Addiction science & clinical practice
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Addict Sci Clin Pract · Nov 2018
Closing the gaps in opioid use disorder research, policy and practice: conference proceedings.
Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116 invited health researchers, clinicians, policymakers, health system leaders, and other stakeholders met at the University of Pennsylvania to discuss approaches to address the gaps in evidence-based substance use disorder policy and practice, with an emphasis on the opioid epidemic. ⋯ These groups met to develop and present policy recommendations based on an opioid use disorder case study. Thirteen policy recommendations emerged across four themes: (1) quality of treatment, (2) continuity of care, (3) opioid prescribing and pain management, and (4) consumer engagement. This conference serves as a proposed model to develop equitable, working relationships among researchers, clinicians, and policymakers.
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Addict Sci Clin Pract · Aug 2018
ReviewEmergency department screening and interventions for substance use disorders.
The emergency department (ED) has long been recognized as providing critical access to the health care system for many, yet only in the past few decades has the ED visit been recognized as an opportunity to identify and link patients to care for substance use disorders (SUDs). This review explores the evidence for ED-based screening, psychosocial and pharmacological interventions, and linkage to treatment for the spectrum of SUDs including high risk alcohol use and alcohol, opioid, tobacco and other SUDs. Despite knowledge gaps, methodological challenges and some inconsistency across interventions studied, opportunities for EDs to improve the care of patients across the spectrum of SUDs are robust.
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Addict Sci Clin Pract · Apr 2018
ReviewMindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research.
Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. ⋯ This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose-response relationships, and research rigor and reproducibility are discussed.
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Addict Sci Clin Pract · Apr 2018
Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff.
Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. ⋯ Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers.
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Addict Sci Clin Pract · Mar 2018
Evaluation of the effect of methamphetamine on traumatic injury complications and outcomes.
This study investigates the impact of methamphetamine use on trauma patient outcomes. ⋯ Methamphetamine positive drug screens in trauma patients were not associated with an increase in hospital mortality; however, a methamphetamine positive drug screen was associated with a longer LOS and an increased heart rate.