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Opioids & SU
The Literature Collection contains over 11,000 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).
11231 Results
10782
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
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10783
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
10785
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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10786
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
10787
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
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View the PubMed citation for US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care10790
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
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, HIT & Telehealth
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Reference Links:
View the DOI record for Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study
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View the PubMed citation for Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study10791
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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10792
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 study10793
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
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, Education & Workforce
See topic collection
10795
Use of a Benchmark Tracking Assessment to Support Expansion of Buprenorphine for Treatment of Opioid Use Disorder in Primary Care
Type: Journal Article
Year: 2021
Publication Place: United States
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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10796
Use of a brief standardized screening instrument in a primary care setting to enhance detection of social-emotional problems among youth in foster care
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
Healthcare Disparities
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10797
Use of a consumer-led intervention to improve provider competencies
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: OBJECTIVE: Client-centered care is a major aim of health care. In mental health, new client-centered treatment approaches that emphasize recovery, rehabilitation, and empowerment can improve outcomes for people with severe and persistent mental illness. However, these approaches are not widely used, in part because many clinicians lack the necessary competencies. The objective of this study was to evaluate the effectiveness of an innovative, consumer-led intervention, Staff Supporting Skills for Self-Help, which was designed to improve provider quality, empower mental health consumers, and promote mutual support. METHODS: The study was conducted at five large community mental health provider organizations in two western states. One organization in each state received the intervention. The intervention included education, clinician-client dialogues, ongoing technical assistance, and support of self-help. It focused on client-centered care, rehabilitation, and recovery. A one-year controlled trial evaluated the effect of the intervention on clinicians' competencies, care processes, and the formation of mutual support groups. Outcomes were assessed by using competency assessment survey instruments and semistructured interviews with clinicians and managers. RESULTS: A total of 269 clinicians participated in the study: 151 in the intervention group and 118 in the control group. Compared with clinicians at the control organizations, clinicians at intervention organizations showed significantly greater improvement in education about care, rehabilitation methods, natural supports, holistic approaches, teamwork, overall competency, and recovery orientation. CONCLUSIONS: A feasible, consumer-led intervention improves provider competencies in domains that are necessary for the provision of high-quality care.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Use of a consumer-led intervention to improve provider competencies
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View the PubMed citation for Use of a consumer-led intervention to improve provider competencies10798
Use of a Mental Health Center Collaborative Care Team to Improve Diabetes Care and Outcomes for Patients With Psychosis
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract:
OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness (compared with usual care) of a collaborative care model to treat community mental health center (CMHC) patients with psychosis and poorly controlled diabetes. METHODS: Stakeholder input was used to adapt a primary care-based collaborative care intervention for CMHC settings. Thirty-five adult CMHC clients with type II diabetes and hemoglobin A1c (HbA1c) >8% or blood pressure >140/90 were randomized to receive either collaborative care or usual care. Change in HbA1c was evaluated between baseline and three months. Paired t tests were used for within-group comparisons. RESULTS: After three months, intervention participants had a statistically significant mean decrease in HbA1c of 1.1% (p=.049). There was no significant change in HbA1c in the usual-care group. CONCLUSIONS: This pilot demonstrates the feasibility and acceptability of implementing collaborative care in CMHC settings and its preliminary effectiveness in improving glycemic control in a high-risk population.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Use of a Mental Health Center Collaborative Care Team to Improve Diabetes Care and Outcomes for Patients With Psychosis
View DOI Record
View the PubMed citation for Use of a Mental Health Center Collaborative Care Team to Improve Diabetes Care and Outcomes for Patients With Psychosis10799
Use of a primary care and pharmacy-based model for the delivery of injectable opioid agonist treatment for severe opioid use disorder: a case report
Type: Journal Article
Year: 2020
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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10800
Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: Little information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency. METHODS: Patients in the intervention group met their GP regularly at least 4 times during the 3 months intervention. In addition to treatment as usual (TAU), patients completed a self-assessment instrument (Montgomery-Asberg Depression Rating Scale) on each occasion, and then GPs used the completed instrument as the basis for a person-centred discussion of changes in depression symptoms. The control group received TAU. Frequency of visits in the TAU arm was the result of the GPs' and patients' joint assessments of care need in each case. Depression severity was measured with Beck Depression Inventory-II (BDI-II), quality of life with EQ-5D, and psychological well-being with the General Health Questionnaire-12 (GHQ-12). Data on sick leave, antidepressant and sedatives use, and care contacts were collected from electronic patient records. All variables were measured at baseline and 3, 6, and 12 months. Mean intra-individual changes were compared between the intervention and TAU group. RESULTS: There were no significant differences between the intervention and control group in depression severity reduction or remission rate, change in quality of life, psychological well-being, sedative prescriptions, or sick leave during the whole 12-month follow-up. However, significantly more patients in the intervention group continued antidepressants until the 6 month follow-up (86/125 vs 78/133, p < 0.05). CONCLUSIONS: When GPs used a depression self-rating scale in recurrent consultations, patients more often continued antidepressant medication according to guidelines, compared to TAU patients. However, reduction of depressive symptoms, remission rate, quality of life, psychological well-being, sedative use, sick leave, and health care use 4-12 months was not significantly different from the TAU group. These findings suggest that frequent use of depression rating scales in person-centred primary care consultations has no further additional effect on patients' depression or well-being, sick leave, or health care use. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01402206 . Registered June 27 2011(retrospectively registered).
Topic(s):
Measures
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