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Medication assisted treatment for opioid

C Holly A Andrilla, Tessa E Moore, Davis G Patterson
PURPOSE: The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office-based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it. The study team interviewed rural physicians successfully prescribing buprenorphine to identify strategies for overcoming commonly cited barriers for providing this service...
October 19, 2018: Journal of Rural Health
Caterina Magnani, Diana Giannarelli, Alice Calvieri, Ana Dardeli, Giovanni Eusepi, Maria Rosa Restuccia, Chiara Mastroianni, Giuseppe Casale
BACKGROUND: Various options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient's ability to take medication. OBJECTIVE: The goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer...
October 13, 2018: Postgraduate Medical Journal
Peter Barglow
BACKGROUND AND OBJECTIVES: Outcome intervention data from Medicare, veteran, prison, and United States' public populations can identify best practices to decrease opioid misuse. Prescription policies for treating pain in the United States and other countries are relevant to preventing overdose. METHODS: Three strategies are considered: (1) Demand Reduction counsels and educates patients and current or potential opioid users about risks and treatment options to reduce motivation to consume opioids...
October 12, 2018: American Journal on Addictions
Naoko A Ronquest, Tina M Willson, Leslie B Montejano, Vijay R Nadipelli, Bernd A Wollschlaeger
Background: Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs. Patients and methods: Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008-2014 MarketScan® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine...
2018: Substance Abuse and Rehabilitation
Hestia Moningka, Sarah Lichenstein, Patrick D Worhunsky, Elise E DeVito, Dustin Scheinost, Sarah W Yip
The current opioid epidemic is an urgent public health problem, with enormous individual, societal, and healthcare costs. Despite effective, evidence-based treatments, there is significant individual variability in treatment responses and relapse rates are high. In addition, the neurobiology of opioid-use disorder (OUD) and its treatment is not well understood. This review synthesizes published fMRI literature relevant to OUD, with an emphasis on findings related to opioid medications and treatment, and proposes areas for further research...
October 3, 2018: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Eric Weintraub, Aaron David Greenblatt, Joy Chang, Seth Himelhoch, Christopher Welsh
BACKGROUND AND OBJECTIVES: The opioid epidemic in the United States has resulted in a public health emergency. Medication-assisted treatment (MAT) with methadone and buprenorphine are evidence-based treatments for opioid use disorder. However, numerous barriers hinder access to treatment in rural areas. The use of telemedicine to deliver psychiatric services is demonstrated to be safe and effective; however, limited data exist on the novel application of telemedicine in the delivery of MAT...
September 28, 2018: American Journal on Addictions
Jessica L Coker, David Catlin, Shona Ray-Griffith, Bettina Knight, Zachary N Stowe
BACKGROUND: The treatment of pregnant women with opioid use disorder is challenging due to the myriad of physical, mental, and social complications. Factors influencing adherence to buprenorphine during pregnancy have not been identified. MATERIALS AND METHODS: Pregnant women with opioid use disorder followed in a tertiary clinic were included in a retrospective chart review from buprenorphine induction through delivery. All women who had been evaluated and treated with buprenorphine from January 1, 2014, to September 31, 2016, were included...
September 15, 2018: Drug and Alcohol Dependence
Erich J Dietrich, Todd Leroux, Carla F Santiago, Melvin D Helgeson, Patrick Richard, Tracey P Koehlmoos
BACKGROUND: Acute low back pain is one of the most common reasons for individuals to seek medical care in the United States. The US Military Health System provides medical care to approximately 9.4 million beneficiaries annually. These patients also routinely suffer from acute low back pain. Within this health system, patients can receive care and treatment from physicians, or physician extenders including physician assistants and nurse practitioners. Given the diversity of provider types and their respective training programs, it would be informative to evaluate variation in care delivery, adherence to clinical guidelines, and differences within the MHS among a complex mix of provider types...
September 17, 2018: BMC Health Services Research
Michael E Herce, Monde Muyoyeta, Stephanie M Topp, German Henostroza, Stewart E Reid
PURPOSE OF REVIEW: To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. RECENT FINDINGS: Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention...
November 2018: Current Opinion in HIV and AIDS
Kathleen Broglio, Marianne Matzo
: Medication-assisted treatment for opioid use disorder (OUD), which incorporates methadone, buprenorphine, or naltrexone, has been shown to reduce all-cause mortality rates in patients with this disease-and the numbers of patients receiving such treatment is substantial. In 2016, among U.S. patients with OUD, nearly 350,000 were treated with methadone, more than 60,000 were treated with buprenorphine, and more than 10,000 were treated with naltrexone. Managing acute pain in patients receiving this treatment can be a significant nursing challenge...
October 2018: American Journal of Nursing
Carlos Nordt, Marc Vogel, Michelle Dey, Andreas Moldovanyi, Thilo Beck, Toni Berthel, Marc Walter, Erich Seifritz, Kenneth M Dürsteler, Marcus Herdener
BACKGROUND AND AIMS: Opioid agonist treatment (OAT) is currently the most effective treatment for people with opioid dependence. In most countries, however, access to the whole range of effective medications is restricted. This study aims to model the distribution of different OAT medications within a naturalistic and relatively unrestricted treatment setting (Zurich, Switzerland) over time, and to identify patient characteristics associated with each medication. METHODS: We used generalized estimating equation analysis with data from the OAT register of Zurich and the Swiss register for heroin-assisted treatment (HAT) to model and forecast the annual proportion of opioids applying exponential distributions until 2018 and patient characteristics between 1992 and 2015...
September 12, 2018: Addiction
Christopher M Jones, Elinore F McCance-Katz
BACKGROUND AND AIMS: Expanding access to medication-assisted treatment with buprenorphine is a cornerstone of the opioid crisis response, yet buprenorphine remains underutilized. Research has identified multiple barriers to prescribing buprenorphine. This study aimed to examine clinician characteristics, prescribing practices and barriers and incentives to prescribing buprenorphine among clinicians with a federal Drug Addiction Treatment Act of 2000 (DATA) waiver to prescribe buprenorphine for opioid use disorder treatment...
September 8, 2018: Addiction
Mercy N Mumba, Lilian J Findlay, Diane E Snow
Approximately 10% of the 20 million Americans who are suffering from substance use disorders are suffering from prescription opioid and heroine misuse. This has led to a rise in overdoses as well as emergency room visits, with over 1000 individuals across the United States being seen in emergency rooms every day. Unfortunately, about 90% of drug overdoses are unintentional. Therefore, finding effective ways to treat opioid use disorders and preventing relapse has now become a national priority. This review of the relevant literature highlights current treatment options available for opioid use disorders, including motivational interviewing, cognitive behavioral therapy, mindfulness meditation, mindfulness based relapse prevention, medication assisted therapies, and combination therapies...
July 2018: Journal of Addictions Nursing
Brayden Kameg, Robert Kaufman, Dawn Lindsay, Ann M Mitchell
PURPOSE: The United States is in the midst of an unprecedented public health crisis, with annual morbidity and mortality data related to opioid use consistently increasing and appearing more worrisome. To mitigate such consequences, it is critical that those with opioid use disorders are provided with and have access to evidence-based treatment modalities. METHODS: The project utilized a course scaffolding approach to integrate a comprehensive substance use framework into an advanced practice nursing curriculum, with an emphasis on medication-assisted treatment as part of an advanced pharmacology course required for licensure...
July 2018: Journal of Addictions Nursing
Eric P Baron
BACKGROUND: Comprehensive literature reviews of historical perspectives and evidence supporting cannabis/cannabinoids in the treatment of pain, including migraine and headache, with associated neurobiological mechanisms of pain modulation have been well described. Most of the existing literature reports on the cannabinoids Δ9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), or cannabis in general. There are many cannabis strains that vary widely in the composition of cannabinoids, terpenes, flavonoids, and other compounds...
July 2018: Headache
Curtis Bone, Lindsay Eysenbach, Kristen Bell, Declan T Barry
The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration...
June 2018: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
Stephen R Baldassarri, Ike Lee, Stephen R Latham, Gail D'Onofrio
Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes...
June 2018: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
Allison L Pitt, Keith Humphreys, Margaret L Brandeau
OBJECTIVES: To estimate health outcomes of policies to mitigate the opioid epidemic. METHODS: We used dynamic compartmental modeling of US adults, in various pain, opioid use, and opioid addiction health states, to project addiction-related deaths, life years, and quality-adjusted life years from 2016 to 2025 for 11 policy responses to the opioid epidemic. RESULTS: Over 5 years, increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths...
October 2018: American Journal of Public Health
Gregory L Stuart, Ryan C Shorey, Christopher R France, Jenny Macfie, Kathryn Bell, Kimberly B Fortner, Craig V Towers, Paul Schkolnik, Susan Ramsey
Opioid misuse has become one of the most pressing public health problems facing the country. In this article, we briefly review literature regarding the opioid epidemic in the United States and the negative consequences of opioid use disorder. We provide information regarding treatment and relapse using a variety of intervention approaches. We call for research on people with opioid use disorder that can contribute to a variety of areas: improving medication-assisted treatment, addressing chronic pain, examination of adjunctive behavioral interventions, overdose, high risk behaviors and infections, pregnancy, diverse populations, and other psychological factors...
2018: Substance Abuse: Research and Treatment
Michael Kidorf, Robert K Brooner, Jessica Peirce, Jim Gandotra, Jeannie-Marie Leoutsakos
This descriptive study evaluates a novel group intervention designed to help opioid-dependent patients in medication-assisted treatment identify and recruit drug-free individuals to support recovery efforts. The Social Network Activation Group works with patients who are actively using drugs and resistant to including drug-free family or friends in treatment. The group encourages patients to attend structured recovery, religious, or recreational activities in the community to find recovery support. For those with underutilized support, motivational interviewing and skills training are used to help patients resolve ambivalence and include family or friends in the treatment plan...
October 2018: Journal of Substance Abuse Treatment
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