Enhancing Primary Care Provider’S Knowledge And Use Of Long-Acting And Oral Naltrexone In The Management Of Opioid And Alcohol Use Disorder, Ariana Juarez-Moncada

Doctor of Nursing Practice Final Manuscripts

Abstract

Objective: This evidence-based project aimed to enhance primary care provider knowledge and prescription rates of naltrexone and long-acting injectable (LAI) naltrexone in a community healthcare setting.

Background: Naltrexone and LAI naltrexone pharmacotherapy is shown to reduce use of alcohol and opioids and improve client retention in patients with alcohol use disorder (AUD) and opioid use disorder (OUD) (Bahji et al., 2020; Morley et al., 2024; Murphy et al., 2022).

Methods: A 30-minute in-service was provided to 14 family practice providers at the clinic. The prescription rate of naltrexone and LAI naltrexone was evaluated for the baseline period of February …

Facebook As A Strategy To Deliver A Peer Navigation Intervention For Recently Incarcerated Women With Opioid Use Disorder: A Mixed Methods Descriptive Profile, Martha Tillson, Jaxin Annett, Marguerite A. Webster, Amanda Fallin-Bennett, Mandi Webster, Amber Clemons, Cynthia Robinson, Kevin Crabtree, Casey Baker-Romans, Michele Staton

Center on Drug and Alcohol Research Faculty Publications

Recovery support and treatment linkages are critical during transitions from incarceration to community but can be challenging to deliver to hard-to-reach populations. This paper will examine Facebook contacts between peer navigators (PNs) and women with opioid use disorder (OUD) following jail release to explore women’s use of PN services, including purpose and content of Facebook messages. As part of a larger clinical trial under the Justice Community Opioid Innovation Network (JCOIN), PNs provided OUD treatment navigation and recovery support for 12 weeks following women’s release from jail, using remote options such as Facebook. Facebook Messenger transcripts between PNs and participants …

Factors Associated With Opioid-Involved Overdose: Descriptive Data From A Randomized Controlled Trial Evaluating Extended-Release Buprenorphine For Perinatal Opioid Use Disorder, Sara M. Witcraft, Leah Holcomb, Yingjia Wei, Gerald Cochran, John T. Winhusen, Michelle R. Lofwall, Peter R. Martin, Jessica L. Young, Jessica Spinali, Constance Guille

Center on Drug and Alcohol Research Faculty Publications

Background: Opioid use disorder (OUD) during pregnancy is a leading contributor to peripartum morbidity and mortality, with overdose deaths rising significantly in recent years. Despite the identification of various factors associated with overdose events, including social, demographic, psychiatric, and neonatal outcomes, the relative contributions of these factors to peripartum overdose history (or lack thereof) remain unclear. Thus, this study aims to characterize factors associated with lifetime opioid-involved overdose events among currently pregnant individuals receiving buprenorphine (BUP) treatment for OUD.   Methods: Treatment-seeking pregnant individuals with an estimated gestational age of 6 to 30 weeks were enrolled in a large multisite randomized …

The Impact Of Quality Of Life And Recovery Capital On Inhibitory Control In Patients On Medication For Opioid Use Disorder, Caroline K. Jeffries

All Theses

The opioid crisis persists as a global health challenge, necessitating a comprehensive understanding of the complex interplay between psychological factors and neurocognitive responses among individuals with opioid use disorder (OUD). Two such psychological factors include recovery capital, an individual's internal and external resources to supporting recovery, and quality of life. Past work suggests that positive levels of recovery capital and quality of life may enhance individuals’ ability to regulate emotions and manage cravings. However, it is unclear how these variables are affected when buprenorphine is taken. This study investigates the influence of recovery capital and quality of life on inhibitory …

Kratom As A Therapeutic Option For Opioid Use Disorder​: A Comprehensive Review​, Harmann Singh, Abdullah Noory, Akash M. Patel, Kush C. Patel, Simran Gandhi

Rowan-Virtua Research Day

Kratom (Mitragyna speciosa) has gained significant attention for its potential role in managing opioid use disorder (OUD). This review examines kratom’s pharmacology, safety profile, addiction potential, and ethical considerations in research, while exploring its future as a therapeutic option. Kratom’s primary alkaloids, mitragynine and 7-hydroxymitragynine, act as partial mu-opioid receptor agonists, producing analgesic and sedative effects at higher doses and stimulant-like effects at lower doses. Preclinical and observational studies suggest kratom may alleviate opioid withdrawal symptoms and cravings, but concerns remain regarding its dependency potential and adverse effects, including gastrointestinal distress, hepatotoxicity, and withdrawal symptoms upon cessation. While kratom carries …

Opioid Epidemic In Maine: An Analysis Of Increasing Overdose-Related Deaths Following The Coronavirus, Aysel S. Hamlin

Thinking Matters Symposium

The rate of drug overdose resulting in death doubled in Maine following the COVID-19 pandemic from the onset of the COVID-19 pandemic in late 2019 through 2022. The correlation between increased isolation during the pandemic and overdose death rates sheds a concerning light on the insufficient resources for people struggling with Opioid Use Disorder (OUD) throughout Maine. The increasing trade and access to fentanyl following the pandemic accounted for the majority of drug-related deaths in Maine in 2021 and 2022. This study examines the need for long-term access to drug treatment in rural and urban Maine, both environments with varying …

The Impact Of Legislation And Implementation Of An Emergency Department Medications For Opioid Use Disorder Program On Buprenorphine Administration, Jacob Manteuffel, Joseph Miller, Nadine Jawad, Alexis Maroney, Revelle Gappy, Nora Sharba, Grant Zydeck

Medical Student Research Symposium

The emergency department (ED) plays a critical role in addressing a wide range of healthcare needs and can be the first point of contact for individuals with opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a medication that helps treat OUD. On January 12, 2023, federal changes removed a major barrier, allowing all clinicians to prescribe buprenorphine. Later in 2023, a Medications for Opioid Use Disorder (MOUD) program was implemented in a high-volume free-standing ED. We aimed to review the impact of these changes on buprenorphine administration.

We conducted a retrospective chart review of buprenorphine administration and ICD …

Extended-Release Buprenorphine Could Overcome Barriers To Medical Treatment Of Opioid Use Disorder In At-Risk Populations, Scott A. Davis, Genevieve Verrastro, E Blake Fagan

HCA Healthcare Journal of Medicine

This article discusses how monthly extended-release buprenorphine can be used to improve the treatment of opioid use disorder (OUD). In particular, the use of monthly extended-release buprenorphine holds promise for patients who have recently been released from jail or prison and are battling OUD, those who are unstable and continue to use opioids illicitly, patients who are experiencing homelessness while also struggling with OUD, and those who are stable and want to be weaned off buprenorphine.

Investigating Sex-Specific Role Of The Kynurenine Pathway In Opioid Withdrawal, Blake Brady

Psychology Theses - Archive

The opioid epidemic has led to a surge in opioid use disorder (OUD) and overdose deaths, making opioid withdrawal a critical area of study. Opioid withdrawal is characterized by both somatic and affective symptoms, including anxiety-like behaviors and physical withdrawal signs, yet the underlying neurobiological mechanisms remain insufficiently understood. The kynurenine pathway (KP), a primary metabolic route for tryptophan (TRP), is increasingly implicated in neuroinflammatory responses and neuropsychiatric disorders, yet its involvement in opioid use and withdrawal remains poorly studied, with even less known about potential sex-specific differences. Historically, the predominant use of male subjects in preclinical research has compounded …

Factors Affecting Waiting Times To Enter Opioid Use Disorder Treatment In The United States With A Particular Focus On Potential Biological Sex Disparity, Stanley Nkemjika, Kenneth Oforeh, Connie Olwit, Olaniyi Olayinka, Terence Tumenta

Department of Psychiatry and Human Behavior Faculty Papers

AIM: Opioid use disorder (OUD) is the problematic use of licit or illicit opioids. Thus far, the literature on biological sex differences in accessing treatment is scarce. Hence, we hypothesize that biological sex has a moderating effect on OUD treatment accessibility. We aim to explore biological sex differences in treatment disparities and its role in wait time to enter OUD treatment.

METHOD: Using the 2018 Treatment Episode Data Set Discharge, the national sample representative of OUD patients in the substance use disorder treatment facilities within the 50 states of the United States was 382,547. Univariate and multivariable logistic analysis of …

Factors Associated With Cognitive Flexibility In People With Opioid-Use Disorder: A Pilot Study, Paul S. Regier, Thais Costa Macedo De Arruda, Laura Sinko, Anne M. Teitelman, Anna Rose Childress

College of Nursing Faculty Papers & Presentations

The ability to adapt to changing circumstances has strong survival value. Individuals with substance use disorders tend to get "stuck" over-responding to drug-reward signals and pursuing drugs despite negative consequences. A lack of flexibility may be tied to impairments in neurocognition, including learning, memory, and executive function. However, results are often mixed, potentially due to heterogeneity in factors such as mental health, personality traits, or prior adversity. This study aimed to identify which factors influence neurocognitive variations within the opioid use disorder (OUD) population. Based on prior literature, we hypothesized that individuals with OUD would show deficits (vs. controls) in …

Linkage Facilitation For Opioid Use Disorder In Criminal Legal System Contexts: A Primer For Researchers, Clinicians, And Legal Practitioners, Milan F. Satcher, Steven Belenko, Anthony Coetzer-Liversage, Khirsten J. Wilson, Michael R. Mccart, Tess K. Drazdowski, Amanda Fallin-Bennett, Nickolas Zaller, Alysse M. Schultheis, Aaron Hogue, Noel Vest, Ashli J. Sheidow, Brandon Del Pozo, Dennis P. Watson, Patrick F. Hibbard, Randy Stevens, L. A. R. Stein

Nursing Faculty Publications

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state …

A Cost-Effectiveness Analysis Of Telehealth Vs. Office-Based Delivery Of Buprenorphine At The Addiction And Substance Abuse Program (Asap) Clinic - University Of New Mexico Hospital: A Societal Perspective, Rana Alkhafaji

Pharmaceutical Sciences ETDs

This study evaluates the cost-effectiveness of office-based versus telehealth delivery of buprenorphine treatment for opioid use disorder (OUD). A retrospective chart review of 135 patients at the University of New Mexico Hospital's Addiction and Substance Abuse Program compared retention rates and costs between the two settings. Retention was defined as continuous treatment for at least six months. No statistically significant difference in retention rates was found, with 51% for office-based and 42% for telehealth. However, office-based treatment had higher total costs, with an incremental cost-effectiveness ratio of $3,750 per 1% increase in retention. The findings suggest telehealth is a cost-effective …

Influence Of Medication Assisted Treatment Weaning On Neonatal Abstinence Syndrome And Outcomes Among Infants Born To Women With Opioid Use Disorder, Rakesh Adelli

Electronic Theses and Dissertations

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome exhibited by infants born to mothers with opioid use disorder (OUD). The American College of Obstetricians and Gynecologists and other professional societies endorse opioid agonist pharmacotherapy (MATs) as the optimal treatment for OUD during pregnancy. This study focuses on impact of weaning of MAT drugs on the incidence of NAS and neonatal birth outcomes among babies born to women with opioid exposure.

The study population included eighty-six pregnant women with OUD, divided in to weaning and non-weaning groups based on their choice to wean the MATs during pregnancy. Univariate analysis was …

Surgery Of The Palatomaxillary Structure, Jessica R Burgess, Kathleen C Heneghan, Tarra G Barot, Jonah J Stulberg

Faculty, Staff and Student Publications

BACKGROUND: Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care.

METHODS: This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association's electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons' management of perioperative pain in patients with opioid use …

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 Departmental Research

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 …

Assessing Providers’ Readiness To Integrate Mat Services In A Primary Care Setting, Carmen Ingram-Thorpe

Theses and Dissertations

Opioid use disorder is a growing concern in the United States. Despite medication-assisted treatment (MAT) being a more effective treatment option than behavioral treatment alone, primary care providers’ rate of adoption and utilization of MAT has not matched the demand of the opioid crisis. The largest barrier facing our local community is the availability of organizations and providers that can and will actually provide MAT services. The purpose of this study was to identify factors that impact primary care providers’ readiness to treat individuals with opioid use disorder (OUD) using MAT. This study used the ADKAR model as framework, which …

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 …

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, …

Patient Engagement In A Multimodal Digital Phenotyping Study Of Opioid Use Disorder, Cynthia I. Campbell, Ching-Hua Chen, Sara R. Adams, Asma Asyyed, Ninad R. Athale, Monique B. Does, Saeed Hassanpour, Emily Hichborn, Melanie Jackson-Morris, Nicholas C. Jacobson, Heather K. Jones, David Kotz, Chantal A. Lambert-Harris, Zhiguo Li, Bethany Mcleman, Varun Mishra, Catherine Stanger, Geetha Subramaniam, Weiyi Wu, Christopher Zegers, Lisa A. Marsch

Dartmouth Scholarship

Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD.

Objective: The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD.

Methods: The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media …

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.

Shared Decision Making In Acute Pain Management In Patients With Opioid Use Disorder: A Scoping Review, Peter D Vu, Aila Malik, A Sarah Cohen, Vishal Bansal, Morgan R Cowan, Gregory M Blazek, Tiffany Champagne-Langabeer

Faculty, Staff and Student Publications

The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is …

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), …

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 …

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 …

Comparing Cigarette-Cue Attentional Bias Between People With Hiv/Aids And People With Opioid Use Disorder Who Smoke, Gopalkumar Rakesh, Joseph L Alcorn, Rebika Khanal, Seth S Himelhoch, Craig R Rush

Faculty, Staff and Student Publications

BACKGROUND: Special populations like people living with HIV/AIDS (PLWHA) and people with opioid use disorder (OUD) smoke tobacco cigarettes at rates three to four times greater than the general population. Patients with tobacco use disorder exhibit attentional bias (AB) for cigarette cues. Eye tracking can quantify this bias by measuring fixation time (FT) on cigarette and matched neutral cues, to calculate an AB score. Although previous studies have measured this bias in people who smoke without any other comorbid conditions, no study, to our knowledge, has measured or compared this bias in special populations.

METHODS: We performed exploratory analyses on …