Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings – A Narrative Review

Stack, Erin; Hildebran, Christi; Leichtling, Gillian; Waddell, Elizabeth Needham; Leahy, Judith M.; Martin, Eric; Korthuis, P. Todd

doi:10.1097/adm.0000000000000810

Cited by 40 publications

(31 citation statements)

References 35 publications

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“…Specifically, facilitators of these linkages include low-threshold programs that will flexibly squeeze patients into an intake or evaluation to provide same day treatment on demand, having dedicated staff and financial resources to directly transport patients from the ED to community sites, champions across both sites facilitating communication, and programs that were able to address the sociostructural barriers to holistic improvement for OUD, including helping patients get identification cards, insurance, or housing. There was enthusiasm for dedicated peer navigators across 3 sites despite the lack of robust evidence …”

Section: Discussionmentioning

confidence: 99%

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Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

Sue

Chawarski

Curry³

et al. 2023

JAMA Netw Open

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ImportanceAn increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized.ObjectiveTo explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions.Design, Setting, and ParticipantsThis qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022.Main Outcomes and MeasuresData collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation.ResultsA total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced.Conclusions and RelevanceIn this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.

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Section: Discussionmentioning

confidence: 99%

“…There was enthusiasm for dedicated peer navigators across 3 sites despite the lack of robust evidence. 31 …”

Section: Discussionmentioning

confidence: 99%

Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

Sue

Chawarski

Curry³

et al. 2023

JAMA Netw Open

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“…While currently no pharmacotherapies are approved for treatment of stimulant use disorders, rigorously studied emerging therapies with modest benefit such as mirtazapine [ 58 ] and combined bupropion/extended-release naltrexone for methamphetamine use disorder [ 59 ] could be integrated with MOUD treatment, when appropriate. Structural interventions such as peer support services that have been used to improve treatment retention [ 60 ], and behavioral therapy (potentially delivered via telehealth) could be adapted to focus on people using both stimulants and opioids.…”

Section: Discussionmentioning

confidence: 99%

Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations

Cook

Foot

Arah

et al. 2023

Addict Sci Clin Pract

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Background Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent “real-world” populations who would benefit from treatment. Methods We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. Results Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30–49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49–0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48–1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51–1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35–1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08–0.69, p = 0.008). Conclusions Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.

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“… 55 Other supports such as navigators and peers can further reduce illness burden by helping patients manage OUD and other complex chronic illnesses, and by reducing stigma. 56 , 57 Broadly, most OUD-related harms are preventable. Safer drug supply and safe consumption spaces reduce overdose; 58 syringe service programs reduce infections.…”

Section: Minimally Disruptive Carementioning

confidence: 99%

Envisioning Minimally Disruptive Opioid Use Disorder Care

Englander

Gregg²,

Levander

2022

J GEN INTERN MED

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Most people who need and want treatment for opioid addiction cannot access it. Among those who do get treatment, only a fraction receive evidence-based, life-saving medications for opioid use disorder (MOUD). MOUD access is not simply a matter of needing more clinicians or expanding existing treatment capacity. Instead, many facets of our health systems and policies create unwarranted, inflexible, and punitive practices that create life-threatening barriers to care. In the USA, opioid use disorder care is maximally disruptive. Minimally disruptive medicine (MDM) is a framework that focuses on achieving patient goals while imposing the smallest possible burden on patients’ lives. Using MDM framing, we highlight how current medical practices and policies worsen the burden of treatment and illness, compound life demands, and strain resources. We then offer suggestions for programmatic and policy changes that would reduce disruption to the lives of those seeking care, improve health care quality and delivery, begin to address disparities and inequities, and save lives.

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Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings – A Narrative Review

Cited by 40 publications

References 35 publications

Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations

Envisioning Minimally Disruptive Opioid Use Disorder Care

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