Medicine and Health Sciences Commons^™

Bridging Gaps In Opioid Use Disorder Treatment: Prehospital And Emergency Department Interventions, Quin W. Buob, Zachary J. Noll

Rowan-Virtua Research Day

Since 2011, drug overdose has been the leading cause of accidental death in the United States, with two-thirds of these deaths related to opioid drugs. In 2020, the CDC reported an increase of over 91,000 overdose-related deaths. Also, non-fatal overdoses face a 5.5% one-year mortality rate post discharge, with a significant portion subsequently overdosing within 48 hours.

Access to Buprenorphine/Medication-Assisted Treatment (MAT) has been instrumental in reducing opioid-related mortality by over two-thirds, yet treatment initiation remains significantly low. Limited access stems from socioeconomic disparities and insufficient substance use treatment resources.

Emergency departments (EDs) have pioneered Buprenorphine inductions, showcasing variable success …

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 …

Bridging The Gap: Evaluating The Impact Of Buprenorphine-Based Prenatal Care On Neonatal Abstinence Syndrome And Maternal Health, Whitney-Lanae Crofcheck-Glenn, Jennifer Nethercutt

Theses, Dissertations and Capstones

Introduction: Neonatal Abstinence Syndrome (NAS), now known as Neonatal Opioid Withdrawal Syndrome (NOWS) by government authorities, is a severe postnatal withdrawal condition caused by opioid exposure during pregnancy. NAS is diagnosed every 25 minutes in the United States. Medication-assisted treatment (MAT) with buprenorphine was used to treat opioid use disorder (OUD) and NAS. The MOTHER trial found that utilizing buprenorphine to treat mother OUD during pregnancy led to significant decreases in LOS and length of therapy.

Purpose of the Study: The purpose of this study is to evaluate the effectiveness of a prenatal care program that integrates buprenorphine-based Medication-Assisted Treatment …

Prevalence And Predictors Of Suicidality Among Adults Initiating Office-Based Buprenorphine., Michelle R. Lent, Karen L Dugosh, Emily Hurstak, Hannah R. Callahan, Kimberly Mazur, Greater Philadelphia Opioid Use Disorder Research Group

PCOM Scholarly Papers

BACKGROUND: Individuals who have substance use disorders may have an elevated risk of suicidality. This study sought to examine the prevalence of, and identify factors associated with, suicidality in adults with opioid use disorder (OUD) initiating office-based buprenorphine treatment.

METHODS: Individuals were eligible to participate if they had OUD and had initiated treatment in the past month. Participants (n = 244) completed a semi-structured interview using the Addiction Severity Index-Lite.

RESULTS: At baseline, 37.70% of participants reported significant thoughts of suicide over their lifetime and 27.46% reported suicidal attempts over their lifetime. Logistic regression analyses were used to identify predictors …

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, …

A Retrospective Comparison Of The Effectiveness Of Buprenorphine Versus Baclofen For Acute Opioid Withdrawal, Matthew Hermenau, Benton Stamper, Kitty Leung, Raymond Pomm, Christina Guerrier, Joseph Cammilleri, Brittany Johnson

HCA Healthcare Journal of Medicine

Background

A significant impediment to opioid cessation or dose reduction is mitigating withdrawal severity that has been shown to affect the course of opioid dependence. Current guidelines recommend the use of buprenorphine and methadone over alpha-2 adrenergic agonists. Baclofen, a GABA-B agonist, has promising results as an adjunct agent for opioid withdrawal but has not been compared to buprenorphine. This study compared the ability of buprenorphine and baclofen to mitigate acute opioid withdrawal.

Methods

This was a single-center, retrospective chart review of 63 patients with diagnosed opioid use disorder that received scheduled buprenorphine or baclofen for 3 days, in addition …

Augmenting Project Echo For Opioid Use Disorder With Data-Informed Quality Improvement, Owen B. Murray, Marcy A. Doyle, Bethany M. Mcleman, Lisa A. Marsch, Elizabeth C. Saunders, Katherine Cox, Delitha Watts, Jeanne Ryer

Faculty Publications

Background

National opioid-related overdose fatalities totaled 650,000 from 1999 to 2021. Some of the highest rates occurred in New Hampshire, where 40% of the population lives rurally. Medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in reducing opioid overdose and mortality. Methadone access barriers disproportionally impact rural areas and naltrexone uptake has been limited. Buprenorphine availability has increased and relaxed regulations reduces barriers in general medical settings common in rural areas. Barriers to prescribing buprenorphine include lack of confidence, inadequate training, and lack of access to experts. To address these barriers, learning collaboratives have trained …

Management Of Opioid Use Disorder In Primary Care, Carolyn Jeffries

Capstone Showcase

The prevalence of opioid use disorder (OUD) in the United States, and worldwide, has drastically increased in the span of 2-3 years. OUD is considered chronic condition and as such requires routine care over a lifetime. This makes OUD patients excellent candidates to be managed by primary care providers (PCPs). This article discusses the various barriers to treatment of OUD in a primary care setting as well methods and models that aim to mitigate these barriers. We will also review how to take a detailed assessment of an OUD patient, mainstays of medication assisted treatment (MAT), and management of side …

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 …

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 …

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 …

Same Day Transportation For Opioid Use Disorder: Impact Of The Crisis Addiction Recovery Transportation (Cart) Program, Katherine Palmer Loveluck, Andrew King

Medical Student Research Symposium

Patients with opioid use disorder (OUD) frequently present to the emergency department (ED). Delays or barriers in referral to recovery programs from the ED may decrease successful linkage to ongoing care. Immediately following discharge is a particularly high-risk time for OUD patients as studies have shown that immediately following a non-fatal overdose there is an increase in death rates¹. To attempt to combat this gap in care The Detroit Medical Center (DMC) partnered with a community program, Team Wellness (TW), to offer direct transportation 18 hours per day to the TW facility. This crisis addiction recovery transportation (CART) …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Medication Assisted Treatment With Buprenorphine/Naloxone Or Methadone: Comparitive Outcomes In Patients With An Opioid Addiction, Deepti Shanbhag

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Hser YI, Evans E, Huang D, et al. Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial. Addiction. 2016;111(4):695-705. https://doi.org/10.1111/add.13238 for a patient with addiction to prescription opioids.

Briding The Gap: Treatment Engagement Profiles And Outcomes Utilizing Novel Models, Allison Koetter

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult …

Predictors Of Neonatal Abstinence Syndrome In Buprenorphine Exposed Newborn: Can Cord Blood Buprenorphine Metabolite Levels Help?, Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh

Stacy D. Brown

Background

Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.

Methods

Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Court Personnel Attitudes Towards Medication-Assisted Treatment: A Statewide Survey, Barbara Andraka-Christou, Meghan Gabriel, Jody L. Madeira, Rod D. Silverman

Articles by Maurer Faculty

Background: Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system.

Methods: We modified a survey by Matusow et al. (2013) to …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

Island Of Harm Reduction, Trevor T. Boyer

Capstones

New York City's Rikers Island has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine or methadone. For many locked up there, though, Rikers is only a way station before a trip upstate to prison. Even now, over 30 years after its treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations.

So for those taking medication in the form or methadone or buprenorphine on Rikers Island pretrial and awaiting sentencing, they're tapered off their doses to …

The Epidemic Of Neonatal Abstinence Syndrome, Historical References Of Its Origins, Assessment, And Management, Enrique Gomez-Pomar, Loretta P. Finnegan

Pediatrics Faculty Publications

Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence. The first case of NAS …

Predictors Of Neonatal Abstinence Syndrome In Buprenorphine Exposed Newborn: Can Cord Blood Buprenorphine Metabolite Levels Help?, Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh

Nicholas E. Hagemeier

Background

Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.

Methods

Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and …

Is Counseling Integral To Buprenorphine-Assisted Opioid Addiction Treatment? Examining Counseling Participation And Treatment Retention At A Richmond, Virginia Clinic, John R. Gyourko, Hilary Colin King

Social Work Student Works

Treatment providers in Virginia are required by law to offer counseling or referrals to all clients receiving medication-assisted opioid use disorder (OUD) treatment (American Society of Addiction Medicine, 2016; Medical Society of Virginia, 2018). Prescribing physicians widely regard counseling as a critical component of medication-assisted OUD treatment (Lin, Lofwall, Walsh, & Knudsen, 2019), and clients perceive counseling to be among the most important factors promoting recovery from opioid dependence (Hay, Huhn, Tompkins, & Dunn, 2019). Research investigating the efficacy of counseling as an OUD treatment component, however, has been equivocal to date (Brown, 2018; Dugosh et al., 2016). The current …

Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal

Family Medicine Clerkship Student Projects

Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.

Buprenorphine For Medication-Assisted Treatment Of Opioid Use Disorder In Pregnancy: Relationship To Neonatal Opioid Withdrawal Syndrome, Niraj R. Chavan, Kristin Ashford, Amanda T. Wiggins, Michelle R. Lofwall, Agatha S. Critchfield

Obstetrics and Gynecology Faculty Publications

Objective To examine the relationship between antepartum buprenorphine dose for medication-assisted treatment (MAT) of opioid use disorder (OUD) and incident neonatal opioid withdrawal syndrome (NOWS).

Study Design We performed a prospective cohort study of pregnant women with a singleton gestation diagnosed with OUD and receiving buprenorphine for MAT at a tertiary care academic institution from July 2015 to January 2017. We divided the study cohort into two groups—pregnancies with versus without NOWS. Substance abuse patterns in pregnancy, maternal, and neonatal clinical outcomes were compared.

Results The incidence of NOWS was 31.11% (n = 28/90) in our study cohort. Pregnancies …

A Mixed Methods Study Of Hiv-Related Services In Buprenorphine Treatment, Hannah K. Knudsen, Jennifer Cook, Michelle R. Lofwall, Sharon L. Walsh, Jamie L. Studts, Jennifer R. Havens

Behavioral Science Faculty Publications

Background: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings.

Methods: Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients …

Predictors Of Neonatal Abstinence Syndrome In Buprenorphine Exposed Newborn: Can Cord Blood Buprenorphine Metabolite Levels Help?, Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh

Shimin Zheng

Background

Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.

Methods

Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and …

Buprenorphine Physician Supply: Relationship With State-Level Prescription Opioid Mortality, Hannah K. Knudsen, Jennifer R. Havens, Michelle R. Lofwall, Jamie L. Studts, Sharon L. Walsh

Behavioral Science Faculty Publications

Background: Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation’s prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states.

Methods: The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of …