Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse
-
COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). ⋯ ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
-
Few primary care patients are screened for substance use. As part of a phased feasibility study examining the implementation of electronic health record-integrated screening with the Tobacco, Alcohol, and Prescription Medication Screening (TAPS) Tool and clinical decision support (CDS) in rural primary care clinics, focus groups were conducted to identify early indicators of success and challenges to screening implementation. Method: Focus groups (n = 6) were conducted with medical assistants (MAs: n = 3: 19 participants) and primary care providers (PCPs: n = 3: 13 participants) approximately one month following screening implementation in three Federally Qualified Health Centers in Maine. ⋯ The TAPS Tool's content, credibility and ease of workflow integration were favorably assessed. Challenges include screening solely at annual visits and self-administered screening for certain patients. Conclusions: Results reveal indicators of implementation success and strategies to address challenges to screening for substance use in primary care.
-
Review Case Reports
Consideration of opioid agonist treatment in a pregnant adolescent: A case report and literature review.
Background: Opioid use greatly increases the risk of overdose death, as well as contracting human immunodeficiency virus (HIV) and hepatitis. Opioid agonist treatment is recommended for pregnant women who are dependent on opioids. However, there is a dearth of studies on the use of opioid agonist treatment in pregnant teenagers. ⋯ A did not attend outpatient treatment and was lost to follow up. Discussion: Based upon our experience and review of the studies regarding opioid use disorder (OUD) and perinatal and adolescent opioid use, we recommend that pregnant adolescents with OUD be referred to opioid agonist treatment with buprenorphine or methadone. Studies specifically addressing opioid agonist treatment in pregnant teenagers are needed.
-
Background: Accurate prevalence estimates are critical to epidemiological research but discordant responses on self-report surveys can lead to over- or underestimation of drug use. We sought to examine the extent and nature of underreported cannabis use (among those later reporting blunt use) from a national drug survey in the US. Methods: We used data from the 2015-2019 National Survey on Drug Use and Health (N = 281,650), a nationally representative probability sample of non-institutionalized populations in the US. ⋯ Although corrected prevalence, cannabis use recoded as use only increased from 15.2% (95% CI: 15.0-15.4) to 15.5% (95% CI: 15.3-15.7), individuals who are aged ≥50 (aOR = 1.81, 95% CI: 1.06-3.08), female (aOR = 1.35, 95% CI: 1.12-1.62), Non-Hispanic Black (aOR = 1.43, 95% CI: 1.16-1.76), or report lower English proficiency (aOR = 3.32, 95% CI: 1.40-7.83) are at increased odds for providing such a discordant response. Individuals with a college degree (aOR = 0.57, 95% CI: 0.39-0.84) and those reporting past-year use of tobacco (aOR = 0.75, 95% CI: 0.62-0.91), alcohol (aOR = 0.42, 95% CI: 0.33-0.54), cocaine (aOR = 0.50, 95% CI: 0.34-0.73), or LSD (aOR = 0.52, 95% CI: 0.31-0.87) were at lower odds of providing a discordant response. Conclusion: Although changes in prevalence are small when correcting for discordant responses, results provide insight into subgroups that may be more likely to underreport use on surveys.
-
Background: Benzodiazepine use in the US Veterans Administration (VA) has been decreasing; however, a small number of veterans with posttraumatic stress disorder (PTSD) continue to receive benzodiazepine. Academic detailing, a targeted-educational outreach intervention, was implemented at VA to help reduce the disparity between existing and evidence-based practices, including the reduction in benzodiazepine use in veterans with PTSD. Since evidence to support the national implementation of academic detailing in this clinical scenario was scarce, we performed a quality improvement evaluation on academic detailing's impact on benzodiazepine use in veterans with PTSD. ⋯ Similar findings were reported for the benzodiazepine day supply; however, no significant differences were reported for total and average LEDD. Conclusions: Although benzodiazepine use has been decreasing in veterans with PTSD, opportunities to improve prescribing continue to exist at the VA. In this quality improvement evaluation, AD-exposed providers were associated with a greater reduction in the prevalence of veterans with PTSD and a benzodiazepine prescription compared with AD-unexposed providers.