For opioid dependent persons, inpatient detoxification (medically assisted withdrawal) often begins a period of abstinence. However, due to the chronic recurring nature of illicit opioid use, inpatient detoxification alone is inadequatefor long-term drug abstinence and improved health outcomes. Yet fewer than 50% of patients receive any aftercare-placing patients at high risk for illicit drug relapse, inattention to chroni medical problems, and high rates of health service use-emergency department visits and hospitalization. In this study, we test the potential benefits of recruiting illicit opioid users uring detoxification and linking them to primary care-based treatment with buprenorphine, an effective, evidence-based therapy for opioid dependence. We suggest that initiation of buprenorphine during inpatient detoxification, and linkage after detoxification discharge to maintenance buprenorphine in primary care practices where drug use, medical, and psychiatric disorders can be treated will reduce drug use and expensive health service use (hospitalization, ED visits) that results from medical complications of illicit drug use among opioid dependent persons. PRIMARY AIMS 1) To determine if buprenorphine, initiated during inpatient detoxification and continued after discharge (LINKAGE), will reduce illicit opioid use compared to a buprenorphine detoxification (DETOX) condition among opioid dependent drug users. 2) To determine if buprenorphine, initiated during inpatient detoxification and continued after discharge (LINKAGE) will reduce emergency department and hospital utilization compared to a buprenorphine detoxification (DETOX) condition among opioid dependent drug users. In the detoxification setting, the prevalence of opioid dependence is high, standard discharge planning yields suboptimal aftercare, patients who have chronic medical disorders and who otherwise might not seek primary medical care are accessible, and inpatient abstinence can set the stage for patients to be more receptive to longer term maintenance treatment. This proposal will test the integrated care paradigm recommended by the Institute of Medicine. Demonstration that the initiation of buprenorphine therapy during illicit opioid inpatient detoxification and linkage o primary care based buprenorphine providers after detoxification improves drug use and health utilization outcomes would have immediate clinical application and impact the standard of care. We believe that the implementation of this evidence-based care strategy is feasible and broadly generalizable, but rigorous examination of its value is important to impact the dissemination of this new service delivery model.
Fewer than 50% of patients who seek inpatient opioid detoxification (medically assisted withdrawal) to initiate abstinence receive aftercare, placing patients at high risk for illicit drug relapse, inattention to chronic medical problems, and high rates of health service use-emergency department visits and hospitalization. In this study, we test the potential benefits of initiation of buprenorphine during inpatient detoxification and linkage after discharge to maintenance buprenorphine in primary care practices. Demonstration that this integrated care approach is superior to standard care would have immediate and generalizable clinical application, but rigorous examination of its value is important to impact the dissemination of this new service delivery model.
| Kenney, Shannon R; Anderson, Bradley J; Bailey, Genie L et al. (2018) Buprenorphine treatment formulations: Preferences among persons in opioid withdrawal management. J Subst Abuse Treat 94:55-59 |
| Stein, Michael D; Kenney, Shannon R; Anderson, Bradley J et al. (2018) Loaded: Gun involvement among opioid users. Drug Alcohol Depend 187:205-211 |
| Chakravorty, Subhajit; Vandrey, Ryan G; He, Sean et al. (2018) Sleep Management Among Patients with Substance Use Disorders. Med Clin North Am 102:733-743 |
| Kenney, Shannon R; Anderson, Bradley J; Bailey, Genie L et al. (2018) Drug Use-Related Normative Misperceptions and Behaviors Among Persons Seeking Heroin Withdrawal Management. J Addict Med : |
| Christopher, Paul P; Anderson, Bradley; Stein, Michael D (2018) Civil commitment experiences among opioid users. Drug Alcohol Depend 193:137-141 |
| Kenney, Shannon R; Anderson, Bradley J; Conti, Micah T et al. (2018) Expected and actual fentanyl exposure among persons seeking opioid withdrawal management. J Subst Abuse Treat 86:65-69 |
| Kenney, Shannon R; Anderson, Bradley J; Bailey, Genie L et al. (2018) Factors associated with naloxone administration in an opioid dependent sample. J Subst Abuse Treat 84:17-20 |
| Blevins, Claire E; Abrantes, Ana M; Kurth, Megan E et al. (2018) Quality of life and well-being following inpatient and partial hospitalization treatment for opioid use disorder. Arch Psychiatr Nurs 32:505-509 |
| Kenney, Shannon R; DiGuiseppi, Graham T; Meisel, Matthew K et al. (2018) Poor mental health, peer drinking norms, and alcohol risk in a social network of first-year college students. Addict Behav 84:151-159 |
| Bozinoff, Nikki; Anderson, Bradley J; Bailey, Genie L et al. (2018) Correlates of Stigma Severity Among Persons Seeking Opioid Detoxification. J Addict Med 12:19-23 |
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