Feasibility and preliminary efficacy of a community support intervention for people with opioid use disorder.

Background And Objectives: People receiving agonist treatment for opioid use disorder often have family or friends who do not use illicit substances and could be mobilized to support recovery efforts. The present study evaluates the feasibility and preliminary efficacy of a community support intervention (CSI) designed to increase drug-free social support and expand drug-free network support.

Methods: Participants receiving methadone treatment and using illicit drugs (n = 33) were randomly assigned to a weekly CSI or education group for 12 weeks.

The Impact of Child Protective Services Involvement on Pregnant and Postpartum Women in Substance Use Disorder Treatment.

: Pregnant women with substance use disorder often fail to complete treatment. Treatment retention can be influenced by many factors, including CPS involvement. This study evaluates the relationship, if any, between active CPS involvement while in treatment and treatment outcomes.

OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities.

Introduction: Rates of hospitalizations from medical complications of opioid use disorder (OUD) are rising and many of these patients require post-acute care at skilled nursing facilities (SNFs). However, access to medication for OUD (MOUD) at SNFs remains low and patients with OUD have high rates of patient-directed discharge (PDD) and hospital readmissions.

Methods: Opioid Use Disorder Medical Patient Engagement, Enrollment in treatment and Transitional Supports (OUD MEETS) program was a clinical pilot designed to increase initiation of buprenorphine and methadone for hospitalized patients with OUD requiring post-acute care.

Psychological First Aid Well-Being Support Rounds for Frontline Healthcare Workers During COVID-19.

Frontline healthcare workers face unprecedented stress from the current SARS COV-2 (COVID-19) pandemic. Hospital systems need to develop support programs to help frontline staff deal with this stress. The purpose of this article is to describe a support program for front line healthcare workers.

Use of an electronic pillbox to increase number of methadone take-home doses during the COVID-19 pandemic.

This study describes use of the commercially available Medminder electronic pillbox at a community substance use disorder treatment program to safely increase the number of methadone take-home doses administered during the COVID-19 pandemic. The pillbox contains 28 cells that lock independently and can be opened only during preprogrammed time windows. This study provided patients (n = 42) deemed vulnerable to take-home mismanagement or more severe symptoms from COVID-19 infection the pillbox and observed them for 11 weeks.

Sexual-risk reduction following the referral of syringe exchange registrants to methadone maintenance: Impact of gender and drug use.

This study evaluates the impact of enrolling syringe exchange registrants in methadone maintenance on change in sexual-risk behaviors. Baltimore Needle Exchange Program (BNEP) registrants (n = 210) participated in a parent study evaluating strategies for initiating methadone maintenance treatment and the study followed them for six months. Study staff administered the Risk Assessment Battery (RAB; Metzger, 1993) monthly throughout treatment.

Reducing Risky Drug Use Behaviors by Enrolling Syringe Exchange Registrants in Methadone Maintenance.

Referral of syringe exchange registrants with opioid use disorder to agonist treatment provides a pathway to further reduce drug use risk behaviors. : This study evaluates the drug use risk reduction benefits of enrolling syringe exchange registrants in methadone maintenance, and the impact of continued illicit drug use on risk reduction. : Baltimore Needle Exchange Program (BNEP) registrants ( = 210) participated in a parent study evaluating treatment initiation strategies for methadone maintenance and were followed for six months.

Developing a community-supported risk reduction intervention for syringe exchange registrants and their drug-free family or friends: a pilot study.

Background: People engaged in injection opioid use often have drug-free family or friends that could be mobilized to support risk reduction and treatment seeking.

Objective: This pilot study evaluated the feasibility and preliminary efficacy of a 6-week community-supported risk reduction group intervention for syringe exchange program (SEP) registrants and drug-free network members.

Method: The group provided risk reduction and treatment readiness education, with weekly assignments for participants to engage together in community activities designed to meet other drug-free people.

The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders.

Despite research demonstrating the benefit of exposure-based therapy for posttraumatic stress disorder (PTSD) in patients with co-occurring substance use disorders, there remains a strong clinical expectation that this treatment will exacerbate substance use or other psychiatric symptoms. The present study evaluated within-session and session-to-session changes in (a) craving and use of substances for a range of drug classes and (b) symptoms of PTSD and other psychiatric distress in a sample of 44 SUD patients who received prolonged exposure (PE) therapy for PTSD. Visual analog scales showed no within-session increases in craving, except for cocaine, within Session 8.

Impact of Personality Disorder on the Treatment of Psychiatric Disorders in People Receiving Methadone-Assisted Treatment.

This study evaluates personality disorder as a moderator of psychiatric treatment response in people receiving methadone-assisted treatment. Participants ( = 125) were enrolled in a 12-week parent study that evaluated the impact of incentives on attendance to psychiatric care. All participants had a current Axis I disorder and were classified based on presence of an Axis II disorder: Axis I-only ( = 46) versus Axis I + II ( = 79).

Mobilizing community support in people receiving opioid-agonist treatment: A group approach.

This descriptive study evaluates a novel group intervention designed to help opioid-dependent patients in medication-assisted treatment identify and recruit drug-free individuals to support recovery efforts. The Social Network Activation Group works with patients who are actively using drugs and resistant to including drug-free family or friends in treatment. The group encourages patients to attend structured recovery, religious, or recreational activities in the community to find recovery support.

Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial.

This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy.

Incentivizing attendance to prolonged exposure for PTSD with opioid use disorder patients: A randomized controlled trial.

Objective: To determine whether contingent monetary incentives increase opioid use disorder patients' attendance to Prolonged Exposure (PE) therapy and whether attendance is associated with improvement in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) outcomes.

Method: Patients (N = 58) with PTSD were offered PE or PE with incentives (PE + I; max $480) to attend PE sessions. Participants were assessed at baseline and weeks 6, 12, and 24 postrandomization.

Effect of traumatic event reexposure and PTSD on substance use disorder treatment response.

Background: A remarkably high rate of traumatic event reexposure has been demonstrated in community-based substance users which negatively impacts their substance use disorder (SUD). The rate and effect of such reexposure in treatment is unknown. Despite increasing evidence that a diagnosis of posttraumatic stress disorder (PTSD) has little influence on long-term SUD treatment outcomes, it is possible that PTSD symptom fluctuations could have effects.

Substance use and response to psychiatric treatment in methadone-treated outpatients with comorbid psychiatric disorder.

The psychiatric care of opioid users receiving agonist therapies is often complicated by high rates of illicit drug use (Brooner et al., 2013). The present study evaluates if illicit drug use (i.

Challenges and outcomes of parallel care for patients with co-occurring psychiatric disorder in methadone maintenance treatment.

Objective: Most opioid users seeking treatment in community-based substance abuse treatment programs have at least one co-occurring psychiatric disorder, and the presence of psychiatric comorbidity in this population is associated with increased psychological distress, poorer quality of life, and reduced response to substance abuse treatment. This observational study describes clinical outcomes of referring patients receiving methadone maintenance with at least one co-occurring psychiatric disorder to a community psychiatry program located on the same hospital campus.

Methods: Participants (n = 156) were offered priority referrals to a community psychiatry program that included regularly scheduled psychiatrist appointments, individual and group therapy, and enhanced access to psychiatric medications for 1 year.

Topiramate for cocaine dependence during methadone maintenance treatment: a randomized controlled trial.

Background: Dual dependence on opiate and cocaine occurs in about 60% of patients admitted to methadone maintenance and negatively impacts prognosis (Kosten et al. 2003. Drug Alcohol Depend.

A randomized trial of Web-based videoconferencing for substance abuse counseling.

Web-based videoconferencing can improve access to substance abuse treatment by allowing patients to receive counseling services in their homes. This randomized clinical trial evaluates the feasibility and acceptability of Web-based videoconferencing in community opioid treatment program (OTP) participants. Participants that reported computer and Internet access (n=85) were randomly assigned to receive 12weeks of weekly individual counseling in-person or via eGetgoing, a Web-based videoconferencing platform.

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.

Background: The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program.

Methods: Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.

Managing psychiatric comorbidity within versus outside of methadone treatment settings: a randomized and controlled evaluation.

Background And Aims: Integrating psychiatric services within substance abuse treatment settings is a promising service delivery model, but has not been evaluated using random assignment to psychiatric treatment setting and controlled delivery of psychiatric care. This study evaluates the efficacy of on-site and integrated psychiatric service delivery in an opioid-agonist treatment program on psychiatric and substance use outcomes.

Design: Participants at the Addiction Treatment Services (ATS) were assigned randomly to receive on-site and integrated substance abuse and psychiatric care (on-site: n = 160) versus off-site and non-integrated substance abuse and psychiatric care (off-site: n = 156), and observed for 1 year.

An observation of lower rates of drug use over time in community syringe exchangers.

Background And Objectives: The present study evaluated changes in rates of self-reported heroin and cocaine use in opioid-dependent individuals newly registered to a syringe exchange program (SEP), and examined the effects of recovery-oriented longitudinal variables (i.e., substance abuse treatment, self-help group participation, employment) on changes in drug use.

Prospective effects of traumatic event re-exposure and post-traumatic stress disorder in syringe exchange participants.

Aim: Determine the effect of traumatic event re-exposure and post-traumatic stress disorder (PTSD) symptom severity on proximal drug use and drug abuse treatment-seeking in syringe exchange participants.

Design: Prospective longitudinal 16-month cohort study of new syringe exchange registrants enrolled in a parent study of methods to improve treatment engagement.

Setting: Data were collected in a research van next to mobile syringe exchange distribution sites in Baltimore, Maryland.

Traumatic event re-exposure in injecting drug users.

Drug users have very high rates of lifetime exposure to traumatic events, leading to significant psychiatric complications. In spite of the high rate of lifetime exposure, very little is known about the rate of ongoing re-exposure to new traumatic events in drug users. We investigated the rate of traumatic event re-exposure in male and female injecting drug users using syringe exchange services in Baltimore (N = 197).

A treatment reengagement intervention for syringe exchangers.

Poor sustained treatment engagement limits the effectiveness of all modalities of substance abuse treatment. This study evaluated the efficacy of a novel treatment reengagement intervention for a subset of syringe-exchange program (SEP) participants (N = 113) that had enrolled in treatment as part of a 4-month clinical trial (M. Kidorf et al.