Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Wakeman, Sarah E.; Rich, Josiah D.

doi:10.1007/s11606-016-3799-7

Cited by 63 publications

(62 citation statements)

References 2 publications

(3 reference statements)

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“…There must be flexible implementation of Medicare coverage of OTPs for older adults placed in long‐term care facilities. Currently, there are regulatory limitations in access to methadone for residents of long‐term care facilities . It is important for treatment of OUD with medications be consistent across settings of care.…”

Section: New Opportunity For Medicare Coverage Of Oud Treatmentmentioning

confidence: 99%

“…Currently, there are regulatory limitations in access to methadone for residents of long-term care facilities. 21 It is important for treatment of OUD with medications be consistent across settings of care. Finally, providers and caregivers alike will need to overcome the myth that OUD is uncommon among older adults.…”

Section: New Opportunity For Medicare Coverage Of Oud Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Help Is on the Way: Medicare Coverage of Opioid Treatment Programs

Felix

Sharfstein

Olsen

2019

J American Geriatrics Society

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Opioid use disorder (OUD) among older adults has been increasing, yet evidence still remains scarce for age‐specific treatment. We discuss the three US Food and Drug Administration–approved medications used to treat OUD (methadone, buprenorphine, and naltrexone) and consider evidence gaps in OUD treatment in older adults. Legislation passed in 2018 (the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act [also known as the SUPPORT Act]) expanded Medicare coverage to include bundled payment for OUD treatment through opioid treatment programs, permitting coverage of methadone treatment for the first time. Since the policy change will take effect in January 2020, healthcare providers need to be aware of new opportunities for treatment when caring for older adult patients with OUD. J Am Geriatr Soc 68:637–640, 2020

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Section: New Opportunity For Medicare Coverage Of Oud Treatmentmentioning

confidence: 99%

Section: New Opportunity For Medicare Coverage Of Oud Treatmentmentioning

confidence: 99%

Help Is on the Way: Medicare Coverage of Opioid Treatment Programs

Felix

Sharfstein

Olsen

2019

J American Geriatrics Society

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“…33 Despite this mounting evidence, there remains systemic stigmatization of people with OUD and inequity as many SNFs, and home infusion companies will not provide either MOUD or services to patients with OUD. 34 Can Oral Antibiotics be Used to Treat Severe Infections Due to IDU?…”

Section: What Is the Best Location For Patients To Receive Antibioticmentioning

confidence: 99%

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

Serota

Vettese

2019

Journal of Hospital Medicine

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A s a result of the epidemic of opioid use disorder (OUD), there has been a secondary surge in hospitalizations for infectious complications of injection drug use (IDU). 1,2 In the previous 10 years, there have been significant increases in IDU-associated human immunodeficiency virus (HIV) 3 and hepatitis C virus (HCV) 4 infection as well as increased hospitalizations from IDU-associated skin and soft tissue infections, osteomyelitis, septic arthritis, bacteremia, fungemia, and infective endocarditis in the United States. 2,[5][6][7] Patients admitted with IDU-associated infections have long lengths of stay, high rates of leaving against medical advice (AMA), readmission, and mortality. [8][9][10][11][12][13] In a British cohort (median age 36 years), five-year mortality after an episode of IDU-associated endocarditis was 42%. 14 Admissions for IDU-associated infections can be a troubling experience for both patients and providers alike. 15 While management decisions of IDU-associated infectious syndromes have sometimes been based on emotion, dogma, and an often-stigmatizing approach toward people suffering from addiction, 16 with a better understanding of addiction and effective treatments, as well as accumulating data in both addiction and infectious disease fields, it is an appropriate time to reevaluate the approach to treatment.The goal of this review is to examine recent evidence and attempt to answer questions that frequently arise in the management of hospitalized patients with IDU-associated infections. The questions addressed in this review primarily stem from the discussion of Schranz and colleagues in their description of increasing hospitalizations for IDU-associated endocarditis. 7 Additionally, questions were developed from discussions with practicing academic hospitalists. For each question, a review of the published literature was performed, with a focus on articles published between 2014 and 2019. Finally, a framework for how to approach patients with infectious complications of IDU is presented. As a comprehensive review of infectious complications of OUD would be difficult to cover in one review, this review will focus on eight questions that frequently arise in the care of inpatients.

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“…Continual relapse due to physical and psychological dependence is the primary cause of detoxification failure. Thus, exploring optimal therapies for opioid relapse is a worldwide challenge . Although current strategies to prevent opioid relapse have improved through multidisciplinary endeavors, the relapse rate after opioid detoxification is still high and ranges from 72% to 88% after 12 to 36 months, as indicated by an epidemiological investigation …”

Section: Introductionmentioning

confidence: 99%

“…Thus, exploring optimal therapies for opioid relapse is a worldwide challenge. 7,8 Although current strategies to prevent opioid relapse have improved through multidisciplinary endeavors, the relapse rate after opioid detoxification is still high and ranges from 72% to 88% after 12 to 36 months, as indicated by an epidemiological investigation. 9 Prolonged neuroendocrine system dysfunctions in opioid addicts play a role in protracted withdrawal symptoms and contribute to relapse vulnerability.…”

Section: Introductionmentioning

confidence: 99%

Transgenic increase in the β‐endorphin concentration in cerebrospinal fluid alleviates morphine‐primed relapse behavior through the μ opioid receptor in rats

Shen³

et al. 2019

Journal of Medical Virology

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Background Opioid‐primed relapse is a global burden. Although current strategies have improved, optimal therapy is urgently needed. Methods A recombinant adenovirus (Ad‐NEP) expressing β‐endorphin (β‐EP) was designed and injected intracerebroventricularly (icv) into the right lateral ventricle in rats. Spatial and temporal β‐EP expression in the lateral ventricle wall, subventricular zone and adjacent choroid plexus and the β‐EP concentration in the cerebrospinal fluid (CSF) were observed during a 21‐day period. A morphine priming‐induced conditioned place preference (CPP) rat model was established. The β‐EP‐ir neuron counts, CSF β‐EP concentration, and CPP score, which were used to evaluate morphine‐primed reinstatement following extinction, were recorded 7 days after the icv injection. Additionally, the rats were pretreated with the irreversible μ opioid receptor antagonist β‐funaltrexamine (β‐FNA) and the selective κ opioid receptor antagonist nor‐binaltorphimine (nor‐BNI) to identify the receptor‐dependent mechanism. Results Both peak β‐EP expression in target neurons and the peak CSF β‐EP concentration occurred 7 to 8 days after Ad‐NEP icv injection. The sustainable increase in the CSF β‐EP concentration was correlated with a decrease in the CPP score 7 days after the Ad‐NEP icv injection. Furthermore, reinstatement was almost reversed by β‐FNA pretreatment 24 hours before the behavioral test, but nor‐BNI had little effect. Conclusion The increasing cerebrospinal fluid β‐endorphin concentrations showed that the therapeutic effect on opioid relapse occurred predominantly through a μ opioid receptor‐dependent mechanism. The Ad‐NEP adenovirus can be considered an alternative therapy for opioid relapse.

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Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Cited by 63 publications

References 2 publications

Help Is on the Way: Medicare Coverage of Opioid Treatment Programs

Help Is on the Way: Medicare Coverage of Opioid Treatment Programs

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

Transgenic increase in the β‐endorphin concentration in cerebrospinal fluid alleviates morphine‐primed relapse behavior through the μ opioid receptor in rats

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