Clinic presenters told the Whatcom County Behavioral Health committee that two locations now offer medications for opioid use disorder, counseling and case management; Division Street serves roughly 59 clients and Flora Street about 19, and staff urged community referrals while noting transit and outreach gaps.

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While medications for opioid use disorder (MOUD) effectively treat opioid use disorder (OUD), concurrent pain management remains challenging. Cannabid…

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Background: Although treatment for opioid use disorder (OUD) often yields high adherence during pregnancy, the risk of returning to opioid misuse during postpartum is high. There are currently no relapse prevention programs tailored to this unique time period. Using a prospective cohort study, we seek to preliminarily identify hormones and/or infant caregiving approaches as novel predictors of postpartum opioid misuse. Objective: As a first step in dissemination of results, this report contains a detailed account of the protocol, as well as recruitment, retention, compliance, and participant satisfaction. Methods: Participants were individuals with OUD (OUD+) and those without (OUD-) who were followed from late pregnancy (≥gestational week 36) to postpartum month five. From childbirth to postpartum week 12, participants completed daily surveys (capturing use, craving, interactions with infant) and weekly face-to-face visits (including collection of biological samples for hormone assays). Follow-up visits using the same procedures occurred at postpartum month four and five. Results: Most participants (50 OUD+, 20 OUD-) notified the study staff of childbirth (93%), completed at least one postpartum clinic visit (87%), and completed follow-up (73%). Compliance with procedures ranged from 81% for weekly surveys to 63% for weekly dried blood spots, generally with lower compliance among OUD+ and at later time points. Among a subgroup of participants (n=31), regardless of group and time point, reported high study satisfaction (e.g., on a scale where 0 is “not at all” and 3 is “extremely”, on average participants reported 2.9±0.4 for their willingness to complete this study again at week 12 postpartum). Conclusions: This prospective cohort study was well tolerated despite the challenging postpartum period. Data collected will provide ample opportunities to identify novel risk/protective factors to inform the development of new relapse prevention intervention programs specific to the needs of those with OUD during early postpartum.

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Background: Opioid use disorder (OUD) affects millions of individuals each year in the United States. Patient retention in medications for opioid use disorder (...

Background: Young adults, defined as individuals between the ages of 18-29, drop out of opioid use disorder treatment more often than older adults. Premature treatment drop-out substantially increases fatal overdose risk. Self-monitoring through #TextMessaging #mhealth has been researched extensively among people with opioid use disorder to identify drop-out risk factors. Self-monitoring could potentially improve methadone treatment engagement among young adults, who are a population that is both hard to reach and more likely to use technology compared to older adults. Self-monitoring can increase risk factor awareness and help patients and counselors develop targeted coping strategies and treatment plans. However, embedding a discussion of risk factor information into existing counseling sessions has been limited, and may offer a promising opportunity to improve engagement among young adults. Objective: This pilot proof-of-concept study examined the implementation of self-monitoring intervention, AWARE (Awareness and Response to the Environment), designed to bring attention to treatment drop-out risk factors among young adults and create discussion about risk factors with their existing treatment counselor Methods: In this formative research, a convenience sample (N=8) of young adults (n=3) in methadone treatment, their counselors (n=3), and clinic leadership (n=2) were recruited from an opioid treatment program after referral from treatment staff. Participants were interviewed to obtain feedback as AWARE was developed. In semi-structured interviews, perspectives regarding barriers to treatment for young adults and AWARE utility were obtained. Concurrently, three dyads of young adults (n=3) and counselors (n=3) piloted the intervention daily for 4 weeks. Results: The 3 consented YAOUD participants (67% female, 67% Latino/a) were sent daily surveys for 28 days (53% overall completion rate). Young adults and counselors found AWARE relevant to their treatment experience and acceptable to complete over 4 weeks. The most reported daily stressors included concerns about the health and well-being of a family member, challenges with staying organized, and feeling overwhelmed by responsibilities without adequate support. ’ In qualitative interviews, counselors and clinic leadership reported that AWARE presented a relevant, new way to engage young adults daily, in addition to weekly counseling sessions. Young adults felt that prompts sent by AWARE offered a type of social support they lacked, like ‘someone checking in on them’. Conclusions: Overall, young adult and counselor participants were able to engage in AWARE in a busy clinic environment, and participants and clinic leadership found it valuable. By addressing common stressors and providing a sense of social connection, AWARE may help fill a gap in support between counseling sessions. However, the study was limited by the small number of young adults engaging in methadone treatment. Further research is needed to refine the measures and methods of AWARE and evaluate its effectiveness.

Background: Despite having evidence-based medication for opioid use disorder, dropout is one of the most common issues noted with this treatment, indicating that new strategies are needed to improve retention and engagement. Prescription digital therapeutics, which are app-based interventions prescribed by a healthcare professional, have the potential to increase adherence to medication for opioid use disorder and retention while overcoming treatment barriers, including provider capacity and patient access. Using a sham app as a control condition for a randomized clinical trial is an innovative method to establish true efficacy of these apps. Objective: This study included the development and testing of a sham smartphone app for opioid use disorder. Methods: After the sham app was developed, participants were enrolled in a 4-week trial examining the use and suitability of the sham app as a control condition. Criteria for determining suitability included (1) participants believe the sham app is an active intervention and (2) participants experience no clinical improvements in depression severity or quality of life after using the sham app. Self-reported depression severity and quality of life were captured before and after using the sham app. A user satisfaction survey and semi structured interviews were conducted at the end of the study. Quantitative analyses included paired two-tailed t-tests. The semi structured interviews were conducted with 20 of the 21 participants, and these interviews were analyzed using rapid qualitative analysis. Results: Overall, 21 participants (Mage=42.0 [SD=6.4], 9 [42.9%] female, and 12 [57.1%] male) were enrolled. Average number of app log ins was 17.8 (SD=10.6) with a range of 1 to 41. There were 2 participants who only logged in 1 time, and 15 (71.4%) participants completed the goal of logging in an average of 3 times per week. No significant differences were found in depression severity (p=.50) or quality of life (quality of life p=.42, physical health p=.58, psychological health p=.07, environmental health p=.44, social relationships p=.86) after using the sham app. Of the 20 participants who completed the semi-structured interview, 19 (95%) believed that they were using an active intervention. The user satisfaction survey revealed high overall satisfaction with the sham app with a score of 91%. Qualitative analyses revealed several recurring themes, including perceived value and impact, potential for behavior change, usage patterns and engagement, perspective and #usability, and perceptions of authenticity. Conclusions: Our sham app met our a priori criteria for suitability as a sham app. No clinical improvements from baseline were observed at end of the study period, and all but one participant believed that they were using an active intervention. Demonstrating that this sham app is suitable as a control condition elevates the rigor of randomized clinical trials and ensures the efficacy of prescription digital therapeutics.

and substance use compared with those without such history. Methods: We conducted a cross-sectional study of 82 individuals receiving methadone for OUD. Participants completed the Childhood Trauma ...

A Rutgers analysis of medical records reveals sharp disparities in use of drug addiction services based on insurance type