Background:
Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and ...increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level.
Methods:
A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths.
Results:
The presence of an NAL had a significant (univariate P-value = .013; multivariable p-value = .010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P-value < .001), MOUD (univariate P-value < .001; multivariable P-value = .009), and Good Samaritan Law (univariate P-value = .033; multivariable P-value = .018).
Conclusion:
Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate.
Currently, the capacity to provide buprenorphine treatment (BT) is not sufficient to treat the growing number of people in the United States with opioid use disorder (OUD). We sought to examine ...participant retention in care rates of primary care delivered BT programs and to describe factors associated with retention/attrition for participants receiving BT in this setting.
A PRISMA-guided search of various databases was performed to identify the articles focusing on efficacy of BT treatment and OUD.
A systematic literature search identified 15 studies examining retention in care in the primary care setting between 2002 and 2020. Random effects meta-regression were used to identify retention rates across studies.
Retention rates decreased across time with a mean 0.52 rate at one year. Several factors were found to be related to retention, including: race, use of other drugs, receipt of counseling, and previous treatment with buprenorphine.
While we only investigate BT through primary care, our findings indicate retention rates are equivalent to the rates reported in the specialty care literature. More work is needed to examine factors that may impact primary care delivered BT specifically and differentiate participants that may benefit from care delivered in specialty over primary care as well as the converse.
•Trends identified in rates of fatal opioid overdose, including by region.•In general, semisynthetic and synthetic overdose rates were more elastic.•Potential implications to policy change associated ...with synthetic opioid use.
Opioid overdose fatalities include deaths from natural opioids (morphine and codeine), semi-synthetic opioids (oxycodone, hydrocodone), synthetic opioids (prescription and illicit fentanyl, tramadol), methadone, and heroin. From 1999 to 2017, there were 702,568 drug overdose deaths in the U.S., with 399,230 attributed to opioids. This study aimed to assess the dynamics of opioid related fatalities throughout the U.S. from 2006-2016. This study is a secondary analysis of data obtained through the Kaiser Family Foundation's analysis of Centers for Disease Control and Prevention data, 1999-2016. The data obtained were from all 50 states and the District of Columbia. A total of 272,130 individuals were included in the analysis. This represents the number of opioid overdose deaths in the United States from 2006-2016. Descriptive analysis of overall rates was conducted and mapped for visualization. Novel predictive models of increase for each drug overdose category were developed and used to calculate rate changes. Finally, the elasticity of change in rate for each drug category was calculated annually for the past 11 years. The highest rate of opioid overdose-related death occurred in West Virginia (40.03 per 100,000). In our secondary analysis, we explored the change in the rate of opioid-related deaths from 2015 to 2016. The changing dynamics of fatal opioid overdose at the state level is critical to guiding policy makers in addressing this crisis. Rates of fatal opioid overdose vary across the states, but we identify some trends. Regional differences are identified in states with the highest overdose rates from all opioids combined.
There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently ...receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.
Active substance users have been characterized as ambivalent about accessing treatment services. Few studies have addressed the social context and related barriers that individuals experience in ...addressing substance abuse problems. These barriers appear to be heightened for female methamphetamine users living in rural areas of Appalachia. The purpose of this study is to document the willingness of active female methamphetamine users to access substance abuse treatment services, their ability to access substance abuse treatment services, and the barriers they experienced in accessing substance abuse treatment services. Findings from a sample of 153 rural female methamphetamine users revealed the majority of respondents met the criteria for substance dependence (99.3%), believed they had a drug problem (84.9%), believed they needed treatment services (62.9%), and wanted to go to treatment "now" (51.4%). However, only one fourth (26.8%) had accessed treatment, and many had experienced barriers in attempting to enter treatment services.
A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify ...factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.
Celotno besedilo
Dostopno za:
DOBA, IJS, NUK, SIK, UILJ, UKNU, UL, UM, UPUK
This article provides information on harm reduction, a recent development in substance abuse services in response to the HIV/AIDS epidemic. The author outlines abstinence and harm reduction ...perspectives and the stages of change model and discusses how these perspectives can be integrated in social work practice. He proposes using harm reduction strategies for individuals for whom the abstinence perspective may not be appropriate. Together, the traditional abstinence and harm reduction perspectives provide a basis for a more comprehensive continuum of care for individuals experiencing problems related to their substance use.
The past decade has seen a marked increase in the illicit use of opioids, as well as a doubling of the percentage of individuals seeking treatment for opioid use disorders. However, little is known ...about the differences between opioid users and nonopioid users in residential treatment. Further, no studies have been published that compare opioid users and nonopioid users in treatment for co-occurring substance use and mental disorders. To address this gap, this study examined differences between opioid and nonopioid substance users in residential treatment for co-occurring disorders. Data was drawn from 1,972 individuals treated between 2009 and 2011 at one of three private residential treatment centers that provide integrated treatment for co-occurring substance use and mental disorders. Data was collected at program intake, and 1- and 6-month postdischarge using the Addiction Severity Index and the University of Rhode Island Change Assessment. To examine within-group changes in substance use, addiction severity, and mental health across time, linear mixed-model analyses were conducted with facility, year, age, gender, and race included as covariates. The authors found more similarities than differences between the two groups on baseline characteristics, treatment motivation, length of stay, and outcomes on measures of substance use, addiction severity, and mental health. The results demonstrate that though opioid users entered treatment with higher levels of substance use-related impairment, they were just as successful in treatment outcomes as their non-opioid-using peers.
An increasing number of Americans are experiencing sleep problems. There is evidence of a complex, bidirectional relationship between sleep disorders, substance abuse, and mental health symptoms. ...Institutional settings have been shown to elicit sleep problems as well. This pilot study was conducted with 28 patients in private, residential, dual-diagnosis treatment for addiction and mental health disorders. Upon admission, consenting patients were administered the Addiction Severity Index to assess pretreatment substance use and mental health symptoms. Patients followed a normal course of treatment as well as participated in a nightly sleep hygiene group that included relaxation suggestions. Evaluations with the Addiction Severity Index were completed again 30 days after discharge from treatment. Significant improvements in some substance use patterns as well as mental health symptoms were noted. Although results cannot be directly attributed to the use of a sleep hygiene group, this pilot study lays the foundation for future investigations of interventions supporting sleep in the dual-diagnosis population.
Objective: The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including ...differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment. Methods: This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay. Results: Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change. Conclusions: The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment.
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