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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
10858 Results
6442
Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: IMPORTANCE: Since 1999, the United States has experienced increases in morbidity and mortality associated with nonmedical use of prescription opioids. OBJECTIVE: To assess national trends in and characteristics of nonmedical prescription opioid use and use disorders and the national trend in related mortality. DESIGN, SETTING, AND PARTICIPANTS: Prevalence of nonmedical use and use disorders and related risk factors were based on data from 472,200 persons aged 18 through 64 years who participated in the 2003-2013 National Surveys on Drug Use and Health. Mortality was based on the 2003-2013 National Vital Statistics System's Multiple Cause of Death Files. EXPOSURES: Prevalence of nonmedical use of prescription opioids. MAIN OUTCOMES AND MEASURES: Nonmedical prescription opioid use and use disorders. RESULTS: Among adults aged 18 through 64 years, the prevalence of nonmedical use of prescription opioids decreased from 5.4% (95% CI, 5.08%-5.70%) in 2003 to 4.9% (95% CI, 4.58%-5.22%) in 2013 (absolute difference, -0.5%; 95% CI, -0.11% to -0.89%), but the prevalence of prescription opioid use disorders increased from 0.6% (95% CI, 0.54%-0.76%) in 2003 to 0.9% (95% CI, 0.75%-1.01%) in 2013 (absolute difference, 0.3%; 95% CI, 0.03%-0.43%). The 12-month prevalence of high-frequency use (>/=200 days) also increased from 0.3% (95% CI, 0.19%-0.35%) in 2003 to 0.4% (95% CI, 0.31%-0.48%) in 2013 (absolute difference, 0.1%; 95% CI, 0.01%-0.29%). Mortality assessed by drug overdose death rates involving prescription opioids increased from 4.5 per 100,000 (95% CI, 4.42-4.61) in 2003 to 7.8 per 100,000 (95% CI, 7.64-7.89) in 2013 (absolute difference, 3.3; 95% CI, 3.09-3.41) among adults aged 18 through 64 years. The mean number of days of nonmedical use of prescription opioids increased from 2.1 (95% CI, 1.83-2.37) in 2003 to 2.6 (95% CI, 2.27-2.85) in 2013 (absolute difference, 0.5, 95% CI, 0.05-0.86). The model-adjusted prevalence of having prescription opioid use disorders among nonmedical users increased to 15.7% (95% CI, 13.87%-17.67%) in 2010, 16.1% (95% CI, 14.36%-17.99%) in 2011, 17.0% (95% CI, 15.07%-19.12%) in 2012, and 16.9% (95% CI, 14.95%-19.03%) in 2013 from 12.7% (95% CI, 11.04%-14.53%) in 2003. CONCLUSIONS AND RELEVANCE: During the 2003-2013 years, among adults aged 18 through 64 years, the percentage of nonmedical use of prescription opioids decreased. In contrast, the prevalence of prescription opioid use disorders, frequency of use, and related mortality increased.
Topic(s):
Opioids & Substance Use
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6444
Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind?
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: OBJECTIVE: Although primary care is associated with better outcomes, many individuals with serious mental illness do not receive general medical services. This study examined patient-level factors associated with not having outpatient general medical visits among individuals with serious mental illness in California. METHODS: The study analyzed administrative, pharmacy, and billing data for 56,895 Medicaid-enrolled adults with serious mental illness treated in community mental health clinics between October 1, 2010, and September 20, 2011. Poisson regression estimated independent associations between predictor variables and outpatient general medical visits. RESULTS: One-third of participants (34%) had no outpatient general medical visits during the study. In multivariate analyses, younger adults (ages 18-27) were less likely than older groups to have such a visit (adjusted relative risk [ARR]=1.07 and 1.19, respectively, for ages 28-47 and 48-67). Women were more likely than men to have such a visit (ARR=1.29). Compared with whites, blacks were less likely to have an outpatient general medical visit (ARR=.93). Rural dwellers were less likely than urban dwellers to have such a visit (ARR=.64). Persons with drug or alcohol use disorders were less likely than those without such disorders to have an outpatient general medical visit (ARR=.95), and those with schizophrenia were less likely than those with any other psychiatric disorder examined to have such a visit. CONCLUSIONS: Individuals with serious mental illness had low use of outpatient general medical services. Integrated care models are needed to engage these individuals and eliminate disparities in morbidity and mortality.
Topic(s):
Healthcare Disparities
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Reference Links: 
View the DOI record for Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind?
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View the PubMed citation for Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind?6445
Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain
Type: Journal Article
Year: 2016
Abstract: Background: Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States. Objective: To evaluate the feasibility and effect of implementing naloxone prescription to patients prescribed opioids for chronic pain. Design: 2-year nonrandomized intervention study. Setting: 6 safety-net primary care clinics in San Francisco, California. Participants: 1985 adults receiving long-term opioid therapy for pain. Intervention: Providers and clinic staff were trained and supported in naloxone prescribing. Measurements: Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review. Results: 38.2% of 1985 patients receiving long-term opioids were prescribed naloxone. Patients prescribed higher doses of opioids and with an opioid-related ED visit in the past 12 months were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month in the 6 months after receipt of the prescription (incidence rate ratio [IRR], 0.53 [95% CI, 0.34 to 0.83]; P = 0.005) and 63% fewer visits after 1 year (IRR, 0.37 [CI, 0.22 to 0.64]; P < 0.001) compared with patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone and those who did not (IRR, 1.03 [CI, 0.91 to 1.27]; P = 0.61). Limitation: Results are observational and may not be generalizable beyond safety-net settings. Conclusion: Naloxone can be coprescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients receiving opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits, such as reducing opioid-related adverse events. Primary Funding Source: National Institutes of Health grant R21DA036776.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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6446
Nontraditional Alcohol and Opioid Agonist Treatment Interventions
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Opioids & Substance Use
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Reference Links: View the PubMed citation for Nontraditional Alcohol and Opioid Agonist Treatment Interventions
6447
Norbuprenorphine and respiratory depression: Exploratory analyses with new lyophilized buprenorphine and sublingual buprenorphine
Type: Journal Article
Year: 2018
Publication Place: Germany
Abstract:
OBJECTIVES: To investigate plasma levels of buprenorphine and norbuprenorphine and their relationship to respiratory depression. MATERIALS AND METHODS: Opioid-dependent subjects were randomized 2 : 1 to novel lyophilized rapid-disintegrating tablet ("bup-lyo") or standard sublingual buprenorphine tablet ("bup-SL"). Measurements included oximetry scores and linked plasma buprenorphine and norbuprenorphine levels. RESULTS: Respiratory depression (cumulative duration of SpO2 30 min) of buprenorphine and particularly with norbuprenorphine. A lower buprenorphine/norbuprenorphine ratio was predictive of respiratory depression. The mean (SD) observed ratio was significantly higher for "bup-lyo" (3.4 (2.8)) compared to "bup-SL" (1.7 (0.77)), p < 0.0001. CONCLUSION: Exploratory investigation found respiratory depression more strongly associated with norbuprenorphine than with buprenorphine. This accords with animal studies..
Topic(s):
Opioids & Substance Use
See topic collection
6453
Novel remote electronic medication supply model for opioid-dependent outpatients with polypharmacy--first long-term case study
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within their setting. Electronic medication management aids (e-MMAs) might be appropriate to simultaneously monitor and improve adherence for these patients. CASE PRESENTATION: We report the first long-term experiences with a novel remote electronic medication supply model for two opioid-dependent patients with HIV. John (beginning dementia, 52 years, 6 tablets daily at 12 am) and Mary (frequent drug holidays, 48 years, 5-6 tablets daily at 8 pm) suffered from disease progression due to non-adherence. We electronically monitored adherence and clinical outcomes during 659 (John) and 953 (Mary) days between July 2013 and April 2016. Both patients retrieved over 90% of the pouches within 75 min of the scheduled time. Technical problems occurred in 4% (John) and 7.2% (Mary) of retrievals, but on-site support was seldom required. Viral loads fell below detection limits during the entire observation period. CONCLUSIONS: Continuous medication supply and persistence with treatment of over 1.7 years, timing adherence of more than 90%, and suppressed HIV viral load are first results supporting the feasibility of the novel supply model for patients on opioid-assisted treatment and polypharmacy.
Topic(s):
HIT & Telehealth
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, Opioids & Substance Use
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6455
Now is the Time to Address Substance Use Disorders in Primary Care
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Now is the Time to Address Substance Use Disorders in Primary Care
View DOI Record
View the PubMed citation for Now is the Time to Address Substance Use Disorders in Primary Care6457
Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: BACKGROUND: Many older adults who die by suicide have had recent contact with a primary care physician. As the risk-assessment and referral process for suicide is not readily comparable to procedures for other high-risk behaviors, it is important to identify areas in need of quality improvement (QI). OBJECTIVE: Identify patterns in physician-patient communication regarding suicide to inform QI interventions. DESIGN: Qualitative thematic analysis of video-taped clinical encounters in which suicide was discussed. PARTICIPANTS: Adult primary care patients (n = 385) 65 years and older and their primary care physicians. RESULTS: Mental health was discussed in 22% of encounters (n = 85), with suicide content found in less than 2% (n = 6). Three patterns of conversation were characterized: (1) Arguing that "Life's Not That Bad." In this scenario, the physician strives to convince the patient that suicide is unwarranted, which results in mutual fatigue and discouragement. (2) "Engaging in Chitchat." Here the physician addresses psychosocial matters in a seemingly aimless manner with no clear therapeutic goal. This results in a superficial and misleading connection that buries meaningful risk assessment amidst small talk. (3) "Identify, assess, and...?" This pattern is characterized by acknowledging distress, communicating concern, eliciting information, and making treatment suggestions, but lacks clearly articulated treatment planning or structured follow-up. CONCLUSIONS: The physicians in this sample recognized and implicitly acknowledged suicide risk in their older patients, but all seemed unable to go beyond mere assessment. The absence of clearly articulated treatment plans may reflect a lack of a coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support required to address suicide risk effectively. To respond to suicide's numerous challenges to the primary care delivery system, QI strategies will require changes to physician education and may require enhancing practice support.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide
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View the PubMed citation for Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide6458
NP Safe Prescribing Of Controlled Substances While Avoiding Drug Diversion
Type: Report
Year: 2022
Publication Place: Treasure Island (FL)
Topic(s):
Grey Literature
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, Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
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, Opioids & Substance Use
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Disclaimer:
This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.
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Access more information about this ResourceReference Links: View the PubMed citation for NP Safe Prescribing Of Controlled Substances While Avoiding Drug DiversionAccess more information about this Resource
Access more information about this Resource6459
Nudging primary care providers to expand the opioid use disorder workforce
Type: Journal Article
Year: 2022
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Nudging primary care providers to expand the opioid use disorder workforce
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View the PubMed citation for Nudging primary care providers to expand the opioid use disorder workforce