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Substance Abuse

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BACKGROUND: Prior studies have suggested that physicians and residents may not have sufficient knowledge to appropriately interpret urine drug tests (UDT) in patients who are prescribed opioids or using illicit substances. Therefore, the aim of this study was to survey psychiatry residents and fellows about their confidence and knowledge in interpreting UDT in patients with chronic pain or receiving office-based opioid treatment. METHODS: All psychiatry residency and fellowship program directors in the New England states were approached to recruit their trainees to participate in an anonymous on-line survey including a 7-item knowledge test...
April 26, 2018: Substance Abuse
Joseph J Palamar, Alberto Salomone, Charles M Cleland, Scott Sherman
BACKGROUND: Non-disclosure of drug use on surveys is common and many drug users unknowingly ingest adulterant or replacement drugs, which leads to underreporting of use of these drugs. Biological testing can complement survey research, and hair-testing is an appealing method as many drugs are detectable for months post-use. We examined willingness to donate a hair sample to be tested among those surveyed in a population at high risk for consuming adulterated drugs-electronic dance music (EDM) party attendees...
April 25, 2018: Substance Abuse
Joshua Eloge, T Celeste Napier, Bezalel Dantz
Substance Use Disorders (SUDs) are pervasive in the United States, with 20.1 million cases in 2016, of which only 19% receive treatment. SUDs permeate all medical specialties and should be considered in the differential diagnosis of every chief complaint. Acknowledging the salience of SUDs provides a unique opportunity for early identification and intervention. Thus, SUDs should be reflected prominently in the History of the Present Illness rather than in the Social History. To this effect, we propose the inclusion of Use (U) in the History of Present Illness, and incorporating "U" into the pedagogical mnemonic of OPQRST that is commonly used in medical training...
April 25, 2018: Substance Abuse
Mary Jo Larson, Cheryl Browne, Ruslan V Nikitin, Nikki R Wooten, Sarah Ball, Rachel Sayko Adams, Kelly Barth
BACKGROUND: This study evaluated an educational intervention intended to increase physician use of patient prescription history information from the state prescription monitoring program (PMP) and their adoption of clinical behaviors consistent with opioid prescription guidelines to reduce patient risk. METHODS: Physician volunteers (N = 87) in community practices and Veterans Administration medical settings in South Carolina received an office-based, individualized, educational intervention (academic detailing) from a trained pharmacist who promoted 3 key messages about safer opioid prescribing...
April 2, 2018: Substance Abuse
Sharon Levy, Shannon Mountain-Ray, Jason Reynolds, Steven J Mendes, Jonas Bromberg
BACKGROUND: Medication treatment for opioid use disorder is effective, and recommended for adolescents, though very few adolescents with opioid use disorder ever receive medications. Reasons include lack of trained medication prescribers for this age group and difficulty in identifying adolescents with substance use disorders. This manuscript examines a novel implementation model of identifying and providing treatment for substance use disorders, including opioid use disorder, in a pediatric primary care practice...
March 29, 2018: Substance Abuse
Tauheed Zaman, Tessa L Rife, Steven L Batki, David L Pennington
BACKGROUND: Co-prescribing opioids and benzodiazepines increases overdose risk. A paucity of literature exists evaluating strategies to improve safety of co-prescribing. This study evaluated an electronic intervention to improve safety for patients co-prescribed chronic opioids for pain and benzodiazepines at 3- and 6-months. METHODS: Prospective cohort study conducted December 2015 through May 2016 at San Francisco Veterans Affairs Health Care System. A clinical dashboard identified 145 eligible patients prescribed chronic opioids and benzodiazepines...
March 29, 2018: Substance Abuse
Sara J Becker, Lourah M Kelly, Augustine Kang, Katherine Escobar, Daniel Squires
BACKGROUND: Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient-, provider-, and organizational-levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multi-level implementation strategy developed by a federally-funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual...
March 29, 2018: Substance Abuse
Dominic Hodgkin, Wenwu Gao, Elizabeth L Merrick, Charles E Drebing, Mary Jo Larson, Constance M Horgan, Monica Sharma, Nancy M Petry, Richard Saitz
BACKGROUND: Unhealthy drug use is a concern in many settings, including military and veteran populations. In 2013, the Veterans Health Administration (VHA) medical center in Bedford, Massachusetts, started requiring routine screening for unhealthy drug use in outpatient primary care and mental health settings, using a validated single question. METHODS: This study used descriptive and multivariable analyses of VHA electronic records for patients eligible for the screening program (N = 16,118)...
March 29, 2018: Substance Abuse
Jessica J Wyse, Adam J Gordon, Steven K Dobscha, Benjamin J Morasco, Elizabeth Tiffany, Karen Drexler, Friedhelm Sandbrink, Travis I Lovejoy
The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt...
March 29, 2018: Substance Abuse
John R Richards, J Adam Hawkins, Eric W Acevedo, Erik G Laurin
BACKGROUND: To determine differences in perception between nurses, residents, and faculty regarding characteristics and treatment of patients who use methamphetamine (meth). METHODS: Survey study performed at an urban, university Level I trauma medical center. RESULTS: 80 nurses, 39 residents, and 45 faculty completed the survey. All groups agreed meth was a significant problem nationwide and in our emergency department (ED). Nurses estimated 33% of their patients used meth, which differed from residents (18%) and faculty (15%)...
March 29, 2018: Substance Abuse
Honora Englander, Talitha Wilson, Devin Collins, Elena Phoutrides, Melissa Weimer, P Todd Korthuis, Jessica Calcagni, Christina Nicolaidis
BACKGROUND: Hospitalizations for severe infections associated with substance use disorder (SUD) are increasing. People with SUD often remain hospitalized for many weeks instead of completing intravenous antibiotics at home; often, they are denied skilled nursing facility admission. Residential SUD treatment facilities are not equipped to administer intravenous antibiotics. We developed a medically enhanced residential treatment (MERT) model integrating residential SUD treatment and long-term IV antibiotics as part of a broader hospital-based addiction medicine service...
March 29, 2018: Substance Abuse
Olubunmi O Asana, Emine R Ayvaci, David E Pollio, Barry A Hong, Carol S North
BACKGROUND: Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time...
March 29, 2018: Substance Abuse
Jocelyn R James, Leah M Gordon, Jared W Klein, Joseph O Merrill, Judith I Tsui
BACKGROUND: Opioid use disorders are a major medical and public health concern. Buprenorphine is approved for the treatment of opioid use disorders; however, a shortage of physicians prescribing buprenorphine is a significant barrier to treatment access. The aims of this study were to evaluate opinions of internal medicine attending and resident physicians about buprenorphine and assess interest in becoming waivered to prescribe. METHODS: Internal medicine resident and attending physicians at a primary care clinic in a large academic hospital were invited to complete surveys...
March 26, 2018: Substance Abuse
Derek Yates, Theresa Frey, Jean Charles Montgomery
BACKGROUND: Since 2014, the Department of Veterans Affairs (VA) has been working to address the ongoing opioid epidemic through opioid-education initiatives, the development of risk calculators, and other risk stratification tools. One primary focus of VA efforts has been the distribution of rescue naloxone kits to veterans at greatest risk of opioid-related adverse events. The purpose of this project was to identify primary care veterans at highest risk for serious opioid-related adverse events using the Risk Index for Overdose and Serious Opioid-Induced Respiratory Depression (RIOSORD) and offer rescue naloxone kits by telephone-based outreach...
March 26, 2018: Substance Abuse
Kathleen Hanley, Sewit Bereket, Ellen Tuchman, Frederick G More, Madeline A Naegle, Adina Kalet, Keith Goldfield, Marc N Gourevitch
BACKGROUND: We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has two main components: (1) A novel online curriculum addressing core SUD research topics, to reach a large number of students. (2) A mentored summer research experience for in-depth exposure. METHODS: Modules were integrated into the curricula of the lead institution, and of five external schools...
March 22, 2018: Substance Abuse
Julienne B Pauly, Christine M Vartan, Abigail T Brooks
BACKGROUND: In recognition of the importance of safe and effective pain management, the Department of Veterans Affairs and the Office of the Under Secretary for Health have encouraged implementation of opioid overdose education and naloxone distribution (OEND) programs at Veterans Affairs Medical Centers (VAMCs). METHODS: An OEND program was developed in August 2015 and implemented in September 2015 at a VAMC which allowed for pharmacist-lead individual and group patient education...
March 22, 2018: Substance Abuse
Erica Dimitropoulos, Stephanie Bertucci, Kara Wong
BACKGROUND: Research has demonstrated that the combination of pharmacotherapy and psychological interventions in alcohol use disorder (AUD) treatment is superior to either alone. Despite this, medications remain highly underutilized in many outpatient treatment facilities. Pharmacists can serve as an excellent resource to aid in improving access to medications. METHODS: This study was a prospective, longitudinal evaluation of a pharmacist's role in a substance use disorder (SUD) clinic, specifically an intensive outpatient program (IOP)...
March 20, 2018: Substance Abuse
Andrew S Moon, Walter Smith, Sawyer Mullen, Brent A Ponce, Gerald McGwin, Ashish Shah, Sameer M Naranje
BACKGROUND: The association between marijuana use and surgical procedures is a matter of increasing societal relevance that has not been well studied in the literature. The primary aim of this study is to evaluate the relationship between marijuana use and in-hospital mortality, as well as to assess associated comorbidities in patients undergoing commonly billed orthopedic surgeries. METHODS: The National Inpatient Sample (NIS) database from 2010 to 2014 was used to determine the odds ratios for the associations between marijuana use and in-hospital mortality, heart failure (HF), stroke, and cardiac disease (CD) in patients undergoing five common orthopedic procedures: hip (THA), knee (TKA), and shoulder arthroplasty (TSA), spinal fusion, and traumatic femur fracture fixation...
March 20, 2018: Substance Abuse
Julie D Yeterian, Krisanne Bursik, John F Kelly
BACKGROUND: A growing literature on adults with substance use disorders (SUD) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately. METHODS: The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice...
March 20, 2018: Substance Abuse
Sean M Murphy, Jared A Leff, Benjamin P Linas, Jake R Morgan, Kathryn McCollister, Bruce R Schackman
BACKGROUND: Health economic evaluation findings assist stakeholders in improving the quality, availability, scalability, and sustainability of evidence-based services, and in maximizing the efficiency of service delivery. The Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH) is a NIDA-funded multi-institutional center of excellence whose mission is to develop and disseminate health-economic research on healthcare utilization, health outcomes, and health-related behaviors that informs substance use disorder treatment policy, and HCV and HIV care of people who use substances...
March 20, 2018: Substance Abuse
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