Medication-assisted Therapy Research Articles

Exploring the Role of Social Norms in Buprenorphine Prescribing among Providers in a Rural Health System

Background: The opioid epidemic in the United States continues to accelerate, with opioid-related deaths increasing 30% from 2019 to 2021. Though medication assisted therapy (MAT) is an effective strategy for the treatment of opioid use disorder (OUD), utilization of this tool remains low, particularly in rural health settings. The aims of this study were (a) to examine perceived barriers to using MAT in a sample of rural health providers, (b) to examine the accuracy of medical providers’ perceptions of descriptive (eg, frequency) and injunctive (ie, approval of) norms related to the use of buprenorphine, and (c) to determine whether greater self-other differences predict greater likelihood of prescribing buprenorphine. Methods: An anonymous electronic survey was sent to 775 rural medical providers (response rate = 9.7%). Results: Results indicated that most providers do not prescribe buprenorphine or do so infrequently. Providers inaccurately believed that they were more accepting than their peers with regards to providing addiction care. Providers who assumed that peers were prescribing buprenorphine more often and were more accepting of it were more likely to engage in this practice themselves. Conclusions: These findings lay the groundwork for testing norms interventions that might enhance the uptake of the use of evidence-based substance use treatment by rural medical providers.

Lived Experience of Postpartum Women in Recovery for Opioid Use Disorder on Medication-Assisted Therapy

Abstract Purpose: The purpose of this study was to understand the lived experiences of postpartum women on medication-assisted therapy for opioid use disorder. Study Design and Methods: van Manen's interpretive hermeneutic phenomenological design was used. Recruitment and data collection from seven participants occurred at an outpatient office offering care for perinatal patients on medication-assisted therapy for opioid use disorder. Data collection occurred between September 2021 and March 2022 via in-person interviews using a demographic data sheet, interview guide, speech recognition software, and digital recordings. Demographic data were analyzed using descriptive statistics. Qualitative data were analyzed using precoding, coding, and thematic analysis via van Manen's interpretive hermeneutic phenomenological method. Results: Seven themes were identified: troubled origins, used opioids to deal with life issues, needed to be self-reliant, opioid use disorder overtook their life, the baby was a motivator to seek treatment, the need for combined medication-assisted therapy and collaborative care, and hope for a better life. Clinical Nursing Implications: Nurses can provide trauma-informed care, support the importance of medication-assisted therapy in recovery, incorporate a collaborative care team with expertise in postpartum opioid use disorder, continue the collaborative care team for a minimum of 1 year, and advocate for the patient's role as parent.

Serum cytokines and inflammatory proteins in individuals with heroin use disorder: potential mechanistically based biomarkers for diagnosis

Opioid use disorders cause major morbidity and mortality, and there is a pressing need for novel mechanistic targets and biomarkers for diagnosis and prognosis. Exposure to mu-opioid receptor (MOR) agonists causes changes in cytokine and inflammatory protein networks in peripheral blood, and also in brain glia and neurons. Individuals with heroin use disorder (iHUD) show dysregulated levels of several cytokines in the blood. However, there is limited data on a comprehensive panel of such markers in iHUD versus healthy controls (HC), especially considered as a multi-target biomarker. We used a validated proximity extension assay for the relative quantification of 92 cytokines and inflammatory proteins in the serum of iHUD on medication-assisted therapy (MAT; n = 21), compared to HC (n = 24). Twenty-nine targets showed significant group differences (primarily iHUD>HC), surviving multiple comparison corrections (p = 0.05). These targets included 19 members of canonical cytokine families, including specific chemokines, interleukins, growth factors, and tumor necrosis factor (TNF)-related proteins. For dimensionality reduction, data from these 19 cytokines were entered into a principal component (PC) analysis, with PC1 scores showing significant group differences (iHUD > HC; p < 0.0001). A receiver-operating characteristic (ROC) curve analysis yielded an AUROC = 91.7% (p < 0.0001). This PC1 score remained a positive predictor of being in the HUD group in a multivariable logistic regression, that included select demographic/clinical variables. Overall, this study shows a panel of cytokines that differ significantly between iHUD and HC, providing a multi-target “cytokine biomarker score” for potential diagnostic purposes, and future examination of disease severity.

Sex disparities in outcome of medication-assisted therapy of opioid use disorder: Nationally representative study.

The opioid epidemic causes massive morbidity, and males have substantially greater overdose mortality rates than females. It is unclear whether there are sex-related disparities at different stages in the trajectory of opioid use disorders, in "real world" settings. To determine sex disparities in non-medical opioid use (NMOU) at the end of outpatient medication-assisted treatment (MAT), using nationally representative data. Observational epidemiological study of publicly funded outpatient MAT programs in the national "Treatment episode data set-discharges" (TEDS-D) for 2019. Persons aged ≥18 in their first treatment episode, in outpatient MAT for use of heroin or other opioids (N=11,549). The binary outcome was presence/absence of NMOU. In univariate analyses, males had significantly higher odds of NMOU, compared to females (odds ratio=1.27; Chi2 [df:1]=39.08; uncorrected p<0.0001; p=0.0041 after Bonferroni correction). A multivariable logistic regression detected a male>female odds ratio of 1.19 (95%CI=1.09-1.29; p<0.0001), adjusting for socio-demographic/clinical variables. Several specific conditions were revealed in which males had greater odds of NMOU compared to females (e.g., at ages 18-29 and 30-39; corrected p=0.012, or if they used opioids by inhalation; corrected p=0.0041). This nationally representative study indicates that males have greater odds of NMOU in their first episode of MAT, indicating more unfavorable outcomes. The study reveals specific socio-demographic and clinical variables under which this sex disparity is most prominent.

Addressing the Dual Challenges of Substance Abuse and HIV/AIDS in Uganda via Innovative Approaches

Uganda has made significant strides in combating HIV/AIDS, yet the concurrent rise in substance abuse presents a complex public health challenge that exacerbates the burden on individuals and healthcare systems. The intersection of substance abuse and HIV/AIDS intensifies health risks and complicates treatment efforts, particularly among vulnerable populations such as youth, sex workers, and men who have sex with men. This review explores the intricate relationship between substance abuse and HIV/AIDS in Uganda, examining the socioeconomic and cultural factors that contribute to this dual epidemic. It also highlights the mental health implications, barriers within the healthcare system, and the critical role of community-based interventions. Furthermore, the review emphasizes the importance of innovative approaches in prevention and treatment, including personalized medicine, pre-exposure prophylaxis (PrEP), medication-assisted therapy (MAT), and the integration of mental health services. The potential of digital health tools, such as telemedicine, is also explored as a means to enhance access to care. Additionally, the review underscores the significance of international organizations and partnerships in supporting local efforts to address these challenges. By integrating these innovative strategies, this review aims to inform policymakers, healthcare practitioners, and community leaders on effective interventions to reduce the prevalence of substance abuse and HIV/AIDS in Uganda and improve health outcomes for affected populations. Keywords: Dual challenges, Substance abuse, HIV/AIDS, Uganda, innovative approaches.

Prescription Opioid Exposure During Pregnancy and Risk of Spontaneous Preterm Delivery

(Abstracted from JAMA Network Open 2024;7(2):e2355990 Up to 21% of pregnant people use opioids to treat acute pain at some point in their pregnancies. Several studies have examined the impact of medication-assisted therapy among women with opioid use disorders and their outcomes, including neonatal opioid withdrawal syndrome.

Implementation of universal screening for substance use in pregnancy in a public healthcare system

ObjectiveScreening questionnaires are one option for identification of at-risk substance use and substance use disorder (SUD) during pregnancy. We report the experience of a single institution following universal implementation of a brief screening tool for self-reported substance use at the first prenatal encounter. Study DesignThis is a prospective implementation study evaluating screening for substance use in pregnancy in a large safety net healthcare system. Universal screening with the National Institute of Drug Abuse (NIDA) Quick Screen V1.0 was integrated into the electronic medical record (EMR) and administered at the first point of contact with the healthcare system. SUD was identified initially with diagnosis within the EMR by a healthcare provider and was confirmed with toxicology (maternal or neonatal) results corroborating a pattern of substance use and maternal and neonatal ICD-10 codes for SUD. Patients identified with SUD were then classified as moderate or severe SUD based on criteria established by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. We measured rates of NIDA implementation across different healthcare settings, evaluated NIDA concordance with ascertainment of SUD, and compared adverse pregnancy outcomes associated with moderate and severe SUD. ResultsFrom July 28, 2021, through June 25, 2022, 14,634 unique pregnant individuals accessed care at ambulatory and acute care sites. Universal implementation of the NIDA Quick Screen identified at-risk substance use in 2146 (14.7%) of those who accessed our system, or 17.1% of 12,550 screened across the system, with greater screen completion in ambulatory over acute care settings. SUD was identified in 256 (1.7%) of 14,634 individuals and moderate or severe SUD was identified in 184 (1.3%). Among those with moderate or severe SUD, 90 (48.9%) were NIDA positive, 22 (12.0%) NIDA negative, and 72 (39.1%) unscreened. Of 94 individuals with NIDA discordance or who were unscreened 76 (81%) accessed initial care through an acute care setting. Of 96 individuals with opioid use disorder, 68 (70.8%) were treated with medication-assisted therapy, and 56 (58.3%) were screened with the NIDA Quick Screen. Among delivered individuals with available outcomes, those with moderate or severe SUD were less likely to seek prenatal care (71 (76%) vs 9852 (98%), <0.001)) and more likely to deliver before 37 weeks, (18 (20%) vs 909 (9%), RR (95% CI) 2.13 (1.40, 3.24)) compared to individuals without SUD. Neonates exposed to moderate or severe SUD were more likely to have birth weight <10th centile for gestational age (20 (22%) vs 1147 (12%), RR (95% CI) 1.92 (1.29, 2.85)) and require admission to the neonatal intensive care unit (NICU) (19 (21%) vs 964 (10%), RR (95%) 1.95 (1.30, 2.93)). ConclusionUniversal screening was implemented across a large public healthcare system at a high rate, with higher rates of implementation in ambulatory settings. NIDA successfully identified at-risk substance use in 17% of the SUD cohort but failed to identify more than 50% of patients with moderate or severe SUD. Patients with moderate and severe SUD accessed care primarily through the emergency department and experienced higher rates of adverse obstetric and neonatal outcomes. Future efforts to identify, engage, and retain this highest-risk group are needed.

The role of attachment and personality traits in choosing opiate addiction replacement therapy

Contemporary medical approaches for opioid addiction often include medication-assisted therapy, utilizing methadone and buprenorphine. However, factors influencing patient preferences for starting buprenorphine or methadone therapy are poorly understood. This study aims to explore whether variances in personality traits and attachment styles are related to treatment preferences among individuals undergoing buprenorphine and methadone maintenance therapies. 300 participants completed the Big Five Questionnaire for personality traits and sub-dimensions and the Experiences in Close Relationship Scale for assessing attachment styles. The results indicated that patients with higher levels of Dynamism, Conscientiousness, and Perseverance personality traits were more likely to choose buprenorphine over methadone for achieving and maintaining abstinence. Although attachment styles showed a greater ability to differentiate between groups compared to personality traits, the differences were not significant. However, Conscientiousness stood out for its high discriminant validity, suggesting that scores in this personality dimension could significantly distinguish between groups, with individuals in the buprenorphine group showing higher levels of Conscientiousness compared to the methadone group. The study suggests a partial association between individuals' preference for abstinence therapy and their personality traits. These findings could be considered useful indicators when choosing maintenance therapy to help opiate-addicted patients achieve and maintain abstinence.

Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial.

Symptoms of anxiety and depression are common in patients with terminal illness and multiple challenges exist with timely and effective care in this population. Several centres have reported that one dose of the serotonergic psychedelic psilocybin, combined with therapeutic support, improves these symptoms for up to 6months in this patient group. Drawing upon related therapeutic mechanisms, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy may have the potential to achieve similar, positive mental health outcomes in this group. Preliminary evidence also supports the tolerability of MDMA-assisted therapy for anxiety and depression in advanced-stage cancer. Up to 32 participants with advanced-stage cancer and associated depression and anxiety will be randomised in a 1:1 ratio into one of two blinded parallel treatment arms. The intervention group will receive 120mg (+ 60mg optional supplemental dose) MDMA-assisted therapy. The psychoactive control group will receive 20mg oral (+ 10mg optional supplemental dose) methylphenidate-assisted therapy. For each medication-assisted therapy session, participants will undergo two 90-min therapeutic support sessions in the week preceding, and one 90-min support session the day after the experimental session. A battery of measures (mood, anxiety, quality of life, mystical experience, spiritual wellbeing, attitudes towards death, personality traits, holistic health and wellbeing, connectedness, demoralisation, expectations, qualitative data and safety measures) will be assessed at baseline and through to the end of the protocol. Participants will be followed up until either 12months post-randomisation or death, whichever occurs first. This study will examine the effect of MDMA-assisted therapy on symptoms of anxiety and depression in advanced-stage cancer. Potential therapeutic implications include establishing the safety and effectiveness of a novel treatment that may relieve mental suffering in patients with life-threatening illness. Trial registered on Australian New Zealand Clinical Trials Registry. ACTRN12619001334190p. Date registered: 30/09/2019. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378153&showOriginal=true&isReview=true.

Decreased Sonographic Head Circumference Is Found in Buprenorphine-Exposed Fetuses [ID 2683396

INTRODUCTION: Neonates diagnosed with neonatal opioid withdrawal syndrome (NOWS) have decreased head circumference compared to non-exposed newborns. This is the first study to evaluate fetal head circumference over time in a group of fetuses with intrauterine buprenorphine exposure. METHODS: Fetal anatomic surveys are commonly performed at around 20 weeks of gestation. Patients treated with medication-assisted therapy (MAT) for opioid use disorder commonly receive estimated fetal weight scans at around 32 weeks of gestation due to the risk of intrauterine growth restriction. Retrospective review of ultrasound reports for three groups of patients were performed. Group 1 (75 patients) was low-dose MAT; group 2 (73 patients) was traditional higher-dose MAT. Group 3 (104 patients) was a control group. The IRB approval was 1220.9e-ETSU, entitled “Effect of Maternal Buprenorphine on Fetal Head Circumference.” RESULTS: At the time of the approximately 20-week scan, no statistical difference was found between the groups. At the approximately 32-week growth scan, however, a comparison of the two buprenorphine groups together versus control group showed a statistically significant difference (P=.018) in head circumference. Although the low-dose group had larger head circumferences than the higher-dose group in the 32-week scan, the difference was not significant. CONCLUSION: Previous studies have shown decreased head circumference in newborns in association with maternal MAT. This is the first study to provide ultrasound confirmation of decreased head circumference in fetuses exposed to buprenorphine. Effects are pronounced in the third trimester; the possibility exists that interventions during pregnancy might preserve fetal brain volume. Further research is needed.

Buprenorphine Decreases Fetal Breathing Movements in Fetal Biophysical Profile Assessment [ID 2683456

INTRODUCTION: Ten percent of pregnant patients in our community receive medication-assisted therapy with buprenorphine during their prenatal course. The American College of Obstetricians and Gynecologists (ACOG) recommends antenatal testing for conditions when risk of stillbirth is greater than 0.8/1,000. Opioid use in pregnancy is associated with modest increased odds of stillbirth (odds ratio 1.3). Our hypothesis was that biophysical profile (BPP) in buprenorphine patients might be different than a control group of high-risk patients due to the effects of buprenorphine. METHODS: This retrospective chart review analyzed the BPP assessments of patients receiving buprenorphine compared to patients followed for chronic hypertension. Patients seen between July 1, 2016, and June 30, 2020, were evaluated. 131 patients were in the buprenorphine group and 46 patients were in the chronic hypertension control group. RESULTS: Patients receiving buprenorphine were more likely to have a fetal breathing score of zero than patients undergoing BPP for hypertension. There is a significant relationship between buprenorphine dosage and breathing motion assessment. Chi-squared test yielded a value of P=.04269. Patients on high-dose buprenorphine are more likely to have values of 0 on fetal breathing motion assessment than low-dose patients. CONCLUSION: This is the first study to show a dose-related effect of buprenorphine on fetal breathing movements. Previous research has shown buprenorphine effects on fetal brain structure. Current guidelines minimize the effects of maternal buprenorphine administration on fetal development. This study adds to prior research; further study on the dose-related long-term and short-term effects of buprenorphine on fetal development is encouraged.

An Interpretive Description of Drug Withdrawal Among Pregnant Women in Jail

ObjectiveTo explore the experience of drug withdrawal among pregnant women in jail. DesignA qualitative interpretive descriptive approach. Setting/ProblemThe care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature. ParticipantsFive women completed interviews for the study. InterventionIn-depth, qualitative interviews. ResultsFive themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment. ConclusionParticipants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

Anesthesia of a drug-addicted pregnant woman. The current state of knowledge

IntroductionStimulant use during pregnancy is a growing concern, particularly in the USA and Europe. This article explores anesthesia challenges in pregnant patients with substance abuse, optimizing analgesic treatment, and addressing newborns of addicted mothers. Understanding substance use differences is crucial for managing complications and providing long-term care.AimInvestigate anesthesia management, analgesic optimization, and care for newborns of drug-addicted pregnant patients.Material and methodsA comprehensive literature review included articles from PubMed (from January 2009 to December 2021) and relevant Polish, English, and German literature.Results and discussionOpioid use by pregnant women, especially in North America, raises concerns for maternal and child health. The incidence of newborns with withdrawal syndrome is rapidly increasing. Anesthesia challenges arise in managing pregnant patients with addiction, including analgesia optimization and reducing neonatal abstinence syndrome risk. Individualized approaches like regional anesthesia minimize systemic opioids and neonatal withdrawal symptoms. Medication-assisted therapy, e.g., buprenorphine and methadone, reduces illicit opioid use and improves outcomes for mother and baby. Collaborative care among providers is essential.ConclusionsManaging drug-addicted pregnant women requires a multidisciplinary approach. Anesthesia providers play a crucial role in ensuring safety and pain control.

Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review.

The opioid epidemic in the United States has led to an increasing number of pregnant patients with opioid use disorder (OUD) presenting to obstetric units. Caring for this complex patient population requires an interdisciplinary approach involving obstetricians, anesthesiologists, addiction medicine physicians, psychiatrists, and social workers. The management of acute pain in the parturient with OUD can be challenging due to several factors, including respiratory depression, opioid tolerance, and opioid-induced hyperalgesia. Patients with a history of OUD can present in one of three categories: 1) those with untreated OUD; 2) those who are currently abstinent from opioids; 3) those being treated with medications to prevent withdrawal. A patient-centered, multimodal approach is essential for optimal peripartum pain relief and prevention of adverse maternal and neonatal outcomes. Medications for opioid use disorder (MOUD), previously referred to as medication-assisted therapy (MAT), include opioids like methadone, buprenorphine, and naltrexone. These are prescribed for pregnant patients with OUD, but appropriate dosing and administration of these medications are critical to avoid withdrawal in the mother. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in a stepwise approach, and regional techniques like neuraxial anesthesia and truncal blocks offer opioid-sparing options. Other medications like ketamine, clonidine, dexmedetomidine, nitrous oxide, and gabapentinoids show promise for pain management but require further research. Overall, a comprehensive pain management strategy is essential to ensure the well-being of both the mother and the fetus in pregnant patients with OUD.

Opiate Use Disorder and Exercise: A Systematic Review

Background: The opiate epidemic continues to cause hardship to American communities, including in all counties in Ohio, and resulted in 100 000 drug overdoses in 2021. Medications such as buprenorphine have helped people affected by opiate use disorder (OUD) to continue through recovery, although medication assisted therapy (MAT) has shown limited retention rates, calling for complimentary interventions to be implemented. Exercise has potential to reduce cardiovascular risk, lower obesity, and improve mental health. The aim of this study is to systematically review the literature on OUD and exercise as an adjunct to MAT. The authors hypothesize that there is a gap in the knowledge as to whether this modality has been thoroughly researched to aid in OUD recovery.Methods: A database literature search of PubMed, CINHAL, and PsychInfo returned a total of 458 abstracts. Four sets of exclusion criteria were implemented resulting in a total of 26 articles. After further review, 8 more articles were excluded by the authors.Results: Eighteen articles including participants with OUD were systematically reviewed. Only 1 article solely fo-cused on participants with OUD and exercise as an adjunct to treatment.Conclusion: Exercise as an adjunct to treatment for OUD is an area of addiction treatment that warrants further investigation. Incorporating exercise into a recovery program for people with substance use disorders (SUD) specifically has been touted as a promising modality, however, limitations in OUD only studies and lack of control groups make it difficult to draw a conclusion to support our hypothesis.

B-326 Home Collected Oral Fluid Specimens Are a Viable Option for Telemedicine Based Toxicology Testing

Abstract Background A standard treatment for Substance Use Disorder (SUD) is Medication Assisted Therapy (MAT) consisting of a buprenorphine-naloxone combination medication. Typically, a urine specimen is collected during the in-office visit for the patient to receive MAT. Urine drug testing (UDT) ensures compliance and adherence with the treatment protocol and is often mandated for MAT. However, access to in-office visits and the ability to provide a specimen for UDT can be problematic for individuals undergoing MAT for SUD due to factors such as limited access to reliable transportation or distance to facilities. The COVID-19 pandemic has eased restrictions around telemedicine, including for the administration of MAT. Telemedicine can be a valuable tool to provide greater access to MAT for individuals by removing transportation barriers to treatment. Gravity Diagnostics partnered with various facilities to provide a telemedicine observed oral fluid toxicology (OFT) collection process. To understand if telemedicine OFT could provide the same information as in-office collected specimens, we compared telemedicine OFT to in-office OFT specimens and for one facility telemedicine-OFT to in-office UDT. Methods Gravity Diagnostics provides OFT through LC-MS/MS quantitative testing for over 72 analytes. Using a deidentified data set from our LIS, we identified OFT specimens that were collected either in-office or through telemedicine during a 6 month period. The ability to determine the effectiveness of telemedicine OFT was measured by examining the unexpected positivity rate of 72 analytes when compared to in-office OFT. We used 2-way ANOVA to determine if the detection rate of unexpected analytes between two collection methods were significantly different. Additionally, we identified a facility that conducted in-office UDT and telemedicine OFT on the same patient population. These data were compared in a similar manner with the unexpected positivity rate for 47 analytes subjected to 2-way ANOVA. Results When the unexpected detection rates between the in-office and telemedicine OFT were compared with a 2-way ANOVA, a P-value of 0.554 was found between the collection methods. This result indicated that the detection rates of unexpected analytes between the in-office and telemedicine collections were not significantly different. Similarly, when the unexpected detection rates between the UDT and the telemedicine-OFT were compared, a P-value of 0.391 was found between the collection methods. This result indicated that the detection rates between in office UDT and telemedicine OFT were not significantly different when compared within the same patient population. Conclusion Our data showed that telemedicine-OFT are comparable to in-office OFT for the detection of unexpected positive analytes. In addition, when the same patient population was tested by either telemedicine-OFT or in-office UDT, no significant difference in detection rates of unexpected positives is observed. Therefore, we are confident that we can utilize telemedicine-OFT to provide greater access to health care for patients undergoing MAT for SUD.

Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study.

The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic.

Association of Medication-Assisted Therapy and Risk of Drug Overdose-Related Hospitalization or Emergency Room Visits in Patients With Opioid Use Disorder.

Objective To examine the differential impacts of medication-assisted therapy (MAT) medications (naltrexone, methadone, and buprenorphine) on drug overdose-related hospitalizations or emergency room (ER) visits in patients with opioid use disorder (OUD). Patients and methods A retrospective cohort study was performed on patients 18 years or older diagnosed with OUD, using Optum's de-identified Clinformatics® Data Mart database. To ensure a new diagnosis of OUD from 2018 to 2019, each patient required one year of continuous enrollment before OUD diagnosis. The primary outcome was the incidence of drug overdose-related hospitalization or ER visits in the follow-up period. Patients were censored at loss of coverage or end of the study (9/30/2020). A multivariable Cox proportional hazard model was built to compare the outcomes across three MAT medications (buprenorphine, methadone, and naltrexone). Results Only 10.38% of the 145,317 OUD patients received MAT prescriptions in the 12 months after diagnosis. The majority of MAT users (77.8%) received buprenorphine. At one year of follow-up, the incidence of drug overdose-related hospitalization or ER visits varied by MAT drug type: naltrexone (14.26%), methadone (12.26%), and buprenorphine (10.23%). Compared to methadone drug users, buprenorphine users had a lower risk of negative outcomes (adjusted hazard ratio: 0.84; 95% confidence interval: 0.73-0.97). Conclusion Buprenorphine was associated with the lowest risk of drug overdose-related hospitalization or ER visits among the MAT drugs. However, only 10.38% of OUD patients received MAT. Increasing MAT availability to patients with OUD is a key step towardpreventing relapse and reducing adverse health outcomes.

Substance use disorder and associated factors at an opioid de-addiction clinic in Western Kenya

BACKGROUND: Opioid substitution therapy with methadone is at the heart of substance use disorder intervention at the Jaramogi Oginga Odinga Teaching and Referral Hospital's medication-assisted therapy (MAT) clinic (JOOTRH). However, little is known about the factors linked to substance use disorders and the substances used by clinic patients. The purpose of this study was to assess the factors associated with substance use disorders and the substances used by MAT-JOOTRH clinic patients. METHODS: Between November 2018 and May 2019, data from 61 patients were collected using questionnaires and summarised using descriptive statistics. RESULTS: Participants were mostly men (92%), between the ages of 31 and 40 (51%), married (48%), employed (71%), living with their nuclear family (49%), and had at least a primary school education (49%). Their average age was 32, 87% had used drugs for more than ten years, and 52% lived in an informal settlement. Cannabis (89%) and heroin (86.9%) were the most commonly used drugs. The main factors associated with first-time substance use were peer pressure (67%), role models (66%), and the environment (46%). The main reasons for regular substance use were withdrawal symptoms (75%), enjoyment (71%), peer pressure (69%), and role models (66%). CONCLUSIONS: According to these findings, peer pressure and withdrawal symptoms may be the primary triggers of substance use disorders in the study area. Young male members of society, particularly those from informal settlements, appear to be the most vulnerable to substance use disorder. Future substance use disorder interventions in the study area should target young male members of society from informal settlements.

The trend of characteristics and pattern of polysubstance co-occurrences among pregnant women: TEDS-A findings

ABSTRACT Objective The study’s objectives were (i) demonstrating the trends of sociodemographic, substance use, and clinical characteristics of pregnant women admitted to substance use treatment facilities from 2011 to 2018 and (ii) mining their patterns of association of polysubstance use. Methods We used the Treatment Episode Data Set – Admissions (TEDS-A) of pregnant women between 2011 and 2018. The Cochran–Armitage test was employed to test the trend, and Market Basket Analysis (MBA) was used for mining association rules to identify polysubstance use patterns. Results Over the years, some cohorts consistently showed majority admissions. Among these, age (30–39 years), education (12 or more years), injection as a route, and medication-assisted opioid therapy showed a significantly increasing trend. Admissions increased significantly with heroin (66%) and methamphetamine (46%) and decreased between 23% and 43% with alcohol, marijuana/hashish, cocaine/crack, other opiates/synthetics, and benzodiazepines. Basket analysis revealed some patterns of polysubstance co-occurrence consistent over the years. For instance, the co-occurrences of {alcohol, marijuana/hashish} or {methamphetamine, marijuana/hashish} were the most common. Conclusions The findings on trends and long-run polysubstance use patterns may help to find pregnant women’s most vulnerable cohorts for effective interventions to minimize the health risk for them and their fetuses.