Prevalence and treatment of opioid use disorders among primary care patients in six health systems

Lapham, Gwen T.; Boudreau, Denise M.; Johnson, Eric A.; Bobb, Jennifer F.; Matthews, Abigail; McCormack, Jennifer; Liu, David; Samet, Jeffrey H.; Saxon, Andrew J.; Campbell, Cynthia I.; Glass, Joseph E.; Rossom, Rebecca C.; Murphy, Mark T.; Binswanger, Ingrid A.; Yarborough, Bobbi Jo H.; Bradley, Katharine A.; Ahmedani, Brian K.; Amoroso, Paul J.; Arnsten, Julia H.; Bart, Gavin; Braciszewski, Jordan M.; Cunningham, Chinazo O.; Hechter, Rulin C.; Horigian, Viviana E.; Liebschutz, Jane M.; Loree, Amy M.; Matson, Theresa E.; McNeely, Jennifer; Merrill, Joseph O.; Northrup, Thomas F.; Schwartz, Robert P.; Stotts, Angela L.; Szapocznik, José; Thakral, Manu; Tsui, Judith I.; Zare, Mohammad

doi:10.1016/j.drugalcdep.2019.107732

Cited by 70 publications

(50 citation statements)

References 46 publications

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“…In fact, of more than four thousand patients screened, except for self-referred patients, no new patients were identified with a positive OUD screen. This finding is surprising in light of other studies which have suggested an approximately 1% prevalence of OUD among primary care populations [ 15 ].…”

Section: Main Textcontrasting

confidence: 64%

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial

Hser

Ober

Dopp

et al. 2021

Addict Sci Clin Pract

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Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.

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Section: Main Textcontrasting

confidence: 64%

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial

Hser

Ober

Dopp

et al. 2021

Addict Sci Clin Pract

Self Cite

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“…The PROUD trial was a pragmatic, cluster-randomized implementation trial testing whether a collaborative care model for office-based addiction treatment increased use of medication for OUD in PC (2014–2016) [ 15 ]. PROUD Phase 1 was a preliminary study to identify potential health systems to participate in the trial and assess the feasibility of cohort identification and data collection [ 16 , 17 ]. Six of eleven health systems participating in Phase 1 provided data for the present study of youth: Kaiser Permanente (KP) Washington, KP Northwest, KP Northern California, KP Colorado, Health Partners, and MultiCare.…”

Section: Methodsmentioning

confidence: 99%

Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Bagley

Chavez

Braciszewski

et al. 2021

Addict Sci Clin Pract

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Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

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“…Chronic noncancer pain was defined as documentation of 2 or more ICD-10 codes for similar pain types at least 30 days apart or an ICD-10 diagnosis for general chronic noncancer pain. 17 Conditions that qualified for Washington State physician-authorized medical use at study start were also identified; although authorization was no longer required to purchase cannabis, it offered benefits (eg, larger per-visit purchases and home-based plant growth). 18 Prescription Medications of Interest in Patients Using Cannabis | Practitioners may be concerned about patients' cannabis use complicating medical treatment or in place of prescribed medications with known efficacy.…”

Section: Practitioner-documented Medical Cannabis Use From Nlp or Diagnosis |mentioning

confidence: 99%

Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State

et al. 2021

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Key Points Question Among primary care patients, what is the prevalence of electronic health record documentation of medical cannabis use and health conditions for which cannabis use might have benefits and risks? Findings In this cross-sectional study of 185 565 patients, 2% had past-year medical cannabis use documented in their electronic health records. Among patients with documented medical cannabis use, 44.5% had documented health conditions for which cannabis use might confer benefits, and 54.5% had conditions for which it might confer risks. Meaning These findings suggest that primary care practitioners should be prepared to discuss potential risks as well as potential benefits of cannabis use with patients.

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Prevalence and treatment of opioid use disorders among primary care patients in six health systems

Cited by 70 publications

References 46 publications

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial

Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State

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