Medications For Opioid Use Disorder Research Articles

People with opioid use disorder (POUD) who are incarcerated are disproportionately impacted by the overdose crisis. We sought to identify overdose policies that allocate resources with maximal efficiency to reduce mortality among POUD in the New Jersey (NJ) Department of Corrections. We created a probabilistic state-transition model of a simulated cohort of POUD incarcerated in NJ to simulate maximizing medication for opioid use disorder (MOUD) during incarceration and/or post-release in the community and naloxone in the community. We estimated how maximizing each intervention individually and in combinations compared to current provision would impact five-year overdose deaths (ODDs), life-years (LYs), and quality-adjusted life-years (QALYs) among the simulated cohort, who moved between different modeled settings and opioid use statuses. Inputs were derived from literature reviews and expert opinion. Costs were in 2021 USD, employing a health sector perspective in base-case analyses and a limited societal perspective in sensitivity analyses, a 3% discount rate, cost-effectiveness criterion of ≤ $100,000/QALY, and life-year and lifetime horizons. At status quo, 141 five-year ODDs will occur in the cohort (n = 2,592), and the cohort will live an average of 17.0 discounted LYs, experiencing 13.3 discounted QALYs. Evaluating interventions individually compared to status quo, maximizing MOUD in incarceration prevents 14 five-year ODDs, adds 0.2 LYs, 0.3 QALYs per-person at a favorable incremental cost-effectiveness ratio (ICER; $34,000/QALY). Maximizing MOUD in the community prevents 40 five-year ODDs, adds 0.9 LYs, 1.1 QALYs at a favorable ICER ($25,000/QALY). Maximizing naloxone prevents 24 five-year ODDs, adds 0.3 LYs, 0.2 QALYs at a favorable ICER ($17,000/QALY). Comparing all combinations of interventions to status quo and each other, the most beneficial combination meeting cost-effectiveness criterion was jointly maximizing community MOUD and naloxone (ICER $25,000/QALY), preventing 56 five-year ODDs, adding 1.2 LYs, 1.3 QALYs. In sensitivity analyses using a limited societal perspective, all interventions were cost-saving. Maximizing all interventions was both most beneficial (42% reduction in death) and cost-saving ($300,000 per capita) over the cohort lifetime. Maximizing MOUD and community naloxone in New Jersey can reduce five-year ODDs by 40%. Considering societal cost-savings, maximizing all three also saves money.

Medication for opioid use disorder (MOUD) reduces mortality and is the standard of care yet use remains low. Hospitalist-led treatment can fill important gaps in care for patients with OUD. Evaluate effectiveness of a hospitalist-led OUD consult service, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET). Retrospective cohort study with quasi-experimental design, using propensity score weighting with historical and concurrent control groups. Adult patients with an OUD diagnosis during hospitalization. COMET consult MAIN MEASURES: Primary outcomes included MOUD receipt during hospitalization and 90-day all-cause mortality, with 30-day all-cause mortality subsequently added. Secondary outcomes included buprenorphine and naloxone prescriptions, length of stay (LOS), 30-day readmission, and 30-day emergency department (ED) visit. There were 5098 encounters for patients with OUD. Inpatient MOUD administration was higher for COMET patients (concurrent control RR = 1.86, 97.5% CI: 1.69-2.04; historical control RR = 2.68, 97.5% CI: 2.36-3.06). Mortality within 30days of discharge was less likely in COMET patients (concurrent control RR = 0.47, 97.5% CI: 0.17-0.96; historical control RR = 0.55, 97.5% CI: 0.22-1.22). Association of COMET with post-discharge mortality lessened at 90days (concurrent control RR = 0.81, 97.5% CI: 0.49-1.31; historical control RR = 0.74, 97.5% CI: 0.44-1.23). COMET patients had fewer 30-day readmissions (concurrent control RR = 0.76, 95% CI: 0.61-0.92; historical control RR = 0.84, 95% CI: 0.68-1.04). COMET was not associated with ED visits within 30days of discharge but was associated with longer LOS. COMET patients were more likely to receive inpatient MOUD with evidence of a lower risk of all-cause mortality and readmission within 30days of discharge. A hospitalist-led consult service can improve care for inpatients with OUD.

The US is experiencing an epidemic of opioid misuse and mortality. Effective treatments are available, including medications for opioid use disorders (MOUD), but they are greatly underused due to a variety of barriers. In response, some US hospitals have established programs to identify emergency department (ED) patients with opioid use disorders (OUD) and begin treatment with MOUD ("ED induction"). For this model to be widely adopted, financial sustainability for hospitals is critical. Little is known about the financial aspects of ED-based treatment models, including insurance billing and reimbursement. Our study addressed the following questions about ED-based induction of OUD treatment: (1) Which components of this model are billable to insurers? (2) How do hospitals fund the components that are not billable? (3) Does ED-based induction generate savings that could help fund that service? We conducted a qualitative study, involving semi-structured interviews with officials at selected US hospitals. Potential interviewees were identified using a snowball sampling approach. We conducted 12 interviews across 10 states, mostly with urban teaching hospitals. Key findings include, (1) medication costs are often billable to insurers, but costs of key para-professional staff like peer navigators are not, requiring the hospital to absorb their salaries. Even some billable costs are reimbursed at low rates which challenge sustainability. (2) To fund non-billable components, hospitals typically rely on time-limited grant funding, including the federal 340B drug rebate program. (3) Several interviewees anticipated cost savings to their hospitals from reduced use of ED services by patients who had no (or low-paying) insurance. These findings indicate that some hospitals are able to sustain ED-based induction of MOUD using time-limited grant funding. However, wider dissemination of this model will likely require more stable funding streams, such as Medicaid reimbursement, paying adequate rates, and coverage of personnel.

BackgroundJustice-involved individuals with opioid use disorder (OUD) face heightened relapse risks during the reentry period. While medications for opioid use disorder (MOUD) are effective, long-term recovery also depends on psychological and structural supports, including situational confidence (perceived ability to resist substance use in high-risk situations) and recovery capital (the internal and external resources that support recovery).MethodsThis cross-sectional study examined situational confidence and its association with recovery capital among 107 justice-involved adults receiving MOUD in an urban jail in Texas. Participants completed the Brief Situational Confidence Questionnaire (BSCQ) and the 10-item Brief Assessment of Recovery Capital (BARC-10). Mental health and substance use were assessed using the PHQ-9, GAD-7, AUDIT, and ASSIST. Bivariate associations were examined using chi-square and Fisher’s exact tests, and a multivariable logistic regression model was used to assess factors associated with high situational confidence (BSCQ ≥ 80%).ResultsParticipants had a mean age of 38.9 years (SD = 0.4); most were male (74.0%), non-Hispanic Black or other race/ethnicity (58.0%), and had a high school education or less (59.8%). A majority (66.4%) reported unstable housing in the 30 days prior to incarceration. Fewer than half (44.9%) reported high situational confidence, with a mean score of 67.6 (SD = 26.9). Higher recovery capital was strongly associated with high situational confidence (aOR = 2.66; 95% CI: 1.52–4.96). Depression (aOR = 0.36; 95% CI: 0.16–0.78), sexual minority status (aOR = 0.14; 95% CI: 0.01–0.78), and reliance on informal income-generating activities (“hustling”) (aOR = 0.30; 95% CI: 0.10–1.01) were associated with lower situational confidence.ConclusionsRecovery capital is a strong predictor of situational confidence among justice-involved individuals receiving MOUD. Interventions that enhance recovery capital, including access to employment, housing, and social support, integrate mental health care, and provide tailored support for marginalized subgroups, may improve recovery outcomes during incarceration and reentry. Brief, validated tools like the BSCQ and BARC-10 may help identify individuals at greater relapse risk and guide more targeted, equity-informed reentry planning.

“Now that we’ve opened the door”: challenges recovery home directors face when housing residents receiving medication for opioid use disorder

Providing comprehensive access to medications for opioid use disorder (MOUD) for people transitioning from United States (US) jails and prisons is important to addressing the substance use disorder (SUD) epidemic. Such policies have augmented public health in other countries, but a precise estimate of its potential impact in the US is lacking. This study sought to estimate: (1) the annual number of opioid overdose deaths (OODs) among individuals released from US jails and prisons, and (2) the number of OODs preventable by providing comprehensive MOUD programs in carceral settings and linkage to care post-release. Nationally weighted synthetic estimates of opioid overdose mortality incidence rates among people released from US jails and prisons in a given year were calculated using mortality rates obtained from published studies. Previously published mortality rates were adjusted, using state-year multipliers, to account for temporal variation among study cohorts. Adjusted rates were weighted and combined to produce synthetic national estimates, then rescaled to reflect national OOD patterns from 2017 to 2022. These rescaled mortality rates were then applied to US jail and prison release statistics to estimate the annual number of OODs among the recently incarcerated. Estimates of MOUD efficacy 12 months post-release were used to estimate the number of potential lives saved through expanded MOUD access. We estimate that 21,784 people [95% synthetic confidence interval (SCI) 18,425 to 25,142] released from US jails and prisons in 2022 died from opioid overdose that year, constituting 27% of annual OODs nationwide. If all jails and prisons provided SUD screening upon entry, MOUD while incarcerated and linkage to care upon release, we estimate that 13,288 OODs (95% SCI 11,239 to 15,337), or 16% of the national total, may have been prevented in 2022. Approximately 27% of opioid overdose deaths in the United States in 2022 occurred among individuals recently released from carceral settings. Expanding access to medications for opioid use disorder to people in custody and those recently released could potentially prevent a substantial portion of opioid overdose deaths in the United States.

The management of anger is problematic for many people and it is a particularly important issue for persons with substance use disorders (SUD). The paper reviews the research studies dating back to 2005 on how to help persons with SUD manage anger. The literature reveals that various pharmaceutical and non-pharmacological approaches have been studied to help persons with SUD manage their anger. In chronic and lower risk situations non-pharmacological are the first line approaches, they include anger management training, cognitive-behavioral based treatments, exercising and relaxing, music therapy and empathy. Atypical antipsychotic and medications for opioid use disorders (MOUD) are also widely used. In acute and high risk of violence situations physical restraint and pharmacological management are the first line intervention. Various nursing frameworks provide a useful basis for integrating various approaches. Current approaches have their advantages and disadvantages and are discussed in this paper.

Despite the continued burden of opioid overdose in communities in the USA, effective treatments for opioid use disorder (OUD), such as medication for opioid use disorder (MOUD), remain underused. Motivational interviewing techniques and linkage to MOUD via digital health are innovative practices developed to overcome persistent barriers to accessing MOUD treatment. These practices are merged in a comprehensive digital health platform, RecoveryPad (developed by the Center for Progressive Recovery). Our study, 'Using System Dynamics Modeling to Foster Real-time Connections to Care' (NIH Award #: 1R61DA057675-01), is a pilot to assess the feasibility and behaviour change potential of RecoveryPad for our target audience of people experiencing OUD. This study will recruit 40 participants in Connecticut and New York through online platforms, such as social media and digital advertising, and direct access via quick-response (QR) codes distributed by local community partners. Eligibility assessment and enrolment will be conducted virtually. Individuals reporting symptoms indicating moderate to severe OUD who are at least 18 years of age are eligible for the study, excluding those who are currently receiving MOUD, pregnant or incarcerated. Enrolled participants will interact with an automated chatbot, live recovery coaches and, if desired, be referred to a telehealth MOUD provider via the RecoveryPad platform. Participants will have access to the platform for 30 days and will be asked to complete brief surveys to assess MOUD engagement and secondary outcomes at 30 and 90 days. Additionally, system dynamics (SD) models will be developed at the individual level to simulate participant interactions with RecoveryPad, and at the community level to improve understanding of the systems affecting OUD and MOUD access. This project received approval from the Yale University Human Investigation Committee in 2024 (HIC # 2000034414). All participants will complete an electronic consent form with detailed study information and release of information to obtain data related to MOUD appointment attendance. Findings and conclusions from this pilot will be disseminated via peer-reviewed publication, advisory board meetings and meetings with community partners. NCT05832879.

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior authorization prohibitions in private insurance remains limited. We synthesized state laws prohibiting prior authorization for MOUD in private insurance in the US. The number of states with such prohibitions grew from two in 2015 to twenty-two in 2023, with variations in the scope of these prohibitions. Seven states have fully prohibited prior authorization for all MOUD ("full prohibitions") since the effective date. Fifteen states adopted legislation that still allows prior authorization under some conditions ("partial prohibitions," including those covering at least one of any MOUD; those covering one of each MOUD; and those with limitations based on modality or formulation, generic or branded status, prior authorization frequency, prescription duration, or emergency conditions). Among these fifteen states, four states transitioned from partial prohibitions to full prohibitions, and eleven states maintained partial prohibitions, although many have broadened the scope of prohibitions over time. The proliferation of prior authorization prohibitions for MOUD highlights that this is an area of significant state legislative focus.

Tobacco and cannabis use among pregnant women with prenatal opioid use.

Shattering the STIGMA: Talking openly about MAT in 12-step recovery programs.

Opioid Use Disorder (OUD) is defined by the persistent use of opioids despite adverse consequences. It is associated with increased mortality and a variety of mental and general medical comorbidities. Risk factors include younger age, male sex, lower educational attainment, lower income, and psychiatric disorders, such as other substance use disorders and mood disorders. Genetics also play a role in susceptibility to opioid use disorders. Long-term selfefficacy in opioid use for non-medical purposes suggests irreversible opioid use disorders. To evaluate the current understanding of opioid use disorders, the limitations in existing treatment approaches were examined, and strategies to improve outcomes through expanded treatment access and personalized care interventions were identified. An analysis was carried out regarding the role of existing pharmacological treatments, barriers within the care cascade, and potential advancements in healthcare delivery and innovation was carried out to address opioid use disorders. A comprehensive review of the literature was conducted by searching electronic databases (e.g., PubMed, Scopus) for articles published over the past 20-25 years. Relevant studies were selected based on predefined inclusion criteria, focusing on OUD risk factors, pharmacological treatments, barriers in the care cascade, and strategies for improving care. The selection process prioritized systematic reviews, clinical trials, and key guidelines. Although medications for opioid use disorders are effective, their impact is hindered by systemic issues at multiple levels of care. Addressing these challenges requires comprehensive efforts, including professional training, innovative treatments, and healthcare reforms to expand access and personalize care.

Despite more recent declines in opioid overdose deaths, opioid use among adolescents and young adults (AYA) continues to be a significant public health crisis in the U.S., contributing to various adverse health outcomes. We summarized peer-reviewed literature on the prevalence, risk factors, treatment options, and barriers to evidence-based care for AYA with opioid misuse and opioid use disorder (OUD). Despite the significant need, treatment access for OUD among AYA is low, with limited utilization of evidence-based practices including medications for OUD (MOUD). Primary barriers to effective treatment include inadequate healthcare provider training, a shortage of specialized facilities, prevalent stigma towards treatment, and prohibitive costs. Furthermore, greater naloxone distribution is necessary to reduce overdose deaths in this population. Comprehensive efforts to enhance MOUD accessibility, integrate behavioral interventions, reduce stigma, and support ongoing research into effective AYA-specific strategies are needed to address this national crisis.

To identify state strategies to increase access to medications for opioid use disorder (MOUD) through Section1115 Substance Use Disorder waivers. We conducted a qualitative analysis of 27 waiver applications that were implemented between 2015 and 2020. We identified barriers and proposed strategies for expanding MOUD access and utilization. After excluding five states due to insufficient information, we analyzed 22 applications. We identified six barriers and eight corresponding strategies. Barriers included care delays, limited MOUD facilities, lack of care transition support, limited MOUD access in residential treatment, insufficient care coordination, and prescriber shortages. Commonly proposed strategies were requiring access to MOUD in residential treatment, which was stipulated by the Centers for Medicare & Medicaid Services, addressing prescriber shortages through education and technical assistance, campaigns to address stigma, and increased reimbursement. Other strategies included changes to prior authorization requirements, efforts to increase the number of facilities that offer MOUD, and changes to improve care transitions. States proposed a variety of strategies to expand access to and use of MOUD. Future research could investigate how these approaches, implemented individually or in combination, are associated with outcome change and impact.

"If he did it, I can do it, too. I can change my life around": The social model of recovery within the context of recovery homes accepting residents prescribed medications for opioid use disorder.

Local level of social inequity moderates implementation of evidence-based practices tailored to minoritized populations to reduce opioid overdose deaths.

Medication for opioid use disorder among adolescents entering specialty treatment for opioid use disorder and trends in the US, 2017-2022.

Substance use disorder (SUD) is the most common cause of pregnancy-associated deaths for women in Illinois. In this article, we describe how to provide multimodality education and teaching opportunities in SUD and medication for opioid use disorder, incorporate community outreach to offer new experiential clinical learning opportunities, and enhance preceptor relationships to bolster educational partnerships as an innovative approach to incorporating SUD education into midwifery programs. Our teaching efforts identify the most vulnerable communities and create an innovative, midwifery-led solution to provide much-needed culturally aligned care addressing health disparities of those in rural and underserved communities. We highlight our utilization of an online education and training platform that students enroll in to obtain foundational knowledge in medication management for opioid use disorder, describe how we expanded clinical partnerships with providers actively providing medication management for opioid use disorders, and discuss how we evaluated those experiences and provided teaching/learning opportunities for students to present material across multiple cohorts of students. This innovative approach to integrating education for medication management of SUD through the above teaching modalities highlights our ability to meet the needs of our patients and prepare the future midwifery workforce with the clinical skills necessary for the work needed in clinical settings across the United States.

Abstract Introduction Some state Medicaid programs place a cap on the monthly number of covered prescription fills, including medications for opioid use disorder (MOUD)–the most effective OUD treatments. Methods Between 2023 and 2024, we employed a quasi-systematic 3-step process (online search, survey of Medicaid experts, request-for-information) to identify contemporary Medicaid cap policy information and conducted a content analysis of cap policies. Results Of the 12 states with contemporary prescription cap policies, 9 operated general caps and 3 operated caps for controlled substances. Across states, caps ranged from 3-6 monthly prescriptions. All states had exemptions based on beneficiary characteristics (e.g., age, health conditions) or medication type (e.g., contraceptives, antipsychotics), 6 of which had cap override policies, and 5 had MOUD-specific exemptions. Conclusion Our search identified a dearth of publicly accessible, contemporary information on Medicaid cap policies, indicating a potential barrier to beneficiaries’ understanding their prescription drug benefits. Further, although all states provided some type of policy carveout, half of the Medicaid programs operating caps did not exempt MOUD, which may negatively impact access to medically-necessary medications for Medicaid beneficiaries with OUD.

BackgroundThe introduction of synthetic opiates and non-opiate sedatives into the illicit drug market has increased overdose risk for individuals who use opiates and other drugs. The ongoing risk of overdose for patients receiving methadone as a medication for opioid use disorder in the context of this more potent and less predictable drug supply is not well characterized. Additionally, little research has explored whether commonly available clinical data (including data available even in low resource settings) can predict near-term acute overdose in patients prescribed methadone for opioid use disorder.ObjectiveTo determine whether the number of recent no-shows to scheduled clinic appointments in the past 30 days is associated with 30-day overdose risk among patients enrolled in one Opioid Treatment Program who are prescribed methadone for opioid use disorder.MethodsWe analyzed clinical records from 1,049 patients in an opioid treatment program (May 2020–April 2024), and for each patient-day, counted the number of no-shows to scheduled clinic appointments (not methadone administrations) in the previous 30 days. Associations between the number of standardized no-shows in the past 30 days and overdose in the subsequent 30 days were analyzed with logistic regression via generalized linear model controlling for temporal and patient-specific variables. Goodness of fit was assessed with marginal R2 and a simulation-based approach designed for multilevel models.ResultsThe sample included 56 overdoses with an average of 0.919 no-shows in the last 30 days (std. dev 1.37). The z-standardized number of no-shows to scheduled appointments in the past 30 days was both statistically and clinically significantly associated with risk of overdose in the next 30 days adjusting for study month and season (odds ratio 1.18 [95% CI 1.13–1.23] P < 0.001), as well as adjusting for demographics and overdoses during study period (odds ratio 1.28 [95% CI 1.22–1.34] P < 0.001), and a marginal R2 of 0.04. Model diagnostics revealed adequate fit using a generalized additive model, with results virtually unchanged from the generalized linear model.ConclusionNo-shows to scheduled clinic appointments in the past 30 days are significantly associated with overdose risk in the next 30 days with a linear relationship among patients receiving methadone in a single opioid treatment program. Population-specific acute risk prediction tools could help clinicians prioritize resources for timely intervention.