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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
10421
Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 2018
Type: Journal Article
Year: 2021
Topic(s):
Financing & Sustainability
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Reference Links: 
View the DOI record for Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 2018
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View the PubMed citation for Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 201810422
Uptake of Web-based clinical resources from the MacArthur Initiative on Depression and Primary Care
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: This study assessed the usability and desired enhancements for the MacArthur Foundation's Depression and Primary Care (MDPC) Web site to determine if resources for integrated depression care that are disseminated through the Web site are incorporated into routine clinical care. Since its launch in 2003, more than 20,000 users registered as members of the MDPC website to read and download depression care resources. Subjects were randomly selected from MDPC Web site users who had previously downloaded the depression toolkit. Web-based survey, which was administered anonymously, included the following domains: (1) socio-demographic data, (2) confidence in managing depression (3) Web site content and design features, (4) desired enhancements to Web site and content, (5) use of resources downloaded from the Web site, and (6) importance of depression care resources. Of the 3,478 randomly selected participants, 666 (19.1%) responded. Web site content was rated "good" or "excellent" for screening and diagnosis (84.3%), treatment (69.8%), patient education (66.2%), and care management (66.9%). The Patient Health Questionnaire-9 (PHQ-9) was rated "very useful" by 68.3%; 47.1% reported using it in at least 25% of encounters with patients who are depressed. PHQ-9 use was significantly associated with higher self-confidence in managing depression (P = 0.05). Evidence-based resources for depression care can be disseminated effectively through a dedicated Web site and may help clinicians incorporate effective care models into routine practice.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Uptake of Web-based clinical resources from the MacArthur Initiative on Depression and Primary Care
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View the PubMed citation for Uptake of Web-based clinical resources from the MacArthur Initiative on Depression and Primary Care10423
Urban health and primary care at Johns Hopkins: urban primary care medical home resident training programs
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Johns Hopkins University recently implemented two novel urban health residency training programs (UHR). The programs include increased access programs, community health worker-delivered care, substance abuse screening and treatment, community psychiatry/ mental health programs, case and disease management teams, and interprofessional training. These programs are designed to create well-trained physicians who competently provide care for the underserved inner-city patient.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Urban health and primary care at Johns Hopkins: urban primary care medical home resident training programs
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View the PubMed citation for Urban health and primary care at Johns Hopkins: urban primary care medical home resident training programs10424
Urban vs. rural differences in prescription opioid misuse among adults in the United States: Informing region specific drug policies and interventions
Type: Journal Article
Year: 2015
Publication Place: Netherlands
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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10426
Urine drug screen findings among ambulatory oncology patients in a supportive care clinic
Type: Journal Article
Year: 2017
Publication Place: Germany
Abstract: PURPOSE: Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making. METHODS: An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study. Twenty-eight of the two hundred thirty-two did not meet inclusion criteria. One hundred fifty of the two hundred four had active cancer, while 54 had no evidence of active disease. Clinicians ordered UDS based on their clinical judgment of patients' substance misuse risk. Edmonton symptom assessment scores, history of substance abuse, alcohol use, tobacco use, aberrant behavior, and morphine equivalent daily dose (MEDD) were obtained. RESULTS: Pain scores and MEDD were higher (p = 0.021; p < 0.001) in the UDS group vs non-UDS. Forty percent of the patients (n = 82/204) had at least one UDS and 70% (60/82) had an inappropriate result. Thirty-nine percent (32) were inappropriately negative, showing no prescribed opioids. Forty-nine of the eighty-two were positive for non-prescribed opioids, benzodiazepine, or illicit substance. Eleven of the forty-nine had only cannabis metabolites in their urine. There were no significant differences between appropriate and inappropriate UDS groups regarding pain scores, MEDD or referral to psychology, psychiatry, or substance abuse specialists. CONCLUSIONS: UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Urine drug screen findings among ambulatory oncology patients in a supportive care clinic
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View the PubMed citation for Urine drug screen findings among ambulatory oncology patients in a supportive care clinic10429
Urine drug screening: a valuable office procedure
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: Urine drug screening can enhance workplace safety, monitor medication compliance, and detect drug abuse. Ordering and interpreting these tests requires an understanding of testing modalities, detection times for specific drugs, and common explanations for false-positive and false-negative results. Employment screening, federal regulations, unusual patient behavior, and risk patterns may prompt urine drug screening. Compliance testing may be necessary for patients taking controlled substances. Standard immunoassay testing is fast, inexpensive, and the preferred initial test for urine drug screening. This method reliably detects morphine, codeine, and heroin; however, it often does not detect other opioids such as hydrocodone, oxycodone, methadone, fentanyl, buprenorphine, and tramadol. Unexpected positive test results should be confirmed with gas chromatography/mass spectrometry or high-performance liquid chromatography. A positive test result reflects use of the drug within the previous one to three days, although marijuana can be detected in the system for a longer period of time. Careful attention to urine collection methods can identify some attempts by patients to produce false-negative test results.
Topic(s):
Opioids & Substance Use
See topic collection
10430
Urine drug testing in chronic pain
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continue to be an issue for physicians and patients. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. Some physicians are apprehensive regarding the use of chronic opioid therapy in chronic non-cancer pain due to a perceived lack of proven evidence, the misuse of opioids, tolerance, dependence, and hyperalgesia. However, others have criticized the underuse of opioids, resulting in the undertreatment of pain. It has been the convention that federal, state, and local governments; professional associations; as well as pharmaceutical companies, physicians, accrediting bodies, medical licensure boards, and the public all share responsibility for preventing abuse of controlled prescription drugs. To overcome the critical challenge of eliminating or significantly curtailing abuse of controlled prescription drugs and at the same time assuring the appropriate treatment for those patients who can be helped by these medications, it is crucial to practice adherence or compliance monitoring of opioid therapy. Compliance monitoring has been shown to be crucial in delivering proper opioid therapy and preserving this therapy for the future. Urine drug testing (UDT) is considered one of the mainstays of adherence monitoring in conjunction with prescription monitoring programs and other screening tools, however, UDT is associated with multiple limitations secondary to potential pitfalls related to drug metabolism, reliability of the tests, and the knowledge of the pain physician. UDT is a widely available and familiar method for monitoring opioid use in chronic pain patients. UDT can provide tools for tracking patient compliance and expose possible drug misuse and abuse. UDT is one of the major tools of adherence monitoring in the assessment of the patient's predisposition to, and patterns of, drug misuse/abuse--a vital first step towards establishing and maintaining the safe and effective use of opioid analgesics in the treatment of chronic pain. This comprehensive review provides the role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse.
Topic(s):
Opioids & Substance Use
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Reference Links: View the PubMed citation for Urine drug testing in chronic pain
10432
Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Opioids & Substance Use
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10433
Urine drug testing: current recommendations and best practices
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: BACKGROUND: The precise role of urine drug testing (UDT) in the practice of pain medicine is currently being defined. Confusion exists as to best practices, and even to what constitutes standard of care. A member survey by our state pain society revealed variability in practice and a lack of consensus. OBJECTIVE: The authors sought to further clarify the importance of routine UDT as an important part of an overall treatment plan that includes chronic opioid prescribing. Further, we wish to clarify best practices based on consensus and data where available. METHODS: A 20-item membership survey was sent to Texas Pain Society members. A group of chronic pain experts from the Texas Pain Society undertook an effort to review the best practices in the literature. The rationale for current UDT practices is clarified, with risk management strategies outlined, and recommendations for UDT outlined in detail. A detailed insight into the limitations of point-of-care (enzyme-linked immunosorbent assay, test cups, test strips) versus the more sensitive and specific laboratory methods is provided. LIMITATIONS: Our membership survey was of a limited sample size in one geographic area in the United States and may not represent national patterns. Finally, there is limited data as to the efficacy of UDT practices in improving compliance and curtailing overall medication misuse. CONCLUSIONS: UDT must be done routinely as part of an overall best practice program in order to prescribe chronic opioid therapy. This program may include risk stratification; baseline and periodic UDT; behavioral monitoring; and prescription monitoring programs as the best available tools to monitor chronic opioid compliance.
Topic(s):
Opioids & Substance Use
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Reference Links: View the PubMed citation for Urine drug testing: current recommendations and best practices
10434
US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: Research has shown significant contribution of integrated behavioural health care; however, less is known about the perceptions of primary care providers towards behavioural health professionals. OBJECTIVE: The current study examined barriers to care and satisfaction with integrated behavioural health care from the perspective of primary care team members. DESIGN: This study utilized archival data from 42 treatment facilities as part of ongoing program evaluation of the Air Force Medical Service's Behavioral Health Optimization Program. SETTING: This study was conducted in a large managed health care organization for active duty military and their families, with specific clinic settings that varied considerably in regards to geographic location, population diversity and size of patient empanelment. STUDY PARTICIPANTS: De-identified archival data on 534 primary care team members were examined. RESULTS: Team members at larger facilities rated access and acuity concerns as greater barriers than those from smaller facilities (t(533) = 2.57, P < 0.05). Primary Care Managers (PCMs) not only identified more barriers to integrated care (beta = -0.07, P < 0.01) but also found services more helpful to the primary care team (t(362.52) = 1.97, P = 0.05). Barriers to care negatively impacted perceived helpfulness of integrated care services for patients (beta = -0.12, P < 0.01) and team members, particularly among non-PCMs (beta = -0.11, P < 0.01). CONCLUSIONS: Findings highlight the potential benefits of targeted training that differs in facilities of larger empanelment and is mindful of team members' individual roles in a Patient Centered Medical Home. In particular, although generally few barriers were perceived, given the impact these barriers have on perception of care, efforts should be made to decrease perceived barriers to integrated behavioural health care among non-PCM team members.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care
View DOI Record
View the PubMed citation for US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care10437
Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Opioids & Substance Use
See topic collection
, HIT & Telehealth
See topic collection
Reference Links:
View the DOI record for Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study
View DOI Record
View the PubMed citation for Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study10438
Use and misuse of opioid agonists in opioid addiction
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Opioids & Substance Use
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10439
Use and misuse of opioid replacement therapies: A Queensland study
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: Buprenorphine/naloxone has recently been introduced in Australia and is available for unsupervised dosing within Queensland. A retrospective observational study of data collected during 2000-2007 for clients obtaining injecting equipment from the Brisbane Harm Reduction Centre in Queensland is presented. The numbers of service occasions and needles and syringes were used as surrogate drug use measures. Buprenorphine and naloxone were misused at lower rates when compared with buprenorphine and methadone. Furthermore, the misuse of opioid replacement therapies represented less than 5% of all illicit opioid injections. Implications and study limitations are discussed.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Use and misuse of opioid replacement therapies: A Queensland study
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View the PubMed citation for Use and misuse of opioid replacement therapies: A Queensland study10440
Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: OBJECTIVE: Although opioids have substantial efficacy for acute pain management, escalation to opioid misuse and abuse is a persistent concern. This report assesses the current status of the opioid epidemic in Maine using three complementary data sets. METHOD: A representative sample of pharmacists (N = 275) completed an online survey regarding the extent that opioids affected their practice. A county-level analysis of opioid prescriptions (N = 1.22 million) reported to the Maine Prescription Monitoring Program (M-PMP) in 2014 and the agents implicated in arrests as reported to the Maine Diversion Alert Program (DAP, N = 2,700) in 2014/15 also was completed. RESULTS: A significantly greater number of pharmacists agreed that opioid misuse (85.9%), rather than diversion (76.8%) or access (54.2%), was a concern. Only half (56.2%) reported use of the M-PMP. Opioids were dispensed to 22.4% of residents (37.7% of women in their 80s). This was enough to supply everyone in Maine with a 16.1-day supply. Buprenorphine accounted for almost half of opioid prescriptions to young adults (46.3% women, 49.3% men). Arrests increased by 13.3% from 2014 to 2015, and the proportion of arrests that involved prescription opioids decreased while those involving stimulants and heroin were elevated. CONCLUSIONS: Pharmacists are very aware of the potential for opioid misuse, but many do not consistently use the M-PMP. There continues to be substantial legitimate use, as well as criminal activity, involving oxycodone and other prescription opioids. Continued vigilance and use of tools like the PMP and DAP are necessary to minimize nonmedical use of opioids in Maine.
Topic(s):
Opioids & Substance Use
See topic collection
, Education & Workforce
See topic collection