Prescription Opioid Addiction Research Articles

White House proposed FY 2025 budget would increase MH BG $35 million, keep SUPTRS BG level

On March 11, the White House released the proposed budget for fiscal year (FY) 2025, which begins Oct. 1, 2024. The proposal includes a 10% set‐aside in the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant, which is funded at just over $2 billion, level with FY 2023, the most recent year for which final numbers are available. The Community Mental Health Services Block Grant would receive $1.043 billion in the proposed budget, a $35 million increase compared to FY 2023. The budget request (the White House asks Congress to fund programs) includes a proposal in which the Substance Abuse and Mental Health Services Administration would use HIV instead of AIDS to calculate the set‐aside in the SUPTRS BG. The State Opioid Response (SOR) grant would receive $1.595 billion, an increase of more than $20 million compared to FY 2023. Among other programs included in the White House request: Strategic Prevention Framework–Partnerships for Success at $135.5 million, level compared to FY 2023; Medication‐Assisted Treatment for Prescription Drug and Opioid Addiction at $111 million, level compared to FY 2023; Drug Courts at $74 million, level compared to FY 2023; Screening, Brief Intervention, and Referral to Treatment grants at $33.8 million, level compared to FY 2023; and Pregnant and Postpartum Women care at $43,931,000, an additional $39 million compared to FY 2023).

Prevention better than cure: expanding on pharmacists’ role in prescription opioid overdose and addiction management

As prescription opioid misuse and abuse increases in prevalence, pharmacists continue to be in frontlines of prevention and therapeutic management. Pharmacists as public health practitioners should be aware of new and relevant paradigms of substance abuse research and prevention and how they can further contribute to mitigation of opioid and other substance use disorders (SUDs). Screening, brief intervention, and referral to treatment (SBIRT) is a prevention tool that has been used to identify, reduce and misuse, abuse, and dependence on substances, including drugs and alcohol. The screening and brief intervention aspects of SBIRT have been shown to be adaptable across multiple health-care settings. Techniques to conduct applicable stages of SBIRT can be learned and used by pharmacists across multiple practice areas as they engage with the public. SBIRT can be used in conjunction or as a supplementary tool to other prevention and management strategies such as the use of prescription drug monitoring programs and naloxone prescription and distribution. We make a case that pharmacists, particularly those in the community setting, who act as the entry points for many patient engagement encounters, can incorporate SBIRT into their counseling and medication therapy management workflows. As pharmacists continue the move toward codifying provider status, their expertise along with expansion of services, such as the application of SBIRT called for in this article, should be continually leveraged to increase access to treatment and services for at-risk patients with SUDs.

Methadone Maintenance and QT-Interval: Prevalence and Risk Factors-Is It Effective to Switch Therapy to Levomethadone?

Methadone is a chiral synthetic opioid primarily used to treat heroin and prescription-opioid addiction: the (R)-enantiomer (Levomethadone) activates the µ-opioid receptor more potently than the (S)-enantiomer, which is a more potent blocker of the hERG potassium channels, resulting in QTc prolongation. The purpose of this retrospective study was to assess the effect of methadone on the QTc interval and to investigate the benefits of Levomethadone. The electrocardiograms of 165 patients taking methadone at various dosages and for different periods of time were examined: the QTc value was manually measured and then adjusted using Bazett's formula. Data analysis revealed a linear association between the dosage of methadone and QTc length; no correlation was found between the QTc value and gender, age, or duration of therapy. In total, 14% of the sample (23 patients) showed a prolongation of the QTc interval (>470 ms in males and >480 ms in females); 10 of the 23 patients with QTc elongation underwent a change of therapy from Methadone to Levomethadone-in 90% of these patients, a normalization in the QTc length was established. This study confirmed the role of methadone, specifically its dosage, in QTc prolongation and the efficiency of Levomethadone as an adequate therapeutic substitute in these circumstances. This study validates the importance of careful electrocardiographic monitoring in methadone-treated patients.

Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans

BackgroundChronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA’s Stepped Care Model to meet veterans’ pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management.ObjectivesThe Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans’ pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation.MethodsA sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO.ResultsOf 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20–9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures.DiscussionData suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.

The Lived Experience of Military Women With Chronic Pain: A Phenomenological Study.

ABSTRACTIntroductionChronic pain, a persistent or recurrent pain lasting more than 3 months, is a widespread problem among military women due to combat-related injuries and post-deployment stressors. Risk factors associated with chronic pain include gender, mental health, post-traumatic stress disorder, and prior physical or military sexual trauma. The most common prevalence of chronic pain is musculoskeletal (e.g., low back and neck), migraine, osteoarthritis, and fibromyalgia. Following deployment, 25% of military women are at risk for chronic pain. Military women are prescribed opioids for pain at a higher rate than men and are at risk for prescription opioid addiction. The unique medical needs of military women, including chronic pain, are poorly understood by health care providers and need to be addressed to achieve full integration into the military. The purpose of this study was to explore a typical day for military women living with chronic pain by examining the participants’ daily life experiences.Material and MethodsUsing van Manen’s approach, 13 active duty, retired, and veteran women were interviewed to explore these lived experiences. The study was approved by the Institutional Review Board at the University of San Diego.ResultsEight themes emerged from an analysis of the participants’ experiences: (1) chronic pain is a frustrating, persistent, daily, and an hourly struggle; (2) resilience in living with chronic pain is the new normal; (3) mission first and the impact of invisible pain; (4) self-care management and internal locus of control with nonpharmacological therapies; (5) pain accepted and managed to improve quality of life; (6) coronavirus disease 2019 (COVID-19) diminished social interactions; (7) pain of sexual trauma is not reported; and (8) disparities in health care due to self-perception of provider bias as pain is not understood.ConclusionsThe study generated new knowledge in Force Health Protection, ensuring (1) a fit and operational readiness force; (2) pre- to post-deployment care for women warriors; and (3) access to health care. The study findings supported previous research and could help direct future research into nursing, medicine, and allied health treatments for military and veterans’ gender-specific health care, education, and training. Furthermore, the military women in this study provided insight into the need for future research to explore unconscious gender bias, health disparities, and a raised awareness of military women living with chronic pain. Findings from this study merit further exploration using other qualitative research methodologies including mixed methods.

Changes in pain during buprenorphine maintenance treatment among patients with opioid use disorder and chronic pain.

Opioid use disorder (OUD) and chronic pain frequently co-occur. Little is known about changes in pain during buprenorphine/naloxone (BUP/NX) maintenance and whether outcomes vary by pain levels. The present study examined changes in pain intensity and pain interference over 12 weeks of BUP/NX maintenance among participants with OUD and chronic pain (N = 194). Differences in outcomes were assessed during BUP/NX maintenance (Week 12) and 2 months following a BUP/NX taper (Week 24). Data from Phase 2 of the Prescription Opioid Addiction Treatment Study (POATS) were used. Two latent transition models were conducted to characterize profiles and transitions between profiles of pain intensity or pain interference (estimated separately). Each model identified a high and low profile. In the pain interference model, the majority were classified in the low profile at baseline. In the pain intensity model, the majority were classified in the high profile at baseline. In both models, patients were more likely to remain in or transition to the low profiles by Week 12. Worse depression was associated with membership in the high pain interference profile at both timepoints. Women were more likely to be in the high pain intensity profile at baseline. Those in the high pain intensity and high pain interference profiles at Week 12 reported worse mental health quality of life (MH-QOL) at Week 12, as well as high pain intensity and high pain interference at Week 24. For a subgroup of patients, high pain intensity and high pain interference remains unchanged during BUP/NX maintenance treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Data-Driven Mathematical Model of the Heroin and Fentanyl Epidemic in Tennessee.

Opioid addiction represents a major national health issue spanning decades. In recent years, prescription opioid use disorder has increasingly led to heroin and fentanyl use, with subsequent increases in mortality rates due to overdose. In this paper, we present a mechanistic, epidemic model for prescription opioid addiction and illicit heroin or fentanyl addiction which aims to better understand and predict the dynamics between these two stages of opioid use disorder. Our model aims to be both parsimonious and robust: as a system of five differential equations it is appropriate for use in theory advancement and yet it remains powerful enough to capture state-level data from Tennessee for the period 2013-2018. A key finding from our data-driven analysis is that, in the face of changing policy around prescription opioids, heroin and fentanyl are now the driving force behind the Tennessee opioid epidemic. Model projections suggest that both addictions and overdoses related to heroin and fentanyl will continue to increase in the next few years (2020-2022), even as addiction to prescription drugs continues to fall. Finally, management strategy analysis suggests that in the changing face of the epidemic, the most successful approach will target availability of treatment with subsequent monitoring of stably recovered individuals to see that they do not relapse, coincident with direct efforts to decrease opioid overdose fatalities (e.g., further availability of Naloxone).

We Need to Talk About Codeine: an Implementation Study to reduce the number of Emergency Department patients discharged on high-strength co-codamol using the Behaviour Change Wheel

BackgroundThe crisis of prescription opioid addiction in the USA is well-documented. Though opioid consumption per capita is lower in the UK, prescribing has increased dramatically in recent decades with an...

Structural MRI and functional connectivity features predict current clinical status and persistence behavior in prescription opioid users

Prescription opioid use disorder (POUD) has reached epidemic proportions in the United States, raising an urgent need for diagnostic biological tools that can improve predictions of disease characteristics. The use of neuroimaging methods to develop such biomarkers have yielded promising results when applied to neurodegenerative and psychiatric disorders, yet have not been extended to prescription opioid addiction. With this long-term goal in mind, we conducted a preliminary study in this understudied clinical group. Univariate and multivariate approaches to distinguishing between POUD (n = 26) and healthy controls (n = 21) were investigated, on the basis of structural MRI (sMRI) and resting-state functional connectivity (restFC) features. Univariate approaches revealed reduced structural integrity in the subcortical extent of a previously reported addiction-related network in POUD subjects. No reliable univariate between-group differences in cortical structure or edgewise restFC were observed. Contrasting these mixed univariate results, multivariate machine learning classification approaches recovered more statistically reliable group differences, especially when sMRI and restFC features were combined in a multi-modal model (classification accuracy = 66.7%, p < .001). The same multivariate multi-modal approach also yielded reliable prediction of individual differences in a clinically relevant behavioral measure (persistence behavior; predicted-to-actual overlap r = 0.42, p = .009). Our findings suggest that sMRI and restFC measures can be used to reliably distinguish the neural effects of long-term opioid use, and that this endeavor numerically benefits from multivariate predictive approaches and multi-modal feature sets. This can serve as theoretical proof-of-concept for future longitudinal modeling of prognostic POUD characteristics from neuroimaging features, which would have clearer clinical utility.

Depression history as a predictor of outcomes during buprenorphine-naloxone treatment of prescription opioid use disorder

BackgroundIn the multi-site Prescription Opioid Addiction Treatment Study (POATS), the best predictor of successful opioid use outcome was lifetime diagnosis of major depressive disorder. The primary aim of this secondary analysis of data from POATS was to empirically assess two explanations for this counterintuitive finding. MethodsThe POATS study was a national, 10-site randomized controlled trial (N = 360 enrolled in the 12-week buprenorphine-naloxone maintenance treatment phase) sponsored by the NIDA Clinical Trials Network. We evaluated how the presence of a history of depression influences opioid use outcome (negative urine drug assays). Using adjusted logistic regression models, we tested the hypotheses that 1) a reduction in depressive symptoms and 2) greater motivation and engagement in treatment account for the association between depression history and good treatment outcome. ResultsAlthough depressive symptoms decreased significantly throughout treatment (p <.001), this improvement was not associated with opioid outcomes (aOR = 0.98, ns). Reporting a goal of opioid abstinence at treatment entry was also not associated with outcomes (aOR = 1.39, ns); however, mutual-help group participation was associated with good treatment outcomes (aOR = 1.67, p <.05). In each of these models, lifetime major depressive disorder remained associated with good outcomes (aORs = 1.63–1.82, ps = .01–.055). ConclusionsFindings are consistent with the premise that greater engagement in treatment is associated with good opioid outcomes. Nevertheless, depression history continues to be associated with good opioid outcomes in adjusted models. More research is needed to understand how these factors could improve treatment outcomes for those with opioid use disorder.

The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients.

Many patients are discharged from hospital after surgery with excessive doses of opioid, and prescription opioid addiction has become a serious public health problem. Inpatient opioid de-escalation performed by clinical phar-macists may assist in reducing opioids before discharge. We aimed to evaluate whether clinical pharmacist-led opioid de-escalation for inpatients after orthopedic surgery led to significant reductions in opioid use at discharge, without resulting in greater pain intensity and side effects. This retrospective pre-/post-intervention study evaluated patients before and after implementation of a phar-macist-led opioid de-escalation service. A major tertiary institution. Ninety eight participants underwent de-escalation, and 98 controls received standard care following ortho-pedic surgery. Pharmacist-led opioid de-escalation was initiated after discharge from the institution's Acute Pain Service. Primary outcome was total morphine oral equivalence (MOE) required in the 24-hours before discharge between the two groups. Secondary outcomes included pain intensity scores and opioid-related side effects. The post-intervention group used significantly less opioids in the 24 hours preceding discharge compared with the precohort (total MOE 30 vs 45 mg; p = 0.025).There were no differences in pain intensity at rest (p = 0.19) or with movement (p = 0.19). Cases experienced significantly less constipation (29 vs 49 percent; p = 0.004); no differences were observed for other side effects. We observed statistically similar pain intensity ratings, in the setting of significantly lowered opioid doses among the post-intervention group prior to discharge. Pharmacist-led inpatient opioid de-escalation is effective, does not increase pain intensity, and reduces constipation. Hospitals should explore the viability of extending pharmacist-led opioid de-escalation to other surgical patients and following hospital discharge, aiming for opioid cessation.

Sociodemographic Characteristics and the Stigmatization of Prescription Opioid Addiction.

The aim of this study was to investigate the relationship between participants' sociodemographic characteristics and the degree to which they stigmatize people with an opioid addiction. A randomized, between-subjects case vignette study (n = 2605) was conducted with a nationwide online survey. We investigated how the stigmatization toward a hypothetical individual who misused prescription opioids differed across participants' sociodemographic factors (ie, age, gender, education, race, and income). Our results showed that study participants who were male, white, low-income, college graduates, and younger rated the hypothetical individual with an opioid addiction with lower stigma. In addition, we showed that participant gender moderated the relationship between information given about initiation of opioid use (received prescription opioids from a doctor vs took prescription opioids from a friend) and opioid stigma perceptions. Our results support previous findings that stigmatizing attitudes towards drug use vary across participant sociodemographic characteristics. The findings from our study provide a better understanding of how stigmatizing attitudes towards prescription opioid use differ across sociodemographic characteristics and can serve to improve negative perceptions of those with an opioid addiction.

Evolution of Analgesic Tolerance and Opioid-Induced Hyperalgesia Over 6 Months: Double-Blind Randomized Trial Incorporating Experimental Pain Models

Contributors to the ongoing epidemic of prescription opioid abuse, addiction, and death include opioid tolerance, withdrawal symptoms, and possibly opioid-induced hyperalgesia (OIH). Thirty stable chronic nonmalignant pain patients entered a 6-month long, randomized, double-blind, dose-response, 2-center trial of the potent opioid levorphanol, conducted over a decade ago during an era of permissive opioid prescribing. Eleven were taking no opioids at study entry and eleven were taking between 35 and 122 morphine equivalents. Five weeks titration preceded twenty weeks stable dosing. Tolerance and OIH were inferred individually based on chronic pain ratings, brief pain inventory scores, and results of the brief thermal sensitization model at 5 opioid dosing sessions.Seventeen patients completed. The average final daily opioid dose was 132; range 14 to 300; average addition 105 morphine equivalents. After observed dosing, the brief thermal sensitization area of hyperalgesia changed minimally but the painfulness of skin heating was reduced. Weekly 0 to 100 visual analog scale pain ratings (average 64 at study entry, 48 at end titration, 45 at end stable dosing) decreased a median 19%, but 8 completed with higher visual analog scale ratings. Three completers had evidence of both tolerance and hyperalgesia. A fully-powered trial similar to this feasibility study is ethically questionable. A large-scale pragmatic trial is more realistic. Trial RegistrationNCT00275249 Evolution of Analgesic Tolerance With Opioids PerspectiveA double-blind, 6-month, high-dose opioid feasibility trial, completed years ago, provides critically important data for clinically defining analgesic tolerance and OIH. Overall benefit was small, and 18% of patients had evidence of both tolerance and OIH. Future work requires a different approach than a classic randomized controlled trial design.

Reducing Opioid Bias is Necessary (ROBIN): An Educational Program to Reduce Addiction Stigma.

Prescription opioid and heroin use and addiction is a local, national, and worldwide epidemic plaguing over 11 million people. Attitudes toward substance use among the general public were highlighted as an area that needs to be further investigated and addressed. The Reducing Opioid Bias is Necessary (ROBIN) educational project was developed and presented to 21 participants as a one-time, 4-hour pretest and posttest design that included theoretical background, short videos, a documentary film, and writings from individuals and community members affected by opioid use disorder (OUD). Participants were assessed on their familiarity, attitudes, and effectiveness of the ROBIN educational program on their perceptions toward persons with OUD. Quantitative data collection included demographic information, level of familiarity, the Attitudes to Mental Illness Questionnaire, and the Drug and Drug Problems Perceptions Questionnaire. Qualitative measures included reflective writing and focus group discussion 2 months after the program. Quantitative measures were completed using descriptive statistics, and qualitative data were sorted for common themes. Spearman's rank rho of 0.947 (p < .05) indicated less familiarity and more bias attitudes toward people with OUD. The paired-sample t test on the Drug and Drug Problems Perceptions Questionnaire indicated a significant decrease in participant bias in the posttest (M = 59.33, SD = 16.48) when compared with the pretest (M = 74.86, SD = 19.38), t(20) = 5.17, p = .00002. The qualitative data from the written reflection and focus group indicated strong changes in participants' overall understanding, empathy, and desire for promoting the educational program. The ROBIN program can reduce bias among community and healthcare subjects. Limitations to the study should be addressed in future research on this topic.

Prefrontal GABA and glutamate levels correlate with impulsivity and cognitive function of prescription opioid addicts: A 1 H-magnetic resonance spectroscopy study.

Prescription opioids are psychoactive substances that can elicit many neuropsychological effects. There are no studies that directly demonstrate the effects of prescription opioid addiction (POA) on the human brain. This study aimed to quantify γ-aminobutyric acid (GABA) and glutamate (Glu) levels in the prefrontal cortex (PFC) of POA patients using proton magnetic resonance spectroscopy (1 H-MRS), and to explore their association with impulsive behavior and cognitive impairment. Thirty-five patients with a definitive clinical diagnosis of codeine-containing cough syrup dependence and 35 matched healthy controls underwent neuropsychological assessments, namely the Barratt Impulsiveness Scale (BIS-11) and the Montreal Cognitive Assessment Scale (MoCA). Point-resolved spectroscopy was performed to detect GABA and glutamate within the medial PFC, and the corresponding levels were estimated using jMRUI and corrected for fraction of cerebrospinal fluid in the 1 H-MRS voxel. The difference in metabolite levels between groups and the correlation between metabolite levels and psychometric scores in patients were analyzed statistically. The peak level predominantly consisting of GABA with a relatively small influence of other chemicals (GABA+) was lower and that of glutamate was higher in the PFC of POA patients than in healthy controls. GABA+ levels correlated negatively with BIS-11 scores but correlated positively with MoCA scores. In contrast, glutamate levels showed a positive correlation with BIS-11 scores but no significant correlation with MoCA scores. The quantitative in vivo measurement of GABA and glutamate levels in the PFC by 1 H-MRS could be a reliable way to evaluate impulsivity and cognitive function of POA.

Effects of craving on opioid use are attenuated after pain coping counseling in adults with chronic pain and prescription opioid addiction.

Risk for prescription opioid addiction is an endemic public health concern, especially for adults with chronic pain. This study examined craving as a mediator from pain to opioid use outcomes during prescription opioid addiction treatment and tested whether counseling in pain coping skills moderated the effects of craving on treatment outcomes. Secondary analysis on a sample (N = 148) randomized to standard or enhanced counseling for 12 weeks with adjunct opioid maintenance medication. Multilevel analyses examined mediated effects between weekly pain, craving, and opioid use, and tested the interaction between craving and a counseling module on pain coping skills. Greater pain predicted greater craving (β = 0.25, p < .001), which predicted next-week opioid use (β = 0.17, p < .001). A statistically significant indirect effect of craving (β = 0.04, 95% CI [0.02, 0.06]) mediated 95% of the total effect from pain to opioid use. A significant interaction (b = -0.22, p < .01) revealed that after receiving the pain coping module, the association between craving and next-week opioid use was reduced, with greater exposure to the module associated with stronger effects (b = -0.12, p < .01). More severe pain predicts greater opioid use due to the association between pain and cravings. Pain coping skills counseling suppressed the association between cravings and opioid use. For adults with chronic pain receiving treatment for prescription opioid addiction, interventions that address cravings through behavioral pain coping skills may be crucial for achieving optimal treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Occupational Therapists' Role for Preventing Prescribed Opioid Addiction in Older Adults

To suggest the aging adaption intervention is also needed for preventing older adults’ prescription opioid addiction.

Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns.

Drug overdose was the leading cause of injury and death in 2013, with drug misuse and abuse causing approximately 2.5 million emergency department (ED) visits in 2011. The Electronic Prescriptions for Controlled Substances (EPCS) program was created with the goal of decreasing rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to "doctor-shop" and alter prescriptions. In this study, we describe the opioid-prescribing patterns of emergency physicians after the introduction of the New York State EPCS mandate. We conducted a retrospective, single-center, descriptive study with a pre-/post-test design. The pre-implementation period used for comparison was April 1-July 31, 2015 and the post-implementation period was April 1-July 31, 2016. All ED discharge prescriptions for opioid medications prior to and after the initiation of New York State EPCS were identified. During the pre-implementation study period, 22,221 patient visits were identified with 1366 patients receiving an opioid prescription. During the post-implementation study period, 22,405 patient visits were identified with 642 patients receiving an opioid prescription. This represented an absolute decrease of 724 (53%) opioid prescriptions (p<0.0001), which is an absolute difference of 2.3% (95% confidence interval 2.0-2.6%). There was a significant decline in the overall number of opioid prescriptions after implementation of the New York EPCS mandate.

In Case You Haven't Heard…

Remember the MAT‐PDOA (Medication Assisted Treatment–Prescription Drug and Opioid Addiction) grant program from the Substance Abuse and Mental Health Services Administration? It ended last September. Robert Ashford, a recovery advocate who is managing editor of the new Journal of Recovery Science, came in after the first year and headed up technical assistance (TA) for it. There were so many challenges to getting people educated about treatment. Twenty‐eight single state authorities (SSAs) received the funding. Some SSAs opted to make opioid treatment programs (OTPs) subrecipients under statewide grants, and many office‐based opioid treatment (OBOT) programs received funding. Ashford recalled that 60 to 80 percent of the training was on enhancing psychosocial reports, with the additional training on best practices for prescribing and induction. In some states, patients were titrated off their buprenorphine or methadone if they took benzodiazepines, and in some, they were refused induction altogether. “This wasn't always coming from the SSA; it was coming from individual lower‐level providers,” he said. Punishing people for using drugs by reducing their take‐home doses of methadone or buprenorphine is bad, he said. “But kicking people out of treatment is worse,” he said. The worst culprits were not the OTPs — they were the OBOT programs, or the Federally Qualified Health Centers (FQHCs) who contracted with them, he said. “There was a lot more sense that clients could be removed from the FQHC programs for noncompliance,” he said. “Sometimes, they would be discharged to a higher level of care. It wasn't a regulation, but many providers were doing it.” This raises questions about the kind of TA that is going to STR and SOR grantees and subrecipients. MAT‐PDOA grants were minuscule by comparison — $25,000. Some states, like Missouri, spent down their STR money quickly, with medication‐first, mainly buprenorphine. Missouri got a lot of patients into treatment by not requiring counseling. “As soon as you require, say, nine hours of clinical engagement, and they want to get reimbursed for it…,” he said, trailing off. “We have a lot of people who aren't getting the medication they need.” This is the purpose of TA: educating providers. But it doesn't always work. “We can educate all day long, but some of these philosophies are too deeply rooted,” he said.

Mental health and opioid addiction comorbidities among chronic pain patients

ObjectiveAssessing mental health and opioid addiction comorbidities among chronic pain patients using a large longitudinal clinical, operational, and laboratory data set.IntroductionThe National Institute for Drug Abuse Report, Common Comorbidities with Substance Use Disorders, states there are “many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.”(1) Prescription opioids are amongst the most commonly used drugs that lead to illicit drug use.(2)Much of the data about the starting point of the prescription opioid addiction is in the patient health history and is recorded within the provider electronic health record and administrative systems.DescriptionThere are a variety of addiction and misuse risk screening tools available and selecting appropriate tools screening can be confusing for providers. Examples of common screening tools: Opioid Abuse Risk Screener (OARS), Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP), Current Opioid Misuse Measure (COMM), Diagnosis, Intractability, Risk, and Efficacy (DIRE). These opioid risk screening tools are interview based and vary in how they survey for psychosocial factors. The screening tools are useful, but are meant only to alert the provider to conduct further investigation.(3)Understanding how the comorbidities recorded in the patient’s clinical interactions may help improve risk assessment investigations and ongoing monitoring programs. Studying the chronic pain patients’ longitudinal clinical, operational, and laboratory records provides the basis for better study controls than those using population based on emergency department admission and mortality events.MethodsThe analysis leverages IBM's Explorys electronic health record (EHR) data, a large integrated source of real world clinical, operational and lab data across 39 large integrated delivery networks that span the continuum of care. In addition to demographic characteristics of drug abusers, we will describe common comorbidities of selected mental health diagnoses, examine coding-related issues, distinguish chronic and episodic addiction and look for regional differences due to state/local level prescribing training and provider addiction awareness.How the Moderator Intends to Engage the Audience in Discussions on the TopicPromote the event through interatction with the @ISDS twitter account and #ISDS19 hashtag.Solicit question for presenters-panelists through social media before the briefing, and meet with presenters before the event to tune the presenations to areas of interest.Conduct a demographic poll of the audience to get them engaged. Ask audience to stand to show their organization-role. e.g. state-local public health, provider, vendor. This helps the presenters adapt to the audience profile.After each panelist speaks, have the panelist ask a question to the audience about a lingering question that arose during the research. Limit the audience to ~1 minute to answer. Allow panelists to ask a few more questions if the process is working, but limit to overall event time schedule.Finish with Q&amp;A from the audience.