Medication-assisted Treatment For Opioid Use Disorder Research Articles

Certified Community Behavioral Health Clinic Services for Clients With Co-occurring Disorders: A Latent Class Approach.

Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions.

7 Evaluating the Feasibility of a New Hybrid Teleneuropsychology Screening Service for Individuals with Opioid Use Disorders: Lessons Learned

Objective:Opioid use disorder (OUD) has been declared a national public health emergency leading to increased enrollment in medication assisted treatment (MAT) programs. Cognitive deficits are seen among those with OUD which can persist even with MAT. Moreover, cognitive deficits predict poor community and treatment outcomes. Neuropsychological evaluations can identify, diagnose, and provide treatment recommendations, and are associated with improved outcomes in non-substance use patient populations. Yet, patients with OUD rarely undergo neuropsychological assessment when participating in opioid use treatment. Teleneuropsychology (TNP) may increase access to care but has not been evaluated with people with substance use disorders (SUDs). This project used a mixed-method design to evaluate the feasibility and impact of a pilot hybrid TNP service with new patients with OUDs entering a MAT program.Participants and Methods:Participants were >18 years old and new patients enrolling in MAT for OUD. Participants were excluded if they planned to move out of town within six months or were pending incarceration. Participants were identified by triage questions at MAT intake based on frequency of relevant co-occurring conditions indicating those with greatest need. Positively triaged individuals were referred to the TNP service which was conducted by a hybrid approach (i.e., patient presents to the clinic and is evaluated from a separate room using video-teleconferencing technology). We aimed to schedule participants within two-weeks of 30-days from intake to the MAT program. Consented participants completed questionnaires of feasibility and acceptability (e.g., satisfaction, usefulness) after undergoing a screening TNP evaluation and feedback of the results and recommendations. Participants also were invited to undergo a brief qualitative interview to further assess facilitators and barriers.Results:Of 57 individuals screened positive, 51 were referred, and 14 were reached to offer TNP. Ten (71.4%) agreed to the TNP evaluation and scheduled an appointment, though 50% had the first appointment scheduled within two weeks of 30-days after intake to MAT. Seven (70%) did not keep the first appointment (no show or cancellation) or were rescheduled due to clinic scheduling. Three were reached to reschedule. All three were unable to keep the appointment, but one did reschedule and keep the third appointment. Of the 4 who attended TNP, only 1 (25%) was within two weeks of 30-days after intake. Of those who attended the TNP appointment, 100% completed the protocol, 75% were satisfied with the evaluation overall, 75% found the evaluation useful, and 67% would recommend TNP to others (one participant did not respond to this question).Conclusions:Neuropsychological assessment may provide valuable information to improve treatment for those with OUDs. This pilot project revealed that individuals with OUDs can tolerate and are satisfied with a screening TNP evaluation and find the evaluation useful. The primary barrier was reaching referred patients. Treatment engagement among those with SUDs is a common challenge. Those with counselors who coordinated with the clinic schedulers were more likely to be reached and scheduled, suggesting support for regular case management. Other lessons learned and potential future steps are discussed.

Characteristics of patients undergoing medication-assisted -treatment for opioid use disorder and their interest in Tai Chi practice.

(1) To explore the characteristics of patients with opioid use disorder (OUD) maintained on either methadone or buprenorphine and (2) to determine the relative acceptability of integrating Tai Chi (TC) practice into an ongoing medication-assisted treatment for opioid use disorder (MOUD) program. Survey study. The University of Arkansas for Medical Sciences Center for Addiction Services and Treatment Program. 97 patients receiving MOUD treatment. Drug use history, treatment status, physical limitation, mental health, pain, and whether participants were interested in using TC to improve health outcomes. At least 30.9 percent of the sample reported moderate or higher level of limitation in performing rigorous physical activities, pain intensity, and pain interference. Between 37.1 and 61.5 percent of the sample reported various psychiatric symptoms. Methadone patients reported higher levels of physical limitations, especially in rigorous activities (p = .012), climbing several flights of stairs (p = .001), and walking more than a mile (p = .011), but similar levels of pain (ps = .664-.689) and psychiatric symptoms (ps = .262-.879) relative to buprenorphine patients. At least 40.2 percent of participants expressed moderate or higher level of interest in TC for improving health outcomes, with methadone patients more interested in participating to ease mental and sleep problems (p = .005) and improve physical fitness (p = .015) compared to buprenorphine patients. High prevalence of physical limitation, pain, and psychiatric comorbidities were found in OUD patients. Since patients were interested in TC to improve their health outcomes, this low-cost intervention, if proven effective, can be integrated into ongoing MOUD programs to improve health in this population.

Smartphone intervention to optimize medication-assisted treatment outcomes for opioid use disorder: study protocol for a randomized controlled trial

BackgroundOpioids accounted for 75% of drug overdoses in the USA in 2020, with rural states particularly impacted by the opioid crisis. While medication-assisted treatment (MAT) with Suboxone remains one of the more efficacious treatments for opioid use disorder (OUD), approximately 40% of people receiving Suboxone for outpatient MAT for OUD (MOUD) relapse within the first 6 months of treatment. We developed the smartphone app-based intervention OptiMAT as an adjunctive intervention to improve MOUD outcomes. The aims of this study are to (1) evaluate the efficacy of adjunctive OptiMAT use in reducing opioid misuse among people receiving MOUD and (2) evaluate the role of specific OptiMAT features in reducing opioid misuse, including the use of GPS-driven just-in-time intervention.MethodsWe will conduct a two-arm, single-blind, randomized controlled trial of adults receiving outpatient MOUD in the greater Little Rock AR area. Participants are English-speaking adults ages 18 or older recently enrolled in outpatient MOUD at one of our participating study clinics. Participants will be allocated via 1:1 randomized block design to (1) MOUD with adjunctive use of OptiMAT (MOUD+OptiMAT) or (2) MOUD without OptiMAT (MOUD-only). Our blinded research statistician will evaluate differences between the two groups in opioid misuse (as determined by quantitative urinalysis conducted by clinical lab staff blinded to group membership) during the 6-months following study enrolment. Secondary analyses will evaluate if OptiMAT-usage patterns within the MOUD+OptiMAT group predict opioid misuse or continued abstinence.DiscussionThis study will test if adjunctive use of OptiMAT improve MOUD outcomes. Study findings could lead to expansion of OptiMAT into rural clinical settings, and the identification of OptiMAT features which best predict positive clinical outcome could lead to refinement of this and similar smartphone app-based interventions.Trial registrationClinicalTrials.govidentifier: NCT05336188, registered March 21, 2022.

Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field

BackgroundMortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. MethodsUsing a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. ResultsWe identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. ConclusionsState regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

Trajectories of craving during medication-assisted treatment for opioid-use disorder: Subtyping for early identification of higher risk

AimsTo examine evidence for subtypes of opioid craving trajectories during medication for opioid use disorder (MOUD), and to (a) test whether these subtypes differed on MOUD-related outcomes, and (b) determine whether nonresponders could be identified before treatment initiation. Design, setting, and participantsOutpatients (n = 211) being treated with buprenorphine or methadone for up to 16 weeks. Growth mixture modeling was used to identify unobserved craving-trajectory subtypes. Support Vector Machines (SVM) were trained to predict subtype membership from pretreatment data. MeasurementsSelf-reported opioid craving (Ecological Momentary Assessment – EMA – three random moments per day). Participant-initiated EMA reports of drug use or higher-than-usual stress. Addiction Severity Index (ASI) pretreatment. FindingsFour craving trajectories were identified: Low (73%); High and Increasing (HIC) (10.9%); Increasing and Decreasing (8.5%); and Rapidly Declining (7.6%). The HIC subgroup reported the highest use of heroin, any opiate, and cannabis during treatment. The Low Craving subgroup reported the lowest use of heroin or any opiate use, and the lowest levels of stress and drug-cue exposure during treatment. SVM models predicting HIC membership before treatment initiation had a sensitivity of 0.70, specificity of 0.78, and accuracy of 0.77. Including 3 weeks of EMA reports increased sensitivity to 0.78, specificity to 0.84, and accuracy to 0.85. ConclusionsSubgroups of MOUD patients show distinct patterns of opioid craving during treatment. Subgroups differ on critical outcomes including drug-use lapse, stress, and exposure to drug cues. Data from enrollment and early in treatment may help focus clinical attention.

Utilization of Telehealth Solutions for Patients with Opioid Use Disorder Using Buprenorphine: A Scoping Review.

Background: A scoping review was conducted to examine the breadth of evidence related to telehealth innovations being utilized in the treatment of opioid use disorder (OUD) with buprenorphine and its effect on patient outcomes and health care delivery. Materials and Methods: The authors systematically searched seven databases and websites for peer-reviewed and gray literature related to telehealth solutions for buprenorphine treatment published between 2008 and March 18, 2021. Two reviewers screened titles and abstracts for articles that met the inclusion criteria, according to the scoping review study protocol. The authors included studies if they specifically examined telehealth interventions aimed at improving access to and usage of buprenorphine for OUD. Results: After screening 371 records, the authors selected 69 for full review. These studies examined the effect of telehealth on patient satisfaction, treatment retention rates, and buprenorphine accessibility and adherence. Conclusion: According to the reviewed literature, incorporation of telehealth technology with medication-assisted treatment for OUD is associated with higher patient satisfaction, comparable rates of retention, an overall reduction in health care costs, and an increase in both access to and usage of buprenorphine. This has been made possible through the expansion of telehealth technologies and a substantial push toward relaxed federal guidelines, both of which were quickly escalated in response to the COVID-19 pandemic. Future research is needed to fully quantify the effect of these factors; however, the results appear promising thus far and should urge policymakers to consider making these temporary policy changes permanent.

Does a Rural Community-Based Intervention Improve Knowledge and Attitudes of Opioid Use Disorder and Medication-Assisted Treatment? A Report From the IT MATTTRs Study.

PurposeUnderstanding knowledge of and attitudes toward medication‐assisted treatment (MAT) for opioid use disorder (OUD) is important to changing the conversation about this devastating public health problem. While several studies report clinician knowledge and attitudes and training, less is known about community member perspectives. As part of the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs), this study describes the implementation of community‐based interventions developed by rural community members and researchers to increase awareness and promote positive attitudes toward MAT for OUD and explores changes in community members’ OUD and MAT knowledge and beliefs.MethodsUsing the Boot Camp Translation process, the High Plains Research Network and Colorado Research Network MAT Advisory Councils developed multicomponent interventions on MAT for OUD. Baseline and postintervention surveys were administered using venue‐based sampling of community members in rural communities.FindingsSurveys were completed by 789 community members at baseline and 798 at postintervention. Nearly half (49%) reported exposure to at least 1 intervention product. Greater exposure to intervention materials was associated with beliefs that using opioids to get high in rural communities is a problem (P < .0001), that opioid addiction is a chronic disease (P = .0032), and that OUD can be treated locally (P = .0003).ConclusionsPartnering with local community members resulted in the successful development and implementation of community‐based interventions, exposure to which was associated with OUD knowledge and beliefs. Locally created interventions should be included in comprehensive approaches to stem the OUD epidemic.

Addiction Management in Hospitalized Patients With Intravenous Drug Use–Associated Infective Endocarditis

Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction. A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions. Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions. Both the historical control group (N= 37) and the intervention group (N= 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found. Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment.

More from Louis Baxter on doctors taking MAT

The question of whether or not doctors and other health care professionals on medication‐assisted treatment (MAT) are safe to practice medicine has been debated for the last few years since the advent of Food and Drug Administration (FDA)–approved MAT for opioid use disorder (OUD). The newly approved medications have been primarily buprenorphine formulations for OUD, naltrexone formulations for OUD and alcohol use disorder (AUD), and, most recently, an alpha 2‐adrenergic medication that specifically targets amelioration of opioid‐withdrawal symptoms from OUD (lofexidine). Quite frankly, the question of safety about medications to treat substance use disorder (SUD) has been asked since the development of methadone for OUD treatment more than 30 years ago.

Opioid use and schizophrenia.

To summarize the current literature regarding comorbid schizophrenia and opioid use disorder (OUD). Epidemiological evidence is unclear on whether patients with schizophrenia have a higher rate of OUD. Patients with OUD have been shown to have a higher risk of developing schizophrenia. However, it is clear that patients with both schizophrenia and OUD are less likely to receive standard of care including medication-assisted treatment (MAT) for opiate use disorder and have worse outcomes compared with patients with schizophrenia who do not abuse opioids. OUD significantly increases the risk of converting patients from prodromal schizophrenia states to schizophrenia or schizoaffective disorder. Shared pathophysiology involving the kappa opioid receptor may help explain the relationships between schizophrenia and OUD. Second-generation antipsychotics, long-acting injectables, and MAT for OUD should be utilized in a dual-diagnosis and treatment approach for patients with schizophrenia and OUD. Exploration into the relationship between schizophrenia and opiate abuse is still in its infancy and requires a significant amount of future attention to clarify the epidemiology of this comorbidity, neurobiological relationship, shared genetic underpinnings, and possible treatments for both the psychotic symptoms and substance abuse.

Poor prenatal care does not predict well child care for children born to mothers with opioid use disorder

ABSTRACT Objectives: Among mothers receiving medication-assisted treatment (MAT) for opioid use disorder (OUD) and their children, (1) assess characteristics associated with adequate prenatal care and well-child care, and (2) determine if prenatal care predicts well-child care and up-to-date immunizations (UTDI). Methods: This is a retrospective study of mothers with OUD and their children, maternal sociodemographic and health characteristics, and child health characteristics. Adequate prenatal care was defined by the Kotelchuck Index, well-child care by AAP recommendations, and UTDI by the 4:3:1:3:3:1:4 series. Results: For the 138 mother-child dyads, mothers were largely young (mean: 29 years), multiparous (73%), and receiving Medicaid (93%); only 31% had adequate prenatal care. The majority of children (67%) had adequate well-child care, and UTDI (93%). Children born to non-Hispanic mothers or with LOS > 5 days were more likely to have adequate well-child care, in contrast to those with wheezing who were less likely. In the adjusted analysis, younger children and those born to primiparous mothers were more likely to have adequate well-child care. Adequate prenatal care did not predict adequate well-child care or UTDI. Conclusions: Despite the fact that mothers receiving MAT for OUD often lacked adequate prenatal care, their children had adequate well-child care and UTDI. Abbreviations: AAP: American Academy of Pediatrics; aOR: Adjusted odds ratio; DTaP: Diphtheria, tetanus toxoids and acellular pertussis vaccine; GA: Gestational age; HepA: Hepatitis A vaccine; HepB: Hepatitis B vaccine; Hib: Haemophilus influenzae type b vaccine; IPV: Inactivated polio vaccine; ICN: Intensive care nursery; LOS: Length of stay; MATER: Maternal Addiction Treatment Education and Research; MAT: Medication-Assisted Treatment; MMR: Measles, mumps, and rubella vaccine; OUD: Opioid use disorder; PCV: Pneumococcal conjugate vaccine; TJU: Thomas Jefferson University; TJUH: Thomas Jefferson University Hospital; US: United States; UTDI: Up-to-date immunizations; 4:3:1:3:3:1:4: 4 DTaP:3 IPV:1 MMR:3 Hib:3 HepB:1 Varicella:4 PCV

Exploring psychological symptoms and associated factors in patients receiving medication-assisted treatment for opioid-use disorder.

Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear. To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment. Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score. The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92-2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61-5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01-0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89-2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms. Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.

Inconsistencies abound in how states handle MAT access under Medicaid

A report commissioned by Congress suggests that while states have made some progress in lifting barriers to medication treatment access for Medicaid beneficiaries with opioid use disorder (OUD), some important obstacles to expanded access remain. Among the inconsistencies in state regulation, the report found a decreasing tendency to assign preferred status to medication‐assisted treatment (MAT) drugs at the same time that prior authorization requirements are declining, as well as more frequent restrictions on MAT for OUD than on medications to treat alcohol use disorders.

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Opioid use disorder (OUD) is a pediatric and adolescent problem as most young adults (aged <25 years) in treatment programs report initiating use before 25 years of age, and there are lifelong impacts from early substance use necessitating early screening for opioid use and subsequent treatment. Medication-assisted treatment (MAT) is a highly effective intervention for OUD, and there is strong evidence for its use with adolescents; however, most adolescents with OUD are unable to access MAT or remain in MAT long term to achieve substantial recovery. Using case examples drawn from a pediatric and adolescent physician's experiences proving MAT to adolescents and young adults (ages 16–24 years), this article explores the personal and socioeconomic determinants in MAT of OUD in adolescents and young adults and provides suggestions for advocacy areas and resources to improve MAT with this population.

Pregnant women in treatment for opioid use disorder: Material hardships and psychosocial factors

BackgroundWhile pregnant women in treatment for opioid use disorder (OUD) face considerable challenges, common material hardships– food insecurity and housing instability, known to negatively impact maternal-child health, have been inadequately researched within this population. This study describes food/housing hardships and evaluates associations with key psychosocial factors. MethodsA single-site prospective study, 100 3rd trimester women receiving prenatal care and medication-assisted treatment for OUD were interviewed, including screening for food/housing hardships, depressive symptoms, intimate partner vulnerability; and self-reported post-traumatic stress disorder (PTSD) history. We developed a three-level categorization combining food/housing screening outcomes: 1) “both insecure”; 2) “either secure”; and 3) “both secure”. Bivariate analyses and linear path analyses evaluated associations among psychosocial variables using “both secure” as the referent group. ResultsOf 100 women, 56% reported food insecurity; 61% housing instability; 42% “both insecure”; 33% “either insecure”; 25% “both secure”. In unadjusted food/housing groups “either insecure” and “both insecure” reported significantly greater depressive symptoms; “both insecure” additionally reported significantly greater intimate partner vulnerability. Path analyses adjusted for PTSD and compared with “both secure” (adjusted mean = 6.2): “either insecure” had greater depressive symptom scores (adjusted means = 9.8, p = .01) while “both insecure” had greater depressive scores (adjusted means 10.5, p = .002). In addition, “both insecure” had a clinically important 5.7 point greater intimate partner vulnerability score. There were no significant interactions between food/housing and PTSD. ConclusionsEven in women receiving prenatal care and treatment for OUD, food/housing material hardships and associated psychosocial factors are of major concern, requiring screening and remediation.

Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review

This systematic review synthesizes evidence on the effects of Medication-Assisted Treatment (MAT) for opioid use disorder (OUD) on functional outcomes, including cognitive (e.g., memory), physical (e.g., fatigue), occupational (e.g., return to work), social/behavioral (e.g., criminal activity), and neurological (e.g., balance) function.Five databases were searched from inception to July 2017 to identify English-language controlled trials, case control studies, and cohort comparisons of one or more groups; cross-sectional studies were excluded. Two independent reviewers screened identified literature, abstracted study-level information, and assessed the quality of included studies. Meta-analyses used the Hartung-Knapp method for random-effects models. The quality of evidence was assessed using the GRADE approach.A comprehensive search followed by 1411 full text publication screenings yielded 30 randomized controlled trials (RCTs) and 10 observational studies meeting inclusion criteria. The studies reported highly diverse functional outcome measures. Only one RCT was rated as high quality, but several methodologically sound observational studies were identified. The statistical power to detect differences in functional outcomes was unclear in most studies.When compared with matched “healthy” controls with no history of substance use disorder (SUD), in two studies MAT patients had significantly poorer working memory and cognitive speed. One study found MAT patients scored worse in aggressive responding than did “healthy” controls. A large observational study found that MAT users had twice the odds of involvement in an injurious traffic accident as non-users.When compared with persons with OUD not on MAT, one cohort study found lower fatigue rates among buprenorphine-treated OUD patients. No differences were reported for occupational outcomes and results for criminal activity and other social/behavioral areas were mixed.There were few differences among MAT drug types. A pooled analysis of three RCTs found a significantly lower prevalence of fatigue with buprenorphine compared to methadone, while a meta-analysis of the same RCTs found no statistical difference in insomnia prevalence. Three RCTs that focused on cognitive function compared the effects of buprenorphine to methadone; no statistically significant differences in memory, cognitive speed and flexibility, attention, or vision were reported.The quality of evidence for most functional outcomes was rated low or very low. In sum, weaknesses in the body of evidence prevent strong conclusions about the effects of MAT for opioid use disorder on functional outcomes. Rigorous studies of functional effects would strengthen the body of literature.

Acute Pain Management for Patients on Medication-Assisted Treatment for Opioid-Use Disorder

Dr. Mayerson is Advanced Practice Registered Nurse and Associate Director for Advanced Practice, Hartford Healthcare Medical Group, Vernon, Connecticut, and Mr. Julian is Doctoral Student, Center for Advancement in Managing Pain, University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269; E-mail: [email protected]. The authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they and their spouses/life partners (if any) have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.CME AccreditationLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This CME activity expires on September 30, 2018.CNE AccreditationLippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Lippincott Professional Development will award 1.0 contact hours for this continuing nursing education activity. This activity has been assigned 0.5 pharmacology credits. Instructions for earning ANCC contact hours are included on page 12 of the newsletter. This CNE activity expires on October 31, 2019.

A parenting education program for women in treatment for opioid-use disorder at an outpatient medical practice

ABSTRACTOpioid use during pregnancy poses serious risks for the mother and the unborn child. Opioid-use disorder may be managed with medication-assisted treatment (MAT) in an outpatient setting, but few MAT practices specifically address the challenges faced by pregnant women. This article describes a medical office-based educational support group for women in MAT for opioid-use disorder who were pregnant and/or parenting young children. Focus groups were conducted to elicit patient feedback. Women indicated that they found the educational support groups beneficial and offered suggestions. In-office educational support groups for pregnant women in treatment for opioid-use disorder are feasible and well received.