Publications by authors named "Elizabeth A Samuels"

37 Publications

Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: A qualitative evaluation.

J Subst Abuse Treat 2021 Apr 14;130:108411. Epub 2021 Apr 14.

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.

Background: Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery.

Methods: Semi-structured qualitative interviews were conducted with 55 ED providers (management and clinical staff) across Rhode Island EDs from November 2019 to July 2020. Thematic analysis of interviews focused on gaps and best practices in post-overdose care delivery, including social and structural factors driving access to, and uptake of, services.

Results: Participants highlighted how automatic service delivery (opt out vs. opt in) and the integration of peer-based services enhanced post-overdose service provision. However, social and structural factors (e.g. insurance barriers, limited outpatient treatment resources) and gaps in provider knowledge of medications for opioid use disorder created barriers to care. Addressing long ED wait times and establishing dedicated care teams for patients following an overdose were seen as critical to improving ED service delivery.

Conclusion: Our findings suggest that post-overdose service delivery within EDs is a useful approach for connecting patients to services, particularly when peer support specialists are involved. However, standardizing service delivery approaches and improving provider education of harm reduction services must be prioritized alongside state-level policy changes to improve access to care for ED patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2021.108411DOI Listing
April 2021

Association Between Emergency Medicine Clerkship Diversity Scholarships and Residency Diversity.

AEM Educ Train 2021 Jul 8;5(3):e10547. Epub 2020 Dec 8.

the Department of Emergency Medicine Alpert Medical School of Brown University Providence RI USA.

Objective: To improve resident diversity, emergency medicine (EM) residencies across the United States have implemented financial scholarships to attract visiting medical students underrepresented in medicine (URiM). The impact of these scholarships on changes in residency racial and ethnic diversity is currently unknown. In this study, we describe characteristics of these visiting elective scholarships for underrepresented students and evaluate changes in residency racial and ethnic diversity after program implementation.

Methods: From 2018 to 2019, we conducted a cross-sectional survey of EM residency programs with a visiting clerkship rotation scholarship for medical students URiM. Programs were identified for study inclusion using the Society for Academic Emergency Medicine's online directory of Visiting Elective Scholarship Programs for Underrepresented Minorities. Program characteristics were analyzed descriptively. Changes in residency racial and ethnic diversity were evaluated using an interrupted time series analysis.

Results: Of 34 programs contacted, 20 responded. While there was some variability in funding sources, scholarship amounts, and application review, most scholarships were similar in implementation practices. Of the 20 program respondents, nine were able to provide complete data on residency race and ethnicity and were included in the time series analysis. After program implementation, the time series analysis showed a significant increase in both underrepresented minority EM residents overall and Black and Latinx EM residents in particular.

Conclusion: Emergency medicine visiting clerkship scholarship programs for medical students URiM vary in funding type and application review but had similar implementation practices. Residency programs increased their racial and ethnic diversity after program implementation. Future investigations are needed to determine specific factors contributing to the successful implementation of scholarship programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166303PMC
July 2021

Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity.

JAMA Netw Open 2021 Jun 1;4(6):e2112795. Epub 2021 Jun 1.

National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut.

Importance: Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity.

Objective: To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics.

Design, Setting, And Participants: This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020.

Main Outcomes And Measures: Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables.

Results: Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08).

Conclusions And Relevance: In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2021.12795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178710PMC
June 2021

Rhode Island's Opioid Overdose Hospital Standards and Emergency Department Naloxone Distribution, Behavioral Counseling, and Referral to Treatment.

Ann Emerg Med 2021 07 15;78(1):68-79. Epub 2021 Apr 15.

Rhode Island Department of Health, Providence, RI.

Study Objective: We sought to determine the influence of the Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder (Levels of Care) on emergency department (ED) provision of take-home naloxone, behavioral counseling, and referral to treatment.

Methods: A retrospective analysis of Rhode Island ED visits for opioid overdose from 2017 to 2018 was performed using data from a statewide opioid overdose surveillance system. Changes in provision of take-home naloxone, behavioral counseling, and referral to treatment before and after Levels of Care implementation were assessed using interrupted time series analysis. We compared outcomes by hospital type using multivariable modified Poisson regression models with generalized estimating equation estimation to account for hospital-level variation.

Results: We analyzed 245 overdose visits prior to Levels of Care implementation (January to March 2017) and 1340 overdose visits after implementation (hospital certification to December 2018). After implementation, the proportion of patients offered naloxone increased on average by 13% (95% confidence interval [CI] 5.6% to 20.4%). Prior to implementation, the proportion of patients receiving behavioral counseling and treatment referral was declining. After implementation, this decline slowed and stabilized, and on average 18.6% more patients received behavioral counseling (95% CI 1.3% to 35.9%) and 23.1% more patients received referral to treatment (95% CI 2.7% to 43.5%). Multivariable analysis showed that after implementation, there was a significant increase in the likelihood of being offered naloxone at Level 1 (adjusted relative risk [aRR] 1.31 [95% CI 1.06 to 1.61]) and Level 3 (aRR 3.13 [95% CI 1.08 to 9.06]) hospitals and an increase in referrals for medication for opioid use disorder (from 2.5% to 17.8%) at Level 1 hospitals (RR 7.73 [95% CI 3.22 to 18.55]). Despite these increases, less than half of the patients treated for an opioid overdose received behavioral counseling or referral to treatment CONCLUSION: The establishment of ED policies for treatment and services after opioid overdose improved naloxone distribution, behavioral counseling, and referral to treatment at hospitals without previously established opioid overdose services. Future investigations are needed to better characterize implementation barriers and evaluate policy influence on patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2021.02.004DOI Listing
July 2021

"I wanted to participate in my own care": Evaluation of a Patient Navigation Program.

West J Emerg Med 2021 Feb 22;22(2):417-426. Epub 2021 Feb 22.

University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.

Introduction: Patient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users.

Methods: We conducted a mixed-methods evaluation of patient experiences and satisfaction with an ED-PN program for patients who visited the ED more than four times in the prior year. Participants were Medicaid-enrolled, English- or Spanish-speaking, New Haven-CT residents over the age of 18. Pre-post ED-PN intervention surveys and post-ED-PN individual interviews were conducted. We analyzed baseline and follow-up survey responses as proportions of total responses. Interviews were coded by multiple readers, and interview themes were identified by consensus.

Results: A total of 49 participants received ED-PN. Of those, 80% (39/49) completed the post-intervention survey. After receiving ED-PN, participants reported high satisfaction, fewer barriers to medical care, and increased confidence in their ability to coordinate and manage their medical care. Interviews were conducted until thematic saturation was reached. Four main themes emerged from 11 interviews: 1) PNs were perceived as effective navigators and advocates; 2) health-related social needs were frequent drivers of and barriers to healthcare; 3) primary care utilization depended on clinic accessibility and quality of relationships with providers and staff; and 4) the ED was viewed as providing convenient, comprehensive care for urgent needs.

Conclusions: Medicaid-enrolled frequent ED users receiving ED-PN had high satisfaction and reported improved ability to manage their health conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5811/westjem.2020.9.48105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972383PMC
February 2021

Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder.

Ann Emerg Med 2021 07 27;78(1):102-108. Epub 2021 Mar 27.

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.

Treatment with buprenorphine significantly reduces both all-cause and overdose mortality among individuals with opioid use disorder. Offering buprenorphine treatment to individuals who experience a nonfatal opioid overdose represents an opportunity to reduce opioid overdose fatalities. Although some emergency departments (EDs) initiate buprenorphine treatment, many individuals who experience an overdose either refuse transport to the ED or are transported to an ED that does not offer buprenorphine. Emergency medical services (EMS) professionals can help address this treatment gap. In this Concepts article, we describe the federal legal landscape that governs the ability of EMS professionals to administer buprenorphine treatment, and discuss state and local regulatory considerations relevant to this promising and emerging practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2021.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238848PMC
July 2021

Using telehealth to improve buprenorphine access during and after COVID-19: A rapid response initiative in Rhode Island.

J Subst Abuse Treat 2021 05 20;124:108283. Epub 2021 Jan 20.

Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America.

Despite its proven efficacy, buprenorphine remains dramatically underutilized for management of opioid use disorder largely due to onerous barriers to treatment initiation. During the COVID-19 pandemic, many substance use disorder treatment facilities have reduced their hours and services, exacerbating existing barriers. To this end, the U.S. Drug Enforcement Administration and Substance Abuse Mental Health Services Administration adjusted their guidelines to allow for new buprenorphine prescriptions following audio-only telehealth encounters, no longer requiring an in-person evaluation prior to treatment initiation. Under this new guidance, we established a 24/7 telephone hotline to function as a "tele-bridge" clinic where people with opioid use disorder can be linked with a buprenorphine prescriber in real-time for OUD assessment and unobserved buprenorphine initiation with connection to follow-up if appropriate. Additionally, we developed an ED callback protocol to reach patients recently seen for opioid overdose and facilitate their entry into care if interested. In this commentary we describe our hotline and ED callback protocols, discuss theoretical and anecdotal benefits to this approach, and advocate for continuation of current regulatory changes post-COVID-19 to maintain expanded access to novel treatment approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2021.108283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817486PMC
May 2021

Shelter Characteristics, Infection Prevention Practices, and Universal Testing for SARS-CoV-2 at Homeless Shelters in 7 US Urban Areas.

Am J Public Health 2021 05 18;111(5):854-859. Epub 2021 Mar 18.

Julie L. Self, Martha P. Montgomery, Karrie-Ann Toews, Temet M. McMichael, Grace E. Marx, Isaac Ghinai, and Emily Mosites are with Centers for Disease Control and Prevention, Atlanta, GA. Elizabeth A. Samuels is with the Rhode Island Department of Health, Providence. Elizabeth Imbert is with the University of California, San Francisco. Cortland Lohff is with the Southern Nevada Health District, Las Vegas. Tom Andrews is with Mercy Care of Atlanta.

To examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection point prevalence during universal testing at homeless shelters in the United States. SARS-CoV-2 testing was offered to clients and staff at homeless shelters, irrespective of symptoms. Site assessments were conducted from March 30 to June 1, 2020, to collect information on shelter characteristics and infection prevention practices. We assessed the association between SARS-CoV-2 infection prevalence and shelter characteristics, including 20 infection prevention practices by using crude risk ratios (RRs) and exact unconditional 95% confidence intervals (CIs). Site assessments and SARS-CoV-2 testing results were reported for 63 homeless shelters in 7 US urban areas. Median infection prevalence was 2.9% (range = 0%-71.4%). Shelters implementing head-to-toe sleeping and excluding symptomatic staff from working were less likely to have high infection prevalence (RR = 0.5; 95% CI = 0.3, 0.8; and RR = 0.5; 95% CI = 0.4, 0.6; respectively); shelters with medical services available were less likely to have very high infection prevalence (RR = 0.5; 95% CI = 0.2, 1.0). Sleeping arrangements and staffing policies are modifiable factors that might be associated with SARS-CoV-2 infection prevalence in homeless shelters. Shelters should follow recommended practices to reduce the risk of SARS-CoV-2 transmission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2021.306198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034028PMC
May 2021

Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students.

JAMA Netw Open 2021 02 1;4(2):e2036136. Epub 2021 Feb 1.

Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.

Importance: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown.

Objective: To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment.

Design, Setting, And Participants: This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020.

Main Outcomes And Measures: Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment.

Results: From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001).

Conclusions And Relevance: This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2020.36136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856540PMC
February 2021

Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study.

Drug Alcohol Depend 2021 02 23;219:108435. Epub 2020 Nov 23.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA. Electronic address:

Background: Medicaid recipients have a high burden of opioid overdose and opioid use disorder (OUD). Opioid agonist therapies are an effective treatment for OUD, but there is a wide and persisting gap between those who are indicated and those who receive treatment. The objective of this study was to identify the predictors of enrollment in opioid agonist therapy within 6 months of an opioid overdose or OUD diagnosis in a cohort of Medicaid recipients.

Methods: Using multiple linked, state-level databases, we conducted a retrospective cohort study of 17,449 Medicaid recipients in Rhode Island who had an opioid overdose or an OUD diagnosis between July 2013 and June 2018.

Results: The majority (58 %) of Medicaid recipients did not enroll in opioid agonist therapy within 6 months. In adjusted models, having one or more prior overdose (adjusted risk ratio [ARR] = 0.33, 95 % CI: 0.28, 0.38), alcohol use disorder (ARR = 0.56, 95 % CI: 0.52, 0.60), or back problems (ARR = 0.58, 95 % CI: 0.55, 0.61) were strong predictors of non-enrollment. Conversely, emergency department (ARR = 1.31, 95 % CI: 1.28-1.34) and primary care provider (ARR = 1.03, 95 % CI: 1.01-1.34) visit frequency above the 75th percentile were associated with timely enrollment in opioid agonist therapy.

Conclusions: Our findings underscore the need to enhance pathways to treatment for OUD through varied nodes of engagement with healthcare systems. Interventions to improve screening for OUD and referrals to opioid agonist therapies should include high-impact settings, such as treatment programs for alcohol and substance use disorders, pain clinics, and outpatient behavioral care settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2020.108435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855664PMC
February 2021

The Impact of COVID-19 on Service Provision for Emergency Department Patients Post-Opioid Overdose: A Field Report.

J Addict Med 2020 Nov 16. Epub 2020 Nov 16.

Department of Epidemiology, School of Public Health, Brown University, Providence, RI (ABC, FLB), Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI (FLB, EAS, RW, JB), Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI (FLB).

Background: To minimize the spread of COVID-19, health and ancillary care providers altered service delivery patterns. These changes included an increase in reliance on telemedicine modalities, a reduction in services or hours of operation, and prohibiting guests and nonessential personnel from healthcare settings. We describe a rapid environmental assessment with senior emergency department (ED) practitioners in Rhode Island to understand how COVID-related procedural changes impact the provision of post-overdose care in ED.

Methods: Semi-structured interviews were conducted with 14 senior healthcare practitioners in EDs across Rhode Island from June to July 2020. Interviews were part of a larger, ongoing study examining the implementation and effectiveness of post-opioid overdose care in EDs and sought to understand how COVID-19 had impacted the provision of services for people who use drugs (PWUD).

Results: COVID-related policy changes challenged the provision of services to PWUD in the ED, and extended challenges in connecting people with OUD to services in the community. Specifically, challenges included transitions to telehealth modalities, required COVID tests for treatment services, and gaps in community resources.

Conclusions: This study underscores opportunities to improve the delivery of services amid overlapping public health crises for PWUD, including bolstering the use of telemedicine in EDs and across the care continuum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000779DOI Listing
November 2020

US drug overdose mortality: 2009-2018 increases affect young people who use drugs.

Int J Drug Policy 2020 11 16;85:102906. Epub 2020 Oct 16.

Department of Epidemiology, Brown University. 121 South Main Street, Providence, RI 02912, USA. Electronic address:

Purpose: Drug overdose mortality remains a public health concern in many countries globally. In the US, overdoses involving synthetic opioids are the primary contributor to overdose mortality. We aimed to assess trends in overdose death due to synthetic opioids among young people and describe key demographic and temporal changes.

Methods: Data from the US National Vital Statistics System Multiple Cause of Death files for 2009-2018 were analysed to determine age-specific overdose death rates by region (i.e. east versus west of the Mississippi River). Age-adjusted overdose mortality rates were used to compare demographic differences in all drug and synthetic opioid overdose among young people (aged 15-34 years) using a joinpoint regression with Poisson-approximated standard errors.

Results: Driven by synthetic opioid overdose, the age burden of mortality shifted towards young people in eastern states and remained approximately constant in western states over the study period. The highest increases in drug overdose mortality rates were observed in young Black and Hispanic people and those living in large metropolitan areas.

Conclusions: Rapid changes in the demographics of overdose demonstrate distinct but overlapping US overdose sub-epidemics, and highlight the need for targeted interventions to reduce overdose risk in young people.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769862PMC
November 2020

Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19.

Int J Drug Policy 2021 07 15;93:102905. Epub 2020 Aug 15.

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Overdose Prevention Program, Rhode Island Department of Public Health, Providence, RI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428767PMC
July 2021

Opioid Policy Changes During the COVID-19 Pandemic - and Beyond.

J Addict Med 2020 Jul/Aug;14(4):e4-e5

The Network for Public Health Law, Los Angeles, CA (CSD); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (EAS).

: The United States is currently in the midst of 2 public health emergencies: COVID-19 and the ongoing opioid crisis. In an attempt to reduce preventable harm to individuals with opioid use disorder (OUD), federal, state, and local governments have temporarily modified law and policy to increase access to OUD treatment and divert some individuals at high risk away from the correctional system. In this Commentary, we briefly describe how people with OUD are at increased risk for COVID-19, discuss existing policy barriers to evidence-based prevention and treatment for individuals with OUD, explain the temporary rollbacks of those barriers, and argue that these changes should be made permanent. We also suggest several additional steps that federal and state governments can urgently take to reduce barriers to care for individuals with OUD, both during the current crisis and beyond.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273953PMC
August 2020

Innovation During COVID-19: Improving Addiction Treatment Access.

J Addict Med 2020 Jul/Aug;14(4):e8-e9

Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI (EAS, LAJK, RSW); Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI (SAC); Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI (CW, RV); The Warren Alpert Medical School of Brown University, Providence, RI (NR).

: During the COVID-19 pandemic, many addiction treatment and harm reduction organizations have had to reduce their hours and services for people with substance use disorders, placing these individuals at increased risk of death. In order to address restricted treatment access during COVID-19, guidance from the Substance Abuse Mental Health Services Administration, the US Drug Enforcement Administration, and the US Department of Health and Human Services has allowed for use of audio-only telehealth encounters for buprenorphine induction without requiring an in-person evaluation or video interface. This has enabled innovations in order to try to meet the needs of the most vulnerable among us during the current pandemic. In this new regulatory environment, we established the Rhode Island Buprenorphine Hotline, a phone hotline which functions as a "tele-bridge" clinic where people with moderate to severe opioid use disorder can be linked with a DATA 2000 waivered provider who can provide an initial assessment and, if appropriate, prescribe buprenorphine for unobserved induction and linkage to outpatient treatment. In this correspondence we briefly share our experience developing this common sense approach to addressing the complex problem of access to treatment only now permissible due to regulatory changes during COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236851PMC
August 2020

Overcoming Barriers to Prescribing Buprenorphine in the Emergency Department.

JAMA Netw Open 2020 05 1;3(5):e204996. Epub 2020 May 1.

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2020.4996DOI Listing
May 2020

Correlates of death during outpatient treatment for opioid use disorder: A national study.

J Subst Abuse Treat 2020 05 15;112:76-85. Epub 2020 Jan 15.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA. Electronic address:

Background: As the burden of opioid use disorder (OUD) increases in the United States, manifold federal and state initiatives have sought to increase access to treatment for OUD, which includes behavioral and pharmaceutical treatment modalities. Although the evidence base for outpatient treatment for OUD-including medications for opioid use disorder-is substantial, few studies have examined the risk factors for fatality during treatment for OUD.

Methods: Treatment Episode Data Set-Discharges (TEDS-D) data were used to evaluate correlates of death during outpatient treatment for OUD in 2016. To determine the correlates of mortality during an outpatient treatment for OUD, we constructed a pooled logistic regression model, stratified by use of medication for opioid use disorder (MOUD), to control for the duration of time in treatment and to identify the independent characteristics that may lead to differences in the odds of mortality during treatment.

Findings: 1861 (0.8%) of 235,745 outpatient treatment episodes for OUD included in our analysis resulted in fatality. Many factors correlated with death during treatment were similar for individuals who did and did not receive MOUD. However, non-White race was only significantly associated with decreases in fatality in non-MOUD treatment episodes. Male sex and reported intravenous drug use at admission were associated with fatality only for treatment episodes that did not involve MOUD.

Conclusions: In this national study of outpatient treatment episodes for OUD, we found differences in age, sex, region, drug use history, treatment setting, and treatment history significantly affected the risk of death during treatment. As more people become engaged with treatment, facilities should work toward delivering optimal treatment for all patients regardless of personal characteristics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2020.01.003DOI Listing
May 2020

Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation.

JAMA Intern Med 2020 05;180(5):653-665

Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.

Importance: Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation.

Objective: To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation.

Design, Setting, And Participants: This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019.

Main Outcomes And Measures: Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation.

Results: A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001).

Conclusions And Relevance: Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamainternmed.2020.0030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042809PMC
May 2020

Randomised clinical trial of an emergency department-based peer recovery support intervention to increase treatment uptake and reduce recurrent overdose among individuals at high risk for opioid overdose: study protocol for the navigator trial.

BMJ Open 2019 11 11;9(11):e032052. Epub 2019 Nov 11.

Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA

Introduction: Effective approaches to increase engagement in treatment for opioid use disorder (OUD) and reduce the risk of recurrent overdose and death following emergency department (ED) presentation for opioid overdose remain unknown. As such, we aim to compare the effectiveness of behavioural interventions delivered in the ED by certified peer recovery support specialists relative to those delivered by licensed clinical social workers (LCSWs) in promoting OUD treatment uptake and reducing recurrent ED visits for opioid overdose.

Methods And Analysis: Adult ED patients who are at high risk for opioid overdose (ie, are being treated for an opioid overdose or identified by the treating physician as having OUD) (n=650) will be recruited from two EDs in a single healthcare system in Providence, Rhode Island into a two-arm randomised trial with 18 months of follow-up postrandomisation. Eligible participants will be randomly assigned (1:1) in the ED to receive a behavioural intervention from a certified peer recovery support specialist or a behavioural intervention from an LCSW. The primary outcomes are engagement in formal OUD treatment within 30 days of the initial ED visit and recurrent ED visits for opioid overdose within 18 months of the initial ED visit, as measured through statewide administrative records.

Ethics And Dissemination: This protocol was approved by the Rhode Island Hospital institutional review board (Approval Number: 212418). Data will be presented at national and international conferences and published in peer-reviewed journals.

Trial Registration Number: NCT03684681.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-032052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858243PMC
November 2019

Reflection: An Ecologic Model of Social Emergency Medicine.

Ann Emerg Med 2019 11;74(5S):S71-S73

Alpert Medical School, Brown University, Providence, RI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2019.08.463DOI Listing
November 2019

Will Emergency Holds Reduce Opioid Overdose Deaths?

N Engl J Med 2019 Nov 16;381(19):1795-1797. Epub 2019 Oct 16.

From the Departments of Emergency Medicine (E.A.S., O.U.W.) and Psychiatry and Human Behavior (P.P.C.), Warren Alpert Medical School, Brown University, Providence, RI; and the Network for Public Health Law, Los Angeles (C.S.D.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMp1907692DOI Listing
November 2019

Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm.

Am J Public Health 2019 11 19;109(11):1564-1567. Epub 2019 Sep 19.

Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI.

The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2019.305268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775926PMC
November 2019

The AAMC Standardized Video Interview and the Electronic Standardized Letter of Evaluation in Emergency Medicine: A Comparison of Performance Characteristics.

Acad Med 2019 10;94(10):1513-1521

L.R. Hopson is emergency medicine residency program director and associate professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-1183-4751. L. Regan is emergency medicine residency program director, vice chair for education, and associate professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0390-4243. M.C. Bond is emergency medicine residency program director and associate professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5527-6758. J. Branzetti is emergency medicine residency program director, Department of Emergency Medicine, New York University School of Medicine, New York, New York; ORCID: http://orcid.org/0000-0002-2397-0566. E.A. Samuels is assistant professor of emergency medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; ORCID: https://orcid.org/0000-0003-2414-110X. B. Naemi is manager, Admissions and Selection Research, Association of American Medical Colleges, Washington, DC. D. Dunleavy is director, Admissions and Selection Research, Association of American Medical Colleges, Washington, DC. M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6800-3932.

Purpose: To compare the performance characteristics of the electronic Standardized Letter of Evaluation (eSLOE), a widely used structured assessment of emergency medicine (EM) residency applicants, and the Association of American Medical Colleges (AAMC) Standardized Video Interview (SVI), a new tool designed by the AAMC to assess interpersonal and communication skills and professionalism knowledge.

Method: The authors matched EM residency applicants with valid SVI total scores and completed eSLOEs in the 2018 Match application cycle. They examined correlations and group differences for both tools, United States Medical Licensing Examination (USMLE) Step exam scores, and honor society memberships.

Results: The matched sample included 2,884 applicants. SVI score and eSLOE global assessment ratings demonstrated small positive correlations approaching r = 0.20. eSLOE ratings had higher correlations with measures of academic ability (USMLE scores, academic honor society membership) than did SVI scores. Group differences were minimal for the SVI, with scores slightly favoring women (d = -0.21) and US-MD applicants (d = 0.23-0.42). Group differences in eSLOE ratings were small, favoring women over men (approaching d = -0.20) and white applicants over black applicants (approaching d = 0.40).

Conclusions: Small positive correlations between SVI score and eSLOE global assessment ratings, alongside varying correlations with academic ability indicators, suggest these are complementary tools. Findings suggest the eSLOE is subject to similar sources and degrees of bias as other common assessments; these group differences were not observed with the SVI. Further examination of both tools is necessary to understand their ability to predict clinical performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000002889DOI Listing
October 2019

Emergency Departments as Barometers for Prescription Opioid Morbidity and Mortality.

Am J Public Health 2019 05;109(5):655-656

Elizabeth A. Samuels is with the Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2019.305045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459661PMC
May 2019

Corrigendum to "Peer navigation and take-home naloxone for opioid overdose emergency department patients: Preliminary patient outcomes" [J. Subst. Abus. Treat. 94 (2018 Nov) 29-34].

J Subst Abuse Treat 2019 Apr 16;99. Epub 2019 Jan 16.

Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street, Suite 100, Providence, RI, United States; Injury Prevention Center, Rhode Island Hospital, 55 Claverick Street, 2nd Floor, Providence, RI, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2019.01.008DOI Listing
April 2019

Looking Through the Prism: Comprehensive Care of Sexual Minority and Gender-nonconforming Patients in the Acute Care Setting.

AEM Educ Train 2018 Dec 23;2(Suppl Suppl 1):S82-S84. Epub 2018 Oct 23.

Department of Emergency Medicine Warren Alpert Medical School Brown University Providence RI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/aet2.10128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304274PMC
December 2018

Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017-2018.

Am J Public Health 2019 02 20;109(2):263-266. Epub 2018 Dec 20.

Elizabeth A. Samuels is with the National Clinician Scholars Program, Yale School of Medicine, New Haven, CT; and the Rhode Island Department of Health, Providence. James V. McDonald, Meghan McCormick, Jennifer Koziol, and Nicole Alexander-Scott are with the Rhode Island Department of Health, Providence. Catherine Friedman is with the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston.

In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. These standards prescribe three levels of hospital and emergency department treatment and prevention of opioid use disorder and opioid overdose and mechanisms for referral to treatment and epidemiological surveillance. By June 2018, all Rhode Island licensed acute care facilities had implemented policies meeting the standards' requirements. This policy has standardized care for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2018.304847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336059PMC
February 2019

A Quality Framework for Emergency Department Treatment of Opioid Use Disorder.

Ann Emerg Med 2019 03 11;73(3):237-247. Epub 2018 Oct 11.

Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address:

Emergency clinicians are on the front lines of responding to the opioid epidemic and are leading innovations to reduce opioid overdose deaths through safer prescribing, harm reduction, and improved linkage to outpatient treatment. Currently, there are no nationally recognized quality measures or best practices to guide emergency department quality improvement efforts, implementation science researchers, or policymakers seeking to reduce opioid-associated morbidity and mortality. To address this gap, in May 2017, the National Institute on Drug Abuse's Center for the Clinical Trials Network convened experts in quality measurement from the American College of Emergency Physicians' (ACEP's) Clinical Emergency Data Registry, researchers in emergency and addiction medicine, and representatives from federal agencies, including the National Institute on Drug Abuse and the Centers for Medicare & Medicaid Services. Drawing from discussions at this meeting and with experts in opioid use disorder treatment and quality measure development, we developed a multistakeholder quality improvement framework with specific structural, process, and outcome measures to guide an emergency medicine agenda for opioid use disorder policy, research, and clinical quality improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2018.08.439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817947PMC
March 2019

Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches.

Addict Behav 2019 02 25;89:85-91. Epub 2018 Sep 25.

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, United States. Electronic address:

Background: Rhode Island has the tenth highest rate of accidental drug overdose deaths in the United States. In response to this crisis, Anchor Recovery Center, a community-based peer recovery program, developed programs deploying certified Peer Recovery Specialists to emergency departments (AnchorED) and communities with high rates of accidental opioid overdoses (AnchorMORE).

Objectives: The purpose of this paper is to describe AnchorED and AnchorMORE's activities and implementation process.

Methods: AnchorED data were analyzed from a standard enrollment questionnaire that includes participant contact information, demographics, and a needs assessment. The AnchorED program outcomes include number of clients enrolled, number of naloxone training sessions, and number of referrals to recovery and treatment services. Overdose deaths and naloxone distribution through AnchorMORE were mapped using Tableau software.

Results: From July 2016-June 2017, AnchorED had 1329 contacts with patients visiting an emergency department for reported substance misuse cases or suspected overdose. Among the contacts, 88.7% received naloxone training and 86.8% agreed to continued outreach with a Peer Recovery Specialist after their ED discharge. Of those receiving peer recovery services from the Anchor Recovery Community Center, 44.7% (n = 1055/2362) were referred from an AnchorED contact. From July 2016-June 2017, AnchorMORE distributed 854 naloxone kits in high-risk communities and provided 1311 service referrals.

Conclusion: These findings indicate the potential impact peer recovery programs may have on engaging high-risk populations in treatment, overdose prevention, and other harm reduction activities. Additional research is needed to evaluate the reach of implementation and services uptake.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.addbeh.2018.09.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240389PMC
February 2019
-->