Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals

Hall, Gerod; Neighbors, Charles J.; Iheoma, Jude; Dauber, Sarah; Adams, MerriBeth; Culleton, Robert; Muench, Fred; Borys, Suzanne; McDonald, Rebecca; Morgenstern, Jon

doi:10.1016/j.jsat.2013.11.002

Cited by 69 publications

(38 citation statements)

References 29 publications

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“…Mobile treatment provides an opportunity to expand outreach to surmount barriers to traditional clinic treatment for chronic disease. A number of programs have implemented mobile services including for opioid addiction using LAAM, 50 methadone, 51-53 HIV education and testing, 54 HIV treatment, 55 for mental health services 56 and for cancer information and support. 57,58 In two MAT studies that are most relevant to the current trial which implemented LAAM and Methadone, findings were supportive of mobile treatment with a risky opioid dependent population.…”

Section: Introductionmentioning

confidence: 99%

“…As emphasized by Hall et al, 53 we need additional strategies that state and local governments can use to increase opioid treatment participation by broadening its reach to different types of patients such as pre-release prisoners, community corrections populations which are often socially disenfranchised and have high opioid use. Furthermore, the stigmatization of methadone and the difficulty for certain individuals to enter and continue treatment based on restrictions for individuals in the criminal justice system 38,39,59 might make medical long-acting treatment more appealing to criminal justice professionals that have to monitor the movement and activities of parolees and home detention individuals in the community.…”

Section: Introductionmentioning

confidence: 99%

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Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment

Gordon

Vocci

Fitzgerald

et al. 2017

Contemporary Clinical Trials

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Background Extended-release naltrexone (XR-NTX), is an effective treatment for opioid use disorder but is rarely initiated in US prisons or with criminal justice populations. Mobile treatment for chronic diseases have been implemented in a variety of settings. Mobile treatment may provide an opportunity to expand outreach to parolees to surmount barriers to traditional clinic treatment. Methods Male and female prisoners (240) with pre-incarceration histories of opioid use disorder who are within one month of release from prison will be enrolled in this randomized clinical trial. Participants are randomized to one of two study arms: 1) [XR-NTX-OTx] One injection of long-acting naltrexone in prison, followed by 6 monthly injections post-release at a community opioid treatment program; or 2) [XR-NTX+ MMTx] One injection of long-acting naltrexone in prison followed by 6 monthly injections post-release at the patient's place of residence utilizing mobile medical treatment. The primary outcomes are: treatment adherence; opioid use; criminal activity; re-arrest; reincarceration; and HIV risk-behaviors. Results We describe the background and rationale for the study, its aims, hypotheses, and study design. Conclusions The use of long-acting injectable naltrexone may be a promising form of treatment for pre-release prisoners. Finally, as many individuals in the criminal justice system drop out of treatment, this study will assess whether treatment at their place of residence will improve adherence and positively affect treatment outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment

Gordon

Vocci

Fitzgerald

et al. 2017

Contemporary Clinical Trials

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“…Pharmacotherapy for addiction has evolved significantly over the past decade (Franck & Jayaram-Lindstrom, 2013; Hall et al, 2014; Riksheim, Gossop, & Clausen, 2014), with more types of medications and methods of administration available. Demonstrated effectiveness and cost-effectiveness have made addiction pharmacotherapy an evidence-based practice (Fullerton et al, 2014; Gastfriend, 2011; Maisel, Blodgett, Wilbourne, Humphreys, & Finney, 2013; Polsky et al, 2010; Rosner et al, 2010; Schackman, Leff, Polsky, Moore, & Fiellin, 2012; Thomas et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Access to Addiction Pharmacotherapy in Private Health Plans

Reif

Horgan

Hodgkin

et al. 2016

Journal of Substance Abuse Treatment

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Background An increasing number of medications are available to treat addictions. To understand access to addiction medications, it is essential to consider the role of private health plans. To contain medication expenditures, most U.S. health plans use cost-sharing and administrative controls, which may impact physicians' prescribing and patients' use of addiction medications. This study identified health plan approaches to manage access to and utilization of addiction medications (oral and injectable naltrexone, acamprosate, and buprenorphine). Methods Data are from a nationally representative survey of private health plans in 2010 (n=385 plans, 935 products; response rate 89%), compared to the same survey in 2003. The study assessed formulary inclusion, prior authorization, step therapy, overall restrictiveness, and if and how health plans encourage pharmacotherapy. Results Formulary exclusions were rare in 2010, with acamprosate excluded most often, by only 9% of products. Injectable naltrexone was covered by 96% of products. Prior authorization was common for injectable naltrexone (85%) and rare for acamprosate (3%). Step therapy policies were used only for injectable naltrexone (41%) and acamprosate (20%). Several medications were often on the most expensive tier. Changes since 2003 include fewer exclusions, yet increased use of other management approaches. Most health plans encourage use of addiction pharmacotherapy, and use a variety of methods to do so. Conclusions Management of addiction medications has increased over time but it is not ubiquitous. However, health plans now also include all medications on formularies and encourage providers to use them, indicating they value addiction pharmacotherapy as an evidence-based practice.

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“…Mobile units that are fully equipped to provide OTP activities, including medication and counseling, have been shown to increase access in disenfranchised urban populations (Hall, 2014). BAART Behavioral Health Services (BBHS), for example, is a mobile methadone program first developed in the San Francisco area, which is now providing care across the country.…”

Section: Introductionmentioning

confidence: 99%

Caring for pregnant opioid abusers in Vermont: A potential model for non-urban areas

Meyer

Phillips

2015

Preventive Medicine

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Opioid addiction is no longer a primarily urban problem. As dependence on heroin and prescription pain relievers has become a significant issue in rural areas, the need for effective treatment of opioid-dependent pregnant women and their neonates has grown accordingly. In addition to the adverse perinatal outcomes associated with opioid addiction in pregnant women, the high costs of caring for these mothers and their babies motivate efforts to develop appropriate treatment models. We found that integration and coordination of services that promote maternal recovery and ability to parent are key requirements for treatment of opioid dependence during pregnancy. Unfortunately, lack of experience and resources make such coordination a real challenge in rural areas. In this review, we discuss how we managed the challenges of developing a comprehensive program for treatment of opioid dependence during pregnancy. In addition, we outline our approach for facilitating the development of community-based programs to help these patients and families in rural regions of Vermont. Close relationships between our tertiary care center, local hospitals, community health care infrastructure, and legislators bolstered our efforts. In particular, appreciation for the severity and importance of the opioid-dependence problem in Vermont among health care providers and state legislators was paramount for our success in developing a state-wide treatment program. This approach can inform similar efforts in other rural regions of the United States, and has great potential to improve both access and quality of care for women struggling with opioid dependence.

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Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals

Cited by 69 publications

References 29 publications

Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment

Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment

Access to Addiction Pharmacotherapy in Private Health Plans

Caring for pregnant opioid abusers in Vermont: A potential model for non-urban areas

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