PATTERNS OF BEHAVIORAL HEALTH SERVICES PROVIDED IN A 2012 NATIONAL SAMPLE OF U.S. OUTPATIENT SUBSTANCE USE DISORDER TREATMENT FACILITIES: IMPLICATIONS FOR THE TREATMENT OF CO-OCCURRING DISORDERS

Abstract

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e143 Hapten selection for heroin vaccines Gary R. Matyas2, Fuying Li1,3, Joshua Antoline1,3, Rashmi Jalah4, Oscar Torres4, Zoltan Beck4, Arthur Jacobson1,3, Carl Alving2, Kenner Rice1,3 1 Drug Design and Synthesis Section, National Institute on Drug Abuse, NIH, Bethesda, MD, United States 2 US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States 3 National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, United States 4 US Military HIV Research Program, Herny M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States Aims: The aim of this study is to select a heroin hapten for a heroin vaccine. Heroin rapidly degrades to 6-acetylmophine and morphine after injection. We hypothesize that a heroin hapten can bedesigned that is chemically stable and can induce antibodies that bind to heroin and its metabolites. Methods: Seven different opioid haptens were synthesized. A mercaptopropanamide group was attached as the linker at the C3, C6or thebridgenitrogen. The acetyl groups of heroinwere replaced with acetamide or 2-oxypropyl groups. The haptens were attached to tetanus toxoid and mixed with liposomal lipid A. Mice were immunized with 3 doses every 3 weeks. The sera were assayed for hapten antibodies. The mice were challenged by the subcutaneous route with heroin (0.75–1mg/kg) and efficacy was assessed by nociception assays. Results: Anti-hapten titers ranged from 100,000 to 6,000,000. Mice immunizedwith haptens coupled at the bridge nitrogenwere only partially protected with a % maximal potential effect (%MPE) ≥50. Animals immunized with C3 position haptens were not challengeddue to lowantibody titers.Mice immunizedwith a C6 linked morphine hapten (MorHap) had a %MPE of 35. After optimization of the MorHap conjugation procedure, the %MPE was <10 and was maintained 9 weeks after the last vaccination. Conclusions: The best haptenwasMorHap,which induced high antibody titers that protected the mice from heroin challenge. MorHap was coupled at the C6 position, whereas bridge nitrogen linked haptens induced high titer antibodies, but only had moderate efficacy. Financial support: This work was supported by a Cooperative Agreement (W81XWH-07-2-067) between the Henry M. Jackson Foundation and the US Army Medical Research and Materiel Command; an Avant Garde award fromNIDA (1DP1DA034787-01); and the NIH Intramural Research Programs of NIDA and NIAAA. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.390 PATTERNS OF BEHAVIORAL HEALTH SERVICES PROVIDED IN A 2012 NATIONAL SAMPLE OF U.S. OUTPATIENT SUBSTANCE USE DISORDER TREATMENT FACILITIES: IMPLICATIONS FOR THE TREATMENT OF CO-OCCURRING DISORDERS Pia M. Mauro, C. Debra M. Furr-Holden, Ramin Mojtabai Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Aims: According to the 2012 National Survey on Drug Use and Health, of the 20.7 million adults meeting substance use disorder (SUD) criteria, 8.4 million (40.7%) had co-occurring mental illness; only 12.2% received specialty treatment for SUD. Facilities often identify theirmain treatment focus, but the categoriesmaynot fully describe clusters of services. To address this potential discrepancy, we empirically derived classes of specialty SUD outpatient treatment facilitiesusingpatternsofbehavioralhealth servicesprovided in the United States. Methods:Data were obtained from the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS). The current study included community-based facilities offering outpatient treatment in the 50 states and the District of Columbia. Latent class analysis (LCA) was used to identify unobserved classes of facilities based on patterns of observed behavioral health services offered. Results: Of the 14,995 facilities participating in the 2012 NSSATS, 11,488 (76.6%) met inclusion criteria. Facility-identified primary treatment focus included SUD treatment (52.0%), mental health (7.5%), SUD and mental health (36.4%), and general health/other (4.1%). Over a third (38.9%) of facilities had special programs or groups for people with co-occurring disorders. Preliminary analyses indicated an 8-class structure distinguishing facilities beyond their primary treatment focus. These findings will be discussed, along with the relationship between empiricallyderived classes and treatment foci. Conclusions: Behavioral health comorbidities are highly prevalent in SUD treatment samples. Given the evolving healthcare environment, understanding the degree to which facilities nationwide provide treatment for co-occurring disorders has clinical and policy implications. Financial Support: Ms. Mauro and Dr. Furr-Holden receive funding from NIDA T32DA007292. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.391 Changes in the pain analgesic and heroin epidemiology