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Addiction Science & Clinical Practice

Margo E Godersky, Andrew J Saxon, Joseph O Merrill, Jeffrey H Samet, Jane M Simoni, Judith I Tsui
BACKGROUND: Buprenorphine effectively reduces opioid craving and illicit opioid use. However, some patients may not take their medication as prescribed and thus experience suboptimal outcomes. The study aim was to qualitatively explore buprenorphine adherence and the acceptability of utilizing video directly observed therapy (VDOT) among patients and their providers in an office-based program. METHODS: Clinical providers (physicians and staff; n = 9) as well as patients (n = 11) were recruited from an office-based opioid treatment program at an urban academic medical center in the northwestern United States...
March 13, 2019: Addiction Science & Clinical Practice
Christopher Sundström, Elisabeth Petersén, Kristina Sinadinovic, Peter Gustafsson, Anne H Berman
BACKGROUND: Swedish national guidelines recommend that all health care settings systematically screen patients for alcohol use and illicit substance use. When hazardous use is identified, it should immediately be addressed, preferably through brief interventions (BI). It is well known that the prevalence of alcohol use and illicit substance use among psychiatric patients is high, but it is not known to what extent screening and BI are routinely carried out in such clinics. METHODS: Two online surveys investigating the use of screening and BI for alcohol and illicit substances were constructed; one for psychiatric outpatient clinic directors and one for staff at these clinics...
March 6, 2019: Addiction Science & Clinical Practice
Jack Tsai, Xian Gu
BACKGROUND: The high prevalence of substance use disorders (SUDs) among incarcerated adults in the U.S. is well-known, but there has been less examination of SUD treatment and rates of incarceration among the population of adults with SUDs as the denominator. The current study uses a population-based sample to address three questions: (1) What is the rate of lifetime incarceration among the population of U.S. adults with SUDs?; (2) Among adults with SUDs, what proportion of those with incarceration histories use SUD treatment compared to those without incarceration histories?; and (3) What individual characteristics are associated with utilization of SUD treatment among adults with incarceration histories? METHODS: Data were based on the National Epidemiologic Survey on Alcohol and Related Conditions-III which surveyed a nationally representative sample of U...
March 5, 2019: Addiction Science & Clinical Practice
Susan E Ramsey, Evan G Ames, Lauren Brinkley-Rubinstein, Anne M Teitelman, Jennifer Clarke, Clair Kaplan
BACKGROUND: Women experiencing incarceration (WEI) engage in high rates of sex- and drug-related behavior that places them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration...
March 4, 2019: Addiction Science & Clinical Practice
Adam Chamberlain, Sylviah Nyamu, Jenerius Aminawung, Emily A Wang, Shira Shavit, Aaron D Fox
BACKGROUND: More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. METHODS: This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, ), a multi-site prospective longitudinal cohort study of post-incarceration medical care...
February 19, 2019: Addiction Science & Clinical Practice
Jennifer McNeely, Andrea B Troxel, Hillary V Kunins, Donna Shelley, Joshua D Lee, Alexander Walley, Zoe M Weinstein, John Billings, Nichola J Davis, Roopa Kalyanaraman Marcello, Bruce R Schackman, Charles Barron, Luke Bergmann
BACKGROUND: Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized. Individuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-based addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients, initiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We are studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals (CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal hospital system in the US...
February 19, 2019: Addiction Science & Clinical Practice
Emily C Williams, Theresa E Matson, Alex H S Harris
BACKGROUND: Effective medications for treating alcohol use disorders (AUD) are available but underutilized. Multiple barriers to their provision have been identified, and optimal strategies for addressing and overcoming barriers to use of medications for AUD treatment remain elusive. We conducted a structured review of published care delivery and implementation studies evaluating interventions that aimed to increase medication treatment for patients with AUD to identify interventions and component strategies that were most effective...
February 12, 2019: Addiction Science & Clinical Practice
Madeleine M Southey, Trent Rees, Margaret Rolfe, Sabrina Pit
BACKGROUND: Residential opioid rehabilitation aims to improve the mental health and quality of life of opioid users through abstinence and residential program participation. This study aimed to determine the depression, anxiety, stress and quality of life amongst maintenance to abstinence (MTA) program residents. Secondary study aims were to assess the personal characteristics of MTA clients, addiction and risk taking behaviours, factors associated with program completion, as well as to assess the reliable change in participants' mental health and quality of life on exit...
February 4, 2019: Addiction Science & Clinical Practice
Alexis Cooke, Haneefa Saleem, Saria Hassan, Dorothy Mushi, Jessie Mbwambo, Barrot Lambdin
BACKGROUND: In Dar es Salaam Tanzania, the first opioid treatment program (OTP) in Sub-Saharan Africa, had very high rates of enrollment of people who use drugs (PWUD) but low rates of antiretroviral therapy (ART) initiation among HIV-positive patients. The integrated methadone and anti-retroviral therapy (IMAT) intervention was developed to integrate HIV services into the OTP clinic. The objective of this paper is to better understand the contextual factors that influence the effectiveness of IMAT implementation using the consolidated framework for implementation research (CFIR)...
January 28, 2019: Addiction Science & Clinical Practice
Tyler N A Winkelman, Katherine Diaz Vickery, Andrew M Busch
BACKGROUND: Tobacco use remains the leading cause of preventable disease and death in the United States and is concentrated among disadvantaged populations, including individuals with a history of criminal justice involvement. However, tobacco use among individuals with a history of criminal justice involvement has been understudied in the United States, and data are needed to inform policy and practice. METHODS: We used data from the 2008-2016 National Survey on Drug Use and Health (unweighted N = 330,130) to examine trends in tobacco use, categories of tobacco use, characteristics of cigarette use, and health care utilization and tobacco use screening among individuals (aged 18-64) with and without a history of criminal justice involvement in the past year...
January 11, 2019: Addiction Science & Clinical Practice
Emmeline Taylor, Christine Timko, Alex H S Harris, Mengfei Yu, Andrea K Finlay
BACKGROUND: Alcohol use disorder (AUD) and unhealthy drinking are prevalent among women involved in the criminal justice system and women military veterans. Pharmacotherapy-including naltrexone, topiramate, acamprosate, and disulfiram-for AUD is one form of effective treatment that is associated with better health and criminal justice outcomes. The current study examined the association of justice involvement with receipt of pharmacotherapy for AUD, as well as other patient factors that may explain variation in receipt of pharmacotherapy for AUD among women veterans who receive care at Veterans Health Administration (VHA) facilities...
January 3, 2019: Addiction Science & Clinical Practice
Robin Newhouse, Michelle Janney, Anne Gilbert, Jon Agley, Giorgos Bakoyannis, Melora Ferren, C Daniel Mullins, Meg Johantgen, Rhonda Schwindt, Kelli Thoele
BACKGROUND: Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use...
December 27, 2018: Addiction Science & Clinical Practice
Brian Chan, Samuel T Edwards, Meg Devoe, Richard Gil, Matthew Mitchell, Honora Englander, Christina Nicolaidis, Devan Kansagara, Somnath Saha, P Todd Korthuis
BACKGROUND: Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research...
December 14, 2018: Addiction Science & Clinical Practice
Sarah M Bagley, Howard Cabral, Kelley Saia, Alyssa Brown, Christine Lloyd-Travaglini, Alexander Y Walley, Ruth Rose-Jacobs
BACKGROUND: Little is known about opioid overdose or naloxone access among pregnant women. OBJECTIVES: The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. METHODS: We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher's exact tests...
December 14, 2018: Addiction Science & Clinical Practice
Hildi Hagedorn, Marie Kenny, Adam J Gordon, Princess E Ackland, Siamak Noorbaloochi, Wei Yu, Alex H S Harris
BACKGROUND: In the US, emergency room visits and overdoses related to prescription opioids have soared and the rates of illicit opioid use, including heroin and fentanyl, are increasing. Opioid use disorder (OUD) is associated with higher morbidity and mortality, higher HIV and HCV infection rates, and criminal behavior. Opioid agonist therapy (OAT; methadone and buprenorphine) is proven to be effective in treating OUD and decreasing its negative consequences. While the efficacy of OAT has been established, too few providers prescribe OAT to patients with OUD due to patient, provider, or system factors...
December 13, 2018: Addiction Science & Clinical Practice
Bryan Borg, Ivor S Douglas, Madelyne Hull, Angela Keniston, Marc Moss, Brendan J Clark
PURPOSE: Patients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient experiences a critical illness. We sought to determine whether alcohol misuse was associated with lower rates of outpatient follow-up after hospital discharge and whether the magnitude of this association differed in patients who experienced a critical illness...
December 4, 2018: Addiction Science & Clinical Practice
Amanda M Bunting, Carrie B Oser, Michele Staton, Katherine S Eddens, Hannah Knudsen
BACKGROUND: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia...
December 3, 2018: Addiction Science & Clinical Practice
Matthew A Miclette, Jared A Leff, Isabella Cuan, Jeffrey H Samet, Brendan Saloner, Gary Mendell, Yuhua Bao, Michael A Ashburn, Marcus A Bachhuber, Bruce R Schackman, Daniel E Polsky, Zachary F Meisel
Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116 invited health researchers, clinicians, policymakers, health system leaders, and other stakeholders met at the University of Pennsylvania to discuss approaches to address the gaps in evidence-based substance use disorder policy and practice, with an emphasis on the opioid epidemic...
November 13, 2018: Addiction Science & Clinical Practice
Zev Schuman-Olivier, Jacob T Borodovsky, Jackson Steinkamp, Qays Munir, Kyle Butler, Mary Ann Greene, Jonah Goldblatt, Hai Yi Xie, Lisa A Marsch
BACKGROUND: While buprenorphine/naloxone (B/N) is approved for opioid use disorder treatment, effective delivery of B/N comes with significant challenges. Most notably, many patients do not take medication daily as prescribed; this non-adherence worsens treatment outcomes, increases healthcare costs, and leads to persistent worries of diversion among providers and policymakers. The present study examines the feasibility, usability, and acceptability of MySafeRx-a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing designed to address the challenges of office-based opioid treatment (OBOT) with B/N...
September 24, 2018: Addiction Science & Clinical Practice
Mandy D Owens, Jessica A Chen, Tracy L Simpson, Christine Timko, Emily C Williams
BACKGROUND: Addiction treatment improves substance use and criminal recidivism outcomes among justice-involved individuals with substance use disorders, but is underutilized. Although information exists regarding barriers to addiction treatment among individuals with substance use disorders more generally, less is known about barriers among individuals with previous justice involvement. The purpose of this pilot study was to describe barriers to addiction treatment in a sample of adults with a substance use disorder who participated in a pilot trial of brief interventions and were recently released from jail...
August 21, 2018: Addiction Science & Clinical Practice
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