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Medication assisted treatment for opioid

Anupama Kotha, Beatrice A Chen, Lauren Lewis, Shannon Dunn, Katherine P Himes, Elizabeth Krans
BACKGROUND: Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD. STUDY DESIGN: This was a retrospective cohort study of 791 pregnant women with OUD on MAT who delivered at an academic institution without immediate postpartum LARC services between 2009 and 2012...
August 13, 2018: Contraception
Lisa Boyars, Constance Guille
Opioid agonist therapy is the standard of care for pregnant women with Opioid Use Disorder, but medication-assisted withdrawal from opioid agonist therapy is increasingly prevalent. We review available literature evaluating the risks and benefits of medication-assisted withdrawal. We highlight the importance of supporting women in making an informed treatment choice that is best for them. Although it is tempting to choose medication-assisted withdrawal to decrease the risk of newborn opioid withdrawal, we caution against this practice...
September 2018: Obstetrics and Gynecology Clinics of North America
C Holly A Andrilla, Davis G Patterson, Tessa E Moore, Cynthia Coulthard, Eric H Larson
The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas...
August 9, 2018: Medical Care Research and Review: MCRR
Marian Wilson, Michele R Shaw, Mary Lee A Roberts
BACKGROUND: Opioid use disorder has drastically increased in recent years within adult populations. Limited understanding exists regarding how people enter medication-assisted treatment (MAT) for opioid use disorder-particularly those who initiate opioid use to treat a painful condition. OBJECTIVES: This research examines the process involved when adults first initiate the use of opioid medicines to treat pain through enrollment in an outpatient MAT program. METHODS: Grounded theory methodology guided the study...
July 26, 2018: Nursing Research
Katrina Hedberg, Lisa T Bui, Catherine Livingston, Lisa M Shields, Joshua Van Otterloo
CONTEXT: Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state. PROGRAM: The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions...
July 18, 2018: Journal of Public Health Management and Practice: JPHMP
Laxmaiah Manchikanti, Jaya Sanapati, Ramsin M Benyamin, Sairam Atluri, Alan D Kaye, Joshua A Hirsch
The opioid epidemic has been called the "most consequential preventable public health problem in the United States." Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016...
July 2018: Pain Physician
Gerald J Stahler, Jeremy Mennis
BACKGROUND: The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. METHODS: Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion...
September 1, 2018: Drug and Alcohol Dependence
Kelly S McGlothen, Lisa M Cleveland
No abstract text is available yet for this article.
July 1, 2018: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
Christopher M Jones
BACKGROUND: Despite concerns over increasing harms associated with prescription opioid injection misuse, there is a paucity of research on the magnitude, characteristics, injection practices, and syringe sources for people who inject prescription opioids; limiting the implementation of targeted policy and programmatic initiatives. MATERIALS AND METHODS: Data from the 2003 through 2014 National Surveys on Drug Use and Health were used to estimate prescription opioid injection trends and examine risky injection practices and syringe sources for people who inject prescription opioids...
November 2018: Addictive Behaviors
Marcia Reinhart, Lauren M Scarpati, Noam Y Kirson, Cody Patton, Nina Shak, Jennifer G Erensen
BACKGROUND: Abuse of prescription opioids [opioid use disorder (OUD), poisoning, and fatal and non-fatal overdose] is a public health and economic challenge that is associated with considerable morbidity and mortality in the USA and globally. OBJECTIVE: To systematically review and summarize the health economics literature published over the last 5 years that describes the economic burden of abuse of prescription opioids. METHODS: Findings from searches of databases including MEDLINE, Embase, and Cochrane CENTRAL as well as hand searches of multiple conference abstracts were screened against predefined inclusion criteria to identify studies reporting cost and healthcare resource utilization (HRU) data associated with abuse of prescription opioids...
July 20, 2018: Applied Health Economics and Health Policy
Jeremy A Adler, Theresa Mallick-Searle
Despite advances in the treatment of severe intractable pain, opioids remain a critical and appropriate component of treatment. However, abuse, misuse, and diversion of prescription opioids are significant public health concerns. Opioid abuse-deterrent formulations (ADFs) are one component of an opioid risk management plan to manage patient's pain relief and quality of life while offering some protection against potentially harmful consequences of opioids from misuse and abuse. Opioid ADFs are designed to make manipulation more difficult and administration via non-oral routes less appealing...
2018: Journal of Multidisciplinary Healthcare
Angélica Meinhofer, Allison E Witman
We estimate the effect of health insurance coverage on opioid use disorder treatment utilization and availability by exploiting cross-state variation in effective dates of Medicaid expansions under the Affordable Care Act. Using a difference-in-differences design, we find that aggregate opioid admissions to specialty treatment facilities increased 18% in expansion states, most of which involved outpatient medication-assisted treatment (MAT). Opioid admissions from Medicaid beneficiaries increased 113% without crowding out admissions from individuals with other health insurance...
July 2018: Journal of Health Economics
Laurie L Meschke, Clea McNeely, Kathleen C Brown, J Mark Prather
BACKGROUND: The lifetime prevalence of unintentional pregnancy among women enrolled in medically assisted treatment (MAT) for opioid use disorder (OUD) has been reported to exceed 80%. Consistent voluntary contraception use by women enrolled in MAT programs can reduce their risk of unintended pregnancies and increase their opportunity to plan the family size they want, yet little is understood about past and current contraception use or associated barriers and facilitators for this population of women...
July 3, 2018: Journal of Women's Health
S E Streisel
BACKGROUND: As opioid use increases in the United States, especially in the correctional population, the most effective treatment approaches need to be utilized. Research has shown that medication-assisted treatment (MAT) provides better outcomes than traditional treatment approaches alone, but is underutilized among correctional-supervised populations. OBJECTIVE: This article looks at how previously identified barriers to implementing MAT can create potential biases regarding the intent to refer individuals to either buprenorphine or methadone among treatment and correctional staff within community corrections...
December 6, 2018: Substance Use & Misuse
Danielle R Dunwoody, Carla R Jungquist
AIM: The purpose of this study was to explore the concept of opioid-induced sedation and how nurses define and measure sedation in the hospital setting. BACKGROUND: Opioid medications are the primary treatment for acute pain in the postoperative setting. One of the most serious side effects of opioid therapy is excessive sedation and respiratory depression. Nurses have the responsibility of providing effective pain management, while keeping the patient safe from adverse sedation and respiratory depression...
June 27, 2018: Nursing Forum
Joanna M Streck, Taylor A Ochalek, Gary J Badger, Stacey C Sigmon
Prevalence of depression, anxiety, and mood disorders among individuals with opioid use disorder far exceeds that of the general population. While psychiatric symptoms often improve upon entry into opioid treatment, this has typically been seen with treatments involving psychosocial counseling. In this secondary analysis, we examined changes in psychiatric symptoms during a randomized clinical trial evaluating an interim buprenorphine treatment without counseling among individuals awaiting entry into comprehensive treatment...
August 2018: Experimental and Clinical Psychopharmacology
Jun Ma, Yan-Ping Bao, Ru-Jia Wang, Meng-Fan Su, Mo-Xuan Liu, Jin-Qiao Li, Louisa Degenhardt, Michael Farrell, Frederic C Blow, Mark Ilgen, Jie Shi, Lin Lu
Opioid use disorder (OUD) is associated with a high risk of premature death. Medication-assisted treatment (MAT) is the primary treatment for opioid dependence. We comprehensively assessed the effects of different MAT-related characteristics on mortality among those with OUD by a systematic review and meta-analysis. The all-cause and overdose crude mortality rates (CMRs) and relative risks (RRs) by treatment status, different type, period, and dose of medication, and retention time were pooled using random effects, subgroup analysis, and meta-regression...
June 22, 2018: Molecular Psychiatry
C Holly A Andrilla, Tessa E Moore, Davis G Patterson, Eric H Larson
PURPOSE: Opioid use disorder (OUD) is a substantial public health problem. Buprenorphine is an effective medication-assisted treatment (MAT) for OUD, but access is difficult for patients, especially in rural locations. To improve access, the Comprehensive Addiction and Recovery Act of 2016 extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat OUD to nurse practitioners (NPs) and physician assistants (PAs). This study summarizes the geographic distribution of waivered physicians, NPs, and PAs at the end of 2017 and compares it to the distribution of waivered physicians 5 years earlier...
June 20, 2018: Journal of Rural Health
Kamilla L Venner, Dennis M Donovan, Aimee N C Campbell, Dennis C Wendt, Traci Rieckmann, Sandra M Radin, Sandra L Momper, Carmen L Rosa
The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/ANs) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: 1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; 2) the need to integrate MAT into AI/AN traditional healing; 3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; 4) systemic barriers; and 5) the need to improve research with AI/ANs using culturally relevant methods...
May 23, 2018: Addictive Behaviors
Sarah B Hunter, Allison J Ober, Colleen M McCullough, Erik D Storholm, Praise O Iyiewuare, Chau Pham, Katherine E Watkins
BACKGROUND: Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS: Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed...
June 18, 2018: Implementation Science: IS
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