Journal: Drug and Alcohol Dependence Reports, 2024, doi: 10.1016/j.dadr.2024.100227
Authors: Michael J. Lynch, Dominic Vargas, Mary E. Winger, Justin Kanter, Jessica Meyers, James Schuster, & Donald M. Yealy
Abstract:
Objective: We evaluated the impact of a telemedicine bridge clinic on treatment outcomes and cost for patients with opioid use disorder. Telemedicine bridge clinics deliver low-barrier rapid assessment of patients with opioid use disorder via audio-only and audiovisual telemedicine to facilitate induction on medication therapy and connection to ongoing care.
Methods: A pre-post analysis of UPMC Health Plan member claims was performed to evaluate the impact of this intervention on the trajectory of care for patients with continuous coverage before and after bridge clinic visit(s).
Results: Analysis included 150 UPMC Health Plan members evaluated at the bridge clinic between April 2020 and October 2021. At least one buprenorphine prescription was filled within 30 days by 91% of patients; median proportion of days covered by buprenorphine was 73.3%, 54.4%, and 50.6% at 30, 90, and 180 days after an initial visit compared to median of no buprenorphine claims 30 days prior among the same patients. Patients had an 18% decline in unplanned care utilization 30 days after initial Bridge Clinic visit, with a 62% reduction in unplanned care cost per member per month (PMPM), 38% reduction in medical cost PMPM, and 10% reduction in total PMPM (medical + pharmacy cost) at 180 days. Primary care, outpatient behavioral health, and laboratory costs increased while emergency department, urgent care, and inpatient costs declined.
Conclusion: Utilization of a telemedicine bridge clinic was associated with buprenorphine initiation, linkage to ongoing care with retention including medication treatment, reduced unplanned care cost, and overall savings.
To read the full text of the article, please visit the publisher’s website.
Journal: PLoS One, 2024, doi: 10.1371/journal.pone.0301535
Authors: Victoria O. Chentsova, Adrian J. Bravo, Eleftherios Hetelekides, Daniel Gutierrez, & Mark A. Prince
Abstract:
Background: While research has examined the effect of stigma from others towards individuals with substance use disorders, few studies have examined the relationship between perceived self-stigma and engagement in substance use more broadly, especially among non-clinical samples.
Aims: The present study examined the relationships between perceptions of self-stigma if one were to develop a substance use disorder, consisting of negative self-esteem and negative self-efficacy, and alcohol or marijuana use behaviors and outcomes.
Method: Participants (n = 2,243; 71.5% female) were college students within the U.S. recruited to participate in an online survey on substance use with a special focus on alcohol and marijuana.
Results: Results indicated no significant differences in stigma scores across individuals with different lifetime alcohol and marijuana use. Stigma ratings did differ between individuals with different profiles of last 30-day alcohol and marijuana use where, generally, individuals with lifetime use but no use in the last 30-day reported higher levels of self-stigma. Correlation analyses indicated that perceived impact of substance use disorder on sense of self-efficacy and self-esteem related negatively to nearly all observed factors of alcohol and marijuana use.
Conclusions: Though self-stigma, and stigma more broadly, has been shown to have negative implications for people with substance use disorders, the present study suggests that for non-clinical populations there may be some protective association between perceived self-stigma and alcohol or marijuana use engagement. This is not to say that self-stigma is a positive clinical intervention. Rather, we interpret these findings to indicate that negative perceptions of substance use disorder on the sense of self may be associated with distinct alcohol and marijuana use behaviors among young adults.
To read the full text of the article, please visit the publisher’s website.
Journal: Harm Reduction Journal, 2024, doi: 10.1186/s12954-024-00986-z
Authors: R. J. Fredericksen, R. Baker, A. Sibley, A. T. Estadt, D. Colston, L. S. Mixson, S. Walters, … J. I. Tsui
Abstract:
Background: In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings.
Methods: We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use.
Results: We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment.
Conclusion: In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
To read the full text of the article, please visit the publisher’s website.
Journal: Frontiers in Pediatrics, 2024, doi: 10.3389/fped.2024.1357970
Authors: Nethra K. Madurai, Lauren L. Jantzie, & Elizabeth Yen
Abstract:
The impact of the opioid epidemic on pregnant people and children is a growing public health crisis. Understanding how opioids affect the developing brain during pregnancy and postnatally remains a critical area of investigation. Biological sex plays a crucial role in all physiologic processes, with the potential for a significant impact on neonatal outcomes, including those infants with opioid exposure. Here, we aim to explore current literature on the effect of sex on neonatal outcomes following prenatal opioid exposure. Sex differences in adults with opioid use disorder have been well studied, including increased mortality among males and higher rates of psychiatric comorbidities and likelihood of relapse in females. However, such differences are not yet well understood in neonates. Emerging clinical data suggest sex-specific effects in infants with prenatal opioid exposure on the expression of genes related to feeding regulation and reward signaling pathways. Increased susceptibility to white matter injury has also been noted in female infants following prenatal opioid exposure. Understanding the impact of sex as a biological variable on neonatal outcomes following prenatal opioid exposure is paramount to improving the health and well-being of infants, children, and adults impacted by the opioid epidemic.
To read the full text of the article, please visit the publisher’s website.