Publications by authors named "K P Stoller"

Driving the overdose epidemic, a significant proportion of adult and adolescent patients seen in neurology practice and hospital settings has substance use disorder. Fortunately, there are effective treatments available, in particular for opioid addiction. Some elements of treatment can be delivered directly in medical office-based settings, while others are best provided from within specialized addiction treatment facilities.

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Purpose: To describe one strategy for dispensing of methadone at emergency department (ED) and hospital discharge implemented within 2 urban academic medical centers.

Summary: Expanding access to medications for opioid use disorder (OUD) is a national priority. ED visits and hospitalizations offer an opportunity to initiate or continue these lifesaving medications, including methadone and buprenorphine.

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Article Synopsis
  • Patients discontinuing methadone for opioid use disorder face increased risk of overdose, and the study aimed to understand their reasons for stopping treatment.
  • Through interviews and focus groups with patients and staff in Baltimore, three internal themes were identified: viewing methadone as a temporary solution, fearing long-term health effects, and experiencing increased cocaine cravings.
  • External themes included the burden of daily dosing, concerns about drug accessibility leading to relapse, and stigma from society, indicating that education and improved treatment strategies could help with retention.
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Access to methadone for opioid use disorder (OUD) in the United States remains limited to regulated and certified Opioid Treatment Programs (OTPs). Collaboration between OTPs and community pharmacies would increase access to and potentially satisfaction with methadone delivery. While it remains illegal for prescribers to write, and pharmacies to dispense, methadone when the indication is OUD, the present pilot study evaluates the feasibility, acceptability, and outcomes of using community pharmacies to dispense methadone prescribed by OTP physicians (in tablet formulation) to a subset of clinically stable OTP patients; all other treatment services were delivered within the OTP.

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