Publications by authors named "Shannon Gwin Mitchell"

87 Publications

Creative Approaches for Assessing Long-term Outcomes in Children.

Pediatrics 2021 Jul;148(Suppl 1):s25-s32

Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.

Advances in new technologies, when incorporated into routine health screening, have tremendous promise to benefit children. The number of health screening tests, many of which have been developed with machine learning or genomics, has exploded. To assess efficacy of health screening, ideally, randomized trials of screening in youth would be conducted; however, these can take years to conduct and may not be feasible. Thus, innovative methods to evaluate the long-term outcomes of screening are needed to help clinicians and policymakers make informed decisions. These methods include using longitudinal and linked-data systems to evaluate screening in clinical and community settings, school data, simulation modeling approaches, and methods that take advantage of data available in the digital and genomic age. Future research is needed to evaluate how longitudinal and linked-data systems drawing on community and clinical settings can enable robust evaluations of the effects of screening on changes in health status. Additionally, future studies are needed to benchmark participating individuals and communities against similar counterparts and to link big data with natural experiments related to variation in screening policies. These novel approaches have great potential for identifying and addressing differences in access to screening and effectiveness of screening across population groups and communities.
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http://dx.doi.org/10.1542/peds.2021-050693FDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287841PMC
July 2021

Organizational Acceptability of Implementing SBIRT for Adolescents in Primary Care.

Subst Use Misuse 2021 1;56(10):1536-1542. Epub 2021 Jul 1.

Friends Research Institute, Baltimore, MD, USA.

Introduction: Adolescent illicit drug, tobacco, and alcohol use can result in sudden and long-term negative health consequences. Primary care environments present the optimal opportunity for screening and brief interventions that target prevention and curtailing use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a service delivery method that could potentially be well-integrated into primary care settings and used to serve a high volume of adolescents. : This qualitative analysis of clinic staff interviews ( = 20), collected during a large cluster-randomized trial to implement two models of adolescent SBIRT, examined barriers and facilitating factors to overall acceptability of SBIRT. This study was conducted in a large, urban Federally Qualified Health Center (FQHC) at 7 sites throughout Baltimore City, Maryland, USA. Participants from each clinic included a range of various roles and responsibilities including: medical assistants ( = 3), nurses ( = 3), primary care providers ( = 4), behavioral health counselors ( = 4), and administrators ( = 6). : Results indicate both barriers and facilitating factors for acceptability of SBIRT in terms of (1) universal screening, (2) provider time demands, (3) behavioral health collaboration, and (4) behavioral health caseloads. : Universal screening was acceptable to participants across organizational roles, but brief interventions and referrals to treatment were found substantially less acceptable.
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http://dx.doi.org/10.1080/10826084.2021.1942054DOI Listing
July 2021

Views of barriers and facilitators to continuing methadone treatment upon release from jail among people receiving patient navigation services.

J Subst Abuse Treat 2021 Aug 4;127:108351. Epub 2021 Mar 4.

Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address:

Background: Patient navigation has potential for assisting patients who initiate methadone during pretrial detention to enter and remain in treatment following release, but we know little about participants' experiences with this service.

Methods: This study drew a purposive sample of male and female participants (N = 17) from participants enrolled in a randomized trial of initiating methadone with vs. without patient navigation while in the Baltimore City Detention Center. The study interviewed participants in the community at 1 and 3 months following release and asked them about their experiences of reentry, methadone treatment continuation, drug use, and interactions with the patient navigator. The study recorded, transcribed, coded using Atlas.ti, and analyzed thematically the interviews.

Results: Participants reported encountering four key challenges in the community: getting to treatment following release, assembling basic supports, managing criminal justice system demands, and staying in treatment. Participants' experiences of the patient navigator's support to address these challenges fell into six thematic groups: showing nonjudgmental caring and persistence, advocating within programs, brokering resources, managing interactions with the criminal justice system, balancing encouragement and self-determination, and offering genuine and familial-type support.

Conclusion: Nearly all participants appreciated the navigator's support and deemed it helpful. The previously reported randomized trial found that participants assigned to initiate methadone treatment with navigation had higher rates of receiving their first "guest" methadone dose in the community but did not have significantly different rates of treatment enrollment or of illicit opioid use compared to those assigned to begin methadone treatment without navigation. Treatment programs should work to improve retention and postrelease outcomes among this population.
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http://dx.doi.org/10.1016/j.jsat.2021.108351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217714PMC
August 2021

Drug and sexual HIV-risk behaviors among adolescents and young adults with opioid use disorder.

J Subst Abuse Treat 2021 May 19;130:108477. Epub 2021 May 19.

Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.

Opioid use disorder (OUD) among adolescents and young adults (youth) is associated with drug use and sexual HIV-related risk behaviors and opioid overdose. This mixed methods analysis assesses risk behaviors among a sample of 15-21-year-olds (N = 288) who were being treated for OUD in a residential drug treatment program in Baltimore, Maryland. Participants were enrolled in a parent study in which they received either extended-release naltrexone (XR-NTX) or Treatment as Usual (TAU), consisting of outpatient counseling with or without buprenorphine, prior to discharge. At baseline, participants were administered the HIV-Risk Assessment Battery (RAB), and clinical intake records were reviewed to determine participants' history of sexual, physical, or other abuse, as well as parental and partner substance use. A sub-sample of study participants completed semi-structured qualitative interviews (N = 35) at baseline, three-, and six-month follow-up periods. This analysis identified gender (e.g., female IRR = 1.63, CI 1.10-2.42, p = .014), the experience of dependence (e.g., previous detoxification IRR = 1.08, CI 1.01-1.15, p = .033) and withdrawal (e.g., severe withdrawal symptoms IRR = 1.41, CI 1.08-1.84, p = .012), and the role of relationships (e.g., using with partner IRR = 2.45, CI 1.15-5.22, p = .021) as influencing high-risk substance use behaviors. Similarly, high-risk sex was influenced by gender (e.g., female IRR = 1.43, CI 1.28-1.59, p < .001), and the role of relationships (e.g., using with partner IRR = 0.78, CI 0.62-0.98, p = .036). These are key targets for future prevention, treatment, and intervention.
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http://dx.doi.org/10.1016/j.jsat.2021.108477DOI Listing
May 2021

Extended-release naltrexone for youth with opioid use disorder.

J Subst Abuse Treat 2021 Apr 15;130:108407. Epub 2021 Apr 15.

Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA. Electronic address:

Background: Few published research studies have examined the effectiveness of extended-release naltrexone (XR-NTX) for the treatment of opioid use disorder (OUD) among adolescents and young adults.

Methods: This two-group randomized controlled trial recruited 288 youth, ages 15-21, with moderate/severe OUD from a residential addiction treatment program in Baltimore, Maryland. The study randomized the youth within the first week of treatment entry to receive either XR-NTX or treatment-as-usual (TAU; either buprenorphine maintenance treatment or treatment without OUD medication following medically managed withdrawal) prior to discharge, with continued treatment in the community for 6 months. However, due to various reasons spanning patients' and caregivers' preferences and constraints, considerable participant nonadherence to randomized condition occurred (i.e., only 30% of the participants randomized to XR-NTX received an initial injection, while 27% of participants randomized to TAU received an XR-NTX injection at treatment discharge, instead of their assigned treatment). The study used generalized linear mixed modeling (GLiMM) to examine self-reported 90-day opioid, cocaine, marijuana, and alcohol use as well as DSM-5 OUD criteria on "intention-to-treat" (as randomized), "as-received" (XR-NTX vs. not XR-NTX), and "as-medicated" (XR-NTX vs. buprenorphine vs. no medication) bases.

Results: The condition x time interactions in the intention-to-treat analyses failed to reach significance for past-90-day self-reported use of illicit opioids, cocaine, marijuana, or alcohol, or in meeting DSM-5 OUD criteria at 3 or 6 months [all ps > 0.05]. However, these findings are of limited interpretive value due to participant nonadherence to their randomized condition. When the study analyzed results by the treatment received at discharge, the "as-received" group x time interaction for illicit opioid use was significant [p = .003], with the XR-NTX group reporting less opioid use in the past 90 days at 3 and 6 months. Participants who received their first XR-NTX dose at inpatient discharge (n = 82) received, on average, 1.3 subsequent injections in the community over the 6-month study follow-up period. Only 2 of the 82 study participants received XR-NTX continuously through the 6-month postdischarge follow-up period. Twelve serious adverse events (SAEs) occurred during the study, but the study determined that only 1 was possibly study related (hepatitis C/elevated liver function test results).

Conclusion: None of the condition x time interactions in the intention-to-treat analyses reached significance. Participants' nonadherence may have contributed to the failure to reject the null hypothesis. Irrespective of randomized condition, participants who received XR-NTX for OUD demonstrated low retention in treatment, receiving an average of only 1.3 subsequent injections, yet reported less opioid use at follow-up than participants who did not received XR-NTX. Treatment programs should consider XR-NTX as a treatment option for youth motivated to receive it. Future research should focus on building developmentally informed strategies to improve uptake of and adherence to relapse prevention medication in this population.
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http://dx.doi.org/10.1016/j.jsat.2021.108407DOI Listing
April 2021

Until there's nothing left: Caregiver resource provision to youth with opioid use disorders.

Subst Abus 2021 Mar 24:1-8. Epub 2021 Mar 24.

Friends Research Institute, Inc, Baltimore, Maryland, USA.

Despite the considerable literature associating certain characteristics of caregivers and family structures with risks of adolescent/young adult (youth) substance use, there has been little study of the role of caregivers in opioid use disorder (OUD) treatment outcomes. This qualitative study sought to understand and contextualize the factors that influenced the resources caregivers provided their youth after residential treatment. In order to improve understandings of the role caregivers play both during and after residential OUD treatment, 31 caregivers of youth who were in a residential substance use disorder treatment center were interviewed at baseline, three-months, and six-months following their youth's discharge. This analysis focused on the provision of caregiver resources and identified three key influences - OUD understandings and expectations, relationships with youth, and the emotional toll on caregivers. This has important implications as residential treatment success rates are relatively low among this population. These findings suggest that engagement of caregivers and families in outpatient care following residential treatment could offer an important opportunity for interventions that promote youth recovery.
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http://dx.doi.org/10.1080/08897077.2021.1901178DOI Listing
March 2021

A clinical protocol of a comparative effectiveness trial of extended-release naltrexone versus extended-release buprenorphine with individuals leaving jail.

J Subst Abuse Treat 2020 Dec 11:108241. Epub 2020 Dec 11.

Behavioral Health System Baltimore, 100 S. Charles Street, Tower II, 8th Floor, Baltimore, MD 21201, United States of America. Electronic address:

This study is a randomized, open label, controlled trial of extended-release buprenorphine (XR-B; BRIXADI™ formulation) versus extended-release naltrexone (XR-NTX) in Maryland jails. A 7-site, open-label, equivalence design will randomly assign 240 adults with a history of opioid use disorder (OUD), stratified by gender and jail, who are nearing release to one of two treatment arms: 1) XR-B in jail or 2) XR-NTX in jail, both followed by 6 monthly injections postrelease at a community treatment program. The primary aim is to determine the rate of pharmacotherapy adherence (number of monthly injections received) of XR-B compared to XR-NTX. The proposed study is innovative because it will be the first randomized clinical trial in the U.S. assessing the effectiveness of receiving XR-B vs. XR-NTX in county jails. The public health impact of the study will be highly significant and far-reaching because most individuals with OUD do not receive treatment while incarcerated, thereby substantially raising their likelihood of relapse to drug use, overdose death, and re-incarceration. Understanding how to expand acceptance of medications for OUD in jails, particularly extended-release medications, and supporting treatment engagement and medication adherence in transition to the community, has far-reaching implications for improving treatment access and success in this population.
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http://dx.doi.org/10.1016/j.jsat.2020.108241DOI Listing
December 2020

Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers.

Drug Alcohol Depend 2021 01 23;218:108423. Epub 2020 Nov 23.

University of Maryland Baltimore County, Catonsville MD, Dept. of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States.

Background: This study examined approaches to delivering brief interventions (BI) for risky substance use and sexual behaviors in school-based health centers (SBHCs).

Methods: 300 Adolescents (ages 14-18; 54 % female) with risky marijuana and/or alcohol use identified via CRAFFT screening (scores >1) were recruited from two SBHCs and randomized to computer-delivered BI (CBI) or nurse practitioner-delivered BI (NBI). Both BIs included motivational and didactic content targeting marijuana, alcohol, and risky sexual behaviors. Assessments at baseline, 3-month, and 6-month follow-up included past 30-day frequency of marijuana use, alcohol use, binge drinking, unprotected sex, and sex while intoxicated; marijuana and alcohol problems; and health-related quality-of-life (HRQoL). A focused cost-effectiveness analysis was conducted. An historical 'assessment-only' cohort (N=50) formed a supplementary quasi-experimental comparison group.

Results: There were no significant differences between NBI and CBI on any outcomes considered (e.g., days of marijuana use; p=.26). From a cost-effectiveness perspective, CBI was 'dominant' for HRQoL and marijuana use. Participants' satisfaction with BI was significantly higher for NBI than CBI. Compared to the assessment-only cohort, participants who received a BI had lower frequency of marijuana (3-months: Incidence Rate Ratio [IRR] = .74 [.57, .97], p=.03), alcohol (3-months: IRR = .43 [.29, .64], p<.001; 6-months: IRR = .58 [.34, .98], p = .04), alcohol-specific problems (3-months: IRR = .63 [.45, .89], p=.008; 6-months: IRR = .63 [.41, .97], p = .04), and sex while intoxicated (6-months: IRR = .42 [.21, .83], p = .013).

Conclusions: CBI and NBI did not yield different risk behavior outcomes in this randomized trial. Supplementary quasi-experimental comparisons suggested potential superiority over assessment-only. Both NBI and CBI could be useful in SBHCs.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108423DOI Listing
January 2021

Opioid overdose experiences in a sample of US adolescents and young adults: a thematic analysis.

Addiction 2021 04 31;116(4):865-873. Epub 2020 Aug 31.

Friends Research Institute, Baltimore, USA.

Background And Aims: Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences.

Design: This study involved thematic analysis of interviews undertaken as part of a mixed-methods, randomized trial of extended release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for adolescents and young adults (aged 15-21 years) with opioid use disorder (OUD).

Setting: Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA.

Participants/cases: As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment.

Measurements: Semi-structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook.

Findings: Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network.

Conclusions: The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself.
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http://dx.doi.org/10.1111/add.15216DOI Listing
April 2021

Leveraging health information exchange for clinical research: Extreme underreporting of hospital service utilization among patients with substance use disorders.

Drug Alcohol Depend 2020 07 27;212:107992. Epub 2020 Apr 27.

Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.

Background: Substance use disorders are associated with inefficient and fragmented use of healthcare services. The Chesapeake Regional Information System for Our Patients, Inc. (CRISP) is a Health Information Exchange (HIE) linking disparate systems of care in the mid-Atlantic region.

Methods: This article describes applications of HIE for tracking hospital service utilization in substance use disorder clinical and services research, drawing upon data from one of the first studies approved to access the CRISP HIE. Participants were 200 medical/surgical inpatients with comorbid opioid, cocaine, and/or alcohol use disorder (45.5 % female; 56.5 % black; 77.5 % opioid use disorder; 42.0 % homeless). This study compared HIE-identified hospital service utilization with conventional methods of participant self-report during in-person research follow-ups (3-, 6-, and 12-months post-discharge) and electronic health record (EHR) review from the hospital system of the index admission.

Results: This sample exhibited high levels of hospital utilization, which would have been underestimated using conventional methods. Relying exclusively on self-report in the 12-month observation period would have identified only 33.8 % of 429 inpatient hospitalizations and 9.0 % of 1,287 ED visits, due to both loss-to-follow-up and failure to report events. Even combining self-report with single-system EHR review identified only 66.2 % of inpatient hospitalizations and 59.8 % of ED visits.

Conclusions: CRISP HIE data were superior to conventional methods for ascertaining hospital service utilization in this sample of patients exhibiting high-volume and fragmented care. The use of HIE holds implications for improving rigor, safety, and efficiency in research studies.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.107992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299087PMC
July 2020

One million screened: Scaling up SBIRT and buprenorphine treatment in hospital emergency departments across Maryland.

Am J Emerg Med 2020 07 6;38(7):1466-1469. Epub 2020 Mar 6.

Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.

Purpose: Identification of problematic alcohol use and substance use in the population has been a clinical challenge, especially during the heightened years of the opioid epidemic. Bringing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to scale in medical settings, such as hospital emergency departments (EDs) could facilitate broad identification of substance use disorders, timely delivery of brief interventions, and successful linkages to treatment.

Procedures: This large-scale data analysis pulled electronic health record (EHR) data from 23 hospitals in the state of Maryland for over 1 million patient visits between July 2014 and November 2018.

Findings: Of the 1,097,142 ED patients screened, 17.2% screened positive for problematic alcohol or any drug use in the previous 12 months. During this same period, 79,899 brief interventions were delivered, 15,961 referrals to outpatient treatment were made and 38.3% of those were successfully linked to treatment. Of the 950 patients exhibiting withdrawal symptoms, over two-thirds patients (70.1%; n = 666) were administered buprenorphine, 94.6% (n = 630) accepted a referral to buprenorphine treatment in the community, and 64.6% (n = 430) attended their first outpatient buprenorphine treatment visit. A total of 2382 patients presented to the ED with a suspected opioid overdose, over half were referred to the intervention program (53.8%) and 63.2% were successfully engaged by the PRCs in the ED.

Conclusions: This analysis supports the scalability of SBIRT in hospital EDs and presents an implementation model that can be replicated in EDs nationwide.
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http://dx.doi.org/10.1016/j.ajem.2020.03.005DOI Listing
July 2020

Adolescent SBIRT implementation: Generalist vs. Specialist models of service delivery in primary care.

J Subst Abuse Treat 2020 04 20;111:67-72. Epub 2020 Jan 20.

University of North Carolina at Wilmington, Wilmington, NC, United States of America.

Background: Drug, alcohol, and tobacco use among adolescents pose significant short- and long-term health consequences and are associated with more severe use as adults. Screening, brief intervention, and referral to treatment in primary care settings has the potential to deliver preventive interventions to a diverse range of adolescents, but optimal implementation of these services needs to be determined. The purpose of this study was to compare implementation of two different SBIRT service delivery models in primary care settings.

Methods: This cluster-randomized trial assigned 7 primary care clinics of a federally qualified health center to implement brief interventions (BI) using a Generalist model (4 sites), in which BIs were delivered by the primary care provider (PCP), or a Specialist model (3 sites), in which BIs were delivered by a behavioral health counselor (BHC) for adolescent patients ages 12-17 years. Implementation was tracked through the clinic's electronic health record, spanning 9639 clinic visits over 20 months. Multilevel logistic regression modeling was used to compare Generalist and Specialist strategies on penetration of BI for patients scoring ≥2 on the CRAFFT substance use screen, delivered by the PCP in the Generalist sites, and via warm hand-off to a BHC in the Specialist sites.

Results: Approximately 62% of adolescent patient visits were screened with the CRAFFT (with <4% screening positive with a CRAFFT score ≥ 2). The Generalist Condition had significantly higher self-reported penetration of BI delivery than the Specialist Condition (38% vs. 8%; Adjusted Odds Ratio = 6.53; p = .005).

Discussion: Despite having co-located behavioral health services at all sites, a Specialist approach to providing BI was less effectively implemented than a Generalist approach in this FQHC. BI delivered by PCPs rather than by hand-off to a BHC may ensure greater penetration of these services in primary care settings. Both implementation models provided a framework for identifying and intervening with adolescent primary care patients whose substance use might have otherwise gone undetected.
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http://dx.doi.org/10.1016/j.jsat.2020.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039979PMC
April 2020

Fentanyl exposure and preferences among individuals starting treatment for opioid use disorder.

Drug Alcohol Depend 2019 11 30;204:107515. Epub 2019 Aug 30.

Powell Recovery Center, 14 S. Broadway, Baltimore, MD, 21231, USA.

Background: Fentanyl has become widespread in the illicit opioid supply, and is a major driver of overdose mortality.

Methods: This study used a medical records review at a community opioid use disorder treatment program to examine patient-level correlates of fentanyl exposure as measured by urine testing at admission (N= 1,174). Additionally, an anonymous survey was conducted with 114 patients about their experiences and preferences regarding fentanyl.

Results: Overall, 39% of patients entering treatment tested positive for fentanyl. Prevalence of fentanyl exposure differed based on other drug test results (fentanyl-positive = 81.1% vs. 15.4% among participants positive vs. negative for heroin/opioids, p < .001; 59.0% vs. 38.3% among participants positive vs. negative for methadone, p = .001; 53.8% vs. 24.9% among participants positive vs. negative for cocaine, p < .001), prior addiction treatment (40.6% vs. 32.0% among participants with vs. without prior treatment, p < .05), and mental health (36.7% vs. 43.1% among participants with vs. without co-occurring psychiatric diagnosis, p < .05). Most participants reported knowingly using fentanyl (56.1%) and knowing people who prefer fentanyl as a drug of choice (65.8%). Preference for fentanyl (alone or mixed with heroin) was expressed by 44.7% of participants. Participants thought fentanyl withdrawal had faster onset (53.5%), greater severity (74.8%), and longer duration (62.0%) than heroin withdrawal.

Conclusions: Recent opioid and cocaine use were strongly associated with fentanyl exposure in this sample. Although fentanyl exposure is often unintentional, there may be a subgroup of individuals who come to prefer fentanyl. Future research should examine the relationship between fentanyl use, patient preferences for fentanyl, and treatment outcomes.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.06.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227777PMC
November 2019

Application of System Dynamics to Inform a Model of Adolescent SBIRT Implementation in Primary Care Settings.

J Behav Health Serv Res 2020 04;47(2):230-244

Friends Research Institute, Baltimore, MD, USA.

System dynamics (SD) modeling is used to compare and contrast strategies for effective implementation of an evidence-based adolescent behavioral health treatment in primary care settings. With qualitative and quantitative data from an on-going cluster-randomized trial in 7 federally qualified health center sites, two implementation conditions were compared: generalist vs. specialist. In the generalist approach, the primary care provider (PCP) delivered brief intervention (BI) for substance misuse (n = 4 clinics). In the specialist approach, BIs were delivered by behavioral health counselors (BHCs) (n = 3 clinics). The resultant SD model compared 'basecase' dynamics to strategic approaches to deploying continuous technical assistance (TA) and performance feedback reporting (PFR). The basecase effectively represented the SBIRT intervention, which reflected actual monthly volume of adolescent primary care visits (N = 9639), screenings (N = 5937), positive screenings (N = 246), and brief interventions (BIs; N = 50) over the 20-month implementation period. Insights gained suggest that implementation outcomes are sensitive to frequency of PFR, with bimonthly events generating the most rapid and sustained screening results. Simulated trends indicated that availability of the BHC directly impacts success of the specialist model. Similarly, understanding PCPs' perception of severity of need for intervention is key to outcomes in either condition.
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http://dx.doi.org/10.1007/s11414-019-09650-yDOI Listing
April 2020

A Comparison of Screening Practices for Adolescents in Primary Care After Implementation of Screening, Brief Intervention, and Referral to Treatment.

J Adolesc Health 2019 07 6;65(1):46-50. Epub 2019 Mar 6.

University of North Carolina at Wilmington, Wilmington, North Carolina.

Purpose: The American Academy of Pediatrics recommends screening adolescents for substance use at all well-child and appropriate acute-care visits. However, many pediatric practices aim for such screenings annually at well-child visits.

Methods: As part of a larger study, 7 urban Federally Qualified Health Center clinics implemented universal screening for risky alcohol and drug use using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. The present study compared uptake of screening and screening results at well-child versus acute-care visits.

Results: Over a period of 13 months for which encounter-level electronic medical records data were available, there were 6,346 clinic visits by 3,475 unique patients aged 12-17 years, at which 76.6% (n = 4,865) of visits had a screening for problematic substance use conducted. Rates of screening were 95.1% (2,750/2,891 involving 2,629 unique adolescents) for well-child visits and 61.2% (2,115/3,455 involving 1,535 unique adolescents) for acute-care visits. Rates of positive screening results were 9.0% (248/2,750 involving 245 unique adolescents) for well-child visits and 7.8% (164/2,115 involving 126 unique adolescents) for acute-care visits. Of the 469 unique adolescents screened only during an acute-care visit during that same period, 40 unique adolescents had positive screening results for a positive screening rate of 8.5%.

Conclusions: Nearly 10% of adolescent patients screened only at acute-care visits would not have been screened if screening was implemented solely at well-child visits, and 40 adolescents reporting substance use would have been missed. The findings highlight the benefits of screening adolescents at every primary care visit to better detect and intervene in adolescents' substance use.
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http://dx.doi.org/10.1016/j.jadohealth.2018.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589381PMC
July 2019

Initiating methadone in jail and in the community: Patient differences and implications of methadone treatment for reducing arrests.

J Subst Abuse Treat 2019 02 19;97:7-13. Epub 2018 Nov 19.

Friends Research Institute, Baltimore, MD, USA.

The extent to which patient characteristics differ between individuals entering methadone treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared treatment-entry characteristics of participants enrolling in methadone treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting methadone treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based treatment. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov NCT 02334215 and NCT 01442493.
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http://dx.doi.org/10.1016/j.jsat.2018.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310067PMC
February 2019

Pharmacotherapy for opioid addiction in community corrections.

Int Rev Psychiatry 2018 10 6;30(5):117-135. Epub 2018 Dec 6.

a Friends Research Institute , Baltimore , MD , USA.

Pharmacotherapy for opioid addiction with methadone, buprenorphine, and naltrexone has proven efficacy in reducing illicit opioid use. These treatments are under-utilized among opioid-addicted individuals on parole, probation, or in drug courts. This paper examines the peer-reviewed literature on the effectiveness of pharmacotherapy for opioid addiction of adults under community-based criminal justice supervision in the US. Compared to general populations, there are relatively few papers addressing the separate impact of pharmacotherapy on individuals under community supervision. Tentative conclusions can be drawn from the extant literature. Reasonable evidence exists that illicit opioid use and self-reported criminal behaviour decline after treatment entry, and that these outcomes are as favourable among individuals under criminal justice supervision as the general treatment population. Surprisingly, there is no conclusive evidence regarding the extent to which pharmacotherapy impacts the likelihood of arrest and incarceration among individuals under supervision. However, given the proven efficacy of these three medications in reducing illicit opioid use and the evidence that, in the general population, methadone and buprenorphine treatment are associated with reduction in overdose mortality, the use of all three pharmacotherapies among patients under criminal justice supervision should be expanded while more data are collected on their impact on arrest and incarceration.
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http://dx.doi.org/10.1080/09540261.2018.1524373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551322PMC
October 2018

How patient navigators view the use of financial incentives to influence study involvement, substance use, and HIV treatment.

J Subst Abuse Treat 2018 11 22;94:18-23. Epub 2018 Jul 22.

Department of Sociomedical Sciences, Mailman School of public Health, Columbia University, 722 West 168th St. 9th floor, New York, NY 10032, USA.

Background And Aims: While patient navigation has been shown to be an effective approach for linking persons to HIV care, and contingency management is effective at improving substance use-related outcomes, Project HOPE combined these two interventions in a novel way to engage HIV-positive patients with HIV and substance use treatment. The aims of this paper are to examine patient navigator views regarding how contingency management interacted with and affected their navigation process.

Design: Semi-structured qualitative interviews.

Participants: 22 patient navigators from the original 10 Project HOPE study sites.

Measurements: Individual, semi-structured interviews lasting approximately 60 min addressed the patient navigator's professional background, descriptions of the participant population, substance use disorder versus HIV treatment entry and engagement issues, and the use of contingency management within the navigation service delivery protocol.

Findings: Patient navigators believed that financial incentives helped motivate participant attendance at navigation sessions, particularly early in study involvement, which helped them to establish rapport and develop relationships with participants. Patient navigators often noted that financial incentives positively influenced targeted HIV health-related behaviors, such as attending medical appointments, which provided a rapid pay-off with an escalating sum. Contingency management was more complex when used by the patient navigators for substance use-related behaviors, particularly when incentives revolved around negative urine screening. Patient navigators noted that not all participants responded the same way to the contingency management and that the incentives were particularly helpful when participants were financially strained with limited resources or when internal motivation was lacking.

Conclusions: Overall patient navigators found the inclusion of contingency management to be helpful and affective at influencing participant behaviors, particularly concerning navigation session attendance and HIV healthcare-related participation. However, issues and concerns surrounding the inclusion of contingency management for drug-related behaviors as delivered in Project HOPE were noted.

Clinical Trials Registration: NCT01612169.
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http://dx.doi.org/10.1016/j.jsat.2018.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404543PMC
November 2018

Commentary on "The More Things Change: Buprenorphine/Naloxone Diversion Continues While Treatment is Inaccessible".

J Addict Med 2018 Nov/Dec;12(6):424-425

Friends Research Institute, Baltimore, MD.

: This commentary puts the recent findings by Carroll et al into historical perspective, noting both the long-held problem of medication diversion when pharmacotherapy access is limited, and the ways in which medication diversion concerns and regulations help create those treatment access barriers. Recent efforts to bridge the treatment gap, including increases in Federal funding through the 21st Century Cures Act and expanding the buprenorphine patient cap and scope of eligible providers under the Comprehensive Addiction Recovery Act (CARA) will likely help; however, important structural barriers remain. Health insurance barriers, including limited Medicaid coverage, combined with stigma against pharmacotherapy persist, which likely means that people in need of treatment will continue to self-treat their symptoms with diverted medications, such as the buprenorphine/naloxone use noted by Carroll and colleagues.
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http://dx.doi.org/10.1097/ADM.0000000000000437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214742PMC
March 2020

Start-Up Costs of SBIRT Implementation for Adolescents in Urban U.S. Federally Qualified Health Centers.

J Stud Alcohol Drugs 2018 05;79(3):447-454

Friends Research Institute, Baltimore, Maryland.

Objective: Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model.

Method: SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used.

Results: The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement.

Conclusions: The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005259PMC
http://dx.doi.org/10.15288/jsad.2018.79.447DOI Listing
May 2018

Treatment outcomes among a cohort of African American buprenorphine patients: Follow-up at 12 months.

Am J Drug Alcohol Abuse 2018 2;44(6):604-610. Epub 2018 May 2.

a Friends Research Institute , Baltimore , MD, USA.

Background: Although buprenorphine/naloxone (bup/nal) is well-established as a safe and effective treatment for opioid use disorders (OUDs), there are few studies reporting 12-month outcomes of patients receiving bup/nal in formerly drug-free outpatient programs.

Objectives: To examine 12-month outcomes by bup/nal treatment enrollment status among a cohort of African American patients enrolled in a clinical trial.

Methods: This analysis builds upon a randomized trial of 300 opioid-dependent African American bup/nal patients in two outpatient programs in Baltimore, MD. A subset of participants (N = 133, n = 47 female) were tracked for a 12-month follow-up interview.

Results: The participants receiving bup/nal at 12 months had significantly fewer opioid-positive urine screens (44% v. 73%) and days of self-reported heroin use (M [SE] = 1.13 [.34] v. 7.12 [1.44]) than the out-of-bup/nal-treatment group (both ps ≤ .001). Similarly, those receiving bup/nal reported significantly fewer days of cocaine use (M [SE] = 0.85 [0.23] v. 2.88[0.75]) and alcohol use (M [SE] = 1.44 [0.38] v. 3.69 [1.04]; both ps<.05). There were no significant differences related to criminal activity, quality of life, and most ASI composite scores. Models adjusting for the baseline value, prior treatment experience, and assigned study condition largely confirmed these findings, except that participants in treatment had fewer days of crime and higher psychological quality of life scores compared to those out-of-treatment.

Conclusions: Those receiving bup/nal at 12 months had significantly lower rates of illicit opioid use than those who were not. Approaches to improve bup/nal treatment retention and reengagement of patients with OUD are needed.
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http://dx.doi.org/10.1080/00952990.2018.1461877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179150PMC
October 2019

Counseling Staff's Views of Patient-Centered Methadone Treatment: Changing Program Rules and Staff Roles.

J Behav Health Serv Res 2018 07;45(3):506-515

Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Conflicts with methadone program counseling staff and violations of program rules can contribute to patients leaving treatment prematurely. This qualitative study was conducted as part of a larger trial of patient-centered methadone treatment (PCM). In-depth, semi-structured interviews at baseline and 12-month follow-up were conducted with five counselors and three clinical supervisors from the programs participating in the PCM parent study. Data were analyzed using Atlas.ti. Counselors reported that, in some cases, PCM allowed them to focus on building a therapeutic alliance with patients because they were not addressing program rule issues. Some reported using more pro-active, innovative strategies for engaging PCM patients and that counseling sessions tended to include a broader range of individually tailored topics, compared to topics normally addressed in typical treatment sessions. Adjusting to the new counselor role was challenging for some counselors and required a shift in tactics to encourage patients' participation in counseling services.

Clinical Trial Registration: Clinicaltrials.gov NCT 01442493.
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http://dx.doi.org/10.1007/s11414-018-9603-1DOI Listing
July 2018

Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service.

Drug Alcohol Depend 2018 05 2;186:23-28. Epub 2018 Mar 2.

Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA. Electronic address:

Background: Substance use disorders (SUD) are associated with non-adherence to medical care and high utilization of hospital services. This study characterized patterns and correlates of rehospitalization among patients seen by a hospital-based SUD consultation-liaison (CL) team.

Methods: This study was a retrospective medical record review of patients in a large urban academic hospital who received SUD consultation and were diagnosed with opioid, cocaine, and/or alcohol use disorder (N = 267). Data were collected on patient characteristics, substance-specific SUD diagnoses (opioids, cocaine, and alcohol), opioid agonist treatment (OAT) with methadone or buprenorphine (treatment status at admission; in-hospital initiation of OAT), and rehospitalization through 180 days post-discharge. Associations with rehospitalization were examined using bivariate tests of independence and multivariate logistic regression, with patient background and medical characteristics, substance-specific SUD diagnoses, and OAT status (at admission and in-hospital initiation) as predictors.

Results: Rehospitalization rates were higher among patients with current opioid (38% vs. 24%; p < .05) and cocaine use disorders (39% vs. 26%; p < .05) compared to patients without these diagnoses. In multivariate logistic regression analysis, the number of medical comorbidities [Adjusted Odds Ratio (AOR) = 1.2; p < .01] and opioid use disorder (AOR = 2.4, p < .05) were independently associated with rehospitalization.

Conclusions: In this sample of hospital patients receiving SUD CL services, the risk of rehospitalization differed by type of SUD diagnosis. In-hospital initiation of OAT is promising for facilitating treatment linkage post-discharge, but this small study did not show differences in rehospitalization based on OAT initiation. These findings could inform services for hospital patients with comorbid SUDs.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.12.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922267PMC
May 2018

Patient perspectives of transitioning from prescription opioids to heroin and the role of route of administration.

Subst Abuse Treat Prev Policy 2018 01 29;13(1). Epub 2018 Jan 29.

Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Background: As the availability of prescription opioids decreases and the availability of heroin increases, some prescription opioid users are transitioning to heroin. This study seeks to explore factors associated with respondents' transition from prescription opioid use to heroin.

Methods: In-depth, semi-structured qualitative interviews (n = 20) were conducted with buprenorphine patients in an opioid treatment program. Respondents were predominantly White (n = 13) and male (n = 13), with a range of treatment tenure (4 days to 2 years).

Results: A vast majority of respondents in this study (n = 15) initiated opioid use with either licit (n = 8) or illicit (n = 7) prescription opioids (e.g. hydrocodone, oxycodone, morphine). Of these respondents, all but two transitioned from prescription opioids to heroin (n = 13). For those respondents who transitioned to heroin, most initiated heroin use intranasally (n = 12), after using prescription opioids in the same manner (n = 9), but before using heroin intravenously (n = 9). Respondents attributed this transition between substances to common explanations, such as "it's cheaper" and "the same thing as pills." However, respondents also dispel these myths by describing: 1) heroin quality is always uncertain, often resulting in spending more money over time; 2) dramatic increases in tolerance, resulting in spending more money over time and transitioning to intravenous use; 3) more severe withdrawal symptoms, especially when respondents transitioned to intravenous use.

Conclusions: Understanding how route of administration and common myths shape key transition points for opioid users will allow practitioners to develop effective harm reduction and prevention materials that target individuals already using prescription opioids.
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http://dx.doi.org/10.1186/s13011-017-0137-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789586PMC
January 2018

Gender and ethnic differences in primary care patients' response to computerized vs. in-person brief intervention for illicit drug misuse.

J Subst Abuse Treat 2018 01 7;84:50-56. Epub 2017 Nov 7.

Friends Research Institute, 1040 Park Avenue, #103, Baltimore, MD 21201, United States.

This study is a secondary analysis from a randomized clinical trial of computerized vs. in-person brief intervention (BI) for illicit drug misuse among adult primary care patients (N=359; 45% Female; 47% Hispanic) with moderate-risk illicit drug misuse as measured by the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This study examined differences in response to the two brief intervention strategies (both based on motivational interviewing) on the basis of gender and ethnicity, comparing non-Hispanic males, non-Hispanic females, Hispanic males, and Hispanic females. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up with the ASSIST. Trajectories in Global Continuum of Illicit Drug Risk Scores were examined using a generalized linear mixed model. There were significant differences in response to computerized vs. in-person BI over time on the basis of gender-ethnic subgroups (Gender×Ethnicity×Condition×Time interaction; p=0.03), with Hispanic males tending to respond more favorably to the computerized BI and Hispanic females tending to respond more favorably to the in-person BI. There was no clear differentiation in response to the two BIs among non-Hispanic males, while among non-Hispanic females the pattern of change converged following baseline differences. Consideration of gender and ethnic differences in future studies of BI is warranted.
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http://dx.doi.org/10.1016/j.jsat.2017.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731246PMC
January 2018

The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center.

Subst Abus 2017 Oct-Dec;38(4):382-388. Epub 2017 Jul 7.

a Friends Research Institute, Inc. , Baltimore , Maryland , USA.

Background: The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses.

Methods: Adolescents (N = 525; 93% African American, 55% female) 12-17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT "yes" responses.

Results: For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79-1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81-0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96-1.00 and 0.79-0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82-0.89 and 0.89-0.96, respectively).

Conclusions: Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in busy pediatric practices.
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http://dx.doi.org/10.1080/08897077.2017.1351413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317511PMC
June 2018

Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics.

J Addict Med 2017 Sep/Oct;11(5):350-356

Friends Research Institute (JG, CDN, SGM, RPS); Johns Hopkins University (KRP); Baltimore City Health Department, Baltimore (LJ); University of Maryland, College Park, MD (KEO).

Background: Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services.

Methods: We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up.

Results: In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01).

Conclusions: SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.
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http://dx.doi.org/10.1097/ADM.0000000000000327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610078PMC
May 2018

Update on Barriers to Pharmacotherapy for Opioid Use Disorders.

Curr Psychiatry Rep 2017 Jun;19(6):35

Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.

Purpose Of Review: The recent heroin and prescription opioid misuse epidemic has led to a sharp increase in the number of opioid overdose deaths in the USA. Notwithstanding the availability of three FDA-approved medications (methadone, buprenorphine, and naltrexone) to treat opioid use disorder, these medications are underutilized. This paper provides an update from the recent peer-reviewed literature on barriers to the use of these medications.

Findings: These barriers are interrelated and can be categorized as financial, regulatory, geographic, attitudinal, and logistic. While financial barriers are common to all three medications, other barriers are medication-specific. The adverse impact of the current opioid epidemic on public health can be reduced by increasing access to effective pharmacotherapy for opioid use disorder.
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http://dx.doi.org/10.1007/s11920-017-0783-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075636PMC
June 2017

Immediate Versus Delayed Computerized Brief Intervention for Illicit Drug Misuse.

J Addict Med 2016 Sep-Oct;10(5):344-51

Friends Research Institute (JG, SGM, RPS), Baltimore; University of Maryland (KEO), College Park, MD; and Wayne State University (SJO), Detroit, MI.

Objective: Computerized brief interventions are a promising approach for integrating substance use interventions into primary care settings. We sought to examine the effectiveness of a computerized brief intervention for illicit drug misuse, which prior research showed performed no worse than a traditional in-person brief intervention.

Methods: Community health center patients were screened for eligibility using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Participants were adult patients (aged 18-62 years; 53% female) with moderate-risk illicit drug use (N = 80), randomized to receive the computerized brief intervention either immediately or at their 3-month follow-up. Assessments were conducted at baseline, 3, and 6-month follow-up, and included the ASSIST and drug hair testing.

Results: Most participants in the sample (90%) reported moderate-risk marijuana use. Although the sample as a whole reported significant decreases in ASSIST Global Drug Risk scores and ASSIST marijuana-specific scores, no significant differences were detected between "immediate" and "delayed" conditions on either of these measures. Likewise, no significant differences were detected between conditions in drug-positive hair test results at either follow-up.

Conclusions: This study did not find differences between immediate versus delayed computerized brief intervention in reducing drug use or associated risks, suggesting potential regression to the mean or reactivity to the consent, screening, or assessment process. The findings are discussed in light of the study's limitations and directions for future research.
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http://dx.doi.org/10.1097/ADM.0000000000000248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042843PMC
October 2017