Recovery Goals and Long-term Treatment Preference in Persons Who Engage in Nonmedical Opioid Use

Hay, Kaitlyn R; Huhn, Andrew S.; Tompkins, D. Andrew; Dunn, Kelly E.

doi:10.1097/adm.0000000000000498

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…The results from SMART highlight the heterogeneity in treatment effect and the need for better patient identification and allocation for interventions in substance use. Herein we propose a method that caters to a health system's patient population to identify subtypes across a cohort of individuals using LCA to augment adaptive treatment interventions like SMART [53]. This approach may be promising to identify and better address the many barriers in treating opioid misuse.…”

Section: Discussionmentioning

confidence: 99%

Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

et al. 2019

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Background Approaches are needed to better delineate the continuum of opioid misuse that occurs in hospitalized patients. A prognostic enrichment strategy with latent class analysis (LCA) may facilitate treatment strategies in subtypes of opioid misuse. We aim to identify subtypes of patients with opioid misuse and examine the distinctions between the subtypes by examining patient characteristics, topic models from clinical notes, and clinical outcomes. Methods This was an observational study of inpatient hospitalizations at a tertiary care center between 2007 and 2017. Patients with opioid misuse were identified using an operational definition applied to all inpatient encounters. LCA with eight class-defining variables from the electronic health record (EHR) was applied to identify subtypes in the cohort of patients with opioid misuse. Comparisons between subtypes were made using the following approaches: (1) descriptive statistics on patient characteristics and healthcare utilization using EHR data and census-level data; (2) topic models with natural language processing (NLP) from clinical notes; (3) association with hospital outcomes. Findings The analysis cohort was 6,224 (2.7% of all hospitalizations) patient encounters with opioid misuse with a data corpus of 422,147 clinical notes. LCA identified four subtypes with differing patient characteristics, topics from the clinical notes, and hospital outcomes. Class 1

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Section: Discussionmentioning

confidence: 99%

Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

et al. 2019

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“…7,36 Although most patients with OUD do not use residential treatment and instead enter outpatient treatment directly, individuals with OUD often report a preference for including residential treatment in their recovery trajectory. 19,37 Several states have recently seen an increase in residential addiction treatment facilities, and many have questionable standards of care. 38 The goals of this study were to examine national databases of facility-level and admissions-level data regarding the availability and use of MOUDs in residential addiction treatment programs.…”

Section: Introductionmentioning

confidence: 99%

Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States

et al. 2020

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IMPORTANCE While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. OBJECTIVE To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. EXPOSURES Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. MAIN OUTCOMES AND MEASURES Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone).

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“…The omission of sleep assessments in OUD treatment research is just one aspect of a larger issue, namely an inconsistent metric of OUD “recovery,” and a vague understanding of what “recovery” means to individuals with OUD. In this review, we use the term recovery to denote improvements in mental health, physical health, and quality of life, with an understanding that there are individual differences in patient-driven endpoints regarding lifestyle, social functioning, and the desire to reduce or eliminate drug use (Hay et al, 2019; Witkiewitz et al, 2020). Extant literature on sleep and OUD is complicated by a limited understanding of how the mu-opioid receptor system, in the presence of either MOUDs (mu-opioid receptor full agonist, partial agonist, and antagonist), or no MOUD, may influence sleep in recovery.…”

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confidence: 99%

Sleep disturbance as a therapeutic target to improve opioid use disorder treatment.

Huhn¹,

Finan²

2022

Experimental and Clinical Psychopharmacology

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Sleep health is an important factor across several physical and mental health disorders, and a growing scientific consensus has identified sleep as a critical component of opioid use disorder (OUD), both in the active disease state and during OUD recovery. The goal of this narrative review is to collate the literature on sleep, opioid use, and OUD as a means of identifying therapeutic targets to improve OUD treatment outcomes. Sleep disturbance is common and often severe in persons with OUD, especially during opioid withdrawal, but also in persons on opioid maintenance therapies. There is ample evidence that sleep disturbances including reduced total sleep time, disrupted sleep continuity, and poor sleep quality often accompany negative OUD treatment outcomes. Sleep disturbances are bidirectionally associated with several other factors related to negative treatment outcomes, including chronic stress, stress reactivity, low positive affect, high negative affect, chronic pain, and drug craving. This constellation of outcome variables represents a more comprehensive appraisal of the quality of life and quality of recovery than is typically assessed in OUD clinical trials. To date, there are very few clinical trials or experimental studies aimed at improving sleep health in OUD patients, either as a means of improving stress, affect, and craving outcomes, or as a potential mechanistic target to reduce opioid withdrawal and drug use behaviors. As such, the direct impact of sleep improvement in OUD patients is largely unknown, yet mechanistic and clinical research suggests that therapeutic interventions that target sleep are a promising avenue to improve OUD treatment. Public Significance StatementIn light of the ongoing opioid crisis, there is a pressing need to improve treatment outcomes for opioid use disorder. Sleep disturbance is a common complaint among persons with opioid use disorder, and interventions that target sleep in this population could improve stress, affect, craving, and/or relapse outcomes.

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Recovery Goals and Long-term Treatment Preference in Persons Who Engage in Nonmedical Opioid Use

Cited by 15 publications

References 28 publications

Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States

Sleep disturbance as a therapeutic target to improve opioid use disorder treatment.

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