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 …

Perinatal Buprenorphine Effects On Offspring Growth, Opioid Withdrawal, And Brain Morphology In Rats, Parker Barnes

Electronic Theses and Dissertations

Opioid use disorder (OUD) impacts 5.6 million people in the US. Buprenorphine (BUP) is a commonly prescribed opioid medication used to treat OUD, including in pregnant women. However, opioid use during pregnancy is associated with poorer infant outcomes including reduced fetal growth, neurodevelopmental deficits, and neonatal opioid withdrawal syndrome (NOWS). Recent clinical data suggests that providing mothers with a lower dose of BUP may result in fewer negative outcomes in infants. Here, a preclinical rodent model of low-dose perinatal BUP exposure was used to study offspring health outcomes in the neonate, juvenile, and adolescent offspring. Dams were given clinically relevant …

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 …

Buprenorphine For Pain Management Vs. Chronic Hydrocodone-Acetaminophen Therapy When Comorbidities Increase The Risk Of Opioid-Related Side Effects, Jessica Zhao, Doo Hee Kim

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Gordon A, Callaghan D, Spink D, et al. Buprenorphine transdermal system in adults with chronic low back pain: a randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase. Clin Ther. 2010;32(5):844-860. https://doi.org/10.1016/j.clinthera.2010.04.018

for a patient on long-term opioid therapy with high risk factors for adverse effects.

Two-Year Opioid Prescription Trends In Local Sanitary Agency Naples 3 South, Campania Region, Italy. Descriptive Analyses And Ai-Based Translational Perspectives, Marco Cascella, Maurizio Capuozzo, Francesco Ferrara, Alessandro Ottaiano, Francesco Perri, Francesco Sabbatino, Valeria Conti, Vittorio Santoriello, Alfonso Maria Ponsiglione, Maria Romano, Francesco Amato, Ornella Piazza

Translational Medicine @ UniSa

Aims: This study delves into the two-year opioid prescription trends in the Local Sanitary Agency Naples 3 South, Campania Region, Italy. The research aims to elucidate prescribing patterns, demographics, and dosage categories within a population representing 1.7% of the national total. Perspectives on artificial intelligence research are discussed.

Methods: From the original dataset, spanning from January 2022 to October 2023, we processed multiple variables including demographic data, medications, dosages, drug consumption, and administration routes.

Results: The analysis reveals a conservative approach to opioid therapy. In subjects under the age of 20, prescriptions accounted for 2.1% in 2022 and declined to …

A Survey Of Barriers And Facilitators To The Adoption Of Buprenorphine Prescribing After Implementation Of A New Jersey-Wide Incentivized Data-2000 Waiver Training Program., Amesika N Nyaku, Erin A Zerbo, Clement Chen, Nicole Milano, Barbara Johnston, Randall Chadwick, Stephanie Marcello, Kaitlan Baston, Rachel Haroz, Stephen Crystal

Cooper Medical School of Rowan University Faculty Scholarship

BACKGROUND: Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing.

METHODS: Participants in the training program completed …

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 …

A Review Of The Effects Of Different Types Of Stigmas On The Retention Rates Of Patients In Medication-Assisted Treatment And How To Combat The Problem, Pamela Cox

Doctor of Nursing Practice Projects

It is difficult to turn on the news without hearing about the opioid epidemic or a recent opioid overdose. There is hope because there is a treatment to help prevent this epidemic. That treatment is known as medication-assisted therapy (MAT), where patients can present and, if they meet the criteria, can be given a prescription for buprenorphine/naloxone combination medication. Treatment with buprenorphine/naloxone has been shown to be highly effective treatment for substance use disorder (SUD). Even though it has been proven that this combination works, less than 20% of patients diagnosed with SUD present for treatment. This study focused on …

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 …

Extended Release Buprenorphine (Sublocade) Prescribing In Primary Care, Heather Kettlewell

Family Medicine Clerkship Student Projects

There are many barriers to accessing opioid use disorder (OUD) treatment, especially for rural communities that may be far away from healthcare providers. There is a need for interventions to increase accessibility of OUD treatment. Extended release injectable buprenorphine (Sublocade) provides an option for patients to receive treatment via once a month injections. This could make OUD treatment more accessible to rural and socioeconomically disadvantaged patients by reducing the number of times they would need to travel to the clinic. Our intervention is to create a protocol for prescribing extended release buprenorphine at Family Medicine Hinesburg.

Buprenorphine/Suboxone Is Safe In Pregnancy: Substance Use And Stigma In The Healthcare Professions, Blake S. Sanford

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Mullins N, Galvin SL, Ramage M, et al. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2020;14(3):185-192. https://doi.org/10.1097/ADM.0000000000000562

for a woman with opioid use disorder during pregnancy.

Prior Authorizations And Addiction Treatment, Channie Cretsinger Mph, Jeremy C. Kourvelas Mph, Jennifer G. Tourville Dnp

SMART Policy Briefs

Key Points

• Concerns about prior authorizations have grown given research demonstrating inconsistent coverage and review policies across insurers, interruptions to care, high provider burden and higher healthcare costs.
• Tennessee policymakers and insurers have recently taken appropriate measures to ease the concerns and minizine unnecessary barriers. TennCare changed their policy on buprenorphine allowances in May 2023, essentially removing the prior authorization barrier for buprenorphine/naloxone preferred products.
• This is a significant step for Tennesseans given that the research shows that once the prior authorization process was removed for medications for opioid use disorder (MOUD), patients with opioid use disorder …

Patterns Of Substance Use And Buprenorphine Utilization To Predict Treatment Utilization For Opioid Use Disorder, Nicole M. Kent

Doctoral Dissertations

Substance use continues to rise in the United States. In 2021, 5.6 million people had an opioid use disorder (OUD). OUD is highly stigmatized and is not treated as a chronic condition. People with OUD have been denied treatment for a single positive urine drug test. Pregnant women are further at risk of criminal charges or losing custody of their child. OUD treatment success is defined as opioid abstinence and the goal of treatment is to taper off medication, despite evidence that treatment retention leads to better outcomes. The purpose of this study was to identify patterns of buprenorphine utilization …

Swallow, Breathing And Survival: Sex-Specific Effects Of Opioids., Michael Frazure

Electronic Theses and Dissertations

This dissertation presents a series of studies examining mechanisms of deglutition and respiration, and how these vital processes are impacted by opioids. The experiments in Chapter Two investigated the role of the upper esophagus in airway protection through systematic activation of pharyngeal and esophageal mechanoreceptors in a cat electromyography model. Chapter Three compared effects of opioid administration on breathing and swallowing between male and female rats, and found that females are more susceptible to opioid-induced depression of breathing and swallow than males. Findings from Chapters Two and Three led to the development of a translational model of opioid-induced dysphagia using …

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, …

The Effects Of Prenatal Buprenorphine Exposure On The Neurobehavioral Development Of The Child, Zaineb Zubair, Maryam Zubair, Juan Alonso, Abdullah Zubair

Rowan-Virtua Research Day

Background: Current guidelines for pregnant women with substance use disorder advise prenatal maintenance of opioid agonist therapy with either buprenorphine or methadone. Despite this rise in prenatal opioid agonist therapy, little is known about the effect of prenatal buprenorphine on the neurobehavioral development of the child. This poses the question: does buprenorphine have a long-lasting effect on the central and peripheral nervous system development and behavior of children who were exposed prenatally?

Methods: A comprehensive literature review identified articles relating to prenatal buprenorphine and neurobehavioral outcomes. Article searches were conducted on PubMed and Dynamed. Publications from 2002 through November 2021 …

Anxiety-Like Behavior In C57bl/6j Mice Is Sexually Dimorphic And Altered By Buprenorphine, Ohm Sharma

Chancellor’s Honors Program Projects

No abstract provided.

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 …

Cost Effectiveness Of Buprenorphine When Used Long Term Versus Short Term Use, Ty Hudgens

MUSC Theses and Dissertations

Since 1999, nearly 841,000 people have died from a drug overdose (CDC, 2022), and substance use disorder (SUD) continues to be a crisis that faces communities across the country. As the crisis continues across communities, the need for medication-assisted opioid use disorder (MOUD) therapy continues to surge.

This was a retrospective analysis of archival data from large national data sources. We constructed well-matched cohorts of patients with short and long-term use of MOUD using propensity score matching of 3 months of baseline data. To measure the cost effectiveness of short-term buprenorphine use verse long-term buprenorphine use.

Estimated Clinical Outcomes And Cost-Effectiveness Associated With Provision Of Addiction Treatment In Us Primary Care Clinics, Raagini Jawa, Yjuliana Tin, Samantha Nall, Susan L Calcaterra, Alexandra Savinkina, Laura R Marks, Simeon D Kimmel, Benjamin P Linas, Joshua A Barocas

2020-Current year OA Pubs

IMPORTANCE: US primary care practitioners (PCPs) are the largest clinical workforce, but few provide addiction care. Primary care is a practical place to expand addiction services, including buprenorphine and harm reduction kits, yet the clinical outcomes and health care sector costs are unknown.

OBJECTIVE: To estimate the long-term clinical outcomes, costs, and cost-effectiveness of integrated buprenorphine and harm reduction kits in primary care for people who inject opioids.

DESIGN, SETTING, AND PARTICIPANTS: In this modeling study, the Reducing Infections Related to Drug Use Cost-Effectiveness (REDUCE) microsimulation model, which tracks serious injection-related infections, overdose, hospitalization, and death, was used to examine …

Can Breaking Heroin Addiction Lead To A Broken Heart? A Case Of Reverse Takotsubo Cardiomyopathy In A Patient With Heroin Withdrawal, Hunter Launer, Daniel Nelson, Alarica Dietzen, Atul Singla

The Texas Heart Institute Journal

Reverse takotsubo cardiomyopathy is triggered by emotional or physical stress and has a presentation similar to that of acute coronary syndrome. A 39-year-old woman with a history of heroin use disorder presented with intractable nausea, vomiting, and diarrhea. She was diagnosed with heroin withdrawal and started on buprenorphine-naloxone. On day 2 of her hospitalization, she developed chest heaviness and had an elevated troponin I level of 3.2 ng/mL (reference range, 0.015-0.045 ng/mL); electrocardiography showed new T-wave inversions in the anterior and inferior leads. Emergent coronary angiography showed patent coronary arteries, and left ventriculography showed basal hypokinesis and apical hyperkinesis, consistent …

Sorting Through Life: Evaluating Patient-Important Measures Of Success In A Medication For Opioid Use Disorder (Moud) Treatment Program, Megan K Reed, Kelsey R Smith, Francesca Ciocco, Richard W. Hass, Avery Lin Cox, Erin L Kelly, Lara Weinstein

Department of Emergency Medicine Faculty Papers

Background: Medication for opioid use disorder (MOUD) is the gold standard treatment for opioid use disorder. Traditionally, "success" in MOUD treatment is measured in terms of program retention, adherence to MOUD, and abstinence from opioid and other drug use. While clinically meaningful, these metrics may overlook other aspects of the lives of people with opioid use disorder (OUD) and surprisingly do not reflect the diagnostic criteria for OUD.

Methods: Authors identified items for a pilesorting task to identify participant-driven measures of MOUD treatment success through semi-structured interviews. Interviews were transcribed verbatim and coded in Nvivo using directed and conventional content …

Prenatal Buprenorphine Exposure Reduces Expression Of Myelin Proteins In Neonatal Longs-Evans Rat, Christopher James Grahe

Theses, Dissertations and Capstones

In the USA and especially in WV, there has been a surge in the rise of opioid use disorder (OUD), and with it a rise in neonatal abstinence syndrome (NAS). What makes this rise in NAS so unfortunate is that the Medications for OUD (MOUD) do not prevent the development of NAS. Although the relationship between MOUD and NAS is still unclear, it is thought that buprenorphine, one of the main substances used to treat OUD in pregnant women, may feed into the development of NAS, which may affect mental and physiological development and cause other health problems. Via understanding …

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 …

Improving Minnesota’S Access To Opioid Use Disorder Treatment And Naloxone, Annasha Doane-Ramkhalawon

Theses and Graduate Projects

Background: In 2020, Minnesota recorded 4,920 admissions with associated opioid use for adults 18 years of age and older.1 2021 put Minnesota's Opioid-related overdose mortality number at 1,017 individuals.2 Methadone and Buprenorphine as MOUD is the first line treatment for Opioid Use Disorder and long-time management as the standard of care.3 Naloxone is the drug of choice for opioid reversal and overdose prevention.3

Purpose: This study aims to investigate the barriers that OUD feel when attempting to receive treatment for OUD and access Naloxone. The indication is the number of OUD- related admissions and OUD-related overdose fatalities. In addition, the …

The Medication-Assisted Therapy (Mat) Program Algorithm At Community Health Centers Riverside (Chc-R), Aathman Swaminathan

Family Medicine Clerkship Student Projects

No abstract provided.

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 …

Comparison Of Pregnancy Complication Rates: Does Opioid Agonist Pharmacotherapy Make A Difference?, Alexa Pfeiffer Oms-Iii, Michael Falcone Oms-Iii, Pritha Aggarwal Oms-Iii, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: Over the past decade, the prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase in pregnancy complications. Opioid agonist pharmacotherapy (OAP) with methadone or buprenorphine is recommended by ACOG for the management of OUD. The objectives of our study are to compare the incidence of pregnancy complications among patients who at the time of their delivery used OAP, OAP plus any additional substance (OAP+), illicit or prescribed opioids, and no opioids.

Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA, between January 1, 2018, through December …