Medication-assisted Treatment Services Research Articles

Reprint- Medication Assisted Treatment: Examining Enrollment and Demographic Factors of Treatment

Opioid Use Disorder (OUD) has been a long-standing epidemic concern related to the continuous growth of variations of the substance and its’ potency. Due to the versatility of the substance to be both an illicit drug and also a prescription medication, the interest in controlling and monitoring its’ use creates a greater public health concern. Treatment overtime has been revitalized to directly address the social, biological, and physiological difficulties of patients with OUDs. Medication Assisted Treatment (MAT) has been explored and has become one of the most widely used plans for treatment of substance use disorders (SUDs) related to pain management issues, dependency, withdrawal, and likelihood of maintaining sobriety. The use of MAT has been proven to be a positive and worthwhile addition to the treatment of OUDs. However, there are gaps in the administration and enrollment of individuals into the programs and facilities that offer MAT services. As this deficit is acknowledged, the current study was posed to examine the relationships among demographic factors relative to OUDs and MAT services. Data from a sample of 973 adults with a diagnosis of OUD relative to all opioid related substances, was analyzed in this study. Relationships among gender, race, employment, education, and types of treatment were explored. Types of treatment included Suboxone and Vivitrol. Overall, this study found that Suboxone treatment was administered more often than Vivitrol treatment. Also, outpatient service members used MAT services more often than inpatient members. Chi-square analyses and an Analysis of Variance were both utilized, indicating gender differences and educational differences. Likewise, specific race differences and employment attainment computed no significant conclusions. Contributions to the findings, limitations of the exploration, and future research directions are all discussed.

When Is Enough, Enough?

When Is Enough, Enough? Megan Homsy This was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment. The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis. After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant. The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice. During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks. In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services. This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient. The ethical challenge behind this case really stems from the transplant team attempting to balance two...

Twelve-month Treatment Retention and Associated Factors: A Comparison of 2 Medically Assisted Therapy Clinics in Dar es Salaam, Tanzania.

Retention in methadone maintenance treatment is instrumental in achieving better treatment outcomes. In this study, we compared 2 medication-assisted treatment (MAT) clinics in Dar es Salaam, Tanzania with respect to patient characteristics, outcomes, and factors that predict 12-month treatment retention. This retrospective registry-based cohort study utilized data collected for routine clinical and program monitoring at 2 sites, Mwananyamala and Muhimbili MAT clinics. Cumulative retention in treatment was calculated using life tables. The analysis of treatment retention predictor variables used both Kaplan-Meier and Cox proportional hazard analyses. We examined the socio-demographic and program-related characteristics of 362 (181 from each clinic) patients. Twelve-month treatment retention was higher at Mwananyamala (73%) than Muhimbili (64%) MAT clinic, but the difference was not significant. In both clinics, a higher methadone dose (>60mg) significantly predicted treatment retention ( P < 0.05). Being employed and traveling an average short distance (<5 km) from home to clinic significantly increased the likelihood of remaining in treatment in Muhimbili MAT clinic (P< 0.05) only. A methadone dose of 60 mg and above was associated with longer retention in treatment. At 1 clinic in a denser and more central location, employment and a short travel distance from home to clinic were associated with longer tenure in treatment. These findings have potential implications for clinical practice, research, and scaling up MAT services in Tanzania.

Tailoring services in opioid treatment programs for patients involved in America\u2019s criminal justice system: national associations and variation by state and Medicaid expansion status

BackgroundOpioid treatment programs (OTPs) are the primary source of medication-assisted treatment (MAT) for many individuals with opioid use disorder, including poor and uninsured patients and those involved in the criminal justice (CJ) system. Substance use treatment services that are tailored to the unique needs of patients often produce better outcomes, but little national research has addressed characteristics associated with whether OTPs offer services specifically tailored to community members involved in the CJ system. Medicaid expansion under the Affordable Care Act has broadly strengthened MAT services, but the role of expansion in supporting MAT services that are specifically tailored towards CJ-involved populations remains unknown. Moreover, it is unknown whether the availability of tailored services varies between Medicaid expansion states.MethodsWe used the 2019 National Survey of Substance Abuse Treatment Services to identify OTPs in the US (n = 1679) and whether they offered services specifically tailored for CJ-involved patients. We used logistic regression to model the association between OTPs offering tailored services and state Medicaid expansion status, adjusted for state-level opioid overdose and community supervision rates.ResultsNationally, only a quarter of OTPs offered services tailored to CJ populations, and the majority of OTPs (73%) were located in Medicaid expansion states. Compared to OTPs in non-expansion states, OTPs in expansion states demonstrated nearly double the odds of offering tailored services (adjusted odds ratio = 1.90, 95% confidence interval = 1.41–2.57, p < 0.0001). The predicted probability of offering tailored services varied by state; probability estimates for all expansion states were above the national mean, and estimates for all non-expansion states were below the national mean.ConclusionOur findings reiterate the role of Medicaid in promoting the adoption of comprehensive OTP services for CJ-involved populations. However, the proportion of OTPs that offered tailored services was relatively low, pointing to the need to continually strengthen Medicaid services and coverage.

CCBHC Thrive launches MAT with CODAC in Rhode Island

Last week, Thrive Behavioral Health and CODAC Behavioral Healthcare announced they would work together to provide medication‐assisted treatment (MAT) for opioid use disorder adjacent to Kent Hospital in Rhode Island. A certified community behavioral health Clinic (CCBHC), Thrive provides a comprehensive range of services that increase access, stabilize individuals in crisis and treat children, adults and families facing serious, complex mental illnesses and substance use disorders. “When Thrive applied for the CCBHC grant, we were charged with identifying gaps in services and creating solutions to those gaps that would break down treatment barriers,” stated Dawn Allen, CCBHC project director. “We determined that there was a need for medication‐assisted treatment in Kent County. Together with CODAC, we are connecting our community members to high‐quality treatment, decreasing their risk of experiencing a fatal overdose, expediting their transitions into long‐term recovery and providing support for them to live healthy, fulfilling lives.” CODAC's President and CEO Linda Hurley stated, “We are proud to partner with Thrive Behavioral Health on this important initiative. Together, we are moving forward in treating individuals struggling with addiction as patients, just like those facing diabetes or cancer, and offering them the most comprehensive, evidence‐based therapeutic approaches available.” Founded in 1971, CODAC has provided MAT services in Rhode Island for more than 40 years, and is the state's longest‐running not‐for‐profit outpatient opioid use disorder treatment provider. CODAC will administer the MAT services, and additional clinical support will come from Thrive's adult outpatient program, which offers wraparound services including individual, group and family counseling; psychiatric medication evaluation and management; case management services;, and an Intensive Outpatient Program for substance use and co‐occurring substance use and mental health disorders.

1137 Improving outcomes for mothers affected by opioids across diverse hospitals through statewide quality improvement

The Illinois Perinatal Quality Collaborative (ILPQC) launched a Mothers and Newborns affected by Opioids quality improvement (QI) initiative in May 2018 to increase OUD screening with a universal validated self-report tool and optimize care for pregnant patients with opioid use disorder (OUD) in participating hospitals. The objective of this analysis is to assess improvement in OUD identification and treatment. Hospitals reported monthly key measures, including a random sample of 10 deliveries per month to evaluate screening and all patients with OUD at delivery. ILPQC facilitated collaborative learning opportunities, rapid-response data, and QI support. Generalized linear mixed effects models were used to determine whether the rate of achievement of optimal OUD care improved over time (6 month increments from July 2018 to June 2020) adjusted for hospital characteristics. 84 hospitals reported 19,220 patients from the screening sample and 2,276 patients with OUD at delivery. Data showed significant improvement across the initiative linking patients to medication assisted treatment (MAT) and recovery treatment services and providing Narcan counseling by discharge, regardless of hospital characteristics (Tab 1). The rate of patients with OUD on MAT increased by 9% every 6 months from 40.4% to 56.6% (p=0.002). The rate of patients with OUD receiving Recovery Treatment Services increased by 7% every 6 months from 46.7% to 79.4% (p=0.001). The rate of patients with OUD receiving Narcan counseling increased 49% every 6 months from 4.8% to 33.6% (p<0.001). A monthly sample of deliveries showed a significant increase in the percent of patients screened with a validated OUD screening tool with estimated median increase 78% (61%, 92%) from 12.1% to 91.6% (p<0.001) (Fig 1). A statewide QI effort to improve care for pregnant patients with OUD significantly improved validated screening for OUD and optimal OUD care including linkage to MAT and recovery treatment services, and receiving Narcan counseling across diverse IL hospitals regardless of hospital characteristics.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

83. A Descriptive Analysis of a Multi-disciplinary Approach to Opioid Use Disorder Treatment Within an Infectious Diseases Clinic

BackgroundOpioid overdose is the leading cause of injury-related death in the US. Kentucky ranks in the top 5 states for opioid overdose deaths. The rate of injection drug use-associated infections (IDU-AI) has risen; the University of Kentucky Infectious Diseases division (UKID) treated 401 endocarditis cases in 2018, of which 73% were IDU-AI. To curb overdose deaths, ease financial burden on healthcare, and improve patient outcomes, patients need tools for recovery from opioid use disorder (OUD). Access to OUD treatment in Kentucky and much of the US is limited. Poverty, unemployment, and legal issues are barriers.MethodsUKID implemented a multi-disciplinary approach to expand access to medication assisted treatment (MAT). This is an ongoing study. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. At enrollment and at three additional time points, patients complete both a study specific and Government Performance and Results Act (GPRA) survey. Patients may start MAT and mental health counseling with UKID or be referred elsewhere and are eligible for transportation assistance and medical case management.ResultsTo date, there have been 127 referrals. Of these, 87 (69%) were eligible and 54 enrolled (62% of eligible). Primary IVDU-AI includes HIV (n=4; 7%), HCV (n=5; 9%), HIV/HCV (n=3; 6%), endocarditis (n=32; 59%), and other (n=10; 19%). Patients are 48% male (n=26) and 91% white (n=91) with a median age of 34 years (IQR: 16); 35% are receiving MAT (n=19) with 14.8% (n=8) managed by UKID. Other service data are available for 51 patients. Naloxone was dispensed to 45 (88%) patients, 24 (47%) received relapse prevention services, 13 (25%) engaged in peer support, 9 (18%) participated in self-help groups, and 10 (20%) received transportation aid.ConclusionIncreasing engagement in MAT and wrap-around services is an important touchpoint for OUD. We present a comprehensive program to achieve this for patients who would otherwise be discharged without follow-up for OUD. This program shows proof of concept that patients can be engaged in MAT by ID providers. Ongoing analysis will include longitudinal review of patient progress and outcomes, including hospital readmission, and a study to determine patients’ perceived impact on their quality of life.Disclosures All Authors: No reported disclosures

Examining trends in substance use disorder capacity and service delivery by Health Resources and Services Administration-funded health centers: A time series regression analysis.

The opioid epidemic and subsequent mortality is a national concern in the U.S. The burden of this problem is disproportionately high among low-income and uninsured populations who are more likely to experience unmet need for substance use services. We assessed the impact of two Health Resources and Services Administration (HRSA) substance use disorder (SUD) service capacity grants on SUD staffing and service use in HRSA -funded health centers (HCs). We conducted cross-sectional analyses of the Uniform Data System (UDS) from 2010 to 2017 to assess HC (n = 1,341) trends in capacity measured by supply of SUD and medication-assisted treatment (MAT) providers, utilization of SUD and MAT services, and panel size and visit ratio measured by the number of patients seen and visits delivered by SUD and MAT providers. We merged mortality and national survey data to incorporate SUD mortality and SUD treatment services availability, respectively. From 2010 to 2015, 20% of HC organizations had any SUD staff, had an average of one full-time equivalent SUD employee, and did not report an increase in SUD patients or SUD services. SUD capacity grew significantly in 2016 (43%) and 2017 (22%). MAT capacity growth was measured only in 2016 and 2017 and grew by 29% between those years. Receipt of both supplementary grants increased the probability of any SUD capacity by 35% (95% CI: 26%, 44%) and service use, but decreased the probability of SUD visit ratio by 680 visits (95% CI: -1,013, -347), compared to not receiving grants. The significant growth in HC specialized SUD capacity is likely due to supplemental SUD-specific HRSA grants and may vary by structure of grants. Expanding SUD capacity in HCs is an important step in increasing SUD access for low income and uninsured populations broadly and for patients of these organizations.

The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico

BackgroundIn the U.S. and Canada, people who inject drugs’ (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID’s experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use.MethodsPReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision.ResultsAt PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants’ recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment.ConclusionTijuana’s abstinence-based drug treatment and recovery services were viewed as unable to meet participants’ recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.

Factors affecting medication assisted treatment success for opioid use disorder

Abstract Background In the United States (US) when opioid use disorder (OUD) is treated with medication assisted treatment (MAT), many patients in MAT will relapse into active opioid use during the recovery process. About 23% drop out of treatment within 3 months, and 40-50% drop out within 6 months of MAT start. Using the Anderson and Newman (2005) Framework for Health Services Utilization, 27 variables reflecting predisposing, enabling, and need factors were used to examine the impact on the number of days patients were retained in treatment. Methods One MAT clinic in rural Michigan used random sample of archival records (n = 390) OUD patients (DSM-V-TR code 304.00, ICD-10 code F11.20) between Jan. 1, 2014 and Nov. 21, 2018 with prescribed buprenorphine as part of MAT program. The first set of linear regressions (backward elimination) defined significant variables for each factor, and the final model included significant variables to predict length of retention in MAT. Results The first step identified legal issues (predisposing), MSHN insurance, distance to clinic, ability to drive, mental health diagnosis, and homelessness (enabling factors); Zung self-reporting depression score, starting dose, past suicide attempt, Hep-C status, and method of use (needs factor) as statistically significant to be used in the final model, controlling for age and gender. Starting dose (unstandardized b = 136.8, 95%CI 98.0, 175.6), driving license (b = 68.3, CI 13.2, 123.4), distance to clinic (b=-1.1, CI -2.2, -0.5) had statistical impact on the length of stay in MAT. Discussion This case study identified enabling factors (starting dose and access to clinic) affecting length of participation in MAT. Other factors warranting provider attention were identified for rural OUD patients. Conclusions Evidence based guidelines for starting doses are needed to increase MAT effectiveness. MAT services should consider distance to clinic as a factor of successful treatment. Key messages Evidence based guidelines for starting doses are needed to increase MAT effectiveness. Opiood treatment services should consider distance to clinic as a factor of successful treatment.

Medical staff perceptions of medication-assisted treatment in a federally qualified health center

ObjectivesTo describe medical staff attitudes and perceived behaviors toward medication-assisted treatment (MAT) in a federally qualified health center (FQHC). The secondary objective was to identify the staff’s perceptions of using pharmacists during MAT. DesignA cross-sectional, descriptive study using a 26-item Web-based survey was developed using the theory of planned behavior (TPB) and consisted of Likert scale and multiple-select options. Setting and participantsMedical staff located at an FQHC in northwest Indiana were eligible to participate if they were 18 years or older. Corporate and administrative staff were not eligible to participate. Outcome measuresPerceptions were measured using the 4 constructs of the TPB: attitude, perceived behavioral control, subjective norm, and intent. The data were analyzed using descriptive statistics. ResultsOf the 240 eligible respondents, 104 employees completed the survey, yielding a 43.3% response rate. The providers generally believed they had the knowledge (83.9% agree or strongly agree) to diagnose patients with opioid use disorder (OUD). From the perceived behavioral control construct, staff were confident of their ability to identify patients for MAT (65.2%); however, most believed they needed additional training on MAT (75%) from the attitude construct. From the subjective norm construct, more than half of the respondents believed that their employer wanted them to be involved in the treatment of a patient with OUD (60.7%). Commonly, from the intent construct, the staff favored adding pharmacists to the care team when managing patients with MAT (57.7%). ConclusionThe staff expressed the need for additional training to provide MAT services and believed this would enable them to become an important part of the MAT team. Adding a trained pharmacist to the care team when managing patients with MAT was favored by the staff. The study showed that health professionals would be more comfortable if a pharmacist were available for MAT consultation.

792: Optimizing care for mothers and newborns affected by opioids by understanding disparities in treatment

The Illinois Perinatal Quality Collaborative (ILPQC) Mothers and Newborns affected by Opioids Obstetric quality improvement (QI) initiative aims to increase the percent of women with Opioid Use Disorder (OUD) linked to Medication Assisted Treatment (MAT) and behavioral health /recovery services. The objective of this analysis is to assess the association between patient demographics and receipt of recommended treatment for women with OUD at participating hospitals during the first year of the initiative to inform QI strategies and improve equity. 89 participating hospitals recorded monthly data in the ILPQC Data System for 886 women with OUD who delivered in the first year of the initiative starting May 2018. ILPQC facilitated collaborative learning opportunities, rapid-response data, and quality improvement support for hospital teams. Differences in demographics were assessed for women receiving recommended care for OUD (including linkage to MAT, behavioral health / recovery services, and Narcan counselling by delivery discharge) using logistic regression analysis. Hospital teams have shown improvement across all initiative aims, however gaps in care remain. Compared to all women with OUD reported in the first year of the initiative, women with Black or Hispanic race/ethnicity, age < 25, no prenatal care or care in a rural location were less likely to be linked to MAT and recovery services (Tab). Rates of women receiving MAT also differed by hospital of delivery (Fig). No demographic differences were seen for Narcan counseling, however counseling rates overall were low. Linkage to MAT/behavioral health counseling/recovery services and receipt of Narcan counselling for pregnant women with OUD reduces maternal overdose deaths and improves pregnancy outcomes. However, receipt of recommended treatment for OUD differs by demographic characteristics including race/ethnicity, age and location of care. Improved understanding of these disparities can help reduce bias, improve equity and optimize care for all pregnant and postpartum women with OUD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A scalable, integrated intervention to engage people who inject drugs in HIV care and medication-assisted treatment (HPTN 074): a randomised, controlled phase 3 feasibility and efficacy study

People who inject drugs (PWID) have a high incidence of HIV, little access to antiretroviral therapy (ART) and medication-assisted treatment (MAT), and high mortality. We aimed to assess the feasibility of a future controlled trial based on the incidence of HIV, enrolment, retention, and uptake of the intervention, and the efficacy of an integrated and flexible intervention on ART use, viral suppression, and MAT use. This randomised, controlled vanguard study was run in Kyiv, Ukraine (one community site), Thai Nguyen, Vietnam (two district health centre sites), and Jakarta, Indonesia (one hospital site). PWID who were HIV infected (index participants) and non-infected injection partners were recruited as PWID network units and were eligible for screening if they were aged 18-45 years (updated to 18-60 years 8 months into study), and active injection drug users. Further eligibility criteria for index participants included a viral load of 1000 copies per mL or higher, willingness and ability to recruit at least one injection partner who would be willing to participate. Index participants were randomly assigned via a computer generated sequence accessed through a secure web portal (3:1) to standard of care or intervention, stratified by site. Masking of assignment was not possible due to the nature of intervention. The intervention comprised systems navigation, psychosocial counselling, and ART at any CD4 count. Local ART and MAT services were used. Participants were followed up for 12-24 months. The primary objective was to assess the feasibility of a future randomised controlled trial. To achieve this aim we looked at the following endpoints: HIV incidence among injection partners in the standard of care group, and enrolment and retention of HIV-infected PWID and their injection partners and the uptake of the integrated intervention. The study was also designed to assess the feasibility, barriers, and uptake of the integrated intervention. Endpoints were assessed in a modified intention-to-treat popualtion after exclusion of ineligible participants. This trial is registered on ClinicalTrials.gov, NCT02935296, and is active but not recruiting new participants. Between Feb 5, 2015, and June 3, 2016, 3343 potential index participants were screened, of whom 502 (15%) were eligible and enrolled. 1171 injection partners were referred, and 806 (69%) were eligible and enrolled. Index participants were randomly assigned to intervention (126 [25%]) and standard of care (376 [75%]) groups. At week 52, most living index participants (389 [86%] of 451) and partners (567 [80%] of 710) were retained, and self-reported ART use was higher among index participants in the intervention group than those in the standard of care group (probability ratio [PR] 1·7, 95% CI 1·4-1·9). Viral suppression was also higher in the intervention group than in the standard of care group (PR 1·7, 95% CI 1·3-2·2). Index participants in the intervention group reported more MAT use at 52 weeks than those in the standard of care group (PR 1·7, 95% CI 1·3-2·2). Seven incident HIV infections occurred, and all in injection partners in the standard of care group (intervention incidence 0·0 per 100 person-years, 95% CI 0·0-1·7; standard of care incidence 1·0 per 100 person-years, 95% CI 0·4-2·1; incidence rate difference -1·0 per 100 person-years, 95% CI -2·1 to 1·1). No severe adverse events due to the intervention were recorded. This vanguard study provides evidence that a flexible, scalable intervention increases ART and MAT use and reduces mortality among PWID. The low incidence of HIV in both groups impedes a future randomised, controlled trial, but given the strength of the effect of the intervention, its implementation among HIV-infected PWID should be considered. US National Institutes of Health.

Medication-Assisted Treatment Improves Child Permanency Outcomes for Opioid-Using Families in the Child Welfare System

Parents who use opioids and are involved in the child welfare system are less likely to retain custody of their children than parents who use other drugs. No previous studies have described medication-assisted treatment (MAT) utilization and child permanency outcomes for this population. The Sobriety Treatment and Recovery Team (START) model is a child welfare–based intervention focused on families with co-occurring substance use and child abuse / neglect issues. This study examined the prevalence and correlates of MAT utilization among parents in the START program with a history of opioid use, and compared child outcomes for families who received MAT services to those who did not. Of the 596 individuals with a history of opioid use in the START program, 55 (9.2%) received MAT. Receipt of MAT services did not differ by gender, age, county of residence, or drug use, though individuals who identified as White were more likely to participate in MAT. In a multiple logistic regression model, additional months of MAT increased the odds of parents retaining custody of their children. To address barriers to MAT, results-focused educational interventions may be needed for the child welfare workforce, as well as programs to improve collaboration and decision-making between the child welfare workforce, court personnel, and drug addiction treatment providers.

Opioid use disorders: Trends and correlates

Aims: The aims of this poster are to (1) explore the trends in opioid use disorders overall, by age and geography and (2) examine differences in the liability for addiction based on age of onset. Methods: Data are from the 2011 National Survey on Drug Use and Heath (NSDUH), 2011 Drug AbuseWarning Network (DAWN), and 2011 Treatment Episode Data Set (TEDS). Results: From 2002 to 2011 the number of people with opioid usedisorders rose38%. Thenumberofpeoplewithprescriptionopioid use disorders is 3 times higher than heroin use disorders, but the increase of heroin use disorders was higher (104%). Over half the peoplewith prescription opioid use disorderswere over the age of 25, but the rate of growth was highest (+55%) among those age 18–25. From 2004 to 2010, this has been a 42% rise in drug related emergency room admissions, with the rates particularly high for prescription opioid alone (132%), prescription opioid +other illicit drugs (139%), prescription opioid + alcohol (+63%) or prescription opioid + illicit drugs +Alcohol (+94%). From 2000 to 2010, there has been a 44% increase in opioid related treatment admissions overall, including 352% for prescription opioids. The rate of growth of prescription Opioid Treatment admissions are growing even more rapidly for young adults ages 18–24 (+489%). Conclusions: The rapid growth in opioid use disorders is being driven by prescription opioid use disorders. While most people are adults, the rate of growth among young adults is much faster and also raises the potential for years of problems ahead. Geographic variation in the rates of disorders suggest that availability and local practices are significant, and that it may be feasible to stop the further rates of disorder or even reverse it. The returnof opioids also has important implications for the need to have detoxification and medication assisted treatment services available as part of health care reform. Financial support: NIDA Grant no. R37 DA011323.

A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.

BackgroundSubstance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.Methods/designEach of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels.DiscussionThrough closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.Trial registrationClinical Trials gov registration number NCT01344122.

Identifying Programmatic Gaps: Inequities in Harm Reduction Service Utilization among Male and Female Drug Users in Dar es Salaam, Tanzania

IntroductionCurrent estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs.Materials and MethodsRoutine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males.ResultsFrom December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse.ConclusionsServices have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services.

Improving public health through access to and utilization of medication assisted treatment.

Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best “one stop shopping” approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.