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

BackgroundPeople living with HIV (PLWH) and opioid use disorder (OUD) commonly experience criminal justice involvement (CJI). We sought to estimate the impact of CJI on 1) HIV care engagement, 2) antiretroviral therapy (ART) prescription rates, and 3) receipt of medications for opioid use disorder (MOUD), among PLWH and OUD in Vietnam.MethodsParticipants were PLWH enrolled in a 12-month MOUD treatment trial of HIV clinic-based buprenorphine vs. methadone referral in Vietnam. We compared those with CJI (arrest, incarceration, or compulsory “06” drug rehabilitation) during the first 9 months of the study to those with no CJI. To ensure participants with CJI had the opportunity to re-engage in treatment, only those who were released before their 9-month study visit were included; participants still incarcerated at 9 months were excluded. Logistic regression models estimated the association between CJI and HIV care engagement (≥ 1 visit), ART prescription, and receipt of MOUD between 9 and 12 months, controlling for demographics, substance use, past CJI, and HIV history.ResultsAt baseline, 234 of 281 participants (83.6%) had a history of arrest/incarceration, and 172 (61.2%) reported prior 06 detention. During their first 9 months of study participation, 14 participants (5.0%) were arrested and 14 participants (5.0%) were sent to compulsory 06 rehabilitation. Being arrested (OR=0.04, 95% CI= (0.007, 0.25)), sent to compulsory 06 rehabilitation (OR=0.08, 95% CI= (0.02, 0.38)), or either (OR=0.07, 95% CI= (0.02, 0.24)), were negatively associated with receipt of MOUD. CJI involvement was also negatively associated with HIV clinic engagement after release (OR=0.20, 95% CI= (0.05, 0.84)). A similar negative association was noted for ART prescription, though it did not reach statistical significance (OR=0.17, 95% CI= (0.03, 1.22)).ConclusionArrest, incarceration, and compulsory 06 rehabilitation negatively impact HIV and OUD care among people with HIV and OUD in Vietnam. Policies that decrease incarceration, and the impacts of incarceration, for people with OUD and HIV may improve care outcomes in Vietnam and elsewhere.DisclosuresP Todd Korthuis, MD, MPH, Alkermes & Indivior (Other Financial or Material Support, Dr. Korthuis serves at principal investigator for NIH-funded studies that accept donated study medicine from Indivior (buprenorphine) and Alkermes (extended-release naltrexone).)

Medication for opioid use disorder (MOUD) is the criterion standard treatment for opioid use disorder (OUD), but nationally representative studies of MOUD use in the US are lacking. To estimate MOUD use rates and identify associations between MOUD and individual characteristics among people who may have needed treatment for OUD. Cross-sectional, nationally representative study using the 2019 National Survey on Drug Use and Health in the US. Participants included community-based, noninstitutionalized adolescent and adult respondents identified as individuals who may benefit from MOUD, defined as (1) meeting criteria for a past-year OUD, (2) reporting past-year MOUD use, or (3) receiving past-year specialty treatment for opioid use in the last or current treatment episode. The main outcomes were treatment with MOUD compared with non-MOUD services and no treatment. Associations with sociodemographic characteristics (eg, age, race and ethnicity, sex, income, and urbanicity); substance use disorders; and past-year health care or criminal legal system contacts were analyzed. Multinomial logistic regression was used to compare characteristics of people receiving MOUD with those receiving non-MOUD services or no treatment. Models accounted for predisposing, enabling, and need characteristics. In the weighted sample of 2 206 169 people who may have needed OUD treatment (55.5% male; 8.0% Hispanic; 9.9% non-Hispanic Black; 74.6% non-Hispanic White; and 7.5% categorized as non-Hispanic other, with other including 2.7% Asian, 0.9% Native American or Alaska Native, 0.2% Native Hawaiian or Pacific Islander, and 3.8% multiracial), 55.1% were aged 35 years or older, 53.7% were publicly insured, 52.2% lived in a large metropolitan area, 56.8% had past-year prescription OUD, and 80.0% had 1 or more co-occurring substance use disorders (percentages are weighted). Only 27.8% of people needing OUD treatment received MOUD in the past year. Notably, no adolescents (aged 12-17 years) and only 13.2% of adults 50 years and older reported past-year MOUD use. Among adults, the likelihood of past-year MOUD receipt vs no treatment was lower for people aged 50 years and older vs 18 to 25 years (adjusted relative risk ratio [aRRR], 0.14; 95% CI, 0.05-0.41) or with middle or higher income (eg, $50 000-$74 999 vs $0-$19 999; aRRR, 0.18; 95% CI, 0.07-0.44). Compared with receiving non-MOUD services, receipt of MOUD was more likely among adults with at least some college (vs high school or less; aRRR, 2.94; 95% CI, 1.33-6.51) and less likely in small metropolitan areas (vs large metropolitan areas, aRRR, 0.41; 95% CI, 0.19-0.93). While contacts with the health care system (85.0%) and criminal legal system (60.5%) were common, most people encountering these systems did not report receiving MOUD (29.5% and 39.1%, respectively). In this cross-sectional study, MOUD uptake was low among people who could have benefited from treatment, especially adolescents and older adults. The high prevalence of health care and criminal legal system contacts suggests that there are critical gaps in care delivery or linkage and that cross-system integrated interventions are warranted.

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

Objectives Limited research has addressed racial/ethnic disparities in receiving medications for opioid use disorder (MOUD) and treatment outcomes. This study examined racial/ethnic differences in receiving MOUD and treatment completion among women of reproductive age with opioid use disorder (OUD). Methods This study utilized data from the 2010–2019 Treatment Episode Data Set (TEDS). The analytic sample consisted of 209,521 women of reproductive age (18–49 years old). Results Overall, MOUD receipt was low for all racial/ethnic groups, with Hispanic and Black women being more likely to receive MOUD than White women. Receipt of MOUD ranged from 18.3% for White women to 21.9% for Hispanic women. Black and Hispanic women had lower odds of completing any treatment for OUD than White women. The rates of OUD treatment completion increased over time (2010 to 2019) for White and Black women, with a small decrease for Hispanic women. For all groups, treatment completion rates without MOUD were higher than those with MOUD. Conclusions Racial/ethnic disparities exist in the receipt of any OUD treatment, receipt of MOUD, and completion of treatment. Monitoring disparities and designing programs to maximize successful receipt and completion of MOUD is necessary for improving intervention efforts for women of reproductive age.

Opioid relapse and MOUD outcomes following civil commitment for opioid use

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

Hospitalizations related to opioid use disorder (OUD) represent an opportunity to initiate medication for OUD (MOUD). To assess whether starting MOUD after a hospitalization or emergency department (ED) visit is associated with the odds of fatal and nonfatal opioid overdose at 6 and 12 months. This population-based cohort study used data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other administrative health datasets, for individuals aged 18 years or older who had diagnosis codes related to OUD recorded at an index ED visit or hospitalization from January 2017 to December 2019. Data were analyzed between May 2023 and January 2024. Receipt of MOUD within the 7 days after an OUD-related hospital visit. The primary outcome was fatal or nonfatal overdose at 6 and 12 months after discharge. Sample characteristics, including age, sex, insurance plan, number of comorbidities, and opioid-related overdose events, were stratified by receipt or nonreceipt of MOUD within 7 days after an OUD-related hospital visit. A logistic regression model was used to investigate the association between receipt of MOUD and having an opioid overdose event. The study included 22 235 patients (53.1% female; 25.0% aged 25-39 years) who had an OUD-related hospital visit during the study period. Overall, 1184 patients (5.3%) received MOUD within 7 days of their ED visit or hospitalization. Of these patients, 683 (57.7%) received buprenorphine, 463 (39.1%) received methadone, and 46 (3.9%) received long-acting injectable naltrexone. Patients who received MOUD within 7 days after discharge had lower adjusted odds of fatal or nonfatal overdose at 6 months compared with those who did not (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.97). At 12 months, there was no difference in adjusted odds of fatal or nonfatal overdose between these groups (AOR, 0.79; 95% CI, 0.58-1.08). Patients had a lower risk of fatal or nonfatal overdose at 6 months associated with buprenorphine use (AOR, 0.50; 95% CI, 0.27-0.95) but not with methadone use (AOR, 0.57; 95% CI, 0.28-1.17). In this cohort study of individuals with an OUD-related hospital visit, initiation of MOUD was associated with reduced odds of opioid-related overdose at 6 months. Hospitals should consider implementing programs and protocols to offer initiation of MOUD to patients with OUD who present for care.

BackgroundMedical devices offer an established therapeutic approach for managing the transition from polysubstance use to abstinence, but little is known about longer-term outcomes.AimDetermine opioid and psychostimulant use over 12 weeks post-discharge following residential use of the NET Device™ or sham among participants with opioid use disorder (OUD).DesignTwelve-week observation following randomized controlled trial of active NET Device (n = 53) versus sham (n = 55) as monotherapy during residential opioid discontinuation in 103 participants who completed >1 post-discharge interview (95% follow-up rate).Setting and participantsAdults with OUD (50.0% with psychostimulant use) recruited at admission from 4 residential addiction treatment facilities in Kentucky.MeasuresPercentage of days using illicit opioids and psychostimulants as well as medications for OUD (MOUD) from weekly timeline follow-back interviews.ResultsActive and sham device groups reported similar rates of MOUD use and illicit opioid and psychostimulant use. In a planned secondary analysis, participants who self-administered active stimulation >24 hours (n = 23) compared to active <24 hours (n = 25), sham >24 hours (n = 21), and sham <24 hours (n = 34) reported significantly (p <.05) lower percentages of days using opioids (1.4% vs 7.4%, 6.8%, and 4.4% respectively) and psychostimulants (1.3% vs 4.1%, 6.7%, and 4.3% respectively) and MOUD (1.2% vs 20.7%, 11.3%, and 16.7% respectively).ConclusionsThe randomized groups did not differ on outcomes. However, participants who self-administered active NET Device stimulation >24 hours reported significantly fewer post-discharge days of opioid or psychostimulant use than those who self-administered active <24 hours or sham, but these findings need to be replicated.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04916600.

Federal emergency authorities were invoked during the COVID-19 pandemic to expand clinical telehealth for opioid use disorder (OUD). To examine the association of the receipt of telehealth services and medications for OUD (MOUD) with fatal drug overdoses before and during the pandemic. This cohort study used exploratory longitudinal data from 2 cohorts (prepandemic cohort: September 1, 2018, to February 29, 2020; pandemic cohort: September 1, 2019, to February 28, 2021) of Medicare Fee-for-Service beneficiaries aged 18 years or older initiating an episode of OUD-related care using Medicare Fee-for-Service data from the Centers for Medicare & Medicaid Services and National Death Index data from the Centers for Disease Control and Prevention. Data analysis was performed from September 19 to October 17, 2022. Prepandemic vs pandemic cohort demographic, medical, substance use, and psychiatric characteristics. Receipt of OUD-related telehealth services, receipt of MOUD, and fatal drug overdose. The prepandemic cohort comprised 105 162 beneficiaries (58.1% female; 67.6% aged 45-74 years). The pandemic cohort comprised 70 479 beneficiaries (57.1% female; 66.3% aged 45-74 years). The rate of all-cause mortality was higher in the pandemic cohort (99.9 per 1000 beneficiaries; 7041 deaths) than in the prepandemic cohort (76.8 per 1000; 8076 deaths) (P < .001). The rate of fatal drug overdoses was higher in the pandemic cohort (5.1 per 1000 beneficiaries; n = 358) than in the prepandemic cohort (3.7 per 1000; n = 391) (P < .001). The percentage of deaths due to a fatal drug overdose was similar in the prepandemic (4.8%) and pandemic (5.1%) cohorts (P = .49). In multivariable analysis of the pandemic cohort, receipt of OUD-related telehealth was associated with a significantly lower adjusted odds ratio (aOR) for fatal drug overdose (aOR, 0.67; 95% CI, 0.48-0.92) as was receipt of MOUD from opioid treatment programs (aOR, 0.41; 95% CI, 0.25-0.68) and receipt of buprenorphine in office-based settings (aOR, 0.62; 95% CI, 0.43-0.91) compared with those not receiving MOUD; receipt of extended-release naltrexone in office-based settings was not associated with lower odds for fatal drug overdose (aOR, 1.16; 95% CI, 0.41-3.26). This cohort study found that, among Medicare beneficiaries initiating OUD-related care during the COVID-19 pandemic, receipt of OUD-related telehealth services was associated with reduced risk for fatal drug overdose, as was receipt of MOUD from opioid treatment programs and receipt of buprenorphine in office-based settings. Strategies to expand provision of MOUD, increase retention in care, and address co-occurring physical and behavioral health conditions are needed.

BackgroundIn 2019, seven county correctional facilities (jails) in Massachusetts initiated pilot programs to provide all Food and Drug Administration–approved medications for opioid use disorder (MOUD).MethodsThis observational study used linked state data to examine postrelease MOUD receipt, overdose, death, and reincarceration among persons with probable opioid use disorder (OUD) in carceral settings who did or did not receive MOUD from these programs from September 1, 2019, through December 31, 2020. Log-binomial and proportional-hazards models were adjusted for propensity-score weights and baseline covariates that remained imbalanced after propensity-score weighting.ResultsThe study cohort included 6400 persons with probable OUD: 2711 (42.4%) received MOUD in jail and 3689 (57.6%) did not. Among persons treated with MOUD in jail, 67.9% received buprenorphine, 25.7% received methadone, and 6.5% received naltrexone. Treated persons were more likely than those not treated to be White (75.4% vs. 58.1%), to be sentenced (31.6% vs. 13.2%), to be receiving MOUD at jail entry (73.7% vs. 17.1%), and to receive MOUD during the first 30 days after community release (60.2% vs. 17.6%; adjusted relative risk, 1.44; 95% confidence interval [CI], 1.38 to 1.50). Only 50.4% of MOUD recipients engaged in MOUD treatment for 75% of the first 90 days after release, and 57.5% were receiving MOUD at 180 days. Receipt of MOUD in jail, as compared with no such receipt, was associated with lower postrelease risks of fatal overdose (adjusted hazard ratio, 0.48; 95% CI, 0.36 to 0.64), nonfatal overdose (adjusted hazard ratio, 0.76; 95% CI, 0.68 to 0.85), death from any cause (adjusted hazard ratio, 0.44; 95% CI, 0.35 to 0.56), and reincarceration (adjusted hazard ratio, 0.88; 95% CI, 0.81 to 0.94). The incidence of hospitalizations did not differ substantially between the two groups.ConclusionsReceipt of MOUD in jail was associated with an increased likelihood of postrelease MOUD initiation and decreased risks of overdose, death from any cause, and reincarceration. (Funded by the National Institutes of Health and others.)

Extended-release naltrexone for youth with opioid use disorder

Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010–2018

Hepatitis C virus (HCV) infections and injection drug use have concurrently increased in the last decade. Evidence supports simultaneously treating chronic HCV and opioid use disorder (OUD) with medication. Kentucky is a hard-hit state for both conditions that has undertaken policy and practice efforts to increase access to both types of medications. To examine receipt of direct-acting antivirals (DAAs) for patients living with HCV-OUD and received any vs. no medications for opioid use disorder (MOUD). We conducted a cross-sectional study using a proprietary dataset from HealthVerity of health claims between 1/1/2020 and 12/31/2021. Kentucky Medicaid beneficiaries aged ≥ 18 with concurrent chronic HCV-OUD diagnoses. Multivariable logistic regression models were used to calculate adjusted proportions of HCV DAA receipt based on receipt of MOUD, adjusting for patient characteristics and region. Of 2149 patients, 36% (n = 780) received HCV DAAs; 84% (n = 1804) received any MOUD during the study period. Buprenorphine was the most common MOUD type used (n = 1414, 66%). Adjusting for covariates, HCV DAA receipt was lower among people who received any vs. no MOUD (33% vs. 46%, p < 0.0001). Methadone (vs. no MOUD, 29% vs. 46%, p = 0.0002) had the greatest difference in odds of HCV DAA receipt. Gaps in HCV treatment among Kentucky Medicaid recipients with OUD were pervasive. Despite evidence supporting HCV-OUD co-treatment, patients receiving MOUD were significantly less likely to receive curative HCV treatment.

Hospitalizations are increasing in the US due to infections related to opioid use disorder (OUD); however, few patients have treatment with medications for OUD (MOUD) initiated. Injectable long-acting buprenorphine (LAB) could help improve MOUD receipt and infection treatment completion. To compare initiation of LAB combined with infectious disease (ID) management (ID-LAB) with treatment as usual (TAU) during inpatient medical hospitalization periods for improving receipt of MOUD at 12 weeks. The Coordinating Opioid Use Treatment Through Medical Management With Infection Treatment (COMMIT) trial was a multisite randomized clinical trial with enrollment from August 19, 2020, through October 31, 2023, at 3 US hospital systems in Connecticut, Pennsylvania, and South Carolina. Eligible participants were individuals hospitalized with a diagnosis of moderate to severe OUD according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and concurrent infection. Intent-to-treat outcomes were assessed at the end of the 12-week intervention period. Participants were randomized 1:1 to receive ID-LAB or TAU during treatment for infection in a hospital setting or early after discharge. All participants received a nurse care medical management intervention. The primary outcome was the proportion of patients who received any form of MOUD at 12 weeks after randomization. Models were adjusted by site, prescription of MOUD in the 30 days prior to hospitalization, and the baseline value of each outcome when assessable. Of the 171 participants who were enrolled, 86 were randomized to the ID-LAB arm and 85 to the TAU arm. A total of 88 participants (51.5%) were men, and median age was 39 (IQR, 33-47) years. At 12 weeks, there was no statistically significant difference in receipt of MOUD between the ID-LAB and TAU groups, with 51 patients (59.3%) and 46 (54.1%), respectively, receiving MOUD (adjusted rate ratio, 1.01; 95% CI, 0.78-1.30). In this randomized clinical trial comparing initiation of LAB for OUD with ID management in the hospital setting compared with TAU, there was no difference between arms in the receipt of MOUD at 12 weeks. The TAU arm had higher retention than anticipated. These findings suggest that hospitalization with an infection related to drug use may present an opportunity to identify OUD and initiate MOUD that may include injectable LAB. The nurse case management services provided to all participants should be evaluated in future studies. ClinicalTrials.gov Identifier: NCT04180020.

Stigma is described as highly relevant to the treatment context for opioid use disorder (OUD) partly because it is known to influence providers' treatment decisions and care provision. However, further study is needed to directly test the salience of stigmatizing views for healthcare decision-making among providers, and particularly those including medication for opioid use disorder (MOUD). This study assessed whether stigma toward illicit opioid use was associated with a willingness to provide or refer patients for MOUD treatment among a sample of healthcare providers. It also evaluated variation in stigmatizing views as a function of familiarity with OUD and MOUD and provider type. Structural equation modeling was utilized to evaluate the antecedents and healthcare decision-making consequences associated with stigma based on survey data from a sample of 144 clinicians participating in a buprenorphine waiver training program (30% female). Providers who have less familiarity with OUD and MOUD and those who are medical students or residents are significantly more likely to endorse stigmatizing views of illicit opioid use. In turn, greater stigma is significantly associated with a lesser willingness to provide treatment or refer patients to MOUD treatment. Further consideration of stigma is recommended in future research to improve clinical practice and increase the implementation of MOUD treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).