Receiving Buprenorphine Treatment Research Articles

Changes in Recovery Capital Among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder in a Telehealth Setting.

Medications for the treatment of opioid use disorder (MOUD) such as buprenorphine are the most effective treatment available for OUD; yet, beyond drug testing results and retention in care, systematically measured clinical outcomes have proven elusive. There is growing interest in integrating systematic monitoring of patient-reported outcomes and measurement-based care as strategies to improve patients' success in treatment. We analyzed changes in recovery capital assessed via the Brief Assessment of Recovery Capital (BARC-10) from baseline to 30-120 days post-intake among patients initiating buprenorphine treatment from May to October 2023 at Ophelia, a telehealth MOUD provider, who were retained for ≥90 days. Differences in baseline characteristics were assessed between patients with and without high "remission-predictive" baseline scores (≥47) using chi-squared and t-tests. Changes in scores from baseline to follow-up were assessed using paired t-tests. In all, 791 patients initiated treatment during the study period, 742 (93.8%) of whom had a baseline BARC-10 score, 542 (73.0%) of whom were retained in treatment for ≥90 days, and 477 of whom (88.0%) had a follow-up BARC-10 score and represent the analysis sample. Older patients, those not requiring buprenorphine induction, and those not using heroin or fentanyl at intake were more likely to have remission-predictive baseline BARC-10 scores (P < .05). Patients with remission-predictive baseline scores (n = 257) had a mean increase of 1.4 (SD = 5.9) from 52.7 (SD = 4.1) (P < .001), and 234 (91%) sustained remission-predictive scores throughout the assessment period. Patients without remission-predictive baseline scores (n = 220) had a mean increase of 9.2 (SD = 8.2) from 38.4 (SD = 6.6) (P < .001), and 129 (59.0%) achieved a remission-predictive score at follow-up. Most patients had increased or sustained already high levels of recovery capital, an established predictor of sustained remission. Further research is required to better understand variability across patients and how it may relate to long-term outcomes.

Low-Dose Buprenorphine Initiation for Hospitalized Patients With Chronic Pain and Opioid Use Disorder or Opioid Misuse: Protocol for an Open-Label, Parallel-Group, Effectiveness-Implementation Randomized Controlled Trial.

Buprenorphine is an effective medication for both opioid use disorder (OUD) and chronic pain (CP), but transitioning from full opioid agonists to buprenorphine, a partial opioid agonist, can be challenging. Preliminary studies suggest that low-dose buprenorphine initiation can overcome some challenges in starting treatment, but no randomized controlled trials have compared low-dose and standard buprenorphine initiation approaches regarding effectiveness and safety or examined implementation in hospital settings. In a pragmatic open-label hybrid type I effectiveness-implementation trial based in a single urban health system, 270 hospitalized patients with (a) CP and (b) OUD or opioid misuse are being randomized to buprenorphine treatment initiation using 5-day low-dose or standard initiation protocols. Outcomes include buprenorphine treatment uptake (primary), defined as receiving buprenorphine treatment 7 days after enrollment, and other OUD and pain outcomes at 1-, 3-, and 6-month follow-up (secondary). Data collection will also include safety measures, implementation of low-dose initiation protocols, patient acceptability, and cost-effectiveness. Comparing strategies in a randomized clinical trial will provide the most definitive data to date regarding the effectiveness and safety of low-dose buprenorphine initiation. The study will also provide important data on treating CP at a time that clinical guidelines are evolving to center buprenorphine as a preferred opioid for CP.

T76 - Development and Clinical Feasibility of an Abbreviated Addiction-Focused Phenotyping Battery Piloted in a Female OUD Sample Receiving Buprenorphine Treatment

T76 - Development and Clinical Feasibility of an Abbreviated Addiction-Focused Phenotyping Battery Piloted in a Female OUD Sample Receiving Buprenorphine Treatment

It takes a village: A pilot study of a group telehealth intervention for support persons affected by opioid use disorder

IntroductionOpioid use disorder (OUD) has devastating effects on individuals, families, and communities. The Community Reinforcement and Family Training (CRAFT) is a Support Person (SP)-focused intervention that aims to increase SPs' communication strategies, positive reinforcement/rewards, and social support. This pilot study, called eINSPIRE (INtegrating Support Persons Into REcovery), adapted CRAFT for delivery via group telehealth. The aims were to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention on patient buprenorphine retention and SP mental health. MethodsThe study recruited patients receiving buprenorphine treatment in a primary care setting across five community health centers with their SP (N = 100 dyads). SP participants were randomly assigned to receive usual care (UC) or the eINSPIRE intervention. We interviewed Patients and SPs at baseline and three months later. The study collected patient buprenorphine retention data from the electronic medical record three months post-baseline. ResultsAbout 88 % (656/742) of potentially eligible patients were able to nominate a SP and 69 % (100/145) of nominated SPs were eligible and consented to the study. eINSPIRE groups had low reach (25 % of SPs attended), but high exposure (M = 7 of 10 sessions attended) and acceptability (classes helped them with their patient's OUD). The proportion of eINSPIRE patients (68 %) and UC patients (53 %) retained on buprenorphine at follow-up were similar (p = 0.203). SPs in both conditions reported similar reductions in their depression, anxiety, and impairment symptoms. ConclusionsPreliminary data suggest that eINSPIRE groups may not be feasible in primary care without further adaptations for this population. A future study with a larger sample size is needed to elucidate the observed distribution differences in buprenorphine retention. Future research should also explore methods to reduce barriers to SP session attendance to improve the reach of this evidence-based intervention.

Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment.

Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder. We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL. A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL. Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.

Brain circuits for maternal sensitivity and pain involving anterior cingulate cortex among mothers receiving buprenorphine treatment for opioid use disorder.

Opioid-induced deficits in maternal behaviors are well-characterized in rodent models. Amid the current epidemic of opioid use disorder (OUD), prevalence among pregnant women has risen sharply. Yet, the roles of buprenorphine replacement treatment for OUD (BT/OUD) in the brain functions of postpartum mothers are unclear. Using functional magnetic resonance imaging (fMRI), we have developed an evolutionarily conserved maternal behavior neurocircuit (MBN) model to study human maternal care versus defensive/aggressive behaviors critical to mother-child bonding. The anterior cingulate gyrus (ACC) is not only involved in the MBN for mother-child bonding and attachment, but also part of an opioid sensitive "pain-matrix". The literature suggests that prescription opioids produce physical and emotional "analgesic" effects by disrupting specific resting-state functional connectivity (rs-FC) of ACC to regions related to MBN. Thus, in this longitudinal study, we report findings of overlapping MBN and pain matrix circuits, for mothers with chronic exposure of BT/OUD. A total of 32 mothers were studied with 6 min rs-FC at 1 month (T1) and 4 months postpartum (T2), including seven on BT/OUD and 25 non-BT/OUD mothers as a comparison group. We analyzed rs-FC between the insula, putamen, and the dorsal anterior cingulate cortex (DACC) and rostral ACC (RACC), as the regions of interest that mediate opioid analgesia. BT/OUD mothers, as compared to non-BT/OUD mothers, showed less left insula-RACC rs-FC but greater right putamen-DACC rs-FC at T1, with these between-group differences diminished at T2. Some of these rs-FC results were correlated with the scores of postpartum parental bonding questionnaire. We found time-by-treatment interaction effects on DACC and RACC-dependent rs-FC, potentially identifying brain mechanisms for beneficial effects of BT, normalizing dysfunction of maternal brain and behavior over the first four months postpartum. This study complements recent studies to ascertain how BT/OUD affects maternal behaviors, mother-child bonding, and intersubjectivity and reveals potential MBN/pain-matrix targets for novel interventions.

Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder.

Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (≥8 hours per day) and watch wear (≥18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. The participants' average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. RR2-10.3389/fpsyt.2022.871916.

The Howard Street Method: A Community Pharmacy-led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals Using Fentanyl.

Buprenorphine treatment significantly reduces morbidity and mortality for people with opioid use disorder. Fear of precipitated withdrawal remains a barrier to starting buprenorphine for patients who use synthetic opioids, particularly fentanyl. We aim to evaluate the development and implementation of a buprenorphine low dose overlap initiation (LDOI) protocol in an urban public health community pharmacy. We performed a retrospective chart review of patients with nonprescribed fentanyl use (N = 27) to examine clinical outcomes of a buprenorphine LDOI schedule, named the Howard Street Method, dispensed from a community pharmacy in San Francisco from January to December 2020. Twenty-seven patients were prescribed the Howard Street Method. Twenty-six patients picked up the prescription and 14 completed the protocol. Of those who completed the protocol, 11 (79%) reported no symptoms of withdrawal and 3 (21%) reported mild symptoms. Four patients (29%) reported cessation of full opioid agonist use and 10 (71%) reported reduction in their use by the end of the protocol. At 30 days, 12 patients (86%) were retained in care and 10 (71%) continued buprenorphine. At 180 days, 6 patients (43%) were retained in care and 2 (14%) were still receiving buprenorphine treatment. We found that a LDOI blister-pack protocol based at a community pharmacy was a viable intervention for starting buprenorphine treatment and a promising alternative method for buprenorphine initiation in an underresourced, safety-net population of people using fentanyl.

Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention.

During the COVID pandemic, overall buprenorphine treatment appeared to remain relatively stable, despite some studies suggesting a decrease in patients starting buprenorphine. There is a paucity of empirical information regarding patterns of buprenorphine treatment during the pandemic. To better understand the patterns of buprenorphine episodes during the pandemic and how those patterns compared to pre-pandemic patterns. Pharmacy claims representing approximately 92% of all prescriptions filled at retail pharmacies in all 50 US states and the District of Columbia. Individuals filling buprenorphine prescriptions indicated for treatment of opioid use disorder. The number of active, starting, and ending buprenorphine treatment episodes March 13 to December 1, 2020, and the expected number of such episodes in 2020 based on the growth in treatment episodes from March 13 to December 1, 2019. The observed number of active buprenorphine episodes in December 2020 was comparable to the expected number, but new treatment episodes starting between March 13 and December 1, 2020, were 17.2% fewer than expected based on the 2019 experience. Similarly, the number of episodes that ended between March 13 and December 1, 2020, was 16.0% fewer than expected. Decreases from expected episode starts and ends occurred throughout the period but were greatest in the 2 months after the declaration of the public health emergency. Beneath the apparent stability of buprenorphine patient numbers during the pandemic, the flow of individuals receiving buprenorphine treatment changed substantially. Our findings shed light on how policy changes meant to support buprenorphine prescribing influenced prescribing dynamics during that period, suggesting that while policy efforts may have been successful in maintaining existing patients in treatment, that success did not extend to individuals not yet in treatment.

Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies

Background: Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. Methods: Using 2006–2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14–64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. Results: Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p < 0.01) in the likelihood of episodes with a duration of at least 180 days in the first four years after policy implementation. The policy was not associated with changes in effective dosage or concurrent prescribing of opioid analgesics or benzodiazepines. Conclusions: Buprenorphine prior authorization policies were associated with a sizeable and significant reduction in episodes of at least 180 days duration, underscoring the importance of identifying and removing barriers to effective and appropriate OUD care.

Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder

ImportanceStimulant medication use is common among individuals receiving buprenorphine for opioid use disorder (OUD). Associations between prescription stimulant use and treatment outcomes in this population have been understudied.ObjectivesTo investigate whether use of prescription stimulants was associated with (1) drug-related poisoning and (2) buprenorphine treatment retention.Design, Setting, and ParticipantsThis retrospective, recurrent-event cohort study with a case-crossover design used a secondary analysis of administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Primary analyses were conducted from March 1 through August 31, 2021. Individuals aged 12 to 64 years with an OUD diagnosis and prescribed buprenorphine who experienced at least 1 drug-related poisoning were included in the analysis. Unit of observation was the person-day.ExposuresDays of active stimulant prescriptions.Main Outcomes and MeasuresPrimary outcomes were drug-related poisoning and buprenorphine treatment retention. Drug-related poisonings were defined using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes; treatment retention was defined by continuous treatment claims until a 45-day gap was observed.ResultsThere were 13 778 567 person-days of observation time among 22 946 individuals (mean [SD] age, 32.8 [11.8] years; 50.3% men) who experienced a drug-related poisoning. Stimulant treatment days were associated with 19% increased odds of drug-related poisoning (odds ratio [OR], 1.19 [95% CI, 1.06-1.34]) compared with nontreatment days; buprenorphine treatment days were associated with 38% decreased odds of poisoning (OR, 0.62 [95% CI, 0.59-0.65]). There were no significant interaction effects between use of stimulants and buprenorphine. Stimulant treatment days were associated with decreased odds of attrition from buprenorphine treatment (OR, 0.64 [95% CI, 0.59-0.70]), indicating that stimulants were associated with 36% longer mean exposure to buprenorphine and its concomitant protection.Conclusions and RelevanceAmong persons with OUD, use of prescription stimulants was associated with a modest increase in per-day risk of drug-related poisoning, but this risk was offset by the association between stimulant use and improved retention to buprenorphine treatment, which is associated with protection against overdose.

Association Between Receipt of Antidepressants and Retention in Buprenorphine Treatment for Opioid Use Disorder: A Population-Based Retrospective Cohort Study.

Objective: Clinical interventions targeting co-occurring psychiatric disorders may represent a tangible target for improving retention in buprenorphine treatment for opioid use disorder. The aims of this study are to characterize receipt of antidepressants among patients receiving buprenorphine treatment and to examine the association between receiving antidepressants and retention in treatment.Methods: A retrospective cohort design was used. Using data from a large national commercially insured population, the cohort was selected as adults aged 18 to 64 years who initiated buprenorphine treatment in outpatient settings between January 1, 2016, and June 30, 2017. Receiving antidepressants was identified as prescription fills in the period between 6 months prior to buprenorphine initiation and during buprenorphine treatment. Buprenorphine discontinuation was defined as no buprenorphine prescription supply for at least 60 days following the end of the last buprenorphine prescription.Results: The cohort consisted of 11,619 individuals who initiated buprenorphine treatment and met our inclusion criteria. The cohort had a mean age of 36.3 years, 63% were male, and 55.7% received at least 1 antidepressant prescription at any time between 6 months prior to buprenorphine initiation and during treatment. Compared with those receiving no antidepressants at all, individuals starting antidepressants during buprenorphine treatment had an adjusted hazard ratio (HR) for treatment discontinuation of 0.72 (95% CI = 0.67-0.77), while receiving antidepressants only prior to buprenorphine initiation was associated with an increased risk of treatment discontinuation (HR = 1.40, 95% CI = 1.28-1.53).Conclusions: Findings suggest that receiving antidepressants during buprenorphine treatment is associated with improved retention. This highlights the critical importance of screening for and treating mental disorders concomitantly with treatment of opioid use disorder.

State Policies and Buprenorphine Prescribing by Nurse Practitioners and Physician Assistants.

Nurse practitioner (NP) and physician assistant (PA) prescribing can increase access to buprenorphine treatment for opioid use disorder. In this cross-sectional study, we used deidentified claims from approximately 90% of U.S. retail pharmacies (2017-2018) to examine the association of state policies with the odds of receiving buprenorphine treatment from an NP/PA versus a physician, overall and stratified by urban/rural status. From 2017 to 2018, the percentage of buprenorphine treatment episodes prescribed by NPs/PAs varied widely across states, from 0.4% in Alabama to 57.2% in Montana. Policies associated with greater odds of buprenorphine treatment from an NP/PA included full scope of practice (SOP) for NPs, full SOP for PAs, Medicaid pay parity for NPs (reimbursement at 100% of the fee-for-service physician rate), and Medicaid expansion. Although most findings with respect to policies were similar in urban and rural settings, the association of Medicaid expansion with NP/PA buprenorphine treatment was driven by rural counties.

Telehealth to improve continuity for patients receiving buprenorphine treatment for opioid use disorder.

Buprenorphine is medication-assisted treatment for opioid use disorder. It is a controlled substance and most states limit the dispensing to a 30-day supply. Patients with opioid use disorder often have social determinants of health barriers that make it difficult to engage with the health system to obtain a new supply of buprenorphine every month. Telehealth can be used to reduce barriers to accessing care and improve continuity of care for patients receiving buprenorphine treatment. To assess the rates of patient continuity for patients receiving buprenorphine treatment via tele-health versus in-person in a primary care outpatient setting. Review of patients receiving buprenorphine treatment for opioid use disorder and rates of continuity by visit type during a 2-year time period May 2019-May 2021. EPIC electronic medical records from an urban university-affiliated ambulatory primary care practice in New Jersey. Patients scheduled for a visit in the outpatient primary care clinic. Approximately 69% were African American, 22% Hispanic, and 9% other. The majority were enrolled in Medicaid. 80% of patients faced one or more barriers to social determinants of health including transportation, housing, and economic stability. Establishment and implementation of HIPAA compliant tele-health following approved state guidelines for buprenorphine prescribing via tele-health. Appointments were scheduled in-person or tele-health by patients' preference. Rates of continuity by visit type for patients receiving buprenorphine treatment during the study time period compared by chi-square. Of the 487 patients seen via tele-health, 297 (61%) continued to receive follow up care. Of the 811 patients seen in-person, 400 (49.3%) continued to receive follow up care, p<.0001. The patients who did not continue to receive follow up care were lost to follow up despite attempts to reach patients to re-engage in care. Our study shows that rates of continuity of care are higher using tele-health for patients receiving medication assisted therapy for opioid use disorder. In an urban underserved population, tele-health can result in improved continuity of care for patients with opioid use disorder. Telehealth may reduce barriers to accessing care including transportation, work schedule, childcare, and other competing demands.

Rapid Overlap Initiation Protocol Using Low Dose Buprenorphine for Opioid Use Disorder Treatment in an Outpatient Setting: A Case Series.

Fear and risk of precipitated withdrawal are barriers for initiating buprenorphine in individuals with opioid use disorder, particularly among those using fentanyl. A buprenorphine rapid overlap initiation (ROI) protocol (also knownas "rapidmicro-dosing") utilizing small, escalating doses of buprenorphine can overcome this barrier, reaching therapeutic doses in 3 to 4 days. We sought to demonstrate the feasibility of implementing a buprenorphine ROI protocol for buprenorphine initiation in the outpatient setting. We conducted a retrospective chart review of patients prescribed an outpatient ROI protocol at the Office-based Buprenorphine Induction Clinic from October to December 2020. The ROI protocol utilizes divided doses of sublingual buprenorphine tablets and blister packaging for easier dosing. Patients were not required to stop other opioid use and were advised to follow up on day 4 of initiation. Twelve patients were included, of whom eleven (92%) were using fentanyl at intake. Eleven patients picked up their prescription. Seven patients returned for follow-up (58%), and all 7 completed the ROI protocol. One patient reported any withdrawal symptoms, which were mild. At 30 days, 7 patients (58%) were retained in care, and 5 (42%) were still receiving buprenorphine treatment, 4 (33%) of whom had been abstinent from nonprescribed opioid use for ≥2 weeks. The ROI protocol was successful in initiating buprenorphine treatment for patients in our outpatient clinic, many of whom were using fentanyl. The ROI protocol may offer a safe alternative to traditional buprenorphine initiation and warrants further study.

Monthly Trends of Substance Use Among Mainers Receiving Buprenorphine Treatment During the COVID-19 Pandemic

Introduction: Drug-related deaths in Maine increased by 23% in the first quarter of 2020 compared to the last quarter of 2019. Most of these deaths were accidental overdoses involving at least one opioid, and 65% of these deaths were caused by fentanyl, according to the Maine Center for Disease Control and Prevention. Methods: This research explored substance use in Maine during 2020. Among the sample of individuals, 46% were homeless and receiving recovery services at a buprenorphine-assisted treatment program at a federally qualified health center in Maine. Charts of 35 patients were reviewed for emergency room visits and urine drug screens. Results: In the sample, 20% of individuals screened positive for fentanyl, 22% screened positive for methamphetamines, and 20% screened positive for cocaine. In the first month after lockdown, the presence of fentanyl and methamphetamines in urine drug screens doubled compared to before the lockdown. In the months after lockdown, the amounts of fentanyl and methamphetamines in drug screens and the number of emergency room visits increased. Discussion: Examples of Maine’s harm-reduction strategies are discussed. These results highlight the urgency to implement more drastic measures statewide, especially among individuals who are homeless and have an opioid and/or a stimulant use disorder. Conclusion: Greater recovery services are required for individuals who are homeless and have a substance use disorder in the aftermath of the pandemic.

A comparison of patients with opioid use disorder receiving buprenorphine treatment with and without peer recovery support services

ABSTRACT Background Opioid addiction continues to be a crisis within the United States. Pharmacological treatments have been studied extensively and are considered superior treatment methods for opioid use disorder (OUD). Adjunctive therapy to pharmacological interventions, including peer recovery support services (PRSS), is also available for patients with OUD, but is less studied. PRSS are designed to provide individual coordination services for patients seeking recovery and treatment, administered by individuals who have lived through the substance use disorder and recovery process. Methods An observational study looking at differences in demographics and treatment engagement between individuals with OUD who were and were not receiving PRSS was conducted. Results ANOVA and chi square analyses indicated no significant demographic differences between groups; however, additional ANOVA analyses demonstrated that patients receiving PRSS attended significantly more OUD medical appointments when compared to their non-PRSS counterparts, F(1, 275) = 8.72, p = .003. A negative binomial regression analysis indicated that receiving PRSS was associated with a greater number of OUD medical appointments attended, even after controlling for length of time in treatment. Conclusions While these results suggest that PRSS may increase treatment engagement in patients with OUD, additional research that uses randomized designs is needed to examine the impact of PRSS on treatment engagement.

Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder

BackgroundTelemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. MethodsThis study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012–2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. ResultsUtilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI: 0.73–0.98) or Black (AOR = 0.54, 95% CI: 0.45–0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI: 2.67–3.17) and to live in rural areas (AOR = 2.12, 95% CI:1.92–2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322–1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67–854) among patients who received treatment in-person. ConclusionsUse of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.

Does incarceration influence patients’ goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail

BackgroundCorrectional facilities increasingly offer medications for opioid use disorder (OUD), including buprenorphine. Nevertheless, retention in treatment post-incarceration is suboptimal and overdose mortality remains high. Our objectives were to understand how incarcerated patients viewed buprenorphine treatment and identify modifiable factors that influenced treatment continuation post-release. MethodsWe conducted semi-structured interviews with 22 men receiving buprenorphine treatment in an urban jail. Interviews were audio recorded, professionally transcribed, and analyzed using a grounded-theory approach. Team members constructed preliminary case memos from transcripts, and then interactively discussed themes within respective memos. We established participant ‘typologies’ by consensus. ResultsDistinct typologies emerged based on participants’ post-release treatment goals: (1) those who viewed buprenorphine treatment as a cure for OUD; (2) those who thought buprenorphine would help manage opioid-related problems; and (3) those who did not desire OUD treatment. Participants also described common social structural barriers to treatment continuation and community re-integration. Participants reported that post-release housing instability, unemployment, and negative interactions with parole contributed to opioid use relapse and re-incarceration. ConclusionParticipants had different goals for post-release buprenorphine treatment continuation, but their prior experiences suggested that social structural issues would complicate these plans. Incarceration can intensify marginalization, which when combined with heightened legal supervision, reinforced cycles of release, relapse, and re-incarceration. Participants valued buprenorphine treatment, but other structural and policy changes will be necessary to reduce incarceration-related inequities in opioid overdose mortality.

Patient, prescriber, and Community factors associated with filled naloxone prescriptions among patients receiving buprenorphine 2017-18

BackgroundPrescribing naloxone to patients at increased opioid overdose risk is a key component of opioid overdose prevention efforts, but little is known about naloxone fills among patients receiving buprenorphine for opioid use disorder, one such high risk group. MethodsThis retrospective cross-sectional study used de-identified pharmacy claims representing 90% of all prescriptions filled at retail pharmacies in 50 states and the District of Columbia. We performed a multivariable logistic regression to examine filled naloxone prescriptions among patients receiving buprenorphine treatment and assessed how filled naloxone prescriptions vary by patient, prescriber, and community characteristics. ResultsFilled naloxone prescriptions occurred among 4.5% of buprenorphine treatment episodes. Episodes paid through Medicaid (aOR 2.40, 95%CI 2.33–2.47) and Medicare (aOR 1.53, 95%CI 1.46–1.60) had higher odds of filled naloxone prescriptions than commercial insurance episodes. Compared to episodes where the primary prescriber was an adult primary care physician, odds of filling a naloxone prescription were higher among episodes prescribed by addiction specialists (aOR 1.30, 95% CI 1.24–1.37) and physician assistants/nurse practitioners (aOR 1.57, 95% CI 1.53–1.61). ConclusionsPrescribing naloxone to patients receiving buprenorphine represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, rates of filling naloxone prescriptions remain low among patients dispensed buprenorphine. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.