Prevalence Of Opioid Use Disorder Research Articles

Opioid Use Disorder in Patients Undergoing Major Lower Extremity Amputation: Prevalence and Outcomes.

Patients with a history of Opioid Use Disorder (OUD) have higher postoperative complication rates and mortality in many settings. Yet, it remains poorly understood how the opioid epidemic has affected patients undergoing major lower extremity amputation (LEA) and whether outcomes differ by OUD status. We conducted a retrospective chart review of all 689 patients who underwent major LEA at a large tertiary referral center from 2015 to 2021. This study assessed patient characteristics and long-term postoperative outcomes for patients with preoperative OUD. 133 (19.3%) patients had a lifetime history of preoperative OUD. Preoperative OUD was associated with key characteristics, comorbidities, and outcome measures. OUD was significantly associated with younger age (P < .001), black race (P = .026), single relationship status (P < .001), BMI <30 (P = .024), no primary care provider (P = .004), and Medicaid insurance (P < .001). Comorbidities significantly associated with OUD include current smoking (P < .001), Human Immunodeficiency Virus (HIV; P = .003), and history of osteomyelitis (P < .001). Preoperative OUD independently predicted lower rates of 30-60-day readmission (odds ratio [OR] .54, P = .018) and 1-12-month reamputation (OR .41, P = .006). There was no significant difference in long-term mortality and follow-up. This study demonstrates the prevalence of OUD in patients undergoing major LEA and reports associations and long-term outcomes. Our findings highlight the importance of recognizing OUD and raise questions about the mechanisms underlying its relation to rates of postoperative readmission and reamputation.

Abstract 12161: Trends in Age, Sex and Racial Differences in the Incidence of Infective Endocarditis in Florida and New York

Introduction: How the incidence of infective endocarditis (IE) changed in various demographic subgroups of the United States along with the worsening opioid epidemic over the last decade is unknown. Methods: This retrospective cohort study used data from the 2005-2018 State Inpatient Databases of Florida and New York. Cases of incident IE were combined with census data to compute age, sex- and race-specific incidence. Joinpoint regression was used to quantify the annualized percentage change (APC) in incidence over time. Results: Of 98,221 incident IE admissions, 70.0% were Non-Hispanic White (NHW) and 60.6% were ≥ 65 years old (yo). The average annual age and sex-standardized incidence of IE in cases/100,000 population was 19.2 (95%CI 18.7-19.6) but this varied by age, sex, and race. Incidence was ≈20% higher in men (20.9 [95%CI 20.2-21.7]) compared to women (17.5 [95%CI 16.8-18.2]) and increased with age in both sexes. Incidence was higher in Black: 22.5 (95%CI 21.0 - 23.9) vs NHW: 20.0 (95%CI 19.3 - 20.6), Hispanic: 13.2 (95%CI 12.3 -14.1) and Asian/Pacific Islander patients: 5.9 (95%CI 4.7 - 7.1). The age and sex-standardized incidence did not change over time (APC 0.5%, p=0.646). However, incidence increased in women 18-44 (APC 11.0%, p&lt;0.001), men 18-44 (APC 7.3, p&lt;0.001) and men 45-64 yo (APC 1.5%, p=0.002) but declined in women ≥ 65 yo(APC -2.8, p=0.049). Most of this increased incidence occurred in NHW women and men 18-44, NHW men 45-64 and Hispanic Men 18-44 yo (Figure 1). Incidence did not change over time in other age/sex groups. Prevalence of opioid use disorder increased by &gt;2-fold in all age/sex groups over time but the pace of increase was faster in NHW women and men 18-44 yo compared to other races of similar demography (p-for-time interaction &lt;0.001). Conclusions: Over the last decade, among residents of Florida and New York, incidence of IE increased in several demographic groups, but the most prominent rise was among young NHW patients, especially young NHW women.

Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment.

People in criminal justice settings (CJS) have high rates of opioid use disorder (OUD) and HIV. Probation is part of the CJS and congregates many individuals with high rates of mental health and substance use disorders relative to the general population; nevertheless, probation remains a major improvement to incarceration. As a steppingstone to full decarceration efforts, community supervision settings like probation can be leveraged as "touchpoints" to identify and link people with OUD (and other co-morbid conditions) to treatment and reduce criminal activity. To determine the feasibility of a modified screening, brief intervention and referral to treatment (SBIRT) strategy to link probationers to opioid agonist therapies (OAT) in the newly created probation system in Ukraine, we conducted a single-arm SBIRT intervention in eight probation centers in four Ukrainian administrative regions. For those screening positive for OUD, interest in OAT was assessed before and after a brief intervention. Those interested in OAT were referred to community OAT services. Participants with OUD also underwent HIV testing. Of the 1,298 consecutive individuals screened, 208 (16.0%) met criteria for opioid dependence. Of these, 122 (58.7%) enrolled in brief intervention, of which 54 (44.3%) had HIV and 14 (25.9%) of these were newly diagnosed. After the brief intervention, interest in starting OAT increased significantly from a median of 7.0 to 8.0 (P = <0.001) using a 10-point scale. Thirty (N = 30; 24.6%) of the enrolled participants initiated OAT and 21 of these (70%) were retained in treatment for 6 months. The prevalence of OUD (and HIV) is high among people in probation in Ukraine. SBIRT can identify a large number of people eligible for OAT, many of whom were willing to initiate and remain on OAT. Integrating SBIRT into probation can potentially assist with OAT scale-up and help address HIV prevention efforts.

Xylazine Use in Pregnancy: The Effects of the Fentanyl Adulterant Xylazine on Pregnant Patients and the Developing Fetus.

A literature review was completed to outline the effects of xylazine on the pregnant patient while raising awareness of the increasing prevalence of opioid use disorder in pregnancy and the increase in adulterants in non-prescribed controlled substances. PubMed and Google Scholar were searched using the key words "xylazine, adulterant," "xylazine, humans," "xylazine, pregnancy," and "xylazine, placenta" to identify the studies evaluating xylazine's effects on humans and the pregnant patient. Studies were included if they provided information on symptoms of xylazine exposure, the prevalence of xylazine in pregnant humans and the hemodynamic effects of xylazine on both human and animal pregnant populations. Animal studies were included given the limited data on xylazine in pregnant humans. Four studies were utilized for background data and five studies were included in the final review of the effects of xylazine on pregnancy. Studies involving humans show that xylazine toxicity can cause respiratory depression, bradycardia, and central nervous system depression. There is evidence of xylazine in human umbilical cord tissue, showing that the fetus is exposed to xylazine. Animal studies show decreased uterine blood flow, increased uterine vascular resistance, and decreased fetal growth in response to xylazine. Due to the limited studies on the effects of xylazine on pregnant populations, providers rely on animal studies for knowledge on xylazine's effects throughout pregnancy. Animal studies suggest an increased risk of adverse effects during pregnancy in response to xylazine. Future studies should focus on the pregnancy outcomes in patients exposed to xylazine to create more robust recommendations for treatment and pregnancy surveillance.

Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties.

Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles. Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties. A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.

Massachusetts Prevalence of Opioid Use Disorder Estimation Revisited: Comparing a Bayesian Approach to Standard Capture-Recapture Methods.

The National Survey on Drug Use and Health (NSDUH) estimated the prevalence of opioid use disorder (OUD) among the civilian, noninstitutionalized people aged 12 years or older in Massachusetts as 1.2% between 2015 and 2017. Accurate estimation of the prevalence of OUD is critical to the success of treatment and resource planning. Various indirect estimation approaches have been used but are subject to data availability and infrastructure-related issues. We used 2015 data from the Massachusetts Public Health Data Warehouse (PHD) to compare the results of two approaches to estimating OUD prevalence in the Massachusetts population. First, we used a seven-dataset capture-recapture analysis under log-linear model parameterization, controlling for the source dependence and effects of age, sex, and county through stratification. Second, we applied a benchmark-multiplier method in a Bayesian framework by linking health care claims data to death certificate data assuming an extrapolation of death rates from observed untreated OUD to unobserved OUD. Our estimates for OUD prevalence among Massachusetts residents (aged 18-64 years) were 4.62% (95% CI = 4.59%, 4.64%) in the capture-recapture approach and 4.29% (95% CrI = 3.49%, 5.32%) in the Bayesian model. Both estimates were approximately four times higher than NSDUH estimates. The synthesis of our findings suggests that the disease surveillance system misses a large portion of the population with OUD. Our study also suggests that concurrent use of multiple methods improves the justification and facilitates the triangulation and interpretation of the resulting estimates. ClinicalTrials.gov Identifier: NCT04111939.

Opioid use disorder amongst young people living with HIV: A 10-year trend

BackgroundThe increasing prevalence of young people living with HIV (YPLWH) is a major public health concern. In 2017, the Centers for Disease Control and Prevention (CDC) reported that young people accounted for 21% (8164) of the 38,739 new HIV diagnoses in the United States. Therefore, understanding opioid use disorder (OUD) among YPLWH is critical in developing effective treatment and prevention strategies. The study intends to provide evidence regarding the prevalence of opioid use disorder as well as to examine the effects of moderators on the diagnosis of OUD among a subset of YPLWH. MethodsThe National Inpatient Sample data (2008–2017) were analyzed. Participants ranged in age from 13 to 24 years old and had an HIV-related ICD code was included. The outcomes were OUD diagnosis, patterns, and moderators. The adjusted effects of the moderators on the likelihood of being diagnosed with opioid use were examined using multivariable logistic regression. ResultsResults from the study showed that 501 (2%) of the 27,538 HIV-positive young people aged 13 to 24 had comorbid Opioid use disorder (OUD). After adjusting for sex, race, and mental health diagnosis (MHD), having HIV (p < 0.05) and an MHD [OR 2.46 (1.92, 3.16)] was associated with a higher risk of OUD. Individuals with the highest income level were 42% less likely to have OUD (Table 3). The likelihood of having OUD is much lower among YPLWH aged 13–24 years from the United States' southern and western states. ConclusionOpioid use disorder (OUD) among young people living with HIV is of public concern. Understanding the drivers of the increasing prevalence provides opportunities for policies aimed at stemming the rise. Overall, our findings suggest that there is a significant need for interventions and support for young people with comorbid HIV and OUD, particularly those with low income and mental health issues. Addressing socioeconomic factors such as poverty and increasing access to mental health services could help reduce the risk of OUD among this population. Additionally, understanding regional differences in drug use could inform targeted prevention and intervention efforts.

Focus on fentanyl in females: Sex and gender differences in the physiological and behavioral effects of fentanyl

The prevalence of opioid use disorder and overdose continues to harm the U.S. population and is further exacerbated by the use of the synthetic opioid, fentanyl, and its analogs. Gender differences in the effects of fentanyl are not well understood. The present article reviews evidence for gender and sex differences in the physiological and behavioral effects of fentanyl in humans and animals. Biological sex seems to be a foundational driver in addiction vulnerability and affects mechanisms related to opioid use including fentanyl. Fentanyl has distinct pharmacodynamics and enhanced efficacy relative to other opioids that highlights the need to investigate how females may be uniquely altered by its use. Behavioral and physiological responses to fentanyl are found to differ by sex and gender in many cases, including outputs like affective symptoms, analgesia, tolerance, and withdrawal emphasizing the need for further research about the role of biological sex on fentanyl use.

Examining sociodemographic correlates of opioid use, misuse, and use disorders in the All of Us Research Program.

The All of Us Research Program enrolls diverse US participants which provide a unique opportunity to better understand the problem of opioid use. This study aims to estimate the prevalence of opioid use and its association with sociodemographic characteristics from survey data and electronic health record (EHR). A total of 214,206 participants were included in this study who competed survey modules and shared EHR data. Adjusted logistic regressions were used to explore the associations between sociodemographic characteristics and opioid use. The lifetime prevalence of street opioids was 4%, and the nonmedical use of prescription opioids was 9%. Men had higher odds of lifetime opioid use (aOR: 1.4 to 3.1) but reduced odds of current nonmedical use of prescription opioids (aOR: 0.6). Participants from other racial and ethnic groups were at reduced odds of lifetime use (aOR: 0.2 to 0.9) but increased odds of current use (aOR: 1.9 to 9.9) compared with non-Hispanic White participants. Foreign-born participants were at reduced risks of opioid use and diagnosed with opioid use disorders (OUD) compared with US-born participants (aOR: 0.36 to 0.67). Men, Younger, White, and US-born participants are more likely to have OUD. All of Us research data can be used as an indicator of national trends for monitoring the prevalence of receiving prescription opioids, diagnosis of OUD, and non-medical use of opioids in the US. The program employs a longitudinal design for routinely collecting health-related data including EHR data, that will contribute to the literature by providing important clinical information related to opioids over time. Additionally, this data will enhance the estimates of the prevalence of OUD among diverse populations, including groups that are underrepresented in the national survey data.

Medication treatment for opioid use disorder among rural primary care patients.

To investigate the prevalence of opioid use disorder (OUD) and medication treatment for OUD (MOUD) receipt in rural primary care settings and identify characteristics associated with MOUD among patients with OUD. Secondary analyses based on electronic health records of all adult patients who visited 1 of the 6 rural primary care clinic sites from October 2019 to January 2021. Mixed effects logistic regression was conducted to assess MOUD receipt (Y/N) in relation to patient characteristics (eg, demographics, other substance use disorders [SUDs], mental health disorders, and chronic pain) and the number of MOUD prescribers per clinic. The prevalence of OUD varied from 0.7% to 8.2% (Mean [SD] = 3.3% [95% CI: 0.4, 6.1]) among 36,762 primary care patients across 6 clinic sites. Among 1,164 patients with OUD, on average 50.1% received MOUD (95% CI: 28.0, 72.3). Patients in clinics with more than 3 MOUD prescribers had more than 3 times the odds of receiving MOUD (OR = 3.42; 95% CI, 1.22-9.62) as those in clinics with fewer than 3 prescribers. MOUD was positively associated with younger age (18-30 [OR = 6.97; 95% CI, 3.37-14.42], 31-64 [OR = 5.03; 95% CI, 2.64-9.57], relative to those 65 and older), having other co-occurring SUDs (OR = 3.77; 95% CI, 2.57-5.52), being male (OR = 1.50; 95% CI, 1.12-2.01), and negatively associated with having chronic pain disorders (OR = 0.69; 95% CI, 0.50-0.94). The prevalence of OUD and MOUD are high but vary considerably across rural primary care clinics; primary care MOUD prescribers play a key role on MOUD access in rural settings.

Cultivating Agents of Change in Medical Students: Addressing the Overdose Epidemic in the United States Through Enhancing Knowledge of Multimodal Pain Medicine and Increasing Accessibility via Open-Access, Web-Based Medical Education and Technology.

Medical students of today will soon be physician leaders and teachers of tomorrow about important relevant topics including the overdose epidemic and its devastating impact on our society. In the United States, the overdose crisis, including drug opioid-related overdoses, the increasing prevalence of opioid use disorder along with the increasing number of patients with chronic pain are intensifying and call attention for nationwide action. A strong medical educational foundation of the understanding of the relationship between pain and substance use disorder, their treatment including opioid analgesic therapy, multimodal and interdisciplinary care, and long-term management is needed to help cultivate comprehensive knowledge and training to prepare the next generation's frontline practitioners to meet these needs. Yet, traditional educational curricula covering these topics are not standardized in medical schools across the nation in the United States. The advent of web-based medical education and the integration of this technology may offer potential solutions to these challenges. Often found equally effective as in-person learning, web-based medical education through open-access modules and other technologies can help increase accessibility, enhance knowledge of multimodal pain management, safe and effective use of opioid analgesics, and other related topics, and provide flexible and powerful teaching initiatives. Our viewpoint is thus that open-access modules and other technology-integrated teaching initiatives can help deliver excellence in pain education, preparing and empowering medical students-our future agents of change-who will be at the forefront of the overdose epidemic.

Exploring mental health comorbidities and opioid agonist treatment coverage among people in prison: A national cohort study 2010–2019

IntroductionDespite a high prevalence of opioid use disorder (OUD) among people in prison, there is little knowledge of how many receive the recommended opioid agonist treatment (OAT) and what characterizes those who receive OAT and those who do not when it comes to mental health comorbidities. We aimed to describe people with OUD in Norwegian prisons over a ten-year period and their OAT status, and to investigate comorbidity of mental health disorders stratified by gender. MethodsData from the PriSUD study, including all people (≥19 years old) imprisoned in Norway between 2010 and 2019, linked to national patient registry data, including ICD-10 codes. We calculated the prevalence (1-year and 10-year) of OUD and OAT, and mental health comorbidity stratified on OAT-status and gender. ResultsAmong the cohort (n=51,148), 7 282 (14.2%) were diagnosed with OUD during the period of observation. Of those, 4 689 (64.4%) received OAT. People with OUD had high levels of comorbidity, including other drug use disorders (92.4% OAT, 90.3% non-OAT), alcohol use disorder (32.1% OAT, 44.4% non-OAT) and any other mental health disorders (61.6% OAT, 68.2% non-OAT). The proportion receiving OAT among people with OUD increased markedly during the ten years of observation; from 35.7% in 2010–70.9% in 2019. ConclusionPeople with OUD, both receiving OAT and not, had substantially more mental health comorbidities than the non-OUD population. Understanding how the prison population changes over time especially in terms of mental health needs related to OUD, is important for correctional health service planning.

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors.

Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.

State- and County-Level Geographic Variation in Opioid Use Disorder, Medication Treatment, and Opioid-Related Overdose Among Medicaid Enrollees

The opioid crisis disproportionately affects Medicaid enrollees, yet little systematic evidence exists regarding how prevalence of and health care utilization for opioid use disorder (OUD) vary across geographical areas. To characterize state- and county-level variation in claims-based prevalence of OUD and rates of medication treatment for OUD and OUD-related nonfatal overdose among Medicaid enrollees. This cross-sectional study used data from the Transformed Medicaid Statistical Information System Analytic Files from January 1, 2016, to December 31, 2018. Participants were Medicaid enrollees with or without OUD in 46 states; Washington, DC; and Puerto Rico who were aged 18 to 64 years and not dually enrolled in Medicare. The analysis was conducted between September 2022 and April 2023. Calendar-year OUD prevalence. The main outcomes were claims-based measures of OUD prevalence and rates of medication treatment for OUD and opioid-related nonfatal overdose. Individual records were aggregated at the state and county level, and variation was assessed within and across states. Of the 76 390 817 Medicaid enrollee-year observations included in our study (mean [SD] enrollee age, 36.5 [1.6] years; 59.0% female), 2 280 272 (3.0%) had a claims-based OUD (mean [SD] age, 38.9 [3.6] years; 51.4% female). Of enrollees with OUD, 41.2% were eligible due to Medicaid expansion, 46.4% had other substance use disorders, 55.8% had mental health conditions, 55.2% had claims indicating some form of OUD medication, and 5.8% had claims indicating an overdose during a calendar year. Claims-based outcomes exhibited substantial variation across states: OUD prevalence ranged from 0.6% in Arkansas and Puerto Rico to 9.7% in Maryland, rates of OUD medication treatment ranged from 17.7% in Kansas to 82.8% in Maine, and rates of overdose ranged from 0.3% in Mississippi to 10.5% in Illinois. Pronounced variation was also found within states (eg, OUD prevalence in Maryland ranged from 2.2% in Prince George's County to 21.6% in Cecil County). In this cross-sectional study of Medicaid enrollees from 2016 to 2018, claims-based prevalence of OUD and rates of OUD medication treatment and opioid-related overdose varied substantially across and within states. Further research appears to be needed to identify important factors influencing this variation.

Opportunities to expand postpartum support for those in recovery from opioid use disorder: Results from a qualitative study

IntroductionOver the past two decades the national prevalence of opioid use disorder (OUD) during pregnancy has increased more than 600%. Managing recovery from OUD during the postpartum period can be particularly challenging. Thus, we sought to identify ways to expand perinatal OUD treatment to ultimately reduce risk of postpartum return to opioid misuse. MethodsWe conducted in-depth semi-structured interviews with pregnant or postpartum (i.e., gave birth within the past year) mothers who have OUD, as well as with professionals who work with this population. Interviews were audio-recorded, transcribed, and coded for themes using Dedoose software using an eco-social framework. ResultsParticipants included 7 mothers (median age 32 years old; 100% receiving treatment for OUD) and 11 professionals (average of 12.5 years in the field; n=7 healthcare providers, n=4 child safety caseworkers). A total of 10 major themes emerged in three levels. First, at an individual level themes included mental health, personal responsibility, and individual agency. Second, at the inter-individual level themes included support from friends and family, and other sources of support. Next, at the systems/institutional level themes included culture of healthcare systems, an ill-equipped healthcare system, social determinates of health, and continuum of care. Finally, a theme identified across all three levels included keeping mother and baby together. ConclusionsSeveral opportunities to enhance the support and clinical care of OUD during the perinatal period were identified. Additional work is needed to explore how these themes may be incorporated into existing programs and/or the development of new interventions.

An Artificial Intelligence-Based Smartphone App for Assessing the Risk of Opioid Misuse in Working Populations Using Synthetic Data: Pilot Development Study.

Opioid use disorder (OUD) is an addiction crisis in the United States. As recent as 2019, more than 10 million people have misused or abused prescription opioids, making OUD one of the leading causes of accidental death in the United States. Workforces that are physically demanding and laborious in the transportation, construction and extraction, and health care industries are prime targets for OUD due to high-risk occupational activities. Because of this high prevalence of OUD among working populations in the United States, elevated workers' compensation and health insurance costs, absenteeism, and declined productivity in workplaces have been reported. With the emergence of new smartphone technologies, health interventions can be widely used outside clinical settings via mobile health tools. The major objective of our pilot study was to develop a smartphone app that can track work-related risk factors leading to OUD with a specific focus on high-risk occupational groups. We used synthetic data analyzed by applying a machine learning algorithm to accomplish our objective. To make the OUD assessment process more convenient and to motivate potential patients with OUD, we developed a smartphone-based app through a step-by-step process. First, an extensive literature survey was conducted to list a set of critical risk assessment questions that can capture high-risk behaviors leading to OUD. Next, a review panel short-listed 15 questions after careful evaluation with specific emphasis on physically demanding workforces-9 questions had two, 5 questions had five, and 1 question had three response options. Instead of human participant data, synthetic data were used as user responses. Finally, an artificial intelligence algorithm, naive Bayes, was used to predict the OUD risk, trained with the synthetic data collected. The smartphone app we have developed is functional as tested with synthetic data. Using the naive Bayes algorithm on collected synthetic data, we successfully predicted the risk of OUD. This would eventually create a platform to test the functionality of the app further using human participant data. The use of mobile health techniques, such as our mobile app, is highly promising in predicting and offering mitigation plans for disease detection and prevention. Using a naive Bayes algorithm model along with a representational state transfer (REST) application programming interface and cloud-based data encryption storage, respondents can guarantee their privacy and accuracy in estimating their risk. Our app offers a tailored mitigation strategy for specific workforces (eg, transportation and health care workers) that are most impacted by OUD. Despite the limitations of the study, we have developed a robust methodology and believe that our app has the potential to help reduce the opioid crisis.

8% of mental health patients have comorbid OUD: Study

The 8% of patients with mental health conditions who have opioid use disorder (OUD) are at high risk for overdose, according to a study that analyzed a large state‐wide Medicaid claims database. The study, presented as a poster by Felipe Castillo, M.D. of Montefiore Medical Center in New York, at the American Psychiatric Association annual meeting in San Francisco last week, noted that OUD among patients — even those in treatment for mental health conditions — is difficult to treat. In particular, there is a high risk of overdose for those who are at a younger age, who have schizophrenia, or receive services in settings that typically serve individuals with more severe mental illness. In addition, the seriously mentally ill individuals with OUD were more likely to have suicide attempts, suicidal ideation and housing instability. OUD prevalence — not overdose — was significantly higher among adults aged 25 and older, American Indian and Hispanic individuals, adults who are male, those who live in a community residence and/or rural domicile, and those with a diagnosis of anxiety, bipolar, and/or post‐traumatic stress disorder. The study population of 523,885 included individuals who were 18 years and older in New York State and enrolled in Medicaid during 2020. The individuals had a mental health diagnosis on at least one inpatient or two outpatient records from a clinical setting. The diagnosis by claim excluded substance use disorders, neurodevelopmental (other than ADHD) and neurocognitive diagnoses alone. The prevalence of co‐occurring OUD was 8.1% among the population examined. Among those with OUD, 7.7% had an opioid overdose in the prior year.

Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers.

Efforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications. We examined whether dual-system use was associated with increased rates of new opioid prescriptions, continued opioid prescriptions and diagnoses of opioid use disorder (OUD). We hypothesized that dual-system use would be associated with increased odds for each outcome. This retrospective cohort study was conducted using Veterans Administration (VA) data from two facilities from 2015 to 2019, and included active patients, defined as Veterans who had at least one encounter in a calendar year (2015-2019). Dual-system use was defined as receipt of VA care as well as VA payment for community care (non-VA) services. Mono users were defined as those who only received VA services. There were 77,225 dual-system users, and 442,824 mono users. Outcomes were three binary measures: new opioid prescription, continued opioid prescription (i.e., received an additional opioid prescription), and OUD diagnosis (during the calendar year). We conducted a multivariate logistic regression accounting for the repeated observations on patient and intra-class correlations within patients. Dual-system users were significantly younger than mono users, more likely to be women, and less likely to report white race. In adjusted models, dual-system users were significantly more likely to receive a new opioid prescription during the observation period [Odds ratio (OR) = 1.85, 95% confidence interval (CI) 1.76-1.93], continue prescriptions (OR = 1.24, CI 1.22-1.27), and to receive an OUD diagnosis (OR = 1.20, CI 1.14-1.27). The prevalence of opioid prescriptions has been declining in the US healthcare systems including VA, yet the prevalence of OUD has not been declining at the same rate. One potential problem is that detailed notes from non-VA visits are not immediately available to VA clinicians, and information about VA care is not readily available to non-VA sources. One implication of our findings is that better health system coordination is needed. Even though care was paid for by the VA and presumably closely monitored, dual-system users were more likely to have new and continued opioid prescriptions.

Increasing Primary Care Utilization of Medication-Assisted Treatment (MAT) for Opioid Use Disorder.

With increasing prevalence of opioid use disorders (OUDs) there is an urgent need for OUD trained front line primary care providers (PCPs) who can help improve patient adherence to addiction treatment. Unfortunately, most physicians have had limited training for treating patients with addiction, leaving clinicians under prepared. To address this need, we created a Medication-Assisted Treatment (MAT) training program specifically designed for PCPs. A 4-hour PCP focused buprenorphine office-based implementation training was designed to supplement the 8-hour SAMHSA DATA 2000 waiver training. The intent of the supplemental training is to increase PCP likelihood of implementing MAT through practical evidenced-based implementation, addressing barriers reported by waivered PCPs. We developed and validated a new pre- and postsurvey instrument that assesses changes in participants knowledge, skills, and attitudes. Data were entered into REDCap, and composite scales were created and analyzed to determine pre-post differences. A total of 183 participants completed pre-post evaluations. Pre-post comparisons indicated substantial improvement in learner levels of confidence in implementing MAT care processes and in their interactions with MAT patients (df = 4, F = 203.518, P < .001). Participants described themselves as more comfortable identifying patients who would benefit from MAT (t = 15.04, P < .001), more competent in implementing MAT (t = 21.27, P < .001) and more willing (t = 15.56, P < .001) to implement MAT after training. Evidence suggests that a new MAT training program that supplements the SAMHSA waiver training increases confidence and willingness to implement MAT among PCPs. Efforts to replicate this success to allow for further generalization and policy recommendations are warranted.

Prenatal methadone exposure selectively alters protein expression in primary motor cortex: Implications for synaptic function.

As problematic opioid use has reached epidemic levels over the past 2decades, the annual prevalence of opioid use disorder (OUD) in pregnant women has also increased 333%. Yet, how opioids affect the developing brain of offspring from mothers experiencing OUD remains understudied and not fully understood. Animal models of prenatal opioid exposure have discovered many deficits in the offspring of prenatal opioid exposed mothers, such as delays in the development of sensorimotor function and long-term locomotive hyperactivity. In attempt to further understand these deficits and link them with protein changes driven by prenatal opioid exposure, we used a mouse model of prenatal methadone exposure (PME) and preformed an unbiased multi-omic analysis across many sensoriomotor brain regions known to interact with opioid exposure. The effects of PME exposure on the primary motor cortex (M1), primary somatosensory cortex (S1), the dorsomedial striatum (DMS), and dorsolateral striatum (DLS) were assessed using quantitative proteomics and phosphoproteomics. PME drove many changes in protein and phosphopeptide abundance across all brain regions sampled. Gene and gene ontology enrichments were used to assess how protein and phosphopeptide changes in each brain region were altered. Our findings showed that M1 was uniquely affected by PME in comparison to other brain regions. PME uniquely drove changes in M1 glutamatergic synapses and synaptic function. Immunohistochemical analysis also identified anatomical differences in M1 for upregulating the density of glutamatergic and downregulating the density of GABAergic synapses due to PME. Lastly, comparisons between M1 and non-M1 multi-omics revealed conserved brain wide changes in phosphopeptides associated with synaptic activity and assembly, but only specific protein changes in synapse activity and assembly were represented in M1. Together, our studies show that lasting changes in synaptic function driven by PME are largely represented by protein and anatomical changes in M1, which may serve as a starting point for future experimental and translational interventions that aim to reverse the adverse effects of PME on offspring.