Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.

Calendar-based timeline follow-back (TLFB) instruments have been used to assess alcohol use, smoking, and other behaviors. We assessed test-retest reliability of an adapted TLFB addressing opioid-related outcomes over 120 days among opioid overdose survivors using nonprescribed opioids. The Repeated-dose Behavioral intervention to reduce Opioid Overdose Trial utilized a TLFB that collected data over the preceding 120 days. A subset of participants was administered a retest TLFB 3-21 days after their TLFB assessment. The test and retest assessed days of opioid and medication for opioid use disorder (MOUD) use, hospitalization, residential substance use disorder (SUD) treatment, incarceration, and overdose during overlapping time periods. For outcomes reported by ≥15% of the sample, intraclass correlation coefficients (ICC) were calculated between test and retest. ICC > 0.9 was considered "very high" reliability. For outcomes reported by <15%, frequencies were described; statistical tests were not conducted. Seventy-seven participants completed a retest. On the test/retest, most participants reported opioid (87%/83%) and MOUD (58%/60%) use. Median (IQR) number of days of opioid and MOUD use on the test/retest was 71 (25-117)/86 (23-108) and 4 (0-72)/5 (0-79) days. ICC between test and retest was >0.9 for both opioid and MOUD use. On test/retest, few participants reported hospitalization (8%/9%), residential SUD treatment (3%/3%), incarceration (5%/7%), or overdose (4%/3%). The adapted TLFB had very high reliability for self-reported opioid and MOUD use over 120 days. For less frequent outcomes, including overdose, a higher frequency or larger sample size is needed to assess reliability.

Methadone and buprenorphine discontinuation among postpartum women with opioid use disorder

Negative affect-associated drug refusal self-efficacy, illicit opioid use, and medication use following short-term inpatient opioid withdrawal management

Association of primary care engagement with initiation and continuation of medication treatment for opioid use disorder among persons with a history of injection drug use

Trajectories of drug treatment and illicit opioid use in the AIDS Linked to the IntraVenous Experience cohort, 2014-2019.

Naturalistic follow-up after a trial of medications for opioid use disorder: Medication status, opioid use, and relapse

Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes. In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months. There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90-1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91-1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34-0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01-1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other(∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05-1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78-0.99). Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.

Perspectives on medication for opioid use disorder (MOUD) access and service delivery among a community sample of people who use opioids in Los Angeles.

The opioid epidemic continues to pose a formidable challenge to public health, necessitating innovative approaches to enhance access to care and support continuity of treatment for individuals with opioid use disorder (OUD). Opioid overdose-related deaths in Detroit have increased over four-fold from 1999 to 2019, yet the rate of medication for opioid use disorder (MOUD) prescriptions in Detroit has been half the rate compared to Michigan as a whole. Limited access to care remains a major factor in continued opioid use, which is driven in part by an individual’s insurance coverage. As the largest payer of substance use disorder services in the United States, Medicaid plays a central role in efforts to address the opioid epidemic. Over half of the Detroit population is either enrolled in Medicaid or uninsured. Henry Ford Hospital (HFH) continues to treat hospitalized patients with OUD. Post-discharge follow-up appointments for continuation of MOUD have been shown to increase rates of prolonged abstinence, reduce rates of readmission, and decrease mortality rates. Despite HFH’s significant community impact, there have been limitations on which insurance carriers are accepted at our institution when patients try to establish outpatient primary care or specialty addiction medicine services for MOUD. This insurance-driven barrier has consequently limited our ability to provide best practices in supporting patients with OUD. To address this disparity, we aimed to investigate the impact of leveraging our partnership with Community Health and Social Services (CHASS) Clinic, a local Federally Qualified Health Center network, as an opportunity for underinsured and non-insured patients with OUD to have increased access to post-discharge follow-up appointments with qualified providers for continuation of MOUD. In collaboration with the HFH Addiction Medicine Consult team, HFH Primary Care Physicians, and CHASS MOUD providers, we designed a multifaceted intervention to improve the continuum of care for patients with OUD. We established a post-discharge referral pathway between HFH and CHASS, enhancing communication channels to facilitate care coordination. If a patient was admitted to HFH with a diagnosis of OUD and received an Addiction Medicine consult, the primary team was advised to arrange a post-discharge follow-up appointment for MOUD. The location of the appointment was determined by the patient’s insurance. Patients already established with HFH, or with commercial insurance, were scheduled with HFH providers for MOUD. Patients with Medicaid or no insurance were scheduled with CHASS MOUD providers. In the six months prior to implementation, only 3 of 60 (5%) of patients with a diagnosis of OUD that received an Addiction Medicine consult were scheduled to have a post-discharge follow-up for MOUD. In three months after implementation, 8 of 32 (25%) patients received post-discharge follow-up for MOUD. By utilizing the partnership between HFH and CHASS, our intervention was associated with a five-fold higher rate of follow-up appointments for continuation of MOUD. These findings underscore the effectiveness of community partnerships in addressing barriers to care and enhancing treatment for individuals with OUD.

Longitudinal effects of interoceptive awareness training as an adjunct to medication treatment for opioid use disorder: A randomized clinical trial of Mindful Awareness in Body-oriented Therapy.

Feasibility and acceptability of a timeline follow-back method to assess opioid use, non-fatal overdose, and substance use disorder treatment

BackgroundStandard medications for opioid use disorder (MOUD) provide effective treatment pathways for recovery compared with no treatment or behavioral therapies alone. That said, people who continue to use non-prescribed opioids despite treatment with MOUD are at greater risk for high attrition and OUD-related harms. Novel, more effective approaches are needed for the treatment of OUD. To that end, glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide a promising option as a non-opioid pharmacological intervention for OUD. Observational studies suggest that GLP-1RAs decrease craving measures in a residential OUD population but no controlled clinical trials have been conducted to determine if GLP-1RAs increase opioid abstinence and reduce craving in individuals with OUD in an outpatient population. The purpose of the current protocol is to evaluate the potential for the GLP-1RA, semaglutide, to increase abstinence and reduce craving in an outpatient population enrolled in a MOUD program and continue to use non-prescribed opioids.MethodThis protocol is a randomized, double-blind, placebo-controlled clinical trial designed to test the efficacy of the GLP-1RA, semaglutide, in 200 participants enrolled in an outpatient MOUD program (n = 100 buprenorphine; n = 100 methadone) for the treatment of OUD. Outcomes include the probability of participants being abstinent from illicit and nonprescribed opioids, as well as measures of craving and days of drug use. Measures will be evaluated using urine toxicology screens and self-report assessments across 19 weeks during a screening visit (Study Week 1), 12 treatment visits (Study Weeks 2–13), a washout visit (Study Week 14), and a final follow-up visit (Study Week 19).DiscussionThis manuscript describes a phase II clinical protocol to collect data on the efficacy of a GLP-1RA, semaglutide, in persons enrolled in an MOUD program and with ongoing non-prescribed opioid use despite treatment with methadone or buprenorphine. Completion of the current project will support the feasibility of phase III clinical trials for further evaluation in larger outpatient OUD populations that may lead to a new indication for GLP-1RA as a novel and effective treatment for OUD.Trial registrationClinicalTrials.gov: NCT06548490. Registered 12 August 2024, https://clinicaltrials.gov/study/NCT06548490.

A large body of research demonstrates the safety and efficacy of medication for opioid use disorder to reduce opioid misuse and related harms. However, stigma is a substantial barrier to broader use of these medications. This endpage reviews the impact of stigma toward medication for opioid use disorder on treatment access, uptake, retention, and outcomes. I then suggests areas for future research and social change. As one of the primary service providers for people with opioid use disorder, social workers should be at the forefront of efforts to destigmatize medication treatments. Social workers are well positioned to address the consequences of stigma toward medication for opioid use disorder through research, education, practice, and systems change. VIDEO ABSTRACT SCRIPT Methadone, buprenorphine, and extended-release naltrexone, the three FDA-approved medications for opioid use disorder, are among the most powerful tools we have in our fight against the rising drug overdose crisis. A large body of research demonstrates the safety and efficacy of these medications to reduce opioid cravings, improve treatment outcomes, and prevent overdose death. However, stigma is a major barrier to their use. Despite a strong evidence base, medications for opioid use disorder are commonly viewed as ineffective and illegitimate treatments that simply ‘substitute one drug for another.’ Stigma is encoded in stringent laws and regulations which limit access to medication. For people with opioid use disorder, stigma can influence beliefs about medications and affect the likelihood that one will initiate and maintain treatment. Stigma also erodes self-esteem and social support, two important predictors for recovery outcomes. In this way, stigma toward medications for opioid use disorder has become a pressing social justice issue. As one of the primary service providers for people with opioid use disorder, social workers should be at the forefront of efforts to destigmatize medication treatments. This endpage is a call to action for social workers to address stigma toward medication treatments through research, education, practice, and systems change.

Opioid relapse and MOUD outcomes following civil commitment for opioid use

Risks of returning to opioid use at treatment entry and early in opioid use disorder treatment: Role of non-opioid substances