Journal of Substance Abuse Treatment最新文献

{"title":"Knowledge, attitudes, and behaviors related to the fentanyl-adulterated drug supply among people who use drugs in Oregon","authors":"Kate LaForge ,&nbsp;Erin Stack ,&nbsp;Sarah Shin ,&nbsp;Justine Pope ,&nbsp;Jessica E. Larsen ,&nbsp;Gillian Leichtling ,&nbsp;Judith M. Leahy ,&nbsp;Andrew Seaman ,&nbsp;Dan Hoover ,&nbsp;Mikaela Byers ,&nbsp;Caiti Barrie ,&nbsp;Laura Chisholm ,&nbsp;P. Todd Korthuis","doi":"10.1016/j.jsat.2022.108849","DOIUrl":"10.1016/j.jsat.2022.108849","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Nonpharmaceutical fentanyl has reconfigured the U.S. </span>illicit drug<span> market, contributing to a drastic increase in overdose drug<span> deaths. While illicit fentanyl has subsumed the drug supply in the Northeast and Midwest, it has more recently reached the West. For this study, we explored knowledge, attitudes, and behaviors among people who use drugs in Oregon in the context of the emergence of fentanyl in the drug supply.</span></span></p></div><div><h3>Methods</h3><p>We conducted in-depth interviews by phone with 34 people who use drugs in Oregon from May to June 2021. We used thematic analysis to analyze transcripts and construct themes.</p></div><div><h3>Results</h3><p>People who use drugs knew about fentanyl, expressed doubt that fentanyl could be found in methamphetamine; believed those who were younger or less experienced were at higher risk for harm; and received information about fentanyl from drug dealers, syringe service programs, or peers (other people who use drugs). Preference for fentanyl's presence in drugs like heroin or methamphetamine was mixed. Some felt that their preference was irrelevant since fentanyl was unavoidable. Participants reported engaging in harm reduction practices, including communicating about fentanyl with dealers and peers, testing for fentanyl, using smaller quantities of drugs, switching from injecting to smoking, and using naloxone.</p></div><div><h3>Conclusion</h3><p>People who use drugs are responding to the rise of fentanyl on the West Coast and are concerned about the increasing uncertainty and hazards of the drug supply. They are willing and motivated to adopt harm reduction behaviors. Harm reduction promotion from syringe service programs and public health agencies is essential to reduce injury and death from nonpharmaceutical fentanyl.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108849"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9370093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call for Kindness, Connection, and Science","authors":"Barbara Straus Lodge","doi":"10.1016/j.jsat.2022.108839","DOIUrl":"10.1016/j.jsat.2022.108839","url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>This personal narrative describes our family's struggle with my adult son's substance use disorder (SUD). Years of traditional tough love treatment programs worsened his SUD and our relationship. When he experienced </span>drug induced psychosis and was hospitalized, I realized I needed to change my approach and understand his </span>behaviors.</p></div><div><h3>Methods</h3><p>I reached out to the recovery community and spoke with many individuals who had walked in my son's shoes. They described feelings of loneliness, self-loathing, and hopelessness while being on the receiving end of tough love. They further described the contrast between those negative feelings, and the life affirming hope associated with communication, empathy, and inclusion. I became inspired to research programs that are based on communication, science, and connection, rather than isolation, judgment, and punishment.</p></div><div><h3>Results</h3><p><span>Family and community are powerful tools and can motive change. An evidence-based program called CRAFT (Community Reinforcement and Family Training) encourages relationships and teaches families skills to connect with their loved ones by effectively communicating and reinforcing positive behaviors, even in the context of unhealthy behaviors. Receiving praise for healthy behavior, recognition for good work, or even a positive acknowledgement for taking baby steps toward self-care can activate the same dopamine-producing reward system as drugs. Individuals with SUD can learn how to feel good in ways that do not involve using substances. Traditional patient-focused treatment programs, which encourage separation, punishment, and distance should not be considered the </span><em>only</em> approach to treatment.</p></div><div><h3>Conclusions</h3><p>Loved ones are not powerless. While we can't <em>make</em> a person change, we can contribute to making them <em>want</em> to change. We have more influence than we once thought possible and need to proactively seek out empirically supported family-based programs that reinforce these approaches.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108839"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40534086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department utilization by individuals with opioid use disorder who were recently incarcerated","authors":"John Will,&nbsp;Marce Abare,&nbsp;Mollie Olson,&nbsp;Alexander Chyorny,&nbsp;Emilee Wilhelm-Leen","doi":"10.1016/j.jsat.2022.108838","DOIUrl":"10.1016/j.jsat.2022.108838","url":null,"abstract":"<div><h3>Introduction</h3><p>Individuals with opioid use disorder (OUD) are highly represented among the incarcerated population<span> and are frequent utilizers of the emergency department<span> (ED). Medications for opioid use disorder (MOUD) are a recognized treatment option for individuals with OUD. Although the field recognizes the benefits of MOUD, we know little about what mitigating effects MOUD offered in jail might have on post-release ED utilization.</span></span></p></div><div><h3>Methods</h3><p><span><span>In this retrospective cohort analysis, we searched </span>electronic medical records (EMR) for incarcerations in the Santa Clara County jail between 8/1/2019 and 8/31/2021 for individuals with OUD (</span><em>N</em><span><span> = 4352) and collected demographic and medication administration data for these individuals. Individuals are considered as having received MOUD if they have at least one administration of methadone, naltrexone<span>, or extended release (XR) buprenorphine during their incarceration. We also collected ED visit data from the same EMR for the 28 days following release from the identified incarcerations. Using </span></span>logistic regression, we compared ED use within 24 h and 28 days for individuals who are incarcerated and treated with MOUD with those not receiving treatment.</span></p></div><div><h3>Results</h3><p>Individuals who received methadone or XR buprenorphine during their incarceration were less likely to present at the 28 days following release than those not receiving treatment, after controlling for age, race, sex assigned at birth, preferred language, and housing status. Most individuals accessing the ED within 28 days of release do so within the first seven days, and the greatest volume occurred in the first 24 h. Individuals released before noon had a lower likelihood of ED presentation within 24 h than those released in the afternoon.</p></div><div><h3>Conclusions</h3><p>Offering methadone and XR buprenorphine to individuals with OUD who are incarcerated is beneficial in mitigating ED utilization within 28 days of release, although further research is needed to understand what other contributing variables, especially those related to follow-up care, could be influencing these results. If possible, release times for individuals could be shifted to the morning to maximize reduction in ED use within 24 h of release. Alternatively, further research should investigate why release times appear to influence ED utilization.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108838"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying factors that contribute to burnout and resilience among hospital-based addiction medicine providers: A qualitative study.","authors":"Erin Bredenberg, C. Tietbohl, A. Dafoe, L. Thurman, S. Calcaterra","doi":"10.2139/ssrn.4116413","DOIUrl":"https://doi.org/10.2139/ssrn.4116413","url":null,"abstract":"INTRODUCTION\u0000Inpatient Addiction Consultation Services (ACS) fill an important need by connecting hospitalized patients with substance use disorders with resources for treatment; however, providers of these services may be at risk for burnout. In this qualitative study, we aimed to identify factors associated with burnout and, conversely, resilience among multidisciplinary providers working on ACS.\u0000\u0000\u0000METHODS\u0000We completed 26 semi-structured interviews with clinicians working on ACS, including physicians, social workers, and advanced practice providers. Twelve institutions across the country were represented. The study recruited participants via email solicitation to ACS directors and then via snowball sampling. We used an inductive, grounded theory approach to analyze data.\u0000\u0000\u0000RESULTS\u0000Providers described factors contributing to burnout and strategies for promoting resilience, and three main themes arose: (1) Systemic barriers contributed to provider burnout, (2) Engaging in meaningful work increased resilience, and (3) Team dynamics influenced perceptions of burnout and resilience.\u0000\u0000\u0000CONCLUSION\u0000Our results suggest that hospital-based addiction medicine work is intrinsically rewarding for many providers and that engaging with other addiction providers to debrief challenging encounters or engage in advocacy work can be protective against burnout. However, administrative and systemic factors are frequent sources of frustration for providers of ACS. Structured debriefings may help to mitigate burnout. Furthermore, training to enhance providers' ability to engage effectively in advocacy work within and between hospital systems has the potential to promote resilience and protect against burnout among ACS providers.","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"14 4","pages":"108924"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41280601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities.","authors":"Theresa E. Tassey, G. E. Ott, A. Alvanzo, J. Peirce, Denis G. Antoine, Megan E Buresh","doi":"10.2139/ssrn.4071354","DOIUrl":"https://doi.org/10.2139/ssrn.4071354","url":null,"abstract":"INTRODUCTION\u0000Rates of hospitalizations from medical complications of opioid use disorder (OUD) are rising and many of these patients require post-acute care at skilled nursing facilities (SNFs). However, access to medication for OUD (MOUD) at SNFs remains low and patients with OUD have high rates of patient-directed discharge (PDD) and hospital readmissions.\u0000\u0000\u0000METHODS\u0000Opioid Use Disorder Medical Patient Engagement, Enrollment in treatment and Transitional Supports (OUD MEETS) program was a clinical pilot designed to increase initiation of buprenorphine and methadone for hospitalized patients with OUD requiring post-acute care. The program comprises a hospital partnership with two SNFs and two opioid treatment programs (OTPs) to improve recovery supports and access to MOUD for patients discharged to SNF.\u0000\u0000\u0000RESULTS\u0000Between August 2019 and August 2020, study staff approached 49 hospitalized patients with OUD for participation in OUD MEETS. Twenty-eight of 30 eligible patients enrolled in the program and initiated buprenorphine or methadone. Twenty-seven (96 %) enrolled patients successfully completed hospital treatment. Twenty-three (85 %) patients successfully completed medical treatment at SNF. Thirteen (46 %) enrolled patients had confirmed linkage to OUD treatment post-SNF. One patient left the hospital (4 %) and four patients left SNF (15 %) via PDD.\u0000\u0000\u0000CONCLUSION\u0000OUD MEETS demonstrates feasibility of hospital, SNF, and OTP partnership to integrate MOUD treatment into SNFs, with high rates of completion of medical treatment and low rates of PDD. Future research should find sustainable ways to improve access to MOUD at post-acute care facilities, including through regulatory and policy changes.","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"143 1","pages":"108895"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45539620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug court utilization of medications for opioid use disorder in high opioid mortality communities","authors":"Douglas B. Marlowe ,&nbsp;David S. Theiss ,&nbsp;Erika M. Ostlie ,&nbsp;John Carnevale","doi":"10.1016/j.jsat.2022.108850","DOIUrl":"10.1016/j.jsat.2022.108850","url":null,"abstract":"<div><h3>Introduction</h3><p>A 2012 national survey found low utilization of medication for opioid use disorder (MOUD) in US drug courts. This study provides an update on MOUD policies and practices among drug courts in communities that the opioid epidemic has substantially impacted.</p></div><div><h3>Methods</h3><p>The study surveyed adult drug courts (<em>N</em><span> = 169, 80 % response rate) in US counties with high opioid mortality rates or numbers of opioid-related deaths about their policies and practices relating to MOUD and the overdose-reversal medication, naloxone.</span></p></div><div><h3>Results</h3><p>Nearly three quarters of the programs (73 %) reported providing access to all FDA-approved MOUD medications, &gt;90 % offer agonist medications (buprenorphine and/or methadone), 80 % provide naloxone training, and 62 % distribute naloxone overdose-reversal kits to their clients. Most programs rely principally on medical judgment for medication decisions (75 %), have received staff training on MOUD (65 %), and have arranged for clients to continue receiving agonist medications while serving jail sanctions for program violations (63 %). Nevertheless, only about one quarter to one half of clients with OUDs receive the medications in most programs, and respondents offered few explanations for this disconnect between policy and practice. In addition, 24 % of the programs continue to overrule medication decisions and 36 % of the jails in these communities do not offer agonist medication for drug court clients serving custodial sanctions.</p></div><div><h3>Conclusions</h3><p>Programs have achieved substantial progress in the past decade in improving drug court policies concerning MOUD in communities enduring the worst brunt of the opioid epidemic; however, programs require further guidance to help them understand and rectify service barriers and put intended MOUD policies into effective operation. The authors provide recommendations to enhance MOUD utilization in drug courts and the broader criminal justice system.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108850"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of extended-release injectable naltrexone among incarcerated persons with opioid use disorder before release from prison versus after release","authors":"Ali Jalali ,&nbsp;Philip J. Jeng ,&nbsp;Daniel Polsky ,&nbsp;Sabrina Poole ,&nbsp;Yi-Chien Ku ,&nbsp;George E. Woody ,&nbsp;Sean M. Murphy","doi":"10.1016/j.jsat.2022.108835","DOIUrl":"10.1016/j.jsat.2022.108835","url":null,"abstract":"<div><h3>Introduction</h3><p>Opioid use disorder (OUD) is highly prevalent among incarcerated populations<span><span>, and the risk of fatal overdose following release from prison is substantial. Despite efficacy, few correctional facilities provide evidence-based addiction treatment. Extended-release injectable </span>naltrexone (XR-NTX) administered prior to release from incarceration may improve health and economic outcomes.</span></p></div><div><h3>Methods</h3><p><span>We conducted an economic evaluation alongside a randomized controlled trial testing the effectiveness of XR-NTX before release from prison (</span><em>n</em> = 38) vs. XR-NTX referral after release (<em>n</em><span> = 48) of incarcerated participants with OUD, both groups continuing treatment at a community addiction treatment center. The incremental cost-effectiveness ratio (ICER) assessed the cost-effectiveness of XR-NTX before release compared to referral after release for three stakeholder perspectives at 12- and 24-week periods: state policymaker, health care sector, and societal. Effectiveness measures included quality-adjusted life-years (QALYs) and abstinent years from opioids. In addition, we categorized resources as OUD-related and non-OUD-related medical care, state transfer payments, and other societal costs (productivity, criminal justice resources, etc.).</span></p></div><div><h3>Results</h3><p>Results showed an association between XR-NTX and greater OUD-related costs and total costs from the state policymaker perspective. QALYs gained were positive but statistically insignificant between arms; however, results showed XR-NTX had an estimated 15.5 more days of opioid abstinence over 24 weeks and statistically significant at a 95 % confidence level based on the distribution of bootstrapped samples. We found that estimated ICERs to be &gt; $500,000 per QALY for all stakeholder perspectives. For the abstinent-year effectiveness measure, we found XR-NTX before release to be cost-effective at a 95 % confidence level for willingness-to-pay values &gt;$49,000 per abstinent-year, across all perspectives.</p></div><div><h3>Conclusions</h3><p>XR-NTX administered to persons who are incarcerated with OUD before release may provide value for stakeholders and bridge a well-known treatment gap for this vulnerable population. Lower than expected participant engagement and missing data limit our results, and study outcomes may be sensitive to methods that address missing data if replicated.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108835"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40606040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting methadone inductions to the fentanyl era","authors":"Megan Buresh ,&nbsp;Shadi Nahvi ,&nbsp;Scott Steiger ,&nbsp;Zoe M. Weinstein","doi":"10.1016/j.jsat.2022.108832","DOIUrl":"10.1016/j.jsat.2022.108832","url":null,"abstract":"<div><p><span>Since 2013, fentanyl and fentanyl analogs, which are significantly more potent than heroin, have been increasingly prevalent in the opioid </span>drug<span><span> supply. A need exists to adapt methadone dosing from opioid treatment programs (OTPs) in this era. Current methadone protocols at many clinics in the United States are based on expert consensus documents that were created prior to the introduction of fentanyl into the drug supply and are relatively conservative. To date, most OTP reform efforts have focused on relaxation of regulations for take-homes and have not addressed the need to adapt methadone induction schedules to be more rapid in the fentanyl era, as allowed by current regulations. Written by OTP and inpatient consult service </span>addiction medicine physicians with expertise in OUD treatment from across the United States, the aims of the perspective piece are to: 1) highlight the need to improve OTP care by adapting methadone inductions to the fentanyl era, 2) cite emerging evidence for and examples of experiences of OTPs using more aggressive methadone inductions, and 3) call for research and updated guidelines on safety and best practices for methadone induction.</span></p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"141 ","pages":"Article 108832"},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40628481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of prenatal substance use policies on commercially insured pregnant females with opioid use disorder","authors":"Nadia Tabatabaeepour ,&nbsp;Jake R. Morgan ,&nbsp;Ali Jalali ,&nbsp;Shashi N. Kapadia ,&nbsp;Angélica Meinhofer","doi":"10.1016/j.jsat.2022.108800","DOIUrl":"10.1016/j.jsat.2022.108800","url":null,"abstract":"<div><h3>Introduction</h3><p>States' approaches to addressing prenatal substance use are widely heterogeneous, ranging from supportive policies that enhance access to substance use disorder (SUD) treatment to punitive policies that criminalize prenatal substance use. We studied the effect of these prenatal substance use policies (PSUPs) on medications for opioid use disorder (OUD) treatment, including buprenorphine, naltrexone, and methadone, psychosocial services for SUD treatment, opioid prescriptions, and opioid overdoses among commercially insured pregnant females with OUD. We evaluated: (1) punitive PSUPs criminalizing prenatal substance use or defining it as child maltreatment; (2) supportive PSUPs granting pregnant females priority access to SUD treatment; and (3) supportive PSUPs funding targeted SUD treatment programs for pregnant females.</p></div><div><h3>Methods</h3><p>We analyzed 2006–2019 MarketScan Commercial Claims and Encounters data. The longitudinal sample comprised females aged 15–45 with an OUD diagnosis at least once during the study period. We estimated fixed effects models that compared changes in outcomes between pregnant and nonpregnant females, in states with and without a PSUP, before and after PSUP implementation.</p></div><div><h3>Results</h3><p>Our analytical sample comprised 2,438,875 person-quarters from 164,538 unique females, of which 13% were pregnant at least once during the study period. We found that following the implementation of PSUPs funding targeted SUD treatment programs, the proportion of opioid overdoses decreased 45% and of any OUD medication increased 11%, with buprenorphine driving this increase (13%). The implementation of SUD treatment priority PSUPs was not associated with significant changes in outcomes. Following punitive PSUP implementation, the proportion receiving psychosocial services for SUD (12%) and methadone (30%) services decreased. In specifications that estimated the impact of criminalizing policies only, the strongest type of punitive PSUP, opioid overdoses increased 45%.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that supportive approaches that enhance access to SUD treatment may effectively reduce adverse maternal outcomes associated with prenatal opioid use. In contrast, punitive approaches may have harmful effects. These findings support leading medical organizations' stance on PSUPs, which advocate for supportive policies that are centered on increased access to SUD treatment and safeguard against discrimination and stigmatization. Our findings also oppose punitive policies, as they may intensify marginalization of pregnant females with OUD seeking treatment.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108800"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9357143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47468770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a claim-based provider-level measurement of use of medications to treat opioid use disorder","authors":"William N. Dowd ,&nbsp;Daniel H. Barch ,&nbsp;Julie H. Seibert ,&nbsp;Tami L. Mark","doi":"10.1016/j.jsat.2022.108824","DOIUrl":"10.1016/j.jsat.2022.108824","url":null,"abstract":"<div><h3>Objective</h3><p>Medication for opioid use disorder (MOUD) is effective but underused. Measuring the percentage of a provider's patients with an opioid use disorder (OUD) who receive MOUD may drive quality improvement and stimulate greater use of medications. This study introduces and tests a provider-level measure of MOUD receipt.</p></div><div><h3>Methods</h3><p>The study used claims and enrollment data from 32 states in the 2014 Medicaid Analytic Extract to measure the proportion of a provider's patients who received MOUD within 30 days of their OUD diagnosis. The research team assessed measure reliability with several tests to establish the effect of provider on MOUD receipt; and assessed the validity by correlation with a measure of emergency department visits or hospitalizations related to substance use.</p></div><div><h3>Results</h3><p>The sample included 434,484 individuals treated for OUD by one or more of 9398 providers. The mean provider score was 38 %, indicating that 38 % of the average provider's patients received an MOUD within 30 days of an OUD diagnosis (44 % for clinicians [<em>N</em> = 5344] and 31 % for facilities [<em>N</em><span> = 4054]). Provider performance varied considerably. The interquartile ranges were 11 %–79 % and 9 %–45 % among clinicians and facilities, respectively. The measure reliably distinguished between lower- and higher-performing providers and demonstrated convergent validity, as indicated by a significant and moderately sized negative correlation between MOUD receipt and substance use–related hospitalizations or emergency department visits.</span></p></div><div><h3>Conclusions</h3><p>The measure may help to improve access to MOUD and OUD outcomes by identifying providers who could benefit from technical assistance, quality improvement initiatives, and resources to expand MOUD prescribing.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"140 ","pages":"Article 108824"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40578167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}