Abstract

Linkage rates and factors associated with linkage from a medication for opioid use disorder mobile clinic in Philadelphia with a focus on African American individuals

Zsofia Szep¹, Rachel Fox, PA-C², David Bennett, Ph D², Jesse Telles, LSW², Corina Ramos², Vincent Mason², Adrian Jones² (1)University of Pennsylvania Perelman School of Medicine, (2)Drexel University

APHA 2022 Annual Meeting and Expo

Introduction:
Multidisciplinary mobile treatment units are one approach to increasing medication for opioid use disorder (MOUD) access in disenfranchised communities and hard to reach populations who likely do not have consistent access to a primary care provider or coordinated care. Drexel HOPE is a mobile MOUD linkage program funded by the SAMHSA minority AIDS initiative with a goal of providing low threshold buprenorphine initiation, stabilization and linkage to care in conjunction with peer recovery support, harm reduction supplies and education to Philadelphia neighborhoods where overdose rates are highest among African American individuals.
Aims: Our primary aim was to determine the prevalence of successful linkage to continued MOUD care at 4 weeks and at 6 months after starting care at the Drexel HOPE mobile unit. Our secondary aim was to describe patient factors that are associated with staying on MOUD care 6 months after linkage to care.
Methods: Prospective study of individuals with opioid use disorder (OUD) who received care from the Drexel HOPE mobile linkage program between October 1st 2020 and September 1st 2021 in Philadelphia. Unpaired t-tests were used to compare continuous variables and chi-squared tests for nominal and ordinal data.
Results: 85 individuals initiated MOUD. 70% were male, 79% African American, 18% reported injection drug use, 30% reported a history of overdose, while only 33% reported steady housing. At intake, 53% of individuals tested positive for fentanyl, 40% for heroin, 12% for oxycodone and 46% for cocaine on a urine drug screen. 69% of patients had previously been on buprenorphine. 62% were linked to MOUD care at 4 weeks, 76% to a primary care provider and 21% to a substance use disorder (SUD) program; of those who linked, 39% remained in care at 6 month follow up. Age, gender, housing instability and whether linked to a primary care practice or substance use treatment program were not associated with linking to or staying in care at 6 months.
Conclusion: This data demonstrates feasibility of a mobile multidisciplinary linkage team to initiate MOUD and link to continued MOUD care. The mobile team is able to serve populations that are unaware of MOUD and are less likely to link through traditional medical settings. We need to further evaluate barriers to linkage and staying in continued MOUD care to improve engagement in continued MOUD care.

Abstract

MOUD dose at release from incarceration is associated with post-release treatment engagement

Ariel Hoadley, MPH¹, Courtney DelaCuesta, BS¹, Linda Hurley, MA, CAGS, LCDCS², Rosemarie Martin, PhD¹ (1)Brown University, (2)CODAC Behavioral Healthcare

APHA 2022 Annual Meeting and Expo

Background. In the two weeks post-release, incarcerated individuals have significant overdose risk. Medications for opioid use disorder (MOUD) during incarceration mitigate this risk, ultimately saving lives. However, sometimes MOUD is not continued post-release. This study evaluates whether dose at release is associated with post-release MOUD engagement.

Methods. Participants were N=688 incarcerated individuals at the Rhode Island Department of Corrections (RIDOC) who were on MOUD for ≥30 days, incarcerated between December 2016-2018, and were released for ≥30 days to a known address. Logistic regression calculated odds of MOUD engagement at 30-days, including enrollment at an opioid treatment provider or prescription fill. Dose was trichotomized into low (methadone: ≤60mg; buprenorphine: 2mg-8mg), moderate (methadone: 61mg-120mg; buprenorphine: 10mg-12mg), and high (methadone: ≥121mg; buprenorphine: 16mg) with medication type as a covariate.

Results. Participants were 36.8 years on average and mostly male (73.5%), white (81.4%), and on methadone (58.9%). Controlling for dose at release, individuals on buprenorphine had 38% lower odds of post-release MOUD at thirty days (OR: 0.62, 95% CI: 0.43, 0.90) than those on methadone. Adjusting for medication type, moderate (OR: 2.00; 95% CI: 1.28, 3.13) and high (OR: 1.84; 95% CI: 1.20, 2.82) dose at release had greater odds of post-release MOUD than low doses.

Conclusion. Consistent with prior research, higher doses within therapeutic range at release were associated with greater post-release MOUD engagement. While more research is needed to investigate causality, medication dose may be a mechanism for improving treatment retention during a high-risk overdose period.

Abstract

Opioid use disorder among West Virginia Medicaid enrollees: What we know

Mohammad Masudul Alam, PhD, MPH, MS¹, Jonathan Young, PhD, MS, MA¹, Rebecca Wallis, MSPH¹, Yilin Cai, MBA, MS¹, Amanda Jones, M¹, Abigail Buehler, MEd¹, J. Leann Hughes-Price, EdS, MA¹, Keith King, MA², Cynthia Parsons, MA², Matthew Christiansen, MD³, Shyama Mahakalanda, PhD, MD, MEcon, MBBS¹, A. Brianna Sheppard, PhD, MA¹ (1)West Virginia University Office of Health Affairs, (2)West Virginia Department of Health and Human Resources Bureau for Medical Services, (3)West Virginia Department of Health and Human Resources Office of Drug Control Policy

APHA 2022 Annual Meeting and Expo

Data indicate that West Virginia (WV) Medicaid enrollees with opioid use disorder (OUD) have disproportionately higher rates of deaths related to opioid overdose compared to the rest of the United States. Medicaid covers approximately 29% of the States’ adult population aged 19 – 64 years. Medicaid enrollees with OUD in WV is a significant burden on mental health system and health expenditures. The WV Bureau for Medical Services has taken several steps to enhance OUD treatment services including reimbursement for medication for OUD (MOUD).

West Virginia University’s Office of Health Affairs (WVU OHA) is conducting a mixed methods analysis to evaluate costs, outcomes, and predictors of treatment success among WV Medicaid beneficiaries with OUD. This ongoing research attempted to recruit 4,800 Medicaid enrollees diagnosed with OUD across the State. Medicaid claims data were used to randomly identify 1,200 enrollees from one of four treatment groups: Buprenorphine, Methadone, Naltrexone, and no medication for opioid use disorder (no-MOUD). The sample was mailed a structured questionnaire for quantitative data collection. Data are being collected through mailed paper surveys, REDCap online surveys, and telephone calls. In addition, 15-20 semi-structured follow-up focus group discussion sessions are being conducted as qualitative data collection but not included in this present paper.

Survey data are being collected on access to and quality of care, social foundation of health and support system, polysubstance use and treatment, opioid dependence, and costs incurred by the participants while seeking treatment. Appropriate statistical analyses will be conducted, including regression modeling, factor analysis, and cluster analysis. Study results will help drive improvements in OUD treatment and target interventions for WV Medicaid beneficiaries and can inform efforts to address OUD in other states.

Abstract

Racial and ethnic disparities in drug overdose deaths in the US during the COVID pandemic

Beth Han, MD, PhD, MPH National Institute on Drug Abuse

APHA 2022 Annual Meeting and Expo

INTRODUCTION
Overdose deaths increased 37.2% from February 2020 to August 2021. Yet, no studies have examined racial/ethnicity disparities in overdose death rates within specific sex and age combinations before and during the COVID-19 pandemic (i.e., since March 2020).

METHODS
Semi-annual drug overdose death data were examined using the National Vital Statistics System’s multiple-cause-of-death 2018-2020 final and 2021 (January-August) provisional files. Age-adjusted sex and race/ethnicity-specific death rates were computed for overall drugs, synthetic opioids-involved, and methamphetamine-involved among 15-34-year-olds and 35-64-year-olds during March 2018-August 2021.

RESULTS
Among 15-34-year-olds during March 2018-August 2021, age-adjusted rates increased in most examined groups for all drugs, synthetic opioids (other than methadone)-involved, and methamphetamine-involved with synthetic opioids (each P<.05), whereas rates involving methamphetamine without synthetic opioids did not increase. In March-August 2021, non-Hispanic American Indian or Alaska Native (AIAN) men had the highest rates for drug overdose deaths overall [42.0 (95% CI=35.5-48.4) per 100,000], synthetic opioids-involved [30.2 (95% CI=24.7-35.7) per 100,000], and methamphetamine-involved without synthetic opioids [6.0 (95% CI=3.6-8.5) per 100,000], while AIAN men and women [9.2 (95% CI=6.1-12.2), 8.0 (95% CI=5.1-10.9), per 100,000], and White men [6.7 (95% CI=6.4-7.0) per 100,000] had the highest rates involving methamphetamine with synthetic opioids.
Among 35-64-year-olds during March 2018-August 2021, age-adjusted rates increased for drugs overall, synthetic opioids-involved, and methamphetamine-involved with and without synthetic opioids among most examined subgroups (each P<.05). In March-August 2021, overall overdose rates were highest among non-Hispanic Black men [61.1 (95% CI=59.4-62.9) per 100,000] and AIAN men [60.0 (95% CI=52.8-67.2) per 100,000]; synthetic opioid-involved rates were highest among non-Hispanic Black men [42.3 (95% CI=41.8-44.8) per 100,000]; rates involving methamphetamine with synthetic opioids were highest among AIAN men and women, and White men [12.6 (95% CI=9.2-16.0), 9.4 (95% CI=6.5-12.3), and 9.5 (95% CI=9.1-9.8), per 100,000, respectively]; and rates involving methamphetamine without synthetic opioids were highest among AIAN men [22.9 (95% CI=18.4-27.4) per 100,000].

DISCUSSION
Our findings suggest that drug overdose mortality exacerbated during the COVID-19 pandemic for almost all examined age-, sex-, and race/ethnicity-specific subgroups, and synthetic opioids (largely fentanyl/analogs) and psychostimulants (primarily methamphetamine) drove these increases. By March-August 2021, the highest rates were among AIAN men for 15-34-year-olds and non-Hispanic Black and AIAN men for 35-64-year-olds. Our results underscore the urgency of tailoring prevention, intervention, and harm reduction efforts (e.g., access to naloxone, medications for opioid use disorder, tools for fentanyl testing of illicit drugs, and methamphetamine treatments) for specific populations, especially AIAN and Black populations.