Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

Mackey, Katherine; Veazie, Stephanie; Anderson, Johanna; Bourne, Donald; Peterson, Kim

doi:10.1007/s11606-020-06257-4

Cited by 136 publications

(116 citation statements)

References 44 publications

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“…Figure 2 B shows three other opioid drugs—buprenorphine, naltrexone, naloxone—that have milder (or no) rewarding properties and are instead used to treat opioid dependence [ 14 ]. It is suggested here that these three drugs may also be converted to molecules that resemble catecholamines (based on their yellow and green moieties), but because they have a larger hydrocarbon structure (blue moiety) attached to the nitrogen atom, this may not be enzymatically removable in vivo and the overall, newly formed molecule may serve as a pharmacological blocker of the endogenous pathways acted upon by the four drugs in Figure 2 A.…”

Section: Proposed Pathways and Published Data Related To The Hypothesismentioning

confidence: 99%

Many Drugs of Abuse May Be Acutely Transformed to Dopamine, Norepinephrine and Epinephrine In Vivo

Fitzgerald

2021

IJMS

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It is well established that a wide range of drugs of abuse acutely boost the signaling of the sympathetic nervous system and the hypothalamic–pituitary–adrenal (HPA) axis, where norepinephrine and epinephrine are major output molecules. This stimulatory effect is accompanied by such symptoms as elevated heart rate and blood pressure, more rapid breathing, increased body temperature and sweating, and pupillary dilation, as well as the intoxicating or euphoric subjective properties of the drug. While many drugs of abuse are thought to achieve their intoxicating effects by modulating the monoaminergic neurotransmitter systems (i.e., serotonin, norepinephrine, dopamine) by binding to these receptors or otherwise affecting their synaptic signaling, this paper puts forth the hypothesis that many of these drugs are actually acutely converted to catecholamines (dopamine, norepinephrine, epinephrine) in vivo, in addition to transformation to their known metabolites. In this manner, a range of stimulants, opioids, and psychedelics (as well as alcohol) may partially achieve their intoxicating properties, as well as side effects, due to this putative transformation to catecholamines. If this hypothesis is correct, it would alter our understanding of the basic biosynthetic pathways for generating these important signaling molecules, while also modifying our view of the neural substrates underlying substance abuse and dependence, including psychological stress-induced relapse. Importantly, there is a direct way to test the overarching hypothesis: administer (either centrally or peripherally) stable isotope versions of these drugs to model organisms such as rodents (or even to humans) and then use liquid chromatography-mass spectrometry to determine if the labeled drug is converted to labeled catecholamines in brain, blood plasma, or urine samples.

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Section: Proposed Pathways and Published Data Related To The Hypothesismentioning

confidence: 99%

Many Drugs of Abuse May Be Acutely Transformed to Dopamine, Norepinephrine and Epinephrine In Vivo

Fitzgerald

2021

IJMS

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“…Many clinicians do not receive robust training around SUD treatment in undergraduate and graduate medical education (9) and medical providers frequently cite concerns related to working with patients with OUD as one of the barriers to prescribing medications for OUD thus further worsening patients' access to care (10,11). In the United States, where this study was completed, until recently clinicians had to certify 8 h of nationally approved additional training in SUD for physicians and 24 h of additional training for Advance Practice Practioners (APPs) or see patients in a specially licensed facility to be able to prescribe MOUD.…”

Section: Introductionmentioning

confidence: 99%

Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes

et al. 2021

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Objective: Substance use disorders remain highly stigmatized. Access to medications for opioid use disorder is poor. There are many barriers to expanding access including stigma and lack of medical education about substance use disorders. We enriched the existing, federally required, training for clinicians to prescribe buprenorphine with a biopsychosocial focus in order to decrease stigma and expand access to medications for opioid use disorder.Methods: We trained a family medicine team to deliver an enriched version of the existing buprenorphine waiver curriculum. The waiver training was integrated into the curriculum for all University of Rochester physician and nurse practitioner family medicine residents and also offered to University of Rochester residents and faculty in other disciplines and regionally. We used the Brief Substance Abuse Attitudes Survey to collect baseline and post-training data.Outcomes: 140 training participants completed attitude surveys. The overall attitude score increased significantly from pre to post-training. Additionally, significant changes were observed in non-moralism from pre-training (M = 20.07) to post-training (M = 20.98, p < 0.001); treatment optimism from pre-training (M = 21.56) to post-training (M = 22.33, p < 0.001); and treatment interventions from pre-training (M = 31.03) to post-training (M = 32.10, p < 0.001).Conclusion: Increasing medical education around Opioid Use Disorder using a Family Medicine trained team with a biopsychosocial focus can improve provider attitudes around substance use disorders. Enriching training with cases may improve treatment optimism and may help overcome the documented barriers to prescribing medications for opioid use disorder and increase access for patients to lifesaving treatments.

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“…Many people recovering from opioid use disorder (OUD) face institutional barriers to recovery, including insufficient access to OUD treatment due to lack of health insurance and/or resources (e.g., transportation or time). For several reasons (e.g., poor treatment by healthcare professionals in prior care-seeking experiences), mistrust of medical professionals is common among those recovering from OUD [1, 2]. In addition, the stigma around OUD may cause providers to discriminate against those seeking medical treatment, potentially increasing mistrust between medical professionals and people who use opioids (PWUO) [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Description of data with respect to post characteristics, network characteristics, and Suboxone use stage -values compare difference across advice-seeking and not advice-seeking posts;2 Total number of posts exclude repeat posts by the same author;3 Normalized values presented due to scale of variable;4 Denotes lifespan of posting user; 5 P-value computed using Pearson's Chi-square test to compare distribution across Suboxone use stage categories for advice-seeking and not advice-seeking.…”

mentioning

confidence: 99%

Identifying Online Advice-Seekers for Recovering from Opioid Use Disorder

García

Dehghanpoor

Stringfellow

et al. 2021

Preprint

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Background: Online communities can provide social support for those recovering from opioid use disorder. However, advice-seekers on these platforms risk exposure to uncurated medical advice, potentially harming their health or recovery efforts. The objective of this analysis is to combine text annotation, social network analysis, and statistical modeling to identify advice-seekers on online social media for buprenorphine-naloxone use and study their characteristics. Methods: We collected 5,258 posts and their comments from Reddit between 2014 and 2019. Among 202 posts which met our inclusion criteria, we annotated each post to determine which were advice-seeking (n=137) and not advice-seeking (n=65). We also annotated each posting user's medication use stage and quantified their connectedness using social network analysis. In order to analyze the relationship between advice-seeking with a user's social connectivity and medication use stage, we constructed four models which varied in explanatory variables. Results: The stepwise model (containing "total degree" (P=0.002), "using: inducting/tapering" (P<0.001), and "using: other" (P=0.01) as significant explanatory variables) outperformed all other models. We found that users with fewer connections and who are currently using buprenorphine-naloxone are more likely to seek advice than users who are well-connected and no longer using the medication, respectively. Importantly, advice-seeking behavior is most accurately predicted using a combination of network characteristics and medication use status, rather than either factor alone. Conclusions: Our findings provide insights for the clinical care of people recovering from opioid use disorder and the nature of online medical advice-seeking overall. Clinicians should be especially attentive (e.g., through frequent follow-up) to patients who are inducting or tapering buprenorphine-naloxone or signal limited social support.

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Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

Cited by 136 publications

References 44 publications

Many Drugs of Abuse May Be Acutely Transformed to Dopamine, Norepinephrine and Epinephrine In Vivo

Many Drugs of Abuse May Be Acutely Transformed to Dopamine, Norepinephrine and Epinephrine In Vivo

Attending a Biopsychosocially Focused Buprenorphine Training Improves Clinician Attitudes

Identifying Online Advice-Seekers for Recovering from Opioid Use Disorder

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