George Pro, PhD, MPH February 22, 2020 · Slide –MAT Medications VolkowN, Jones E, Einstein E,...

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

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


Researchstudybackground

RESEARCHQUESTIONS

TowhatextentdoesMATeffectareductioninopioiduse?


MATreceipt

Areductioninopioiduse

totaleffect

Race/ethnicityGender

moderation

AnddoestheMATeffectchangebasedonracial/ethnicandgendergroup?

Datasourceandmethods

TreatmentEpisodeDataset-Discharges(2015-2017)

Restrictedtothoseintreatmentwithheroinorotheropioidsindicatedatoutpatientadmission

n=232,547

Statisticalmodelingtopredicttheprobabilityofclinicalimprovement


Descriptivefindings

GreaterMATreceipt

LessMATreceipt


Descriptivefindings

Greaterreductioninuse

Lessreductioninuse

ReceivedMAT

DidnotreceiveMAT


Measuringgroupdifferencesusingstatisticalmodels

3.79


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


MedicaidexpansionsundertheACA

MedicaidExpansionDecisions– asofNov.2019–

Adoptedandimplemented

Adoptedbutnotimplemented

Notadopted


Substanceabuseandmentalhealthparity

MentalHealthParityandAddictionEquityAct

EvaluatingStateMentalHealthandAddictionParityStatutes:ATechnicalReport


Substanceabuseandmentalhealthparity

UnitedStates,ColorCodedbyStatutoryGrades

A-BCDF

Statutorygrades


RelevancetoArizonaandneighboringstates

n=138,000 n=3,061n=1,438n=2,045


RelevancetoArizonaandNativeAmericanstates

ArizonaRank #12

New MexicoRank #34

OklahomaRank #49


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

Slide– OpioidtypesNationalInstituteonDrugAbuse.(January2019).OverdoseDeathRates.TrendsandStatistics.NationalInstitutesofHealth.https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

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&currentTimeframe=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

George Pro, PhD, MPH February 22, 2020 · Slide –MAT Medications VolkowN, Jones E, Einstein E,...

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