Journal of substance abuse treatment
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To classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid overdose with rehabilitation services. ⋯ Over the past two decades, the rate of both OUD diagnoses and opioid overdoses increased substantially in US hospitals while rates of inpatient detoxification and rehabilitation services identified by diagnosis codes declined. It is critical that inpatients diagnosed with OUD or treated for opioid overdose are linked effectively to substance use disorder treatment at discharge.
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J Subst Abuse Treat · Aug 2019
Opioid medication discontinuation and risk of adverse opioid-related health care events.
Between 2012 and 2017, the United States dramatically reduced opioid prescribing rates. While this may be appropriate given the opioid epidemic, there has been little research to guide the clinical practice of discontinuing patients from opioid medications and opioid death rates have continued to increase. ⋯ Faster rates of opioid tapering were associated with a greater probability of adverse events and many patients discontinued opioids suddenly, with no dose reduction. Additional clinical guidance, research, and interventions are needed to ensure that patients' opioid prescriptions are discontinued safely.
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J Subst Abuse Treat · Jul 2019
Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study.
Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences of care for patients with OUD-associated endocarditis and the healthcare providers who deliver that care. ⋯ This qualitative analysis highlights multiple patient and health system factors that may explain poor clinical outcomes experienced by individuals with OUD-associated endocarditis. A sick, complex, stigmatized patient population was noted, with new physical and mental comorbidities often developing on top of pre-existing ones. Perceived barriers to effective treatment of OUD-associated endocarditis included the complexity of managing two life threatening illness simultaneously, external stigma towards individuals with OUD, and discontinuity in longitudinal care.
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J Subst Abuse Treat · Jun 2019
Determining spatial access to opioid use disorder treatment and emergency medical services in New Hampshire.
This research presents an analysis of spatial access to both opioid use disorder treatment facilities and emergency medical services in New Hampshire during 2015-2016, a period during which there was a steep increase in unintentional overdoses involving fentanyl. For this research, spatial access was computed using the enhanced two-step floating catchment area model combined with the Huff model to assess access across New Hampshire and gives attention to supply-side parameters that can impact spatial access. The model is designed to measure access to healthcare services for opioid use disorder patients offered at treatment centers or from buprenorphine treatment practitioners, as well as from emergency medical services across New Hampshire. ⋯ The insights from this research showed that for this period, while the opioid crisis was impacting many towns in New Hampshire, high levels of access to treatment services were not uniform across the state. When comparing the access results with data on the towns of residence for individuals who died from unintentional overdoses involving fentanyl during 2015 and 2016, estimates found that approximately 40% of the towns were not estimated to be in the highest class of access to treatment services at the time. This research provides information for local public health officials to support planning strategies to address opioid use disorder treatment access in high-risk regions.
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J Subst Abuse Treat · Jun 2019
Randomized Controlled Trial Comparative StudyTreatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods.
In a double-blind, non-inferiority randomized controlled trial injectable hydromorphone, a licensed short acting opioid analgesic, was shown to be as effective as diacetylmorphine for the treatment of severe opioid use disorder. An appropriate question is whether hydromorphone offered open-label can attract and retain patients. ⋯ As treatment with injectable hydromorphone expands across Canada, our study contributes in a unique manner by providing evidence that the high retention rates observed during the clinical trial were maintained when participants started open-label hydromorphone.