Rates Of Opioid Use Disorder Research Articles

Opioid use disorder in the active service: Implications for intervention.

Military service members experience occupational-specific injuries that may result in chronic pain and comorbid behavioral health concerns. Data from the Defense Medical Epidemiology Database was used to examine opioid use disorder (OUD) diagnoses between 2016 and 2021. Statistical analysis calculated incidence rates and diagnostic variability by demographic density. The average incidence rate of OUD was 6.1 (per 10,000) and declined by 34% between 2016 and 2021. Diagnoses were most frequently made in service members classified as male, married, white, aged 30-39, junior enlisted, and serving in the Army. To our knowledge, this is the first study to examine the incidence rates of OUD among active duty personnel.

Racial disparities in opioid use disorder and its treatment: A review and commentary on the literature

Despite public interventions, the rate of opioid use disorder (OUD) continues to rise. In this focused review of the existing literature, the authors describe how increases in OUD, as well as opioid-related deaths, have occurred disproportionately among people of color. Black patients in particular are dying of overdose at an increased rate, however are less likely to receive any treatment for OUD. Additionally, Black patients are less likely to receive buprenorphine than White patients, but more likely to receive methadone. Potential causes of these disparities are discussed, as well as the impact of the COVID-19 pandemic, and the successes of several pilot programs.

Opioid Use Disorder Among the Economically Disadvantaged in the Rural South.

This study aimed to identify county-level hotspots and associated risk factors for opioid use disorder (OUD) in the state of Alabama. Using 2015 to 2019 Alabama Medicaid administrative claims data, Medicaid recipients with OUD were identified. We performed local indicators of spatial association analysis to identify hotspots of OUD rates. Using logistic regression, we examined county-level social determinants of health associated with county OUD hotspots. There was a +14.13% percentage change from 2015 to 2019. The county level local indicators of spatial association analysis found that 5 counties in the northwestern part of Alabama remained "hotspots" throughout the entire study period. Results of the logistic regression model showed that location within the Appalachian region was an independent predictor of high OUD rates (b = 2.58; adjusted odds ratio, 13.27, P = 0.04). The high rates of OUD may reflect the economic distress and lack of access to resources germane to the Appalachian region in Alabama.

Buprenorphine Dispensing Among Youth Aged ≤19 Years in the United States: 2015-2020.

Opioid related overdose among adolescents and young adults in the United States is rising. Medications for opioid use disorder (MOUD), including buprenorphine can reduce the risk of overdose, however they are underutilized. A better understanding of buprenorphine prescribing to youth will help inform interventions to expand access to treatment. We used IQVIA data to examine buprenorphine dispensing trends among youth aged ≤19 years from 2015 to 2020. Dispensing was examined by prescriber specialty, age, and sex. Data were weighted to provide national estimates. The rate of buprenorphine dispensed to youth decreased 25% over the study period, from 0.84 to 0.63 prescriptions per 1000 youth per year. The proportion of youth dispensed buprenorphine also decreased 45%, from 7.6 to 4.2 persons per 100 000 per year. Over the same time, the proportion of adults aged ≥20 years dispensed buprenorphine increased 47%, from 378 to 593 persons per 100 000. Differences in dispensing by sex and temporal trends were also noted. Pediatricians accounted for less-than 2% of all prescriptions dispensed. Buprenorphine dispensing to youth is low and declining in recent years. Given rates of opioid use disorder among youth, these findings suggest that many youth who could benefit from MOUD are not receiving it. Pediatricians could play a role in expanding access to MOUD for this high-risk population. Efforts to expand access to MOUD for adolescents could include improving training in opioid use disorder treatment of pediatricians and encouraging all clinicians who care for adolescents and young adults to obtain waivers to prescribe buprenorphine for MOUD.

The opioid epidemic.

An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.

The prevalence of opioid use disorder in Kentucky’s counties: A two-year multi-sample capture-recapture analysis

BackgroundKentucky has one of the highest opioid overdose mortality rates in the United States. Accurate estimates of people with opioid use disorder (OUD) are critical to plan for the scope of interventions required to reduce overdose and opioid misuse. Commonly used household surveys are known to underestimate OUD at the state-level and do not provide county-level estimates. MethodsWe performed a multi-sample capture-recapture analysis to estimate OUD prevalence in Kentucky in 2018 and 2019. We utilized four statewide datasets that were linked at the individual level: 1) Registry of Vital Statistics, 2) Emergency Medical Services (EMS), 3) Kentucky’s Prescription Drug Monitoring Program (PDMP), and 4) Kentucky Medicaid. We included persons aged 18–64 years who resided in Kentucky between 2018 and 2019. We identified individuals with administrative data consistent with OUD in each of the datasets, including a fatal opioid-involved overdose (Vital Statistics), EMS runs for suspected opioid overdose, receipt of buprenorphine for OUD treatment (PDMP), or Medicaid claims for OUD. Observed and estimated counts of OUD cases and prevalence of OUD among the adult population in Kentucky. ResultsThe estimated statewide OUD prevalence was 5.5 % and 5.9 % for 2018 and 2019, respectively, ranging from 1.3 % to 17.7 % across Kentucky counties. As expected, counties with the highest OUD rates were Appalachian counties (eastern area) of the state. ConclusionsOur analysis reveals a substantially larger proportion of KY residents have OUD than previously estimated. Our approach offers a model for states needing county-level estimates of OUD.

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Age-related Impact of the CDC's 2016 Guideline for Prescribing Opioids for Chronic Pain on Opioid Prescribing Levels and Health Outcomes among the Patients with Sickle Cell Disease

INTRODUCTON: The Guideline for Prescribing Opioids for Chronic Pain instituted by the Centers for Disease Control and Prevention (CDC) in 2016 has been found to be effective in decreasing opioid use. However, this decrease has included patient groups that fall outside of the intended scope of the guideline such as patients with sickle cell disease (SCD) who already experience difficulty accessing needed pain management. The aim of this study was to evaluate the effect of CDC's 2016 Opioid Guideline on opioid prescribing level and health outcomes among patients with SCD. Because patients with SCD may experience different symptoms and complications as they age, the consequences were assessed by age group. METHODS: This retrospective cohort study employed an interrupted time series analysis using the IBM® MarketScan® Commercial Database from 1/1/2011 to 12/31/2019. The study population included individuals ≥1 years old who had ≥3 SCD diagnosis codes within 5 years and had no cancer diagnosis. Monthly-measured opioid prescribing levels included: opioid prescription rate, mean daily morphine milligram equivalents (MME) per prescription, and mean number of days supplied per prescription. Health outcomes included: monthly rates of vaso-occlusive crisis (VOC)-related emergency department (ED) visits and hospitalizations, and monthly rates of healthcare facility visits related to opioid use disorder (OUD), depression, and anxiety. Segmented regressions (breakpoint: March 2016) were conducted for all outcomes to compare trends before and after the guideline release. RESULTS: The study included 14,979 SCD patients (1-65 years old, mean [SD] age = 25.9 [16.9], 56.9% female). After the guideline release, compared to the pre-guideline period, 1) children (1-12 years; N=3,916 [26.4%]) experienced significant decreases in the opioid prescription rate (-0.09 prescription/100 person-month, p=0.001), mean daily MME per prescription (-1.02 MME/month, p=0.001) and the number of days supplied per prescription (-0.02 days/month, p=0.009), but a significant increase in the VOC-related hospitalization rate (+0.11 hospitalizations/100 person-month, p=0.021); 2) adolescents (13-18 years; N=1,782 [11.9%]) experienced significant decreases in the mean daily MME per prescription (-8.48 MME/month, p=0.012) and the number of days supplied (-0.03 days/month, p=0.003), but an increase in the VOC-related hospitalization rate (+0.21 hospitalizations/100 person-month, p=0.003); 3) young adults (19-27 years; N=2,599 [17.4%]) experienced a significant decrease in the number of days supply (-0.04 days/month, P<0.001), and no significant change in the VOC-related outcomes; 4) adults 28-45 years (N=4,293 [28.7%]) experienced significant decreases in opioid prescription rate (-0.48 prescription/100 person-month, p<0.001), mean daily MME per prescription (-21.19 MME/month, p<0.001), and the number of days supplied (-0.06 days/month, p<0.001), but significant increases in VOC-related ED visit rate (+0.13 visits/month, p<0.001) and hospitalization rate (+0.30 hospitalizations/100 person-month, p<0.001); and 5) adults 46-65 years (N=2,344 [15.6%]) experienced significant decreases in the opioid prescription rate (-0.55 prescription/100 person-month, p<0.001), mean daily MME per prescription (-3.68 MME/month, p<0.001), the number of days supplied (-0.03 days/month, p=0.003), and VOC-related ED visit rate (-0.1 visits/100 person-months, p=0.023). OUD-related healthcare facility visits did not differ in either pediatric (1-18 years) or adult (19-65 years) patients before vs. after the guideline release. Depression-related visits increased significantly (+0.09 visits/100 person-months, p=0.002) among adult patients while anxiety-related visits decreased significantly (-0.05 visits/100 person-months, p=0.023) among the same population post-guideline compared to the pre-guideline periods. CONCLUSIONS: The CDC guideline release was associated with a decrease in opioid prescribing levels across all age groups even though the guideline was intended only for the adult population. Overall, pain-related health outcomes were negatively impacted by the guideline: older age groups with increased ED visits and younger age groups with increased hospitalizations, while there were no decreases in the rate of OUD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Cost Analysis of Buprenorphine Extended-Release Injection Versus Sublingual Buprenorphine/Naloxone Tablets in a Correctional Setting.

Incarcerated clients experience high rates of opioid use disorder and overdose. It is critical that opioid agonist treatment (OAT) is provided in correctional facilities. However, few receive OAT due to concerns about diversion, misuse, and safety. Buprenorphine extended-release (BUP-XR), a monthly buprenorphine depot injection, could be especially advantageous in the correctional setting as it can prevent diversion and misuse, saving staff resources and time. An injection of BUP-XR is costly compared with a monthly supply of buprenorphine/naloxone (BUP/NX) tablets. We demonstrate that when factoring in the added costs of medication preparation, administration, monitoring, and personnel, it is more economical to provide BUP-XR than BUP/NX. Other facilities, by utilizing our cost breakdown, can determine whether BUP-XR is economically advantageous at their own facility.

S57 Opioid Use Patterns in Patients With Chronic Pancreatitis and Concomitant Mental Illness: A Propensity-Matched Cohort Analysis

Introduction: Chronic pancreatitis (CP) is commonly associated with pain that can be difficult to manage. This can result in high rates of healthcare utilization and chronic opioid use. Many patients with CP have concomitant mental health disorders (MHDs) which may be associated with greater disease burden. Genetic links between CP-associated pain and MHDs have been described. Given the current opioid epidemic trend, it is critical to assess whether concomitant MHDs affect opioid usage patterns in patients with CP. The aim of this study was to identify whether patients with coexisting CP and mental illness have higher opioid usage compared to their counterparts without any diagnosed mental illness. Methods: This was a large cohort study using TriNetX, which links anonymized inpatient and outpatient electronic health record data from more than 80,000,000 patients. We created two cohorts: patients with chronic pancreatitis from 2010-2020 with and without co-existing mental health disorders. The cohorts underwent 1:1 propensity matching based on age, sex, race, ethnicity, and alcohol and nicotine dependence. The primary outcome was a new diagnosis of opioid use disorder at 3 years after the first diagnosis of CP. Secondary outcomes at 3 years included any opioid use, long-term opioid use, opioid overdose, and all-cause mortality. Results: After matching, two cohorts of 48,960 patients remained for analysis. All covariates were well-matched. In the MHD cohort, 51.6% had mood /affective disorders (F30-39), 49.5% had anxiety (F40-48), and 5.9% had non-mood psychotic (F20-29). At 3 years, the MHD cohort had a near 5-fold increase in the rate of opioid use disorder (7.1% vs 1.6%, OR =4.8, 95% CI 4.4-5.2). The MHD cohort also had significantly higher rates of any opiate use,(OR 1.5, 95% CI 1.4-1.5), long-term opioid use (OR 2.2, 95% CI 2.1-2.3), opioid overdose (OR 4.2, 95% CI 3.7-4.6), and all-cause mortality (OR 1.3, 95% CI 1.2-1.3) (Table). Conclusion: In propensity-matched cohorts, patients with CP and concomitant MHDs had higher rates of opioid use disorder, long-term use, overdose, and all-cause mortality compared with those without MHDs. As CP-related pain has been shown to be augmented in patients with MHDs – specifically depression – identifying this opioid risk is critical in the management of these patients. Table 1. - Measures of Association. CP w/ MHD: chronic pancreatitis with mental health disorder cohort, CP w/o MHD: chronic pancreatitis without mental health disorder cohort Outcome Patients with outcome (% risk), CP w/ MHD Patients with outcome (% risk), CP w/o MHD Odds Ratio (OR) 95% Confidence Interval (CI) p-value Opioid use disorder (dependence or abuse) 3,467 (7.1%) 767 (1.6%) 4.8 4.4-5.2 < 0.0001 Opiate use (ever) 13,846 (28.3%) 10,310 (21.1%) 1.5 1.4-1.5 < 0.0001 Adverse opiate event 592 (1.2%) 158 (0.3%) 3.8 1.4-1.5 < 0.0001 Opiate overdose 1,809 (3.7%) 448 (0.9%) 4.2 3.7-4.6 < 0.0001 Long-term opiate analgesic use 9,896 (20.2%) 5,046 (10.3%) 2.2 2.1-2.3 < 0.0001 All-cause mortality 6,958 (14.4%) 5,702 (11.8%) 1.3 1.2-1.3 < 0.0001

Examining Geographic Variation of Opioid Use Disorder Encounters in the USA.

The objectives were (1) to characterize patient encounters of opioid use disorder (OUD) using Health Facts® database; and (2) to identify geographic variation, patient characteristics, and facility characteristics impacting patients' reduced OUD encounters over time. Patient encounters were included if the patient (1) was 18years old or greater; (2) had an index encounter; (3) survived at least 30days after the discharge. The OUD encounter was based on ICD-10 codes. The date at which a patient first had an OUD encounter was the index date. For the first objective, OUD encounters were described according to patient characteristics, facility characteristics, and geographic variation. Patient characteristics were age, gender, marital status, race, health insurance coverage, discharge disposition, and patient type. Facility characteristics were care setting, medical specialty, census region, census division, urban vs. rural, acute vs. non-acute, and teaching hospital status. For the second objective, patients were examined 1year prior to through 1year after the index date. A logistic regression was used to determine the likelihood of reduced OUD encounters over time, conditional upon geographic variation, patient characteristics, and facility characteristics. A total of 265,643 OUD encounters were identified. East South Central was associated with the highest population-based rate of OUD among nine census divisions. In the logistic regression (n = 10,762), discharged to home, outpatient, emergency room, psychiatry, East North Central, West North Central, and urban areas were significant positive predictors for reduced OUD encounters over time, whereas age and Mountain were significant negative predictors. East South Central was associated with the highest population-based rate of OUD. Compared with East South Central, East North Central and West North Central had a significantly positive impact on fewer encounters of OUD over time.

153. In opioid naïve patients undergoing thoracolumbar spinal fusions, smoking increases odds for postoperative opioid use disorder

<h3>BACKGROUND CONTEXT</h3> Opioids are commonly used for management of pain following thoracolumbar spinal fusions. Numerous studies have identified patient and surgical risk factors for opioid dependence including preoperative opioid use, affective disorders, and invasiveness of surgery. However, the association of smoking and opioid use disorder, specifically in preoperative opioid naïve patients, has not been well characterized in spine literature. <h3>PURPOSE</h3> The purpose of this study is to characterize the risk for opioid use disorder (per DSM-V) after thoracolumbar spinal fusions among active smokers who were opioid naïve prior to surgery. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective analysis using the Mariner-53 database (administrative database containing 53 million participants). <h3>PATIENT SAMPLE</h3> We sampled patients (age > 18 years) who were opioid naïve preoperatively and underwent thoracolumbar fusions with and without a history of smoking, based on ICD-9 and ICD-10 diagnostic codes. <h3>OUTCOME MEASURES</h3> Opioid utilization and rates of opioid use disorder within 6 months of surgery were measured and compared. <h3>METHODS</h3> A total of 30,856 patients were identified, and exact 1:1 matching based on baseline patient demographics, procedure type (single vs multi-level fusion), affective disorders (depression, anxiety), social determinants of health and comorbidities were used to create two groups with identical covariates: smoking group (n=2,960) and nonsmoking group (n=2,960). <h3>RESULTS</h3> Baseline characteristics were similar between both groups. Postoperatively, opioid utilization rates at 6 months were similar between both groups (56.8% vs 57.4%, p=0.65). However, opioid naïve patients who were active smokers had higher odds of developing opioid use disorder postoperatively compared to nonsmokers (OR 4.18, 95% CI: 3.20 - 5.46). <h3>CONCLUSIONS</h3> Active smokers who are opioid naïve prior to thoracolumbar spinal fusion are 4 times more likely to develop opioid use disorder postoperatively compared to nonsmokers. Further multi-institutional prospective studies are needed to corroborate our findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A role for the circadian transcription factor NPAS2 in the progressive loss of non-rapid eye movement sleep and increased arousal during fentanyl withdrawal in male mice.

Synthetic opioids like fentanyl are contributing to the rise in rates of opioid use disorder and drug overdose deaths. Sleep dysfunction and circadian rhythm disruption may worsen during opioid withdrawal and persist during abstinence. Severe and persistent sleep and circadian alterations are putative factors in opioid craving and relapse. However, very little is known about the impact of fentanyl on sleep architecture and sleep-wake cycles, particularly opioid withdrawal. Further, circadian rhythms regulate sleep-wake cycles, and the circadian transcription factor, neuronal PAS domain 2 (NPAS2) is involved in the modulation of sleep architecture and drug reward. Here, we investigate the role of NPAS2 in fentanyl-induced sleep alterations. To determine the effect of fentanyl administration and withdrawal on sleep architecture, and the role of NPAS2 as a factor in fentanyl-induced sleep changes. Electroencephalography (EEG) and electromyography (EMG) was used to measure non-rapid eye movement sleep (NREMS) and rapid eye movement sleep (REMS) at baseline and following acute and chronic fentanyl administration in wild-type and NPAS2-deficient male mice. Acute and chronic administration of fentanyl led to increased wake and arousal in both wild-type and NPAS2-deficient mice, an effect that was more pronounced in NPAS2-deficient mice. Chronic fentanyl administration led to decreased NREMS, which persisted during withdrawal, progressively decreasing from day 1 to 4 of withdrawal. The impact of fentanyl on NREMS and arousal was more pronounced in NPAS2-deficient mice. Chronic fentanyl disrupts NREMS, leading to a progressive loss of NREMS during subsequent days of withdrawal. Loss of NPAS2 exacerbates the impact of fentanyl on sleep and wake, revealing a potential role for the circadian transcription factor in opioid-induced sleep changes.

Emerging Disparities in the Placement of Law Enforcement-Based Treatment Referral and Recovery Programs

Rising rates of opioid use disorder, overdoses, and opioid-related criminal offenses have prompted U.S. law enforcement agencies to adopt alternatives to arrest and formal criminal processing. Police departments frequently implement treatment referral programs and claim an affiliation with the Police Assisted Addiction and Recovery Initiative (PAARI). Although expanding to hundreds of agencies, PAARI efforts may not be equally distributed across communities, raising concerns about access to non-arrest diversion and increasing disparities in the criminal processing of drug-related offenses. This study compares the characteristics and geographic placement of law enforcement agencies with and without PAARI programs in 29 states. Law enforcement agencies situated in communities with lower rates of poverty and smaller Black populations have lower odds of having a PAARI program. Agencies based in counties with more overdose deaths and greater unmet treatment needs have increased odds of deflection programing. This placement of PAARI programs reflects broader inequalities in criminal justice and health. More advantaged, predominantly white communities benefit from diversionary programs while fewer alternatives to formal criminal processing exist for lower-income areas and communities of color. Additional research should explore these growing disparities in the deployment of law enforcement-based treatment referral programs and their consequences on drug law enforcement.

Medications for Opioid Use Disorder During Incarceration.

The opioid epidemic has had a devastating impact on incarcerated individuals, with significantly higher rates of opioid use disorder (OUD) and risk of opioid overdose than the general public. Medications for OUD (MOUDs) are currently used with an interdisciplinary approach with good outcomes, but MOUD-approved medications are grossly underutilized in this population. Post incarceration, individuals without MOUDs have lessened their opioid tolerance after abstinence, resulting in staggering death rates or reincarceration from OUD. This article will describe the barriers within the criminal justice system that impede the provision of appropriate treatment for OUD. A structural intervention approach that addresses the barriers will be discussed, as well as patient outcomes associated with MOUDs, and recommendations for education, practice, and future research.

Practice Patterns in Prescribing Buprenorphine in the New Jersey Department of Corrections.

Inmates have high rates of opioid use disorder and are at risk for morbidity and mortality both during incarceration and after release. We conducted a retrospective chart review to assess prescribers' fidelity to the New Jersey Department of Corrections practice guideline for prescribing maintenance or prerelease buprenorphine. We compared the entire group of inmates prescribed buprenorphine at the conclusion of 2019 (n = 875) with a sample of inmates diagnosed with opioid use disorder (OUD) but not prescribed buprenorphine (n = 396) and a sample of inmates not diagnosed with OUD (n = 367). Inmates on buprenorphine were more likely to be male, White, in treatment for a mental illness, have higher scores on the Texas Christian University Drug Screen, be closer to release, have multiple substance use disorder comorbidities, and have more substance-related disciplinary charges. They were most often prescribed buprenorphine-naloxone strips, with doses ranging from 2 mg to 12 mg, and a median dose of 8 mg. Racial disparities in prescribing were observed, though the reasons for this are likely multifactorial, and research from the community has shown similar findings. We propose strategies to reduce these differences, including staff education, patient education, and quality improvement initiatives.

Opioid misuse viewed through person and place in the rural West.

This article overviews the current statistics and factors related to increased rates of opioid use disorder (OUD) in rural areas, uncovering factors that may contribute to increased vulnerability to opioid overdose. We qualitatively review opinions, feelings, and thoughts surrounding this issue in rural areas of Utah, analyzing participant stories in reference to three themes through qualitative interviews, including the solitude of addiction, the beguiling strength of addiction, and one way out of addiction. In 2018, three focus groups were convened with 25 individuals from the rural area. Participants either currently or formerly (selfreported substance free for 6 months or more) experienced OUD with prescription opioids and heroin, or were family members of individuals who currently and formerly experienced OUD. These focus groups addressed current issues in OUDs in a rural Utah community related to person, place, and time. Following the focus groups, six individuals were invited to participate in semi-structured interviews. In-depth, semi-structured interviews queried individual experiences through a phenomenological approach, using a moderator guide with queries focused on identified themes related to the solitude, the intensity, and the difficulty escaping substance use disorder (SUD). Methodology included training community scholars with lived experience and member-checking to ensure phenomenological emphasis. Our qualitative reviews of the experience of OUD and SUD in rural Utah discussed the relevance and the nuance of the three identified themes. The interviewee statements further underscore the solitude, intensity, and difficulty of an individual's journey through SUD, the all-consuming nature of OUD, and the trouble that these factors cause in rural recovery. We conclude that even during difficult situations in the rural experience with the opioid crisis, hope persists. OUD support in rurality may differ from the expected urban experience and include more coordination with criminal justice workers. Rural Americans have insights to share that could help turn the tide of this crisis.

A randomized clinical trial of strengths-based case management to link emergency department patients to opioid use disorder treatment

BackgroundDespite the existence of effective pharmacotherapies, rates of opioid use disorder and opioid overdose deaths have continued to increase. Emergency department (ED) visits provide an important opportunity to engage in treatment patients with untreated opioid use disorder (OUD). Case management implemented in other settings is effective in linking those with opioid and other drug use disorders to longer-term treatment, but research has not established its efficacy in the ED. Here we report the results of a trial of Strengths-Based Case Management (SBCM) for people with untreated OUD who are identified during ED visits, with the primary goal of linking them to pharmacologic treatment. MethodsThe study identified patients with untreated OUD during a treatment episode at a large urban ED. The study randomly assigned three hundred participants in 1:1 ratio to receive SBCM or screening, assessment, and referral (SAR) to OUD treatment. Those assigned to SBCM received up to six sessions of SBCM with the primary goal of linkage to treatment. Primary outcomes were initiation of treatment and engagement in pharmacotherapy for OUD. The study defined a “successful outcome” for opioid use as a 3-month urine negative for illicit opioids and no more than 2 days of self-reported opioid misuse in the 4 weeks prior to the 3-month interview. ResultsRates of treatment initiation were not significantly different in the SBCM and SAR groups (57.4% vs. 49.7%, respectively, p > 0.05), nor did engagement in pharmacotherapy differ significantly between groups (p > 0.05). During the 90 days following the index ED visit, SBCM and SAR participants engaged in pharmacotherapy for a mean of 21.8% (SD = 35.1%) versus 17.7% (SD = 31.0%) of days, respectively. Likewise, no significant difference occurred between groups in rates of “successful opioid use outcome” as defined a priori (p > 0.05), although self-reported opioid use over the entire 6-month follow-up period was lower in the SBCM group (10.8 vs. 13.4 days/month, p = 0.042). ConclusionsSBCM-ED did not improve OUD treatment initiation and engagement in this ED study. Although these findings do not necessarily generalize to all EDs, other approaches, such as direct referral or initiation of treatment in the ED, have considerable empirical support, and should be implemented where they are feasible.

The High Cost of Opioid Use in Pregnancy

Background: Numerous investigators have highlighted the need to integrate opioid use disorder (OUD) treatment with maternity care. Since data first became available in 2014, Montgomery County (Ohio) has experienced the highest rates of OUD and unintended opioid overdose deaths in the state. This paper examines the demographics and costs of medical treatment for pregnant women with OUD and their newborns with prenatal exposure to opioids (PEO). Methods: The study involved a retrospective records review of all newborns born between May 1, 2016, and April 30, 2017, at a large, urban medical center. Newborns with PEO were matched with a control group by mother's type of insurance, race/ethnicity, method of birth, and maternal parity. Results: Establishing which of the pregnant women should be diagnosed with OUD and be included in the study group was inordinately challenging. Ultimately, of the 3841 infants birthed during the study period, 131 (3.4%) were iden-tified as being born to mothers with OUD. Significantly more mothers with OUD were White and on Medicaid. Only 25 (19.2%) mothers with OUD engaged in treatment for substance use. Compared to the control group, newborns with PEO were much more likely (71.4% versus 25.4%) to be admitted to the NICU and had much longer lengths of stay in both the NICU (mean of 14.4 versus 4.1 days) and hospital (16.9 versus 5.8 days), resulting in dramatic increases in health care cost. Conclusion: These data underscore the need for a comprehensive, systematic approach to OUD and PEO and affirm the government as a major stakeholder in the care of infants born to these women.

Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021

During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016,† and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018-2019 (1,2). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory§; and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach.