Commentary on Jin <i>et al</i>. (2020): Regulatory and allocative policies inform access to opioid agonist therapy

Priest, Kelsey C.

doi:10.1111/add.15190

Cited by 3 publications

(3 citation statements)

References 15 publications

(17 reference statements)

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“…Given the ways in which concerns about AUB and overdose influence regulations, treatment access, and prescribing practices, research teasing out the nature of this relationship is critical. [19][20][21][22][23] Buprenorphine alone usually does not cause overdose, as it is a partial opioid agonist and is most commonly prescribed in a co-formulation with naloxone (an opioid antagonist); however, AUB could potentially be implicated in an overdose if mixed with other substances. Existing literature assessing this relationship is sparse.…”

Section: Discussionmentioning

confidence: 99%

Alternative use of Buprenorphine among People who use Opioids in Three U.S. Cities

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Alternative use of Buprenorphine among People who use Opioids in Three U.S. Cities

et al. 2022

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“…Although both medications are federally regulated (e.g., buprenorphine prescribing panel limits), methadone regulations 5 limit the ability to create individualized treatment plans, to meet patient specific needs, and can impact employment opportunities or personal relationships. 6 Long-standing oppressive forces (e.g., racism and classism) [7][8][9] inform the system design differences between methadone and buprenorphine. The methadone system was established, in part, to address White political concerns related to crime and increased heroin use in New York City in the late 1960s, specifically targeting predominantly Black inner-city communities.…”

Section: Introductionmentioning

confidence: 99%

“…Long-standing oppressive forces (e.g., racism and classism) 7 – 9 inform the system design differences between methadone and buprenorphine. The methadone system was established, in part, to address White political concerns related to crime and increased heroin use in New York City in the late 1960s, specifically targeting predominantly Black inner-city communities 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Differences in the Delivery of Medications for Opioid use Disorder during Hospitalization by Racial Categories: A Retrospective Cohort Analysis;

et al. 2022

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Background: As the drug-related overdose crisis and COVID-19 pandemic continue, communities need increased access to medications for opioid use disorder (MOUD) (i.e., buprenorphine and methadone). Disparities in the type of MOUD prescribed or administered by racial and ethnic categories are well described in the outpatient clinical environment. It is unknown, however, if these disparities persist when MOUD is provided in acute care hospitals. Methods: This study assessed differences in the delivery of buprenorphine versus methadone during acute medical or surgical hospitalizations for veterans with opioid use disorder (OUD) by racial categories (Black Non-Hispanic or Latino vs. White Non-Hispanic or Latino). Data were obtained retrospectively from the Veterans Health Administration (VHA) for federal fiscal year 2017. We built logistic regression models, adjusted for individual and hospital-related covariates, and calculated the predicted probabilities of MOUD delivery by racial categories. Results: The study cohort (n = 1,313 unique patients; N = 107 VHA hospitals) had a mean age of 57 (range 23 to 87 years), was predominantly male (96%), and composed entirely of Black (29%) or White (71%) patients. White patients were 11% more likely than Black patients to receive buprenorphine than methadone during hospitalization (p = 0.010; 95% CI: 2.7%, 20.0%). Among patients on MOUD prior to hospitalization, White patients were 21% more likely than Black patients to receive buprenorphine (p = 0.000; 95% CI: 9.8%, 31.5%). Among patients newly initiated on MOUD during hospitalization, there were no differences by racial categories. Conclusion: We observed disparities in the delivery of buprenorphine versus methadone during hospitalization by racial categories. The observed differences in hospital-based MOUD delivery may be influenced by MOUD received prior to hospitalization within the racialized outpatient addiction treatment system. The VHA and health systems more broadly must address all aspects of racism that contribute to inequitable MOUD access throughout all clinical contexts.

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Hospital policies for opioid use disorder treatment: A policy content analysis and environmental scan checklist

Priest

Englander

McCarty

2021

General Hospital Psychiatry

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Commentary on Jin et al. (2020): Regulatory and allocative policies inform access to opioid agonist therapy

Cited by 3 publications

References 15 publications

Alternative use of Buprenorphine among People who use Opioids in Three U.S. Cities

Alternative use of Buprenorphine among People who use Opioids in Three U.S. Cities

Differences in the Delivery of Medications for Opioid use Disorder during Hospitalization by Racial Categories: A Retrospective Cohort Analysis;

Hospital policies for opioid use disorder treatment: A policy content analysis and environmental scan checklist

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