Background: To address the opioid use disorder (OUD) public health crisis, the ADvancing Pharmacological Treatments for OUD (ADaPT-OUD) external facilitation randomized trial was conducted in 8 intervention and 27 matched control low-performing Veterans Health Administration (VHA) facilities to increase the prescribing of medications for OUD (MOUD). Facilities were considered low-performers if they were in the bottom quartile of the facility ratio of Veterans with OUD who received MOUD. The objective of this analysis was to evaluate the healthcare expenditures of Veterans with OUD who received care in ADaPT-OUD intervention facilities compared to those receiving care in matched control facilities. Methods: Difference-in-differences (DID) design was used to compare the overall, outpatient, and inpatient expenditures (extracted from the VHA data warehouse) of Veterans diagnosed with OUD or receiving MOUD between the 2 groups 12 months before and after the intervention. Results: A total of 7348 Veterans with a diagnosis of OUD or prescribed MOUD on at least 1 encounter 12 months after ADaPT-OUD intervention at all sites (92.39% male and 83.26% white) were included for analysis. ADaPT-OUD intervention did not have a substantial impact on overall healthcare costs. However, we reported 4% fewer total encounters in the intervention sites (DID, 95% confidence intervals [CI]: 0.96 [0.92-1.00]) compared to the control sites, driven by a decline in non-VA services. Notably, the outpatient psychiatric-related costs were $391 (95% CI: $49-$733) higher per Veteran within the year after the intervention sites received external facilitation compared to control sites. Conclusions: Veterans at intervention sites with an OUD history had higher outpatient psychiatric-related costs, which could be explained by increased access to optimal mental health services at VHA. Improving access to OUD treatment at VA may lead to more coordinated and comprehensive treatment of both OUD and other associated mental health and physical comorbidities.
Objectives: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes. Background: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown. Methods: Matched event study analysis comparing early population-level outcomes in 6 states that passed laws targeting patient brokering between 2018 and 2019 and 24 comparison states with similar census region and presence of recovery residence regulations, anti-kickback laws, state SUD task forces. Outcomes, analyzed through 2019, included monthly rates of opioid-related mortality and quarterly rates of opioid-related emergency department visits and hospitalizations per 100,000 residents, and state-year prevalence of unusual patterns of claims for SUD-related services. Results: In 2018, there was a mean of 326.9 (SD = 72.0) opioid-related hospitalizations/100k state residents, 234.6 (SD = 37.7) opioid-related ED visits/100k state residents, and 122.9 (SD = 73.6) opioid-related deaths/100k state residents in the states in our treatment group. We did not observe evidence that passage of state laws targeting patient brokering or deceptive marketing was associated with changes in any of our outcomes. Conclusions: The passage of state laws targeting patient brokering is not associated with significant changes in opioid-related outcomes. Additional resources may be needed to accompany implementation and enforcement efforts before desired policy effects are realized.
Background: Substance use is a major global public health challenge. A well-trained health care workforce is needed to prevent, address, and treat substance use disorders (SUD) internationally. Methods: In September 2021, the Yale Schools of Medicine (YSM) and Public Health (YSPH) and the University of Jordan (UJ) collaborated to establish the Yale-UJ Joint Training Program in Addiction Medicine. The curriculum was developed using the six-step Kern Model. The program aimed to create opportunities for cross-cultural, interprofessional education in addiction medicine to address education and treatment gaps. Results: The two-year program led to novel learning, training, and research opportunities in addiction medicine for faculty, staff, and students at YSM, YSPH, and UJ. The program implemented 16 lectures, a live in-person training workshop, three student-led discussion events, a student-led exchange network, a novel elective course, two cross-institutional research projects, and resulted in three published peer reviewed articles, two international conference presentations, three elective training opportunities, and one postdoctoral training. The program was well received by students and faculty and resulted in SUD treatment stakeholder collaboration in both countries. Conclusions: Establishment of a cross-national, interprofessional joint training program creates opportunities to implement novel education, research, and mentorship to prepare a culturally informed workforce.
BACKGROUND:While smoking has been associated with alertness, it has also been reported as a stress relief and sleep aid. However, evidence on tobacco self-medication to improve sleep remains limited, particularly among adolescents. Therefore, the aim of this study was to explore the prevalence of tobacco self-medication in adolescents and analyze the association with sleep quality. METHODS:A cross-sectional descriptive study was conducted with 1,121 Spanish adolescents (mean age = 16.2 ± 0.7; 57.1% female) from public secondary schools. Participants completed assessments on their sleep quality and Cigarette Use. Analysis of variance and multinomial logistic regression analyses were conducted. RESULTS:Among adolescents, 5.4% (n = 61) reported smoking cigarettes as a sleep aid in the past month, accounting for a third of those who had smoked in that timeframe (19.9%; n = 225). Adolescents smoking cigarettes for self-medication showed significantly higher cigarette consumption compared to those with past-month use only (mean diff. = 2.1; η² = .10) and longer regular use (mean diff. = 6.9 months; η² = .08). Self-medication was associated with poorer sleep quality, shorter sleep, longer sleep onset latency, and frequent nighttime awakenings. Adolescents experiencing poor sleep and frequent awakenings had twice the likelihood of using tobacco as a sleep aid in the past month (OR = 2.1 and OR = 2.2, respectively). CONCLUSIONS:This study brings attention to adolescent self-medication practices and their associations with poor sleep outcomes. Findings underscore the need for further investigation into self-medication with implications for prevention strategies during adolescence.
Background: People who inject drugs (PWID) may develop skin and soft tissue infections because of limited access to sterile injection supplies and education regarding safer injection techniques. The purpose of this study was to assess wound care experiences, knowledge, and practices among individuals accessing community-based services and inform service provision for PWID. Methods: Using convenience sampling, participants of an organization that engages with PWID in Austin, Texas, were engaged in a multiphase mixed-methods study. Phase 1 (N = 39) included completion of a 23-item quantitative survey; eligibility required injection drug use in the past 30 days. Phase 2 (N = 20) included brief semi-structured interviews to explore wound care practices. Participants received $20 grocery store gift cards for participating in each phase. Qualitative data were analyzed using an analytic matrix to identify themes. Results: PWID reported injecting methamphetamine, heroin, and fentanyl; 53.8% (21/39) injected more than 1 substance. The same proportion (21/39) had experienced at least 1 injection-related wound in the past 6 months and reported often or always self-treating injection-related wounds. Their reasons included confidence in self-treating, lack of perceived wound severity, and experience of stigma. Interview participants described their experiences with infections, how they cleaned wounds and obtained antibiotics, how they decided when to seek medical care (eg, wound severity, confidence in self-treatment), and barriers to seeking care (eg, stigma, financial concerns). Conclusions: Needs for wound care treatment and education among PWID are currently unmet, and stigma from health care providers remains a challenge to seeking early intervention for infections. Delivering wound care services and education through community-based organizations that have established credibility and connection may enhance access to care.
