Post on 02-Aug-2020
NationalPerspectiveontheEpidemiologyofOpioidAddictionandTreatment
GeorgePro,PhD,MPH
February22,2020
Agenda
• Opioidepidemicbackground
• TreatmentServicesResearchatNAU
• FutureResearchatNAU
Background
OpioidtypesBackground |TreatmentServices|FutureNAUResearch
Racial/ethnicdisparitiesBackground |TreatmentServices|FutureNAUResearch
DifferencesbystateandregionBackground |TreatmentServices|FutureNAUResearch
ConvergingepidemicsBackground |TreatmentServices|FutureNAUResearch
NationalSurveyonDrugUseandHealth
ConvergingepidemicsBackground |TreatmentServices|FutureNAUResearch
NationalSurveyonDrugUseandHealth
ConvergingepidemicsBackground |TreatmentServices|FutureNAUResearch
NationalSurveyonDrugUseandHealth
TreatmentServicesResearchatNAU
Medication-assistedtherapy
Emptyopioidreceptor
Methadone
Fullagonist
Buprenorphine
Partialagonist
Naltrexone
Antagonist
Background|TreatmentServices |FutureNAUResearch
MATtrendsBackground|TreatmentServices |FutureNAUResearch
TreatmentEpisodeDataset-Discharges
MAToutcomesBackground|TreatmentServices |FutureNAUResearch
ProG,UtterJ,CramJ,BaldwinJ(2019)
Racial/ethnicandgenderdifferencesinassociationsbetweenmedication-assistedtherapyandreducedopioidusebetweenoutpatienttreatmentadmissionanddischarge
JournalofPsychoactiveDrugs
Accepted/inpress
Researchstudybackground
• DefinitionsofMATsuccessvary
• Reducingopioiduseimproveshealthandsafety
• Toleratingsomecontinuedopioiduseisaharmreductionstrategy
Background|TreatmentServices |FutureNAUResearch
Researchstudybackground
RESEARCHQUESTIONS
TowhatextentdoesMATeffectareductioninopioiduse?
Background|TreatmentServices |FutureNAUResearch
MATreceipt
Areductioninopioiduse
totaleffect
Race/ethnicityGender
moderation
AnddoestheMATeffectchangebasedonracial/ethnicandgendergroup?
Datasourceandmethods
TreatmentEpisodeDataset-Discharges(2015-2017)
Restrictedtothoseintreatmentwithheroinorotheropioidsindicatedatoutpatientadmission
n=232,547
Statisticalmodelingtopredicttheprobabilityofclinicalimprovement
Background|TreatmentServices |FutureNAUResearch
Descriptivefindings
GreaterMATreceipt
LessMATreceipt
Background|TreatmentServices |FutureNAUResearch
Descriptivefindings
Greaterreductioninuse
Lessreductioninuse
ReceivedMAT
DidnotreceiveMAT
Background|TreatmentServices |FutureNAUResearch
Measuringgroupdifferencesusingstatisticalmodels
3.79
Background|TreatmentServices |FutureNAUResearch
MATreceipt
Areductioninopioiduse
totaleffectaOR=3.79
Race/ethnicityGender
1
Differencesinclinicalimprovementsusingstatisticalmodeling
moderation
DiscussionBackground|TreatmentServices |FutureNAUResearch
FutureNAUresearch
MATmedications
Methadone,buprenorphine(Suboxone),andnaltrexone(Vivitrol)havesimilarefficacy
Effectiveness differsbasedonclientcharacteristicsandpreferences
OUDtreatmentservicesthatofferallthreeareoptimal
Background|TreatmentServices|FutureNAUResearch
MATavailabilityandutilization
ThemajorityoftreatmentserviceprovidersdonotofferMAT
≈1/3ofindividualswithaneedforMATreceiveit
Insurancecoverageforeachmedicationvarieswidely
Fewerthan15%ofaddictionservicephysicianshaveappliedforalicensetoprescribebuprenorphine
Background|TreatmentServices|FutureNAUResearch
MedicaidexpansionsundertheACA
MedicaidExpansionDecisions– asofNov.2019–
Adoptedandimplemented
Adoptedbutnotimplemented
Notadopted
Background|TreatmentServices|FutureNAUResearch
Substanceabuseandmentalhealthparity
MentalHealthParityandAddictionEquityAct
EvaluatingStateMentalHealthandAddictionParityStatutes:ATechnicalReport
Background|TreatmentServices|FutureNAUResearch
Substanceabuseandmentalhealthparity
UnitedStates,ColorCodedbyStatutoryGrades
A-BCDF
Statutorygrades
Background|TreatmentServices|FutureNAUResearch
RelevancetoArizonaandneighboringstates
n=138,000 n=3,061n=1,438n=2,045
Background|TreatmentServices|FutureNAUResearch
RelevancetoArizonaandNativeAmericanstates
ArizonaRank #12
New MexicoRank #34
OklahomaRank #49
Background|TreatmentServices|FutureNAUResearch
Conclusion
Conclusion
• Prevention+ MAT
• Acomplexissuewithmanyintersectingparts
• Progresswillbedrivenbyinterdisciplinaryefforts
• Importanceofinterprofessional education
Thankyou
Extraslides
0
0.25
0.5
0.75
1
MAT, no alcohol MAT + alcohol No MAT, noalcohol
No MAT + alcohol
Gro
up p
ropo
rtio
ns
AI/AN men AI/AN women Black men Black women
Latino men Latina women White men White women
Groupdifferencesinreducedopioidusebetweenoutpatientadmissionanddischarge
References
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Slide– Racial/ethnicdisparitiesHenryJ.KaiserFamilyFoundation.(2018).OpioidOverdoseDeathRatesbyRace/Ethnicity.HealthStatus:OpioidOverdoseDeaths.https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
ParkhurstND,BurkeA,Montiel A,DavisJ,RitcheyJ.(2018).TheOpioidEpidemicinIndianCountry.IndianHealthServiceCooperativeAgreement.PublicHealthEmergencyandPreparednessTechnicalAssistance.InterTribalCouncilofArizona,Inc.TribalEpidemiologyCenter.https://itcaonline.com/wp-content/uploads/2018/10/ITCA-TEC-Opioid-Report-2018.pdf
Slide– DifferencebystateandregionHenryJ.KaiserFamilyFoundation.(2018).OpioidOverdoseDeathRatesbyRace/Ethnicity.HealthStatus:OpioidOverdoseDeaths.https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Slide– StudyBackgroundZhangZ,Friedmann P,GersteinD.(2003).Doesretentionmatter?Treatmentdurationandimprovementindruguse.Addiction,98(5),673-684.
Brugal M,DennisB,Bhalerao A,PlaterC,etal.(2002).Factorsassociatedwithnon-fatalheroinoverdose:Assessingtheeffectoffrequencyandrouteofheroinadministration.Addiction,97(3)319-327.
Macmadu,A.,Carroll,J.,Hadland,S.,Green,T.,&Marshall,B.(2017).Prevalenceandcorrelatesoffentanyl-contaminatedheroinexposureamongyoungadultswhouseprescriptionopioidsnon-medically.AddictiveBehavior,68,35-38.
Bruneau,J.,Roy,E.,Arruda,N.,Zang,G.,&Jutras-Aswad,D.(2012).TherisingprevalenceofprescriptionopioidinjectionanditsassociationwithhepatitisCincidenceamongstreet-drugusers.Addiction,107(7),1318-1327.
Young,A.,&Havens,J.(2012).TransitionfromfirstillicitdrugusetofirstinjectiondruguseamongruralAppalachiandrugusers:Across-sectionalcomparisonandretrospectivesurvivalanalysis.Addiction,107(3),587-596.
Veilleux,J.,Colvin,P.,Anderson,J.,York,C.,&Heinz,A.(2010).Areviewofopioiddependencetreatment:Pharmacologicalandpsychosocialinterventionstotreatopioidaddiction.ClinicalPsychologyReview,30(2),155-166.
Slide– MATMedicationsVolkow N,JonesE,EinsteinE,Wargo E.Preventionandtreatmentofopioidmisuseandaddiction:Areview.JAMAPsychiatry.2019;76(2):208-216.
ConneryHS.Medication-assistedtreatmentofopioidusedisorder:Reviewoftheevidenceandfuturedirections.HarvardReviewofPsychiatry.2015;23(2):63-75.
BurnsL,Gisev N,Larney S,etal.AlongitudinalcomparisonofretentioninbuprenorphineandmethadonetreatmentforopioiddependenceinNewSouthWales,Australia.Addiction.2015;110(4):646-655.
YarboroughB,Stumbo S,McCartyD,Mertens J,Weisner C,GreenC.Methadone,buprenorphineandpreferencesforopioidagonisttreatment:Aqualitativeanalysis.DrugAlcoholDepend.2016;160:112-118.
JarvisB,Holtyn A,BerryM,etal.Predictorsofinductionontoextended-releasenaltrexoneamongunemployedheroin-dependentadults.JournalofSubstanceAbuseTreatment.2018;85:38-44.
Mojtabai R,MauroC,WallM,BarryC,Olfson M.Medicationtreatmentforopioidusedisordersinsubstanceusetreatmentfacilities.HealthAffairs.2019;38(1):14-23.
Slide– MATAvailabilityandUtilizationMojtabai R,MauroC,WallM,BarryC,Olfson M.Medicationtreatmentforopioidusedisordersinsubstanceusetreatmentfacilities.HealthAffairs.2019;38(1):14-23.
Volkow N,Frieden T,HydeP,ChaS.Medication-assistedtherapies- Tacklingtheopioid-overdoseepidemic.NewEnglandJournalofMedicine.2014;370:2063-2066.
VestalC.Infightinganopioidepidemic,medication-assistedtreatmentiseffectivebutunderused.HealthAff (Millwood).2016;35(6):1052-1057.
Fiscella K,Wakeman SE,Beletsky L.(2018).Buprenorphinederegulationandmainstreamingtreatmentforopioidusedisorder:XtheXWaiver.JAMAPsychiatry,76(3):229-230.
RosenblattRA,Andrilla HA,etal.(2015).GeographicandspecialtydistributionofUSphysicianstrainedtotreatopioidusedisorder.AnnalsofFamilyMedicine,13(1):23-26.
Slide– MedicaidExpansionsundertheACAHenryJ.KaiserFamilyFoundation.(2019).StatusofStateActionontheMedicaidExpansionDecision.StateHealthFacts.MedicaidandHealthReform.https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?activeTab=map¤tTimeframe=0&selectedDistributions=status-of-medicaid-expansion-decision&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Slide– SubstanceAbuseandMentalHealthParityDouglasM,Wrenn G,Bent-WeberS,TontiL,etal.(2018).EvaluatingStateMentalHealthandAddictionParityStatutes:ATechnicalReport.Kennedy-Satcher CenterforMentalHealthEquityatMorehouseSchoolofMedicine.TheKennedyForum.https://chp-wp-uploads.s3.amazonaws.com/www.paritytrack.org/uploads/2018/09/KF-Evaluating-State-Mental-Health-Report-0918_web.pdf