COVID 19 and the Opioid Epidemic: An Analysis of Clinical Outcomes During COVID 19
Background and Objectives/UNASSIGNED:Here we aimed to characterize clinical outcomes in those receiving treatment at a Veterans Health Administration (VHA) methadone maintenance treatment program (MMT) during the COVID 19 pandemic in which SAMSHA regulations for MMTs were changed to provide a greater number of methadone allotments and decreased clinic-visit frequency. Methods/UNASSIGNED:We report results of a single-site, pre-post cohort study of urine drug screen data 3â€‰months before and after an increase in allotments of take-home medication from the methadone clinic. One hundred twenty-nine patients met inclusion criteria for this study. The study was reviewed by the NYHHS IRB committee and granted final approval by the Research and Development Committee. Results/UNASSIGNED:â€‰>â€‰.05), number of new medical illnesses or overdoses. We controlled for participant age, substance use disorder diagnosis, psychiatric disorder diagnosis, and number of years in treatment. Discussion/Conclusions/UNASSIGNED:The results of the study illustrate the relative safety of the changes made at this particular MMT during the pandemic. Additionally, there was continued adherence to methadone treatment with minimal change in illicit substance use during period 1 and period 2. Scientific Significance/UNASSIGNED:To these authors' knowledge this paper is one of the first to examine clinical outcomes in those with opioid addiction prescribed methadone from MMTs during the COVID 19 pandemic.
Prescription Drug Monitoring Program: Access in the First Year
BACKGROUND AND OBJECTIVES/OBJECTIVE:Prescription Drug Monitoring Programs (PDMP) detect high-risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. METHODS:Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. RESULTS:One-third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same-day PDMP access (Pâ€‰<â€‰.0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all Pâ€‰<â€‰.05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c-statisticâ€‰=â€‰0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR]â€‰=â€‰0.47, 95% confidence interval [CI]â€‰=â€‰0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (ORâ€‰=â€‰0.30, 95% CIâ€‰=â€‰0.10, 0.90) or had a urine toxicology screen in the past year (ORâ€‰=â€‰2.00, 95% CIâ€‰=â€‰1.40, 2.90). DISCUSSION AND CONCLUSIONS/CONCLUSIONS:Utilization of the PDMP varied by specialty and setting. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one-third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00-00).
A single-site retrospective cohort study on the impact of emergency substance abuse and mental health services administration (SAMHSA) guidelines on methadone maintenance therapy patients during the COVID19 pandemic [Meeting Abstract]
Maintaining patient safety and continuity of care is of the utmost importance in methadone treatment. However, many patients face considerable barriers for entry into methadone maintenance therapy (MMT). The pre-COVID19 requirements for patients enrolled in methadone treatment may pose an additional such barrier to patients with work or travel obligations. Therefore, it is imperative that federal methadone policy strike an appropriate balance between the interests of patient retention and safety and the interests of access to care. These considerations are particularly important in the context of current and future infectious diseases outbreaks or other crises. The necessity of strict methadone policies for opioid use disorder should continue to be explored with further research studies. XXBackground(s): To facilitate social distancing during the COVID- 19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) has permitted clinicians discretion to prescribe up to 28 days of take-home methadone doses to patients in opioid treatment programs (OTPs) regardless of patients' duration of prior treatment. Previously, the United States had long maintained take-home restrictions aimed at preventing overdose and diversion, but the effectiveness of these restrictions and of supervised consumption of methadone overall have been poorly studied. XXObjective(s): Determine the effects of early access to takehome doses on treatment retention in MMT. Examine the risk of overdose given early access to take-home methadone doses. Characterize the effectiveness of implementation of emergency methadone policies in the context of a public health crisis. XXMethod(s): Following the SAMHSA restriction changes, in March 2020 the OTP at the Veterans Affairs New York Harbor Health System in Manhattan suspended new patient enrollment and offered current patients between 4 and 28 days of take-home methadone, based on clinician assessment of patient risk. The proposed study will perform a retrospective chart review comparing the rates of patient dropout and illicit drug overdose in the 3 months prior to these changes to the rates in the 3 months following. XXResult(s): Results are forthcoming pending IRB approval. XXConclusion(s): Conclusions are forthcoming pending IRB approval. Scientific Significance: This will be the first study of its kind to examine changes in SAMHSA's take-home methadone schedule and patient outcomes in times of crisis. Of note, New York City OTPs and their patients have struggled to maintain continuity of care during other states of emergency, such as 9/11 and Hurricane Sandy. Thus, the results may further inform the approach to regulatory oversight of methadone prescription during states of disaster
Psychiatric consequences of nitrous oxide abuse
Acute Necrotizing Pancreatitis following Long-Term Antipsychotic Use [Case Report]
Nitrous Oxide Inhalant Use Disorder Preceding Symptoms Concerning for Primary Psychotic Illness [Meeting Abstract]
Systemic racism and substance use disorders
Increasing attention to systemic racism in the United States in all aspects of life has sharpened focus on its effects on the health outcomes of Black, Latinx, and Indigenous populations. Racial disparities in substance use disorders remain a significant public health problem in mental health, and psychiatrists require sufficient knowledge and awareness to help address these disparities. First, this article reviews evidence of racial disparities in substance use disorders. We then discuss the historical and legal foundations of systemic racism and substance use disorder disparities and explore research examining the role of systemic racism in substance use disorder outcomes on structural and individual levels. Finally, we discuss recommendations for providing substance use disorder care in a more racially equitable manner.
Nitrous Oxide Inhalant Use Disorder Preceding Symptoms Concerning for Primary Psychotic Illness [Case Report]
BACKGROUND AND OBJECTIVE/OBJECTIVE:Nitrous oxide has long been used recreationally for its ability to induce euphoria and other deliriant effects. In modern times, it remains a popular, legal, and widely available option for those seeking altered states. Though substance-induced psychotic symptoms have been mentioned in the literature, the potential long-term negative neuropsychiatric effects related to its use have not been well established. METHODS AND RESULTS/RESULTS:This is a patient case report of a young man (Nâ€‰=â€‰1) who initially presented with acute neurological symptoms requiring hospitalization due to heavy nitrous oxide inhalant use, and went on to present with symptoms concerning for a primary psychotic illness over multiple inpatient admissions. He provided both verbal and written consent to share his story for this case report. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:It is important to consider nitrous oxide use as a possible contributing factor to the development of primary psychotic illness. SCIENTIFIC SIGNIFICANCE/CONCLUSIONS:deficiency. Here, we present a patient with risk factors for psychotic illness developing psychotic illness following extensive nitrous oxide use. This report offers a unique perspective of longitudinal follow-up (often not provided with reports on this topic), and illustrates the importance of healthcare providers inquiring about nitrous oxide abuse in patients presenting with early psychotic symptoms. (Am J Addict 2020;00:00-00).
Subcutaneous Buprenorphine for a Patient With a History of Misusing an Indwelling Catheter: AÃ‚ Case Report
An Impaired Physician with Alcohol Use Disorder and Multiple Medical Comorbidities