Literature Collection

INTRODUCTION: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. METHODS: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018-June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. RESULTS: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. CONCLUSION: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED's potential as an initiation point for medication-assisted treatment in OUD patients.

PURPOSE: The co-occurrence of substance use disorders and mental health disorders in adolescents, known as dual diagnosis, complicates treatment adherence, heightens relapse risk, and increases engagement in risky behaviors. This study contrasts these groups' healthcare utilization, interventions, and clinical profiles. METHODS: In a retrospective, longitudinal cohort study using the TriNetX Research Database, we analyzed data from 82 U.S. healthcare organizations. The study encompassed 1,757,913 adolescents aged 10 to 21 diagnosed with substance use disorders, mental health disorders, and a combination of both from 2004 to 2023. Propensity score matching was applied to adjust for demographic and clinical variables, assessing healthcare utilization, treatment initiation, and social challenges. RESULTS: Among 1,757,913 adolescents, 14.0 % (n = 246,776) had a dual diagnosis. Compared with isolated MHD, adolescents with DDx had significantly higher odds of emergency department use (OR 2.64, 95 % CI 2.27-2.70) and inpatient hospitalization (OR 2.73, 95 % CI 2.69-2.77). Relative to isolated SUD, DDx also showed elevated ED use (OR 1.56, 95 % CI 1.53-1.58) and inpatient care (OR 2.55, 95 % CI 2.50-2.61). Pharmacologic treatment initiation was more common in DDx, including antidepressants (53.1 % vs. 44.8 % MHD; OR 1.40, 95 % CI 1.38-1.42) and antipsychotics (35.5 % vs. 18.9 % MHD; OR 2.36, 95 % CI 2.33-2.39). DDx also demonstrated higher rates of social and environmental problems (19.3 % vs. 8.6 % MHD and 3.9 % SUD). DISCUSSION: Adolescents with dual diagnoses constitute a distinct demographic with intricate clinical profiles and heightened healthcare needs, emphasizing the need for integrated care approaches that address clinical symptoms and social determinants. Early identification and comprehensive interventions are crucial to improving outcomes.

Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCV would also facilitate referrals to newly available curative HCV treatments following delivery.