Smartphone App-Based Contingency Management and Opioid Use Disorder Treatment Outcomes.

Importance: Opioid use disorder continues to be a national crisis, contributing to substantial morbidity and mortality. Medication is the only evidence-based treatment for opioid use disorder; however, improving clinical outcomes may require augmenting it with psychosocial interventions, such as contingency management (CM), specifically, smartphone app-based CM.

Objective: To evaluate whether augmenting medication for opioid use disorder (MOUD) with app-based CM is associated with fewer days of opioid use at the end of treatment and greater retention than treatment with MOUD only.

The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder.

Introduction: In 2017, we launched the "B-Team" (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program.

Methods: This is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas.

Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact.

Background: Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices.

Sociodemographic and patient reported outcomes by racial and ethnicity status among participants in a randomized controlled trial for methamphetamine use disorder.

Background: There has been a significant increase in methamphetamine use and methamphetamine use disorder (Meth UD) in the United States, with evolving racial and ethnic differences.

Objectives: This secondary analysis explored racial and ethnic differences in baseline sociodemographic and clinical characteristics as well as treatment effects on a measure of substance use recovery, depression symptoms, and methamphetamine craving among participants in a pharmacotherapy trial for Meth UD.

Methods: The ADAPT-2 trial (ClinicalTrials.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Background: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients.

Stigma towards opioid use disorder in primary care remain a barrier to integrating software-based measurement based care.

Background: Opioid use disorder (OUD) is a deadly illness that remains undertreated, despite effective pharmacological treatments. Barriers, such as stigma, treatment affordability, and a lack of training and prescribing within medical practices result in low access to treatment. Software-delivered measurement-based care (MBC) is one way to increase treatment access.

A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.

Background And Aims: Socio-cultural (gender) and biological (sex)-based differences contribute to psychostimulant susceptibility, potentially affecting treatment responsiveness among women with methamphetamine use disorder (MUD). The aims were to measure (i) how women with MUD independently and compared with men respond to treatment versus placebo and (ii) among women, how the hormonal method of contraception (HMC) affects treatment responsiveness.

Design: This was a secondary analysis of ADAPT-2, a randomized, double-blind, placebo-controlled, multicenter, two-stage sequential parallel comparison design trial.

Mindfulness-Based Interdisciplinary Pain Management Program for Complex Polymorbid Pain in Veterans: A Randomized Controlled Trial.

Objective: To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with 2 or more comorbid psychiatric conditions.

Design: Two-arm randomized controlled trial testing a 3-week intervention with assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up.

Setting: Department of Veterans Affairs medical facility.

Survey of Barriers and Facilitators to Prescribing Buprenorphine and Clinician Perceptions on the Drug Addiction Treatment Act of 2000 Waiver.

Importance: As opioid-related deaths continue to climb, methods to reduce barriers to prescribing buprenorphine for individuals with opioid use disorder (OUD) are needed. Recent conversations by state and federal authorities targeting low-threshold buprenorphine aim to reduce some barriers to prescribing buprenorphine; however, what remains unclear is whether removal of the requirement to obtain a waiver for prescribing buprenorphine through the Drug Addiction Treatment Act of 2000 (an X-waiver) will be enough to increase access to buprenorphine.

Objective: To assess barriers and facilitators of obtaining an X-waiver and prescribing buprenorphine.

Addressing chronic pain with Focused Acceptance and Commitment Therapy in integrated primary care: findings from a mixed methods pilot randomized controlled trial.

Background: Over 100 million Americans have chronic pain and most obtain their treatment in primary care clinics. However, evidence-based behavioral treatments targeting pain-related disability are not typically provided in these settings. Therefore, this study sought to: 1) evaluate implementation of a brief evidence-based treatment, Focused Acceptance and Commitment Therapy (FACT-CP), delivered by an integrated behavioral health consultant (BHC) in primary care; and 2) preliminarily explore primary (self-reported physical disability) and secondary treatment outcomes (chronic pain acceptance and engagement in valued activities).

Analgesic Effects of Oxycodone in Combination With Risperidone or Ziprasidone: Results From a Pilot Randomized Controlled Trial in Healthy Volunteers.

Background And Objectives: Patients taking opioids are at risk of developing dependence and possibly abuse. Given the role of the mesolimbic dopamine system in opioid reward, blocking dopamine D2 receptors should limit the abuse liability of opioid analgesics. This pilot study evaluates the analgesic efficacy of oxycodone combined with an atypical antipsychotic (dopamine D2 receptor antagonist).

Adapting and scaling a single site DEA X-waiver training program to a statewide initiative: Implementing GetWaiveredTX.

Objectives: To address the critical need for opioid use disorder (OUD) treatment by rapidly planning and implementing a statewide DEA X-waiver training initiative expanding office-based OUD treatment in Texas by: (1) facilitating access to buprenorphine waiver trainings to targeted regions and health care providers across the state; and (2) supporting completion of DEA X-waiver requirements.

Methods: We used a transdisciplinary and theory-driven approach to adapt and rapidly scale up an existing, previously successful DEA X-waiver initiative. Pre-implementation activities included a literature review to identify OUD treatment barriers and demographic analyses to identify high-need areas of the state.

Peer-based recovery support services delivered at recovery community organizations: Predictors of improvements in individual recovery capital.

Background: While clinical interventions used to support the recovery process of U.S. adults are well understood, community-based solutions such as peer-based recovery support services delivered by a recovery community organization are not.

If there were an effective pharmacotherapy for cocaine use disorder, what would it do?

While thirty years of research into an effective cocaine pharmacotherapy has yielded no treatments, knowledge gained doing this work underscores the importance of rigorous clinical design, of attention to medication adherence and of defining endpoints. The field needs a high-risk/high-reward strategy to engineer new compounds that help people to use less cocaine and to preserve gains made during treatment, particularly during lapse/relapse.

Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts.

Background: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors.

Five-year Pain Intensity and Treatment Trajectories of Post-9/11 Veterans With Mild Traumatic Brain Injury.

Pain is a pervasive problem that affects nearly half of the U.S. Veterans deployed in support of the Global War on Terror (Post-9/11 Veterans) and over half of the Post-9/11 Veterans with diagnosed traumatic brain injury (TBI).

Pain, psychological flexibility, and continued substance use in a predominantly hispanic adult sample receiving methadone treatment for opioid use disorder.

Background: We explored pain, psychological flexibility, and continued substance use among 100 adults treated with methadone for opioid use disorder (OUD). All participants had co-occurring chronic pain.

Methods: Participants recruited from a community treatment center between 2009 and 2010 completed an interviewer-facilitated assessment.

Network Alterations in Comorbid Chronic Pain and Opioid Addiction: An Exploratory Approach.

The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a pain-induction fMRI task.

Mining patterns of comorbidity evolution in patients with multiple chronic conditions using unsupervised multi-level temporal Bayesian network.

Over the past few decades, the rise of multiple chronic conditions has become a major concern for clinicians. However, it is still not known precisely how multiple chronic conditions emerge among patients. We propose an unsupervised multi-level temporal Bayesian network to provide a compact representation of the relationship among emergence of multiple chronic conditions and patient level risk factors over time.

Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training.

Objective: The primary objective was to evaluate the efficacy of commercially available mobile app-delivered mindfulness training (AMT), compared with waitlist control (WC), on quality of life (QOL) among women diagnosed with breast cancer. The secondary outcome was dispositional mindfulness. Enrollment, app utilization, and study completion are reported as feasibility objectives.

Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006-2014.

Introduction: Between 2001 and 2009, opioid analgesic prescriptions in the Military Health System quadrupled to 3.8 million. The sheer quantity of opioid analgesics available sets the stage for issues related to misuse, abuse, and diversion.

Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic.

Most of the 100 million Americans with persistent pain are treated in primary care clinics, but evidence-based psychosocial approaches targeting pain-related disability are not usually provided in these settings. This manuscript describes the rationale and methods for a protocol to pilot test the feasibility and effectiveness of Acceptance and Commitment Therapy (ACT), an evidence-based psychological treatment for persistent pain, delivered by a Behavioral Health Consultant in primary care. Eligible patients are identified through electronic health record registries and invited to participate via secure messaging, letters and a follow-up phone call.

The relationship between self-compassion and the risk for substance use disorder.

Objective: This study explored the relationship between substance use disorder risk and self-compassion and posits a model for how the two are related through the mitigation of suffering.

Method: Study participants were recruited using social media to complete an online survey that included a basic socio-demographic survey and two validated instruments, the Self-Compassion Survey and the National Institute on Drug Abuse (NIDA) Alcohol Smoking and Substance Involvement Screening Test (ASSIST), which screens for substance use disorder (SUD) risk. Established cut scores for ASSIST were used to divide participants into low, moderate and high-risk groups.

Prescription Opioid Use is Associated with Virologic Failure in People Living with HIV.

Prescription opioid misuse is a rising epidemic in the U.S., and people living with HIV are at increased risk.