Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its “alternative use” (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24–0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23–0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19–0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22–16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53–9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12–5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50–9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.
People with Alzheimer disease (AD) are at increased risk of falls and disproportionately burdened with vestibular impairment compared with healthy older adults. Although physical therapy (PT) and vestibular physical therapy (VPT) are effective rehabilitation interventions in improving balance and fall risk, referral patterns for these services in the AD population are understudied. A retrospective chart review was conducted of patients seen for primary AD care at a tertiary AD referral center to investigate the frequency of rehabilitation referrals. Of the 801 people with AD seen for AD care in 1 year, 48 individuals (6.0%) were referred to PT and 5 individuals (0.6%) to VPT. People with AD appear to receive very infrequent PT and VPT referrals, despite the potentially large number of people with AD who could benefit from PT and VPT services to improve their balance and vestibular function.
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