a significant burden on patients, was not desired by patients, and may be associated with harm.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499749","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 : 2024-07-01DOI: 10.1016/j.josat.2024.209449
Introduction
While randomized-controlled trials have shown that heroin-assisted treatment (HAT) is superior to methadone maintenance alone in treatment of refractory clients, little is known about client factors associated with retention in HAT in routine care.
Methods
This retrospective cohort study assessed predictors of retention in first treatment episode among a consecutive cohort of clients admitted to HAT in Denmark from 2010 to 2018, who could be matched to the Danish population register and for whom a Short Form Health Survey (SF-36) was available at admission (N = 432). The study derived predictors from client self-reports at intake and administrative data available in national registers. Cox proportional hazards regression modelled retention in treatment.
Results
The one-year retention rate was 69.63 % (95 % CI 65.06 %–73.74 %), and the median time in treatment was 2.45 years (95 % CI, 1.83–3.12). Bivariate analyses showed that retention was lower for clients who had recent cocaine or benzodiazepine use and among those who had experienced an overdose in the year prior to enrollment in HAT. Age below 40, recent illegal activity, poorer emotional wellbeing, previous residential treatment experience, and previous intensive outpatient treatment were also predictors of dropout from HAT.
Conclusions
This observational study found that retention in HAT in routine care was similar to rates observed in randomized-controlled trials conducted in other countries. The results suggest that addressing polysubstance use as part of the HAT program may promote long-term retention, as may directing resources to certain subgroups identified at intake, including clients under 40 years and those who report recent criminal activity, emotional problems, or overdoses. The findings that previous residential treatment and intensive outpatient treatment were associated with dropout were unexpected.
简介：尽管随机对照试验表明，在治疗难治性患者方面，海洛因辅助治疗（HAT）优于单纯的美沙酮维持治疗，但在常规护理中，与保留HAT治疗相关的患者因素却鲜为人知：这项回顾性队列研究评估了2010年至2018年期间丹麦连续接受HAT治疗的患者队列中首次治疗疗程保留率的预测因素，这些患者可与丹麦人口登记册进行匹配，入院时可获得简表健康调查（SF-36）（N = 432）。研究从患者入院时的自我报告和国家登记册中的行政数据中得出了预测因素。结果显示，一年的保留率为 69%：一年保留率为 69.63 %（95 % CI 65.06 %-73.74%），治疗时间中位数为 2.45 年（95 % CI，1.83-3.12）。双变量分析表明，近期吸食过可卡因或苯并二氮杂卓的受试者，以及在加入 HAT 前一年吸食过量毒品的受试者，留院率较低。年龄在40岁以下、近期有非法活动、情绪较差、曾有过住院治疗经历以及曾接受过强化门诊治疗也是预测从 "戒毒之家 "辍学的因素：这项观察性研究发现，在常规护理中，戒毒治疗中心的保留率与在其他国家进行的随机对照试验中观察到的保留率相似。研究结果表明，将解决多种药物使用问题作为 HAT 项目的一部分，可能会促进长期保留率，也可能会将资源用于在接受治疗时确定的某些亚群，包括 40 岁以下的患者以及报告近期有犯罪活动、情绪问题或用药过量的患者。之前的住院治疗和强化门诊治疗与辍学有关，这一发现出乎意料。
{"title":"Predictors of retention in heroin-assisted treatment in Denmark 2010–2018 – A record-linkage study","authors":"","doi":"10.1016/j.josat.2024.209449","DOIUrl":"10.1016/j.josat.2024.209449","url":null,"abstract":"<div><h3>Introduction</h3><p>While randomized-controlled trials have shown that heroin-assisted treatment (HAT) is superior to methadone maintenance alone in treatment of refractory clients, little is known about client factors associated with retention in HAT in routine care.</p></div><div><h3>Methods</h3><p>This retrospective cohort study assessed predictors of retention in first treatment episode among a consecutive cohort of clients admitted to HAT in Denmark from 2010 to 2018, who could be matched to the Danish population register and for whom a Short Form Health Survey (SF-36) was available at admission (<em>N</em> = 432). The study derived predictors from client self-reports at intake and administrative data available in national registers. Cox proportional hazards regression modelled retention in treatment.</p></div><div><h3>Results</h3><p>The one-year retention rate was 69.63 % (95 % CI 65.06 %–73.74 %), and the median time in treatment was 2.45 years (95 % CI, 1.83–3.12). Bivariate analyses showed that retention was lower for clients who had recent cocaine or benzodiazepine use and among those who had experienced an overdose in the year prior to enrollment in HAT. Age below 40, recent illegal activity, poorer emotional wellbeing, previous residential treatment experience, and previous intensive outpatient treatment were also predictors of dropout from HAT.</p></div><div><h3>Conclusions</h3><p>This observational study found that retention in HAT in routine care was similar to rates observed in randomized-controlled trials conducted in other countries. The results suggest that addressing polysubstance use as part of the HAT program may promote long-term retention, as may directing resources to certain subgroups identified at intake, including clients under 40 years and those who report recent criminal activity, emotional problems, or overdoses. The findings that previous residential treatment and intensive outpatient treatment were associated with dropout were unexpected.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949875924001619/pdfft?md5=3dc8ef3ed951859dfd202b9902e719e9&pid=1-s2.0-S2949875924001619-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499750","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 : 2024-07-01DOI: 10.1016/j.josat.2024.209445
Introduction
Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic.
Methods
In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions.
Results
At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items mostly followed the pattern predicted from the qualitative findings.
Conclusions
The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.
{"title":"Multi-level alignment processes in the sustainment of a youth substance use treatment model following a federal implementation initiative: A mixed method study","authors":"","doi":"10.1016/j.josat.2024.209445","DOIUrl":"10.1016/j.josat.2024.209445","url":null,"abstract":"<div><h3>Introduction</h3><p>Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions.</p></div><div><h3>Results</h3><p>At the time of interview, staff from 80 % of the treatment organizations (<em>n</em> = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items mostly followed the pattern predicted from the qualitative findings.</p></div><div><h3>Conclusions</h3><p>The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499820","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 : 2024-06-30DOI: 10.1016/j.josat.2024.209448
Introduction
Although Black Americans tend to consume less alcohol than non-Hispanic/Latine White Americans, Black Americans who do drink alcohol appear at especially high risk for negative alcohol-related problems. This alcohol-based health disparity indicates a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment efforts. Minority stress-based models posit that stressors such as racism increase negative emotions, which may be associated with using substances such as alcohol to cope with negative emotions. Yet, little research has directly assessed emotional reactions to racism and whether it plays a role in drinking-related behaviors.
Method
Participants were 164 Black American undergraduates at a racially/ethnically diverse university who endorsed current alcohol use 18–48 (M = 21.7, SD = 4.3). Participants completed an online survey regarding their experiences with racism and alcohol-related behaviors.
Results
Experiencing more frequent racism was related to greater negative emotions experienced in response to racism (i.e., negative emotional reactivity to racism) and alcohol-related problems. More frequent racism was related to more alcohol-related problems via the sequential effects of negative emotional reactivity to racism and coping motivated drinking.
Conclusions
These data indicate that the experience of negative emotions that occur after experiencing racism and attempts to cope with those negative emotions by consuming alcohol play important roles in drinking behaviors among Black Americans.
{"title":"Racism and alcohol-related problems among Black adults: The role of negative emotionality to experiencing racism","authors":"","doi":"10.1016/j.josat.2024.209448","DOIUrl":"10.1016/j.josat.2024.209448","url":null,"abstract":"<div><h3>Introduction</h3><p>Although Black Americans tend to consume less alcohol than non-Hispanic/Latine White Americans, Black Americans who do drink alcohol appear at especially high risk for negative alcohol-related problems. This alcohol-based health disparity indicates a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment efforts. Minority stress-based models posit that stressors such as racism increase negative emotions, which may be associated with using substances such as alcohol to cope with negative emotions. Yet, little research has directly assessed emotional reactions to racism and whether it plays a role in drinking-related behaviors.</p></div><div><h3>Method</h3><p>Participants were 164 Black American undergraduates at a racially/ethnically diverse university who endorsed current alcohol use 18–48 (<em>M</em> = 21.7, <em>SD</em> = 4.3). Participants completed an online survey regarding their experiences with racism and alcohol-related behaviors.</p></div><div><h3>Results</h3><p>Experiencing more frequent racism was related to greater negative emotions experienced in response to racism (i.e., negative emotional reactivity to racism) and alcohol-related problems. More frequent racism was related to more alcohol-related problems via the sequential effects of negative emotional reactivity to racism and coping motivated drinking.</p></div><div><h3>Conclusions</h3><p>These data indicate that the experience of negative emotions that occur after experiencing racism and attempts to cope with those negative emotions by consuming alcohol play important roles in drinking behaviors among Black Americans.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494530","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 : 2024-06-29DOI: 10.1016/j.josat.2024.209446
Introduction
Telemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals.
Methods
This paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors.
Results
Between October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral.
Conclusions
The rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.
{"title":"Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings","authors":"","doi":"10.1016/j.josat.2024.209446","DOIUrl":"10.1016/j.josat.2024.209446","url":null,"abstract":"<div><h3>Introduction</h3><p>Telemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals.</p></div><div><h3>Methods</h3><p>This paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors.</p></div><div><h3>Results</h3><p>Between October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral.</p></div><div><h3>Conclusions</h3><p>The rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478130","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 : 2024-06-28DOI: 10.1016/j.josat.2024.209447
Ducel Jean-Berluche
{"title":"Rising above: A true account of overcoming trauma and substance use disorder","authors":"Ducel Jean-Berluche","doi":"10.1016/j.josat.2024.209447","DOIUrl":"10.1016/j.josat.2024.209447","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473250","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 : 2024-06-19DOI: 10.1016/j.josat.2024.209441
Diana Bowser , Robert Bohler , Margot T. Davis , Dominic Hodgkin , Constance Horgan
Background
The national opioid crisis continues to intensify, despite the fact that opioid use disorder (OUD) is treatable and opioid overdose deaths are preventable through first-line treatment with medications for opioid use disorder (MOUD). This study identifies and categorizes payment-related barriers that impact MOUD access and retention from both the provider and patient perspectives and provides insight into how these barriers can be addressed.
Methods
We performed a critical review of the literature (peer-reviewed studies and relevant documents from the gray literature) to identify payment-related access and retention barriers to MOUD. We used the results of this review to develop an analytic framework to understand how payment impacts MOUD access and retention for both providers and patients. In addition, we reviewed action plans developed by Massachusetts communities that participated in the Healing Communities Study (HCS) to analyze which payment-related barriers were addressed through the study.
Results
We identified 18 payment-related barriers that patients or providers face when initiating or continuing MOUD with either methadone or buprenorphine in Opioid Treatment Programs (OTP) and non-OTP settings. Patient-related barriers mainly relate to health insurance coverage or the design of health plans (e.g., cost sharing, covered benefits) resulting in direct (medical and non-medical) and indirect costs that can affect both access and retention, especially as they relate to services provided in OTPs. Provider-related barriers include low reimbursement and administrative burden and are most likely to impact access to MOUD. Evidence-based strategies to expand MOUD as part of the HCS in Massachusetts targeted about half of the patient and provider payment-related barriers identified.
Conclusion
Patients and providers face an array of payment-related barriers that impact access to and retention on MOUD, most of which relate to inadequate health insurance coverage, features of health plans, and key federal and state policies. As new regulatory policies are enacted that expand access to MOUD, such as greater flexibility in OTPs and MOUD delivered via telehealth, it will be important to align these delivery changes with payment reform involving payers, providers, and policymakers.
{"title":"Payment-related barriers to medications for opioid use disorder: A critical review of the literature and real-world application","authors":"Diana Bowser , Robert Bohler , Margot T. Davis , Dominic Hodgkin , Constance Horgan","doi":"10.1016/j.josat.2024.209441","DOIUrl":"10.1016/j.josat.2024.209441","url":null,"abstract":"<div><h3>Background</h3><p>The national opioid crisis continues to intensify, despite the fact that opioid use disorder (OUD) is treatable and opioid overdose deaths are preventable through first-line treatment with medications for opioid use disorder (MOUD). This study identifies and categorizes payment-related barriers that impact MOUD access and retention from both the provider and patient perspectives and provides insight into how these barriers can be addressed.</p></div><div><h3>Methods</h3><p>We performed a critical review of the literature (peer-reviewed studies and relevant documents from the gray literature) to identify payment-related access and retention barriers to MOUD. We used the results of this review to develop an analytic framework to understand how payment impacts MOUD access and retention for both providers and patients. In addition, we reviewed action plans developed by Massachusetts communities that participated in the Healing Communities Study (HCS) to analyze which payment-related barriers were addressed through the study.</p></div><div><h3>Results</h3><p>We identified 18 payment-related barriers that patients or providers face when initiating or continuing MOUD with either methadone or buprenorphine in Opioid Treatment Programs (OTP) and non-OTP settings. Patient-related barriers mainly relate to health insurance coverage or the design of health plans (e.g., cost sharing, covered benefits) resulting in direct (medical and non-medical) and indirect costs that can affect both access and retention, especially as they relate to services provided in OTPs. Provider-related barriers include low reimbursement and administrative burden and are most likely to impact access to MOUD. Evidence-based strategies to expand MOUD as part of the HCS in Massachusetts targeted about half of the patient and provider payment-related barriers identified.</p></div><div><h3>Conclusion</h3><p>Patients and providers face an array of payment-related barriers that impact access to and retention on MOUD, most of which relate to inadequate health insurance coverage, features of health plans, and key federal and state policies. As new regulatory policies are enacted that expand access to MOUD, such as greater flexibility in OTPs and MOUD delivered via telehealth, it will be important to align these delivery changes with payment reform involving payers, providers, and policymakers.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294987592400153X/pdfft?md5=27a843c3a37f30cb20a7d0178836a245&pid=1-s2.0-S294987592400153X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437893","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 : 2024-06-16DOI: 10.1016/j.josat.2024.209442
Background & aims
Anxiety and substance use disorders are highly comorbid and represent two of the leading causes of disease burden globally. Psychosocial interventions are important treatment options for people with co-occurring anxiety and substance use (A-SUD). To date, few reviews have assessed the efficacy of psychosocial treatments for patients with A-SUD. This systematic review and meta-analysis aims to synthesize this literature and assess the efficacy of psychosocial interventions among patients with A-SUD.
Methods
We searched all relevant records published until March 2023 in Medline, EMBASE, PsycINFO, CINAHL and Google Scholar. Two authors extracted and reconciled relevant data and assessed risk of bias. Random effects models were used to calculate effect sizes using Hedges' g for post treatment and follow-up time points. Main outcomes of the review were anxiety, alcohol use, and use of other substances. We examined effects on depression as a secondary outcome since it commonly co-occurs with A-SUD.
Results
Psychosocial interventions for co-occurring A-SUD showed moderate effects on anxiety (g = 0.44), alcohol (Hedges' g = 0.29), and other substance use (g = 0.38) at post intervention. Large effects were observed on depression (g = 0.88) at post intervention with high heterogeneity. These effects were maintained at follow-up for anxiety (Hedges' g = 0.38), other substances (g = 0.44), and depression (g = 0.50). Moderation analyses for demographic factors, intervention characteristics, community level factors, anxiety reduction, and alcohol use reduction, were non-significant.
Conclusions
The current meta-analysis investigated the effects of psychosocial interventions on patients with anxiety and co-occurring SUD. The analyses indicated promising moderate-sized effects of treatment on anxiety, alcohol, all other drug use, and depression. The findings point to important avenues for psychosocial treatment while highlighting critical gaps in knowledge to be addressed in future research.
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Pub Date : 2024-06-14DOI: 10.1016/j.josat.2024.209440
Brooke S. West , Anna Krasnova , Morgan M. Philbin , José E. Diaz , Jeremy C. Kane , Pia M. Mauro
Introduction
Substance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status.
Methods
We included participants from the 2015–2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income.
Results
Overall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08–3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07–4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20–0.77).
Conclusions
Despite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.
导言：药物使用障碍（SUD）与艾滋病的感染和护理中断有关。大多数研究都侧重于临床样本；然而，我们使用了一个具有全国代表性的社区样本，按 HIV 感染状况来估算 SUD 治疗需求和使用情况：我们纳入了 2015-2019 年全国药物使用和健康调查中符合 DSM-IV SUD 标准的 18 岁及以上参与者（n = 22,166 人）。参与者自我报告是否曾有医疗保健专业人员告诉他们感染了艾滋病毒或艾滋病[即艾滋病毒感染者（PWH）、非艾滋病毒感染者（PWH）、艾滋病毒感染状况未知]。结果包括过去一年的1) 使用过任何药物滥用治疗；2) 使用过任何专科药物滥用治疗；3) 感知到的药物滥用治疗需求。调查加权多变量逻辑回归模型根据 HIV 感染状况估算了每种结果的可能性，并对年龄、性别、种族/民族、教育程度、调查年份、医疗保险状况和家庭收入进行了调整：总体而言，0.5% 的人是艾滋病毒携带者，0.8% 的人艾滋病毒感染状况不明。在所有群体中，过去一年接受过任何药物滥用治疗的比例都很低（10.3% 的受访者为非艾滋病毒携带者，24.2% 的受访者为艾滋病毒携带者，17.3% 的受访者为艾滋病毒感染状况未知者）。据报告，7.2% 的非公共卫生人员、17.8% 的公共卫生人员和 10.9%的艾滋病病毒感染状况不明的受访者使用过专业的药物滥用治疗。4.9% 的非公共卫生人员、12.4% 的公共卫生人员和 3.7% 的艾滋病毒感染状况未知的受访者表示有治疗需求。在调整后的模型中，吸毒成瘾者比非吸毒成瘾者更有可能报告过去一年中使用过任何药物滥用治疗（aOR = 2.06; 95 % CI = 1.08-3.94）或过去一年中使用过专业药物滥用治疗（aOR = 2.07; 95 % CI = 1.07-4.01）。在患有大麻以外的药物使用障碍的人群中，艾滋病毒感染状况不明的受访者比艾滋病毒阴性者更不可能报告过去一年的治疗需求（aOR = 0.39; 95 % CI = 0.20-0.77）：结论：尽管艾滋病感染者对药物滥用的治疗需求很高，但超过四分之三患有药物滥用的艾滋病感染者表示过去一年没有接受过治疗。与非艾滋病感染者相比，艾滋病感染者的治疗利用率较高，专科治疗利用率也较高，但所有群体的药物滥用治疗率都很低。由于药物滥用与艾滋病的不良后果相关，我们的研究结果凸显了将药物滥用治疗与艾滋病检测和护理相结合的必要性。增加获得 SUD 治疗的机会有助于减少 HIV 护理过程中与 SUD 相关的不良后果。
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Pub Date : 2024-06-13DOI: 10.1016/S2949-8759(24)00131-0
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