•4.9% of patients initiated OAT within 30 days of a new OUD episode.•Timely OAT less likely among patients with HIV, psychiatric diagnosis, rurality.•Timely OAT more likely among African Americans ...(AFAM), alcohol-related diagnosis, patients with HCV.
Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV.
We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter.
4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 – 0.62), PWH (aOR = 0.79, 95% CI 0.68–0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34–1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48–2.08), diagnosis year 2005–2008 relative to 2000–2004 (aOR = 1.24, 95% CI 1.05–1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27–1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models.
PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
Gabapentin is commonly prescribed for chronic pain, including to patients with HIV (PWH). There is growing concern regarding gabapentin's potential for harm, particularly in combination with opioids. ...Among PWH, we examined factors associated with higher doses of gabapentin receipt and determined if receipt varied by opioid use. We examined data from the Veterans Aging Cohort Study, a national prospective cohort including PWH, from 2002 through 2017. Covariates included prescribed opioid dose, self-reported past year opioid use, and other sociodemographic and clinical variables. We used multinomial logistic regression to determine independent predictors of gabapentin receipt. Among 3,702 PWH, 902 (24%) received any gabapentin during the study period at a mean daily dose of 1,469 mg. In the multinomial model, high-dose gabapentin receipt was associated with high-dose benzodiazepine receipt (adjusted odds ratio aOR, 95% confidence interval CI= 1.53, 1.03-2.27), pain interference (1.65 1.39-1.95), and hand or foot pain (1.81, 1.45-2.26). High-dose gabapentin receipt was associated with prescribed high-dose opioids receipt (2.66 1.95-3.62) but not self-reported opioid use (1.03 0.89-1.21). PWH prescribed gabapentin at higher doses are more likely to receive high-dose opioids and high-dose benzodiazepines, raising safety concerns.
Minimal research has examined body image dissatisfaction (BID) among patients receiving methadone maintenance treatment (MMT). We tested associations between BID and MMT quality indicators ...(psychological distress, mental and physical health-related quality of life HRQoL) and whether these associations varied by gender.
One hundred and sixty-four participants (n = 164) in MMT completed self-report measures of body mass index (BMI), BID, and MMT quality indicators. General linear models tested if BID was associated with MMT quality indicators.
Patients were primarily non-Hispanic White (56%) men (59%) with an average BMI in the overweight range. Approximately 30% of the sample had moderate or marked BID. Women and patients with a BMI in the obese range reported higher BID than men and patients with normal weight, respectively. BID was associated with higher psychological distress, lower physical HRQoL, and was unrelated to mental HRQoL. However, there was a significant interaction in which the association between BID and lower mental HRQoL was stronger for men than women.
Moderate or marked BID is present for about three in 10 patients. These data also suggest that BID is tied to important MMT quality indicators, and that these associations can vary by gender. The long-term course of MMT may allow for assessing and addressing novel factors influencing MMT outcomes, including BID.
This is one of the first studies to examine BID among MMT patients, and it highlights MMT subgroups most at risk for BID and reduced MMT quality indicators due to BID.
•We explored alexithymia and pain in patients in treatment for opioid use disorder.•Alexithymia was associated with greater pain interference and pain catastrophizing.•Increased alexithymia was ...associated with reduced pain acceptance.•Alexithymia contributes to pain interference and may be a therapeutic target.•Pain catastrophizing and acceptance mediated effects of alexithymia on interference.
Alexithymia, difficulty identifying and describing one’s emotions coupled with a tendency to externalize, is a potentially important yet understudied treatment target for patients with opioid use disorder. The aim of this study was to examine the role of alexithymia in pain experience among individuals with opioid use disorder.
One-hundred-and-sixty-four patients receiving methadone maintenance treatment completed a battery of self-report measures related to alexithymia, drug use, and pain experiences. Comparisons were performed on the full sample between those with or without clinically significant levels of alexithymia. For a subsample reporting pain (n = 138), intercorrelations were performed to test whether drug use history, pain catastrophizing, pain acceptance, and alexithymia were related to pain severity and pain interference. Regression analyses were performed to test for serial mediation of pain catastrophizing and pain acceptance on the relationship between alexithymia and pain interference in this subsample.
Individuals with alexithymia showed increased pain catastrophizing and interference, and intercorrelations indicated that increased alexithymia was associated with increased pain interference, more pain catastrophizing, and reduced pain acceptance. A serial regression model among a subset of patients with pain indicated that pain catastrophizing and pain acceptance mediated the effect of alexithymia on pain interference.
These findings suggest that alexithymia, as well as both pain catastrophizing and pain acceptance, contribute to interference associated with pain and are potentially important intervention targets among methadone-treated patients with pain.
•Most people with opioid use disorder (OUD) are also addicted to cigarette smoking.•62% of OUD patients reported electronic cigarette (EC) use history.•Daily EC use was associated with higher odds of ...being a former smoker.•Interventions using ECs may be effective to help reduce harms and mortality in OUD.
Although smoking is prevalent among populations with opioid use disorder (OUD), few studies have examined electronic cigarette (EC) use in individuals seeking opioid agonist therapy (OAT). The aim of this study was to evaluate the prevalence and correlates of EC use among individuals seeking OAT.
782 patients seeking OAT for OUD completed surveys assessing current and past EC use, reasons for use, current and past cigarette smoking, nicotine dependence, psychiatric distress, trauma, and pain. Bivariate and multivariate models evaluated correlates of daily EC use, past-30-day EC use, and current cigarette smoking.
6% of patients reported daily EC use, 18% reported past-30-day use, 62% reported EC use history, and 85% reported current cigarette smoking. 46% reported using ECs to quit or cut down smoking. In multivariate analyses, daily EC use was associated with higher odds of being a former smoker (OR 21; CI 1.7–273) and lower odds of ever smoking more than 100 cigarettes (OR 0.07; CI 0.01–0.32), while EC use in the past 30 days was associated with lower odds of being Caucasian (OR 0.55; CI 0.34–0.89), ever smoking more than 100 cigarettes (OR 0.13; CI 0.02–0.67), and history of chronic pain (OR 0.59; CI 0.38-0.90), and higher odds of reporting psychiatric distress (OR 1.5; CI 1.1–2.2).
EC use is common among people with OUD who smoke cigarettes. Those with daily use had higher odds of being former smokers than current smokers. Interventions using ECs may be effective to help reduce harms and mortality in OUD.
Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder ...(OUD). Using data from the Veterans Aging Cohort Study (VACS), we identify variables independently associated with OAT retention overall and by HIV status. Among 7,334 patients with OUD, 13.7% initiated OAT, and 27.8% were retained 12-months later. Likelihood of initiation and retention did not vary by HIV status. Variables associated with improved likelihood of retention included receiving buprenorphine (relative to methadone), receiving both buprenorphine and methadone at some point over the 12-month period, or diagnosis of HCV. History of homelessness was associated with a lower likelihood of retention. Predictors of retention were largely distinct between patients with HIV and patients without HIV. Findings highlight the need for clinical, systems, and research initiatives to better understand and improve OAT retention.
Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), ...few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.
Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates.
There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables (
's < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853,
< 0.001, 95% CI = -0.114, -0.056, OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435,
< 0.001, 95% CI = -0.371, -0.316, OR = 0.709) after accounting for covariates.
Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.
The cross-sectional retrospective study examined whether ethnicity moderates relationships between pain interference and both psychopathology and general medical conditions among Hispanic and ...non-Hispanic white adults. Participants comprised 32,574 (14% Hispanic; 86% white) National Epidemiologic Survey on Alcohol and Related Conditions respondents. While Hispanic respondents were less likely than white respondents to report severe pain interference (11.4% vs. 11.9%) or moderate pain interference (5.7% vs. 7.8%), and were more likely to report no or low pain interference (82.9% vs. 80.3%), the magnitude of these ethnic group differences was relatively small. Pain interference was associated with multiple past-year Axis-I psychiatric disorders and general medical conditions in both Hispanic and white respondents. Stronger relationships were observed in Hispanic compared to white respondents between moderate pain interference and any heart condition, tachycardia, and hypertension, and between severe pain interference and any mood disorder. Stronger relationships were observed in white compared to Hispanic respondents between severe pain interference and both social phobia and any stomach condition. Differences between Hispanic and white respondents on the prevalence of pain interference and on the strength of the associations between pain interference and specific psychiatric disorders and general medical conditions underscore the complexity of ethnic health disparities and suggest the importance of further study of underlying mechanisms.
•Examined pain interference in Hispanic and white adults.•Hispanic adults were less likely to report moderate or severe pain interference.•Ethnicity moderated links between pain, psychopathology and medical conditions.
The quality and impact of psychotherapy sessions are primary concerns in service delivery. However, no published investigations of quality or impact of psychotherapy sessions with American Indian ...(AI) patients could be found in the scientific literature. We sought to demonstrate that collecting such data is feasible as well as to inform the development of evidence-based practices and cultural adaptations. To this end, we asked psychotherapists treating AIs in outpatient psychotherapy within an urban community clinic to rate the quality and impact of sessions delivered to their clients. Eight psychotherapists self-reported session quality and impact with the Session Evaluation Questionnaire, Form 5 (SEQ-5; Stiles, 1980, 1984) immediately following service delivery to 112 separate, consecutive clients. Session quality was assessed with measures of depth and smoothness. Post-session impact was assessed with measures of positivity and emotional arousal. Overall, sessions were rated as equally deep, but smoother, more positive, and less emotionally arousing in comparison to a sample of experienced university-based psychotherapists (Cummings et al., 1993). However, sessions provided by AI psychotherapists were rated as deeper, less positive, and more emotionally arousing than sessions provided by White psychotherapists. Replicating this study in a larger sample and including client as well as observer ratings will help to move this nascent line of research forward.
Impact Statement
Given the absence of studies reporting on session quality and impact with American Indian psychotherapy clients, we wondered about the quality and impact of psychotherapy with this group. Overall, sessions were rated by therapists as equally deep, but smoother, more positive, and less emotionally arousing in comparison to a sample of experienced university-based psychotherapists. However, sessions provided by AI psychotherapists were rated as deeper, less positive, and more emotionally arousing than sessions provided by White psychotherapists. The findings show that measuring session quality and impact is feasible and that measuring these constructs can provide important quality assessment information for stakeholders. Session quality and impact ratings in this study compare favorably to a sample of experienced university-based therapists, suggesting high quality service provision. Researchers and clinic directors working in American Indian healthcare settings are encouraged to measure session quality and impact.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone ...maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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