The development and initial validation of the Russian version of the BASIS-24

BackgroundPeople living with HIV (PLWH) and opioid use disorder (OUD) commonly experience criminal justice involvement (CJI). We sought to estimate the impact of CJI on 1) HIV care engagement, 2) antiretroviral therapy (ART) prescription rates, and 3) receipt of medications for opioid use disorder (MOUD), among PLWH and OUD in Vietnam.MethodsParticipants were PLWH enrolled in a 12-month MOUD treatment trial of HIV clinic-based buprenorphine vs. methadone referral in Vietnam. We compared those with CJI (arrest, incarceration, or compulsory “06” drug rehabilitation) during the first 9 months of the study to those with no CJI. To ensure participants with CJI had the opportunity to re-engage in treatment, only those who were released before their 9-month study visit were included; participants still incarcerated at 9 months were excluded. Logistic regression models estimated the association between CJI and HIV care engagement (≥ 1 visit), ART prescription, and receipt of MOUD between 9 and 12 months, controlling for demographics, substance use, past CJI, and HIV history.ResultsAt baseline, 234 of 281 participants (83.6%) had a history of arrest/incarceration, and 172 (61.2%) reported prior 06 detention. During their first 9 months of study participation, 14 participants (5.0%) were arrested and 14 participants (5.0%) were sent to compulsory 06 rehabilitation. Being arrested (OR=0.04, 95% CI= (0.007, 0.25)), sent to compulsory 06 rehabilitation (OR=0.08, 95% CI= (0.02, 0.38)), or either (OR=0.07, 95% CI= (0.02, 0.24)), were negatively associated with receipt of MOUD. CJI involvement was also negatively associated with HIV clinic engagement after release (OR=0.20, 95% CI= (0.05, 0.84)). A similar negative association was noted for ART prescription, though it did not reach statistical significance (OR=0.17, 95% CI= (0.03, 1.22)).ConclusionArrest, incarceration, and compulsory 06 rehabilitation negatively impact HIV and OUD care among people with HIV and OUD in Vietnam. Policies that decrease incarceration, and the impacts of incarceration, for people with OUD and HIV may improve care outcomes in Vietnam and elsewhere.DisclosuresP Todd Korthuis, MD, MPH, Alkermes & Indivior (Other Financial or Material Support, Dr. Korthuis serves at principal investigator for NIH-funded studies that accept donated study medicine from Indivior (buprenorphine) and Alkermes (extended-release naltrexone).)

BackgroundHospitalizations for severe injection related infections (SIRI) amongst persons who inject drugs (PWID) are often complicated by patient directed discharge (PDD), incomplete antibiotic treatment and 90-day readmission. Despite a strong association with improved clinical outcomes, medications for opioid use disorder (MOUD) remain significantly underutilized in this patient population. Beginning in January of 2022, our institution revised several key policies that had limited inpatient use of MOUD while also implementing a new order set to facilitate MOUD inductions. This study seeks to quantify the clinical impact of these interventions in PWID admitted with SIRI.MethodsWe first performed a retrospective analysis of all PWID hospitalized with SIRI between January 2018 and December 2020 to establish baseline rates of PDD, antibiotic completion and 90-day readmission in patients who received MOUD compared to those who did not. Subsequent analyses will utilize a quasi-experimental design to compare the same clinical outcomes in patients admitted before and after institutional guideline revision and MOUD order set implementation.ResultsA total of 97 patients were included in our baseline assessment, of which 21 (21.6%) received MOUD while hospitalized. Of patients receiving MOUD, 11 (52.4%) were new inductions. Use of MOUD was associated with significantly lower rates of PDD (5 [23.8%] MOUD patients vs 40 [53.3%] no MOUD patients; OR, 0.273 [95% CI, 0.091-0.823]) and significantly higher rates of antibiotic completion (17 [81.0%] MOUD patients vs 36 [48.0%] no MOUD patients; OR, 4.6 [95% CI, 1.41-14.98]).ConclusionOur baseline data agrees with existing literature in finding MOUD to be an effective way of reducing PDD and increasing antibiotic completion in PWID admitted with SIRI. However, overall MOUD utilization was low, particularly after accounting for the effect of individuals prescribed MOUD prior to admission. Forthcoming data will assess the impact of institutional guideline revision and MOUD order set implementation on PDD, antibiotic completion and hospital readmission in PWID admitted with SIRI.DisclosuresAll Authors: No reported disclosures.

SummaryBackgroundThe syndemic of injection drug use and serious injection-related infections is leading to increasing mortality in the USA. Although outpatient treatment with medications for opioid use disorder reduces overdose risk and recurrent infections, hospitalisation remains common. We evaluated the clinical impact, costs, and cost-effectiveness of hospital-based strategies to address the US opioid epidemic.MethodsWe developed a microsimulation model to compare the cost-effectiveness of: standard hospital care—detoxification for opioids, no addiction consult service (status quo); expanded inpatient prescribing of medications for opioid use disorder, including bridge prescriptions (ie, medication until they can see an outpatient provider) when possible (medications for opioid use disorder with bridge); implementation of addiction consult services within the hospital (addiction consult services alone); and a combined medication for opioid use disorder with addiction consult services strategy (combined). We used clinical trials and observational cohorts to inform model inputs. Outcomes were life-years, discounted costs, incremental cost-effectiveness ratios, hospitalisations, and deaths. We did deterministic sensitivity analyses on key model inputs related to costs and sequelae of drug use and probabilistic sensitivity analysis to further address uncertainty.FindingsAmong people who inject opioids in the USA, we estimated that expanding medications for opioid use disorder with bridge prescriptions would reduce hospitalisations and overdose deaths by 3·2% and 3·6%, respectively, and the combination of expanded medications with opioid use disorder along with addiction consult sevices would reduce hospitalisations and overdoses by 5·2% and 6·6%, respectively, compared with the status quo. Mean lifetime costs ranged from US$731 400 (95% credible interval 447 911–859 189 for the medications for opioid use disorder strategy) to $741 200 (470 930–868 551 for the combined strategy) per person. Assuming a willingness-to-pay threshold of $100 000 per life-year gained, medications for opioid use disorder with bridge and combined strategies were cost-effective ($7600 and $14 300, respectively). A scenario that assumed ideal access to harm reduction services came to the same conclusions as the base case and our results were robust in deterministic and probabilistic sensitivity analyses.InterpretationThe combined interventions of expanding hospital-based prescribing of medications for opioid use disorder and implementing addiction consult services could improve life expectancy, be cost-effective, and could be the basis for a comprehensive hospital-based strategy for addressing the opioid epidemic in the USA and countries with similar opioid epidemics.FundingNational Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.

Ambivalence and contingencies: A qualitative examination of peer recovery coaches' attitudes toward medications for opioid use disorder

Gender differences in receipt of telehealth versus in person behavioral therapy, medication for opioid use disorder (MOUD), and 90-day MOUD retention during the pandemic: A retrospective veteran cohort study

Factors affecting problem-solving court team decisions about medications for opioid use disorder

Background: Criminal problem-solving and dependency courts set treatment standards for opioid use disorder (OUD) but sometimes prohibit or limit utilization of medications for OUD (MOUD). Court staff beliefs about MOUD inform court treatment policies. Court staff MOUD policies may also be influenced by social norms, meaning perceptions of opinions of other individuals/entities about MOUD, including opinions of fellow staff in their court, staff in other courts, the state supreme court, other state agencies, the National Association of Drug Court Professionals (NADCP), federal agencies, and local peer support groups. To date no study has examined social norms among court staff with respect to MOUD. Methods: We distributed an online cross-sectional survey in 2019 to all criminal problem-solving and dependency court staff in Florida. Respondents were asked to identify the extent to which they cared about different entities’/individuals’ opinions about MOUD and the extent to which they perceived each of those entities/individuals as encouraging MOUD. We hypothesized that court role and court type would be associated with responses. We used descriptive statistics, logistic regressions, and difference of proportions tests to analyze data. Results: 20% of the population (n = 119) completed the survey. Respondents cared most about the opinions of external treatment providers with whom they collaborate, fellow staff in their court, and the NADCP regarding MOUD. Fewer than half felt that any of these entities/individuals encourage methadone or oral buprenorphine. Additionally, fewer than 11% of respondents felt that local twelve-step peer support groups encourage the use of any form of MOUD. Conclusions: MOUD education should target all members of court teams, including collaborating treatment providers. Since court staff care relatively little about the MOUD opinions of staff in other courts, changes in opinions in one court may not affect changes in opinions in a neighboring court. The NADCP should more explicitly state its support for MOUD, and specifically oral buprenorphine and methadone treatment.

Background Problem-solving courts use an interdisciplinary approach with treatment mandates, hearings, and monitoring to rehabilitate individuals arrested for drug-related crimes or lost custody of children due to drug use. Medications for opioid use disorder (MOUD) are the standard of care for treating opioid use disorder (OUD), but few problem-solving court clients with OUD are referred to MOUD. Previous studies found court staff often harbor misconceptions about MOUD and could benefit from MOUD education. Tailoring education to the intended audience is an educational best practice. We sought to identify content and style preferences for two MOUD education videos: 1) an introduction to MOUD and, 2) MOUD myths/misconceptions. Methods We recruited 40 Florida problem-solving court staff. Using semi-structured interviews, invited document/script edits, and qualitative surveys, we collected data at each of four video development stages. We used template analysis for qualitative data. Results Court staff desired the following content: OUD as a chronic brain condition and MOUD as an effective response; MOUD risks and benefits; how MOUD is accessed; and the appropriate role of court staff with MOUD decisions. Style preferences were: no juvenile/cutesy animation; relatable characters/environments; simple concept illustration; individualizing the learning experience; and combinations of scientific animated videos and successful stakeholder interviews. Discussion Our findings reinforce the importance of tailoring MOUD education to the audience. Court staff’s wish for education about their appropriate role with MOUD reflects their unique position making treatment referrals. Court staff’s desire for stakeholder recordings of success stories mirrors the importance of opinion leaders in other dissemination studies.

To describe patterns of medication for opioid use disorder (MOUD) during pregnancies in the opioid use disorder (OUD) cohort of MAT-LINK, a sentinel surveillance network of pregnancies at US clinical sites. Seven clinical sites providing care for pregnant people with OUD collected electronic health record data. Pregnancies were included in this analysis if (1) the pregnancy outcome occurred between January 2014 and August 2021, (2) the person had OUD, and (3) there was any electronic health record-documented MOUD during pregnancy. Analyses describing MOUD type, demographic characteristics, and timing during pregnancy were performed. Among 3911 pregnancies with any documented MOUD, more than 90% of pregnancies with methadone were to publicly insured people, which was greater than percentages for pregnancies with other MOUD. Buprenorphine with naloxone and naltrexone were two MOUD types that were increasingly common among pregnant people in recent years. In most pregnancies, prenatal care and MOUD were first documented in the same trimester. During the first, second, and third trimesters, there were 37%, 61%, and 91% of pregnancies with MOUD, respectively. Approximately 87% (n = 3412) had only 1 documented MOUD type, versus 2 or 3 types. However, discontinuity in MOUD across trimesters was still observed. In MAT-LINK's OUD cohort, the overall frequency of MOUD improved over the course of pregnancy. Contextual factors, such as insurance status and year of pregnancy outcome, might influence MOUD type. Prenatal care and MOUD might be facilitators for one another; however, there are still opportunities to improve early linkage and continuous access to both prenatal care and MOUD during pregnancy.

Implementing evidence-based treatment for pregnant people with opioid use disorder in jail: A qualitative analysis of jail administrator and clinician perspectives.

BackgroundAn emerging public health threat of methamphetamine/opioid co-use is occurring in North America, including increases in overdoses related to concomitant methamphetamine/opioid use. This presents a potential risk to established treatments for opioid use disorder (i.e., medications for opioid use disorder [MOUD]). To date, few studies have examined the impact of methamphetamine use on MOUD-related outcomes, and no studies have synthesized data on MOUD retention.MethodsA scoping review was undertaken to examine the impact of methamphetamine use on MOUD retention. All original published research articles were searched in Embase, MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Protocols, and Google scholar databases. Data were extracted into a standardized data extraction chart. Findings were presented narratively.ResultsAll eight included studies demonstrated an increased likelihood of treatment discontinuation or dropout among patients enrolled in MOUD who used methamphetamine. The frequency of methamphetamine use was also associated with MOUD dropout, in that those who used methamphetamine more often were more likely to discontinue MOUD. The definitions and measurements of MOUD retention varied considerably, as did the magnitude of effect size.ConclusionsResults indicate that methamphetamine use has an undesirable impact on MOUD retention and results in an increased risk of treatment discontinuation or dropout. Strategies to identify concurrent methamphetamine use among individuals engaging in MOUD and educate them on the increased risk for dropout should be undertaken. Further research is needed to understand how MOUD retention among patients with concomitant opioid and methamphetamine use can be improved.

The association between attitudes and the provision of medications for opioid use disorder (MOUD) in United States jails

A large body of research demonstrates the safety and efficacy of medication for opioid use disorder to reduce opioid misuse and related harms. However, stigma is a substantial barrier to broader use of these medications. This endpage reviews the impact of stigma toward medication for opioid use disorder on treatment access, uptake, retention, and outcomes. I then suggests areas for future research and social change. As one of the primary service providers for people with opioid use disorder, social workers should be at the forefront of efforts to destigmatize medication treatments. Social workers are well positioned to address the consequences of stigma toward medication for opioid use disorder through research, education, practice, and systems change. VIDEO ABSTRACT SCRIPT Methadone, buprenorphine, and extended-release naltrexone, the three FDA-approved medications for opioid use disorder, are among the most powerful tools we have in our fight against the rising drug overdose crisis. A large body of research demonstrates the safety and efficacy of these medications to reduce opioid cravings, improve treatment outcomes, and prevent overdose death. However, stigma is a major barrier to their use. Despite a strong evidence base, medications for opioid use disorder are commonly viewed as ineffective and illegitimate treatments that simply ‘substitute one drug for another.’ Stigma is encoded in stringent laws and regulations which limit access to medication. For people with opioid use disorder, stigma can influence beliefs about medications and affect the likelihood that one will initiate and maintain treatment. Stigma also erodes self-esteem and social support, two important predictors for recovery outcomes. In this way, stigma toward medications for opioid use disorder has become a pressing social justice issue. As one of the primary service providers for people with opioid use disorder, social workers should be at the forefront of efforts to destigmatize medication treatments. This endpage is a call to action for social workers to address stigma toward medication treatments through research, education, practice, and systems change.

Increasing access to medications for opioid use disorder (MOUD) is a key strategy in addressing the opioid crisis. To increase MOUD access, state governments have pursued a combination of increased funding for MOUD and requirements that providers offer treatment. Louisiana has pursued multiple strategies, including a requirement that residential treatment programs offer MOUD as part of their licensure. Using Louisiana Medicaid claims data for enrollees with diagnosed OUD from the period 2018-21, we analyzed trends in MOUD between enrollees treated in residential and nonresidential settings and across demographic subgroups, and we compared trends by MOUD type. MOUD use more than tripled from 2018 to 2021 among Louisiana Medicaid enrollees diagnosed with OUD. Most of the increase in MOUD was attributable to buprenorphine use. Methadone uptake also contributed to greater MOUD use but was almost exclusively used by enrollees treated in nonresidential settings, whereas naltrexone was consistently more common in residential treatment. By 2021, differences persisted across demographic groups: MOUD use was highest among enrollees who were White, were older, had comorbidities, and lived in a metropolitan area. Policies that promote MOUD in substance use treatment programs, particularly residential programs, are critical tools for policy makers confronting a complex and unprecedented national overdose crisis.

Introduction Access to medications for opioid use disorder (MOUD) varies across racial and ethnic groups. As the largest payer for MOUD, Medicaid has potential to ensure access for all enrollees. We aimed to quantify recent trends and state variation in MOUD use by race and ethnicity in Medicaid. Methods Using a distributed research network, we conducted a cross-sectional study of 11 states' Medicaid data from 2016 to 2020. Among enrollees diagnosed with opioid use disorder (OUD), we measured the percent receiving MOUD (overall; and methadone, buprenorphine, naltrexone, separately), continuity of MOUD for ≥180 days, and claims-based overdose event rates. We estimated logistic regression models in each state with fixed effects for year, race/ethnicity, and year and race/ethnicity interaction terms to examine changes in demographic differences in outcomes over time, adjusting for patient characteristics. We pooled estimates using random effects meta-analyses. Results Of the 542,414 enrollees with OUD in 2020, 430,891 (79.4%) were non-Hispanic white, 77,952 (14.4%) were non-Hispanic Black, 17,094 (3.2%) were Hispanic, and 16,477 (3.0%) had other race or ethnicity. MOUD use increased among enrollees in all racial and ethnic groups over time. The share of non-Hispanic white enrollees diagnosed with OUD receiving MOUD increased from 52.3% to 68.8% from 2016 to 2020 while the percent of non-Hispanic Black enrollees receiving MOUD from 37.2% to 49.7% during that period. Differences were widest for buprenorphine versus methadone or naltrexone. In adjusted analyses, Hispanic and Non-Hispanic Black enrollees were less likely to receive MOUD (adjusted odds ratios (AOR) = 0.67 [95 CI 0.49–0.91] and AOR = 0.41 [95 CI 0.33–0.52], respectively) compared to non-Hispanic white enrollees in 2016. Differences in receipt of MOUD did not change from 2016 to 2020. Non-Hispanic Black enrollees were less likely to have continuous MOUD relative to non-Hispanic white enrollees (AOR = 0.68 [95 CI 0.61–0.77)]. Overdose events peaked in 2017 for all racial and ethnic groups and were highest for Hispanic enrollees in 2020. Conclusion MOUD increased among all racial and ethnic groups in 11 state Medicaid programs from 2016 to 2020. Yet, racial and ethnic differences in MOUD persisted, especially for buprenorphine. Our findings can inform Medicaid efforts to improve access to MOUD for all enrollees affected by OUD.