Medicine and Health Sciences Commons^™

Improving Outcomes For Persons With Opioid Use Disorder By Introducing Buprenorphine In The Emergency Department, Emily Caroline Wegenka, Mary Johnson, Thomas Vajen

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid related death is the leading cause of accidental death in adults younger than 50 years old in the United States (US) with approximately 130 opioid related deaths daily. Emergency department (ED) visits for a non-fatal overdose, the one-year mortality is 4.7-5.5%. Studies show increased access to medications for opioid use disorder (MOUD) decrease morbidity and mortality related to OUD. Additionally, there is evidence that initiating MOUD in the ED increases engagement in outpatient follow up, also reducing morbidity and mortality associated with OUD.

LOCAL PROBLEM: The setting for this practice improvement project was a non-profit, rural …

Real-World Dispensing Of Buprenorphine In California During Prepandemic And Pandemic Periods, Yun Wang, Alexandre Chan, Richard Beuttler, Marc L. Fleming, Todd Schneberk, Michael Nichol, Haibing Lu

Pharmacy Faculty Articles and Research

Introduction: The opioid overdose crisis in the United States has become a significant national emergency. Buprenorphine, a primary medication for individuals coping with opioid use disorder (OUD), presents promising pharmacokinetic properties for use in primary care settings, and is often delivered as a take-home therapy. The COVID-19 pandemic exacerbated the scarcity of access to buprenorphine, leading to dire consequences for those with OUD. Most existing studies, primarily focused on the immediate aftermath of the COVID-19 outbreak, highlight the challenges in accessing medications for opioid use disorder (MOUDs), particularly buprenorphine. However, these studies only cover a relatively short timeframe. Methods: To …

Expansion Of Osteopathic Medicine Practitioner Education On Substance Use Disorders, Joanna Petrides, Stuti Jha, Alexander Kowalski, Suzanna Hosein, Philip B Collins, Joshua Coren

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Medical school graduates are generally not well prepared to treat patients with substance use disorders (SUDs), even though opioid overdose deaths in the United States have increased in recent years. When it comes to training in SUDs, osteopathic medicine lags far behind allopathic medicine. It was only in 2019 that the American Osteopathic Association approved Board Certification in Addiction Medicine to help combat the opioid epidemic. Few articles have been published in the literature pertaining to substance use education for osteopathic students and trainees.

OBJECTIVES: The goal of this study was to expand the education of osteopathic medical students …

Recovery Capital, Mental Health And Substance Use Among Individuals Initiating Office-Based Buprenorphine Treatment For Opioid Use Disorder, Hannah R. Callahan, Karen Dugosh, Emily Hurstak, Patty Mccarthy, Emily Garber, Daniel Dejoseph, Julia Dejoseph, Michelle R. Lent

The Journal of Integrated Primary Care

Recovery capital refers to the internal and external resources available to support an individual in their recovery from substance use disorders. Using data from an ongoing trial, the current study examined recovery capital among 225 individuals initiating office-based buprenorphine treatment for opioid use disorder (OUD) at Federally Qualified Health Centers in the mid-Atlantic region. At baseline, participants completed the Brief Assessment of Recovery Capital-10 (BARC-10), a validated measure assessing the 4 major domains of recovery capital and completed a urine toxicology screening. Participants reported BARC-10 scores of 49.22 on average (SD = 8.14). Average scores were highest for the …

Implementation Of A Screening, Brief Intervention, And Referral To Treatment Protocol For Treatment Of Opioid Use Disorder In Post-Carceral Populations, Adaora Ede, Mary Johnson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid use disorder (OUD) is a pressing public health issue in the US affecting marginalized populations the most. Within the correctional setting, 65% of inmates are affected with OUD, worsening health outcomes when untreated.

LOCAL PROBLEM: This evidence-based practice (EBP) project targeted justice-involved individuals with co-occurring OUD at a behavioral health clinic in Johnson City, Tennessee. This project aimed to improve outcomes related to recidivism and relapse through clinician education and the implementation of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol.

METHODS: Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was the guiding EBP model for the …

Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton

Master's Projects and Capstones

As the opioid epidemic continues to have devastating effects on our communities, medications to treat opioid use disorder (MOUDs) are severely underutilized especially for adolescents. Unlike adults, minors need parental approval before obtaining MOUDs presenting a key barrier to timely treatment. Being able to treat adolescents as soon as they are ready is critically important for people with OUD, and while cost and other barriers have been addressed in the literature, there is a paucity on how parental consent affects the accessibility of treatment. This paper aims to explore a potential policy in California that addresses the lack of access …

A Call To Action: Person-Centered Care Aligned With Reproductive Justice For Incarcerated Pregnant People With Substance Use Disorder, Essence Hairston, Aunchalee El Palmquist, Andrea K. Knittel, Kevin Mensah-Biney, Crystal M. Hayes, Amelia Mack, Hendrée E. Jones

School of Social Work Faculty Publications

Although research has proven that jails and prisons are ineffective in preventing or reducing substance use among pregnant people, the USA continues to rely heavily on the criminal legal system as its intervention. Pregnant people with an opioid use disorder are more likely to experience incarceration than pregnant people without an opioid use disorder. In some states, pregnant people are transported from jail to prison through the process of safekeeping in order to receive physical or mental health care that the jail does not provide, despite conviction status. When pregnant and postpartum safekeepers with an opioid use disorder experience incarceration, …

Neonatal Abstinence Syndrome (Nas): What You Need To Know, Maren Wright Wright Voss, Amelia Van Komen, Emily Hamilton, Aarica Cleveland, Jaclyn Miller

All Current Publications

National overdose deaths continue to rise, with 2021 marking the first time U.S. overdose deaths topped 100,000 in a 12-month timeframe. Substance use, such as alcohol, cocaine, opioids, and marijuana, during pregnancy is also increasing. As the U.S. struggles with harmful substance use, a growing number of infants are born with neonatal abstinence syndrome (NAS), a harmful outcome of fetal exposure to substances. This fact sheet will talk about why and what to do, with recommendations for safe treatment and support during pregnancy.

Factors Affecting Initiation And Retention Of Medication-Assisted Recovery (Mar) Within A Pilot Pharmacist-Involved Practice Model At A Federally Qualified Healthcare Center (Fqhc) During The Covid-19 Pandemic, Tiffany Nguyen, Thomas Craig Cheetham, Souhiela Fawaz, Richard Beuttler, Sharon Xavioer

Pharmacy Faculty Articles and Research

Background: During the COVID-19 pandemic, opioid-related overdose deaths increased. Although Medication-Assisted Treatment or Recovery (MAT or MAR) is available, initiation and retention rates vary. The goal of this study was to evaluate clinical, demographic, and Social Determinant of Health factors affecting MAR initiation, on-time initiation of medications, and successful retention in the program. The secondary goal was to evaluate the impact of a novel interprofessional practice model incorporating pharmacists. Methods: A retrospective analysis was conducted using electronic health record data from a pilot MAR Program initiated within a California Federally Qualified Healthcare Center. Results: From September 2019 to August 2020, …

Prevention And Education In Medication Assisted Treatment Facilities, Lindsey Mccartt

Epsilon Sigma at-Large Research Conference

Introduction and Background: Between 1999 and 2014 the number of patients in the labor and delivery that were on medication for opioid use disorder (MOUD) quadrupled. The rate of unintended pregnancies in pregnant patients of mOUD is at a tremendous high due to inconsistencies in the use of reliable contraception in this population.

Purpose Statement: To reduce the number of unintended pregnancies and infants born with neonatal abstinence syndrome there is a need for prevention and required education for men and women in medication-assisted facilities.

Literature Review: Twenty research studies were reviewed and evaluated. These articles were …

Childhood-Onset Attention-Deficit/Hyperactivity Disorder Exacerbates Opioid Use Disorder Consequences: Mediation By Impulsive Phenotypes, Liam R. Browning, Ciara Cannoy, Tabitha E. H. Moses, Leslie H. Lundahl Phd, David M. Ledgerwood Phd, Mark K. Greenwald Phd

Medical Student Research Symposium

Background: Attention deficit hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes.

Aim: This cross-sectional study examines relationships between childhood ADHD (inferred as predating substance use) and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by foreshortened time perspective and drug-use impulsivity.

Methods: Individuals who report heroin use (N=214) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), …

Opioid Use Disorder Prediction Using Machine Learning Of Fmri Data, A. Temtam, Liangsuo Ma, F. Gerard Moeller, M. S. Sadique, K. M. Iftekharuddin, Khan M. Iftekharuddin (Ed.), Weijie Chen (Ed.)

Electrical & Computer Engineering Faculty Publications

According to the Centers for Disease Control and Prevention (CDC) more than 932,000 people in the US have died since 1999 from a drug overdose. Just about 75% of drug overdose deaths in 2020 involved Opioid, which suggests that the US is in an Opioid overdose epidemic. Identifying individuals likely to develop Opioid use disorder (OUD) can help public health in planning effective prevention, intervention, drug overdose and recovery policies. Further, a better understanding of prediction of overdose leading to the neurobiology of OUD may lead to new therapeutics. In recent years, very limited work has been done using statistical …

A Constructivist Grounded Theory Analysis Of Seven Medical Provider Perspectives On Major Barriers To Prescribing Buprenorphine To Youth With Opiold Use Disorder In Outpatient Medical Settings: "We Should Be Providing Them With What We Know To Be The Gold Standard Of Care"., Maeve O'Leary Sloan

Antioch University Dissertations & Theses

This study utilized Primary Care Provider (PCP) perspectives to unveil major barriers to prescribing buprenorphine to youth (ages 16-25) with opioid use disorder (OUD). Semi-structured interviews were conducted with seven PCPs recruited through convenience and snowball sampling. Interviews were conducted and recorded via Zoom video conferencing. Transcripts were generated and analyzed for themes using a Constructivist Grounded Theory (CGT) approach. The CGT of the present study describes four major barriers that limit PCP prescription of buprenorphine to youth: 1) PCPs Feel Overwhelmed, 2) PCPs Feel Ill Equipped to Treat Youth Patients with OUD, 3) PCPs Hold and Observe Stigma toward …

Successful Buprenorphine Transition While Overlapping With A Full Opioid Agonist To Treat Chronic Pain: A Case Report, Kishan V. Patel, Sidharth Sahni, Lanvin F. Taylor

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Buprenorphine is a partial mu opioid agonist that has been increasingly utilized to treat patients with chronic pain and opioid use disorder (OUD). The drug has proven to provide significant chronic pain relief at low doses ranging from 75 to 1800 mcg. The conventional buprenorphine transitional process delays its introduction until patients begin withdrawal. However, this process can pose a barrier to both patients and providers due to some patients' inability to tolerate traditional prerequisite withdrawal. To our knowledge, this is a rare reported case to describe a transitional process utilizing buccal buprenorphine in which a patient with chronic pain …

Patient Perspectives On Opioid Risk Discussions In Primary Care, Stephanie A. Hooker, Inih J. Essien, Caitlin M. Borgert-Spaniol, Rebecca C. Rossom, Anthony W. Olson, Katrina M. Romagnoli, Leif I. Solberg

Journal of Patient-Centered Research and Reviews

Purpose: Both patients and clinicians have described discussions of potential opioid risks as challenging. This study’s goal was to understand patient perspectives on discussing opioid risks with primary care clinicians (PCCs).

Methods: Patients identified to be at elevated risk for problems with opioids (ie, opioid use disorder [OUD] diagnosis, taking a medication for OUD, or having ≥ 3 opioid prescriptions in the last year) were recruited from an integrated, Upper Midwest health system to participate in semi-structured qualitative interviews. Interview questions aimed to better understand patient views on conversations about opioid risks with PCCs and perceptions of OUD screening and …

A Polypharmacological Approach To Relapse Prevention In An Animal Model Of Heroin Addiction, Scott T. Ewing

Dissertations, Theses, and Capstone Projects

Chemical compounds that target dopamine (DA) D1 or D3 receptors have shown promise as potential interventions in animal models of cue-induced relapse. However, undesirable side effects or pharmacodynamic profiles have limited the advancement of new compounds in preclinical studies when administered as independent treatments. In this series of experiments, we explored the effects of co-administration of a D1-recepter partial agonist (SKF 77434) and a D3-receptor antagonist (NGB 2904) in heroin-seeking rats within a ‘conflict’ model of abstinence and cue-induced relapse. Rats were first trained to press a lever to self-administer heroin and drug delivery was paired contingently with cues (e.g., …

Multimodal Approach To Chronic Pain Management And Prevention Of Opioid Use Disorder, Hannah Elston

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background. Chronic pain (CP) is a major public health problem that affects one-third of the population and can interfere with the activities of daily life and cause decreased quality of life. Patients with CP have been increasingly prescribed opioids, contributing to the rise in the opioid epidemic. Due to the long-term nature of CP, the use of opioids as the sole treatment for CP can cause tolerance and increased dosages overtime which can lead to addiction and potentially overdose. Therefore, CP treatment should include multimodal approaches to treatment to prevent opioid misuse, opioid use disorder (OUD), and overdose. Multimodal treatments …

The Impact Of Covid-19 On The Opioid Epidemic, Hailey Stewart

Undergraduate Honors Theses

The COVID-19 pandemic adversely affected the lives of most Americans. People with Substance Use Disorder (SUD) were particularly vulnerable to the negative effects brought on by the pandemic. This study explored the increase in deaths due to opioid overdose during the pandemic exacerbated by factors such as increased stress, decrease in treatment options due to social distancing requirements and facility closures, social isolation, and an increase in spare time. Access to treatment for opioid use disorder (OUD) was interrupted by the measures meant to mitigate the spread of COVID-19. Through a systematic review of current literature, it was demonstrated that …

House: Homeless Opioid User Service Engagement Program. Year 1 Report, Mary Lindsey Smith Phd, Katharine Knight Mph, Evelyn Ali Bs, Thomas Chalmers Mclaughlin Msw, Phd, Katie Rosingana Ba, Tyler Egeland Ba, Mark Richards Bs, Karen Pearson Mlis, Ma

Substance Use Research & Evaluation

Homelessness and lack of stable housing is often a barrier to achieving stability for individuals who are experiencing homelessness (IWAEH) with an OUD. In order to meet the complex needs of IWAEH with OUD, the Department of Health and Human Services funded a pilot program in 2021, the Homeless Opioid Users Service Engagement (HOUSE) Program; clinicians at Greater Portland Health provide clients with low-barrier Medication Assisted Treatment (MAT), while staff at Preble Street provide casework support and rapid housing assistance to individuals who have been identified as being at high risk of overdose, are experiencing homelessness, and are diagnosed with …

R.A.C.E. To Recovery Year 1 Evaluation Summary Report, Katie Rosingana Ba, Evelyn Ali Bs, Tyler Egeland Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

Through a collaborative effort led by the Healthy Community Coalition, the multi-sector Rural Addiction Care Expansion (R.A.C.E.) to Recovery initiative consortium is utilizing evidence-based, community-wide response to impact and reduce the effects of the opioid epidemic in the Western Maine Public Health District/ Greater Franklin County. To assess and evaluate the implementation, successes, and challenges of the RACE to Recovery project, the Cutler Institute is collecting and analyzing data for both process and outcomes of the initiative.

In the first year of the initiative, the Cutler evaluation team utilized both primary and secondary data to assess RACE to Recovery program …

Monthly Trends Of Substance Use Among Mainers Receiving Buprenorphine Treatment During The Covid-19 Pandemic, Sarosh Khan

Journal of Maine Medical Center

Introduction: Drug-related deaths in Maine increased by 23% in the first quarter of 2020 compared to the last quarter of 2019. Most of these deaths were accidental overdoses involving at least one opioid, and 65% of these deaths were caused by fentanyl, according to the Maine Center for Disease Control and Prevention.

Methods: This research explored substance use in Maine during 2020. Among the sample of individuals, 46% were homeless and receiving recovery services at a buprenorphine-assisted treatment program at a federally qualified health center in Maine. Charts of 35 patients were reviewed for emergency room visits and urine drug …

Implementing Evidence-Based Treatment Of Patients With Opioid Use Disorder In An Inpatient Addiction Treatment Center, Emily Ashley

Doctor of Nursing Practice

Patients with opioid use disorder are at increased risk for overdose and death should they relapse due to reduced opioid tolerance after a period of abstinence. A retrospective chart review was performed at an inpatient drug and alcohol treatment center to identify areas in need of improvement. The global aim of this project was to promote patient adherence to treatment, as well as increase the prevention of patient overdose and death after inpatient treatment. Project objectives include improving provider management of opioid use disorder through standardizing patient education, increasing prescription of relapse prevention medication, initiating prescription of naloxone at discharge …

Physician-Perceived Barriers To Treating Opioid Use Disorder In The Emergency Department, Gideon Logan, Amber Mirajkar, Jessica Houck, Fernando Rivera-Alvarez, Emily Drone, Parth Patel, Alexandra Craen, Larissa Dub, Nubaha Elahi, David Lebowitz, Ayanna Walker, Latha Ganti

Emergency Medicine Faculty Publications

Objective

We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities.

Methods

This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed …

Perspectives On Extended-Release Naltrexone Induction Among Patients Living With Hiv And Opioid Use Disorder: A Qualitative Analysis, Kim A. Hoffman, Robin Baker, Laura C. Fanucchi, Paula J. Lum, Lynn E. Kunkel, Javier Ponce Terashima, Dennis Mccarty, Petra Jacobs, P. Todd Korthuis

Internal Medicine Faculty Publications

BACKGROUND: The CHOICES study randomized participants with HIV and opioid use disorder (OUD) to HIV clinic-based extended-release naltrexone (XR-NTX), which requires complete cessation of opioid use, versus treatment-as-usual (i.e., buprenorphine, methadone). Study participants randomized to XR-NTX were interviewed to assess their experiences with successful and unsuccessful XR-NTX induction.

METHODS: Semi-structured qualitative interviews were completed with a convenience sample of study participants with HIV and OUD (n = 37) randomized to XR-NTX in five HIV clinics between 2018 and 2019. All participants approached agreed to be interviewed. Interviews were digitally recorded, professionally transcribed, and analyzed using thematic analysis.

RESULTS: Participants …

Support For Me: Substance Use Disorder Prevalence And Treatment Capacity Assessment, Rachel T. Gallo Mph, Katharine Knight Mph, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The aim of this report was to understand the sociodemographic and geographic distribution of substance use disorder (SUD) prevalence in Maine, through a claims-based analysis which assessed current statewide capacity to address SUD by examining current SUD treatment and recovery infrastructure, service utilization patterns, and geographic distribution of services and usage throughout the state to identify any gaps in treatment and recovery capacity.

The authors would like to note that this report was completed during the planning phase of the SUPPORT for ME project, which was funded by the Centers for Medicare & Medicaid Services (CMS) via the SUPPORT Act …

Opioid Use Disorder: A Crisis Of Concern, Evangella Harville

Electronic Theses and Dissertations

According to a statement from the U.S. Centers for Disease Control and Prevention, between 2000 and 2017, approximately 700,000 people died from drug overdoses in the United States. Approximately 128 persons lose their life each day from an opioid overdose. The data for this study were collected by the vice president of operations at the study site from a preexisting database for 2019 and 2020. The participants were inpatient patients, 18 and older, both male and female, and were from all ethnicities. The study facility was located in Western New York and offered a 30-bed inpatient treatment center with 24-hour …

Prescribers' Satisfaction With Delivering Medications For Opioid Use Disorder, Hannah K. Knudsen, Randy Brown, Nora Jacobson, Julie Horst, Jee-Seon Kim, Hanna Kim, Lynn M. Madden, Eric Haram, Todd Molfenter

Behavioral Science Faculty Publications

BACKGROUND: Expanding access to medications for opioid use disorder (MOUD), such as buprenorphine and extended release (XR) naltrexone, is critical to addressing the US opioid epidemic, but little is known about prescriber satisfaction with delivering these two types of MOUD. The current study describes the satisfaction of prescribers delivering buprenorphine and XR-naltrexone while examining whether satisfaction is associated with current patient census and organizational environment.

METHODS: As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 41 MOUD prescribers in Florida, Ohio, and Wisconsin completed a web-based survey. The survey included …

Pregnancy And Substance Use, Elise Withers, Krista Thompson, Emily Hamilton, Maren Wright Voss

All Current Publications

The use of alcohol and other harmful substances, such as cocaine, opioids, and marijuana during pregnancy has increased over the last decades (Sebastiani et al., 2018). Using these substances can be very harmful to the unborn baby and mother (Viteri et al., 2015). This fact sheet covers (1) the consequences of substance use and (2) the current recommendations for substance use during pregnancy.

Perceived Ability To Treat Opioid Use Disorder In West Virginia, A. Brianna Sheppard, Jonathan C. Young, Steve M. Davis, Garrett E. Moran

Journal of Appalachian Health

Introduction: Medication-assisted treatment (MAT) is an evidence-based therapy for opioid use disorder (OUD) that has not been fully implemented in rural areas due to patient, provider, and logistical barriers. Limited information is available on provider perceptions of barriers to MAT in rural Central Appalachia which has very high rates of OUD compared to the rest the United States.

Purpose: Determine perceived barriers for potential prescribers to using MAT, including buprenorphine, as part of treatment for OUD in West Virginia.

Methods: A 30-question, anonymous survey was sent to physicians, physician assistants and advanced practice registered nurses using an online link. Link …

A Crisis Of Her Own: Fatal Opioid Overdose, Opioid Use Disorder, And Intimate Partner Violence Among Rural Utah Women, Timothy Light, Erin Fanning Madden, Debasree Das Gupta, Hilary Disch, Katie Zaman, Suzanne Prevedel, Sandra H. Sulzer

All Current Publications

The Centers for Disease Control report that the rate of overdose deaths among women is rapidly increasing, with women experiencing a 532% increase in fatal opioid overdose deaths between 1999 and 2017, compared to a 355% increase for men. Among women, those in rural areas have disproportionately higher drug overdose death rates than women in urban areas (Mazure & Fiellin, 2018), indicating an opportunity for targeted rural public health interventions to slow overdose fatality increases among women. This fact sheet reviews Utah trends, potential factors increasing fatal opioid overdose, intimate partner violence and substance use disorders, and provides resources for …