Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

ASSESSING THE RELATIONSHIP BETWEEN CRIMINAL JUSTICE INVOVEMENT, OPIOID USE DISORDER TREATMENT, AND OPIOID OVERDOSE IN MARYLAND: A POPULATION-BASED APPROACH

Background: The U.S. is in the midst of an unprecedented opioid epidemic. Opioid agonist treatments (OAT) are effective at reducing opioid-related morbidity and mortality, but most persons do not receive these treatments. Justice-involved individuals have particularly high rates of overdose, and yet are least likely to receive OAT. Methods: This dissertation aimed to characterize the relationship between criminal justice involvement, OUD treatment, and opioid overdose in Maryland by analyzing a database of linked administrative records across the state for 2013-2016. Data were obtained from the Maryland Department of Health and other State agencies and included criminal justice records for drug and property crimes, records for OUD treatment delivered in specialty settings, buprenorphine prescription records, inpatient and emergency hospital records from acute-care non-federal hospitals, and records for deaths investigated by the chief medical examiner. Risk factors for overdose death and correlates of OAT were assessed using multivariate logistic regression. Relative hazards of overdose mortality between periods of OAT and non-medication treatments were assessed using Cox proportional hazard regression adjusted using propensity score weights. Results: The strongest predictor of opioid overdose death among the justice-involved was having had any hospital encounter (aOR: 9.25(95C.I:6.69-12.8)). Additional predictors included being older, being White, having more arrests, having been arrested for a drug charge, having a misdemeanor drug charge, and having been released from incarceration during the study time frame. Periods in OAT were found to be highly protective against overdose risk compared to periods in non-medication treatment (aHR: 0.18(0.08-0.40)). However, periods following non-medication treatment (aHR: 5.43(2.88-10.23)) and following OAT (aHR: 5.84(3.10-10.99)) had equally elevated risk compared to periods in non-medication treatment. 17.5% of justice-involved adults received OUD treatment. Predictors of not receiving OAT included having a co-occurring substance use disorder or being referred to treatment by a criminal justice source. Factors protective against opioid overdose death included being Black (aOR:0.43(0.20,0.90)) and having received OAT (aOR:0.41(0.22,0.75)). Conclusions: Efforts to address opioid harms should expand access to and retention in OAT, especially among the justice-involved. Pragmatic research approaches can advance our understanding of health outcomes among representative samples and generate findings directly applicable to policy and practice

Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review.

BACKGROUND: The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. METHODS: Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. RESULTS: Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. CONCLUSIONS: The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs

A interação entre comportamentos de consumo de droga, contextos e acesso aos cuidados de saúde: Um estudo qualitativo explorando atitudes e experiências de usuários de crack no Rio de Janeiro e São Paulo, Brasil

<p>*Traduzido do artigo original (originally published as):</p><p>Krawczyk N, Filho CLV, Bastos FI. The interplay between drug-use behaviors, settings, and access to care: a qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo, Brazil.Harm Reduction Journal. 2015;12:24. doi:10.1186/s12954-015-0059-9.</p><p><b>RESUMO</b></p><p>Antecedentes: Apesar da crescente atenção em torno do uso de crack no Brasil, pouco se sabe sobre as histórias dos usuários, seus padrões de consumo, e a interação de hábitos de consumo de droga, contextos e acesso/barreiras ao(s) cuidados de saúde. Estudos qualitativos raramente comparam os achados de pessoas que usam crack a partir de diferentes contextos. Este estudo tem como objetivo explorar os insights de usuários regulares de crack em duas grandes cidades brasileiras e examinar como fatores sociais e contextuais, incluindo o estigma e a marginalização, influenciam o uso inicial e diversos problemas de saúde e sociais.</p> <p>Métodos: Entrevistas em profundidade e grupos focais foram realizados com 38 adultos usuários de crack recrutados em bairros pobres do Rio de Janeiro e São Paulo. As entrevistas e grupos focais foram gravadas em áudio e transcritas na íntegra. Procedeuse à análise qualitativa e os conteúdos foram organizados e analisados por temas recorrentes relevantes para os interesses do estudo.</p> <p>Resultados: Para os participantes do estudo de ambas as cidades, o uso frequente de crack desempenha um papel central na vida diária e leva a uma série de consequências físicas, psicológicas e sociais. Os interesses comuns entre os usuários incluem o uso excessivo de crack, o engajamento em comportamentos de risco, a utilização pouco frequente de serviços de saúde, a marginalização e a dificuldade em reduzir o consumo de drogas.</p> <p>Conclusões: As condições desfavoráveis em que muitos usuários de crack crescem e vivem podem perpetuar os comportamentos de risco, e o estigma marginaliza ainda mais os usuários dos serviços de saúde e de recuperação necessários. A redução do estigma e do discurso moralizante relacionado ao uso de drogas, especialmente entre os profissionais de saúde e policiais, pode incentivar os usuários a procurar atendimento necessário. Novas alternativas de cuidado para usuários marginalizados, baseados em redução de danos estão sendo desenvolvidas em algumas localidades no Brasil e outros países, e deveriam ser adaptadas e expandidas para populações vulneráveis.</p

Synthesising evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy.

As the USA faces a worsening overdose crisis, improving access to evidence-based treatment for opioid use disorder (OUD) remains a policy priority. Federal regulatory changes in response to the COVID-19 pandemic substantially expanded flexibilities on take-home doses for methadone treatment for OUD. These changes have fuelled questions about the effect of new regulations on OUD outcomes and the potential effect on health of permanently integrating these flexibilities into treatment policy going forward. To aide US policy makers as they consider implementing permanent methadone regulatory changes, we conducted a review synthesising peer-reviewed research on the effect of the flexibilities of methadone take-home policies introduced during COVID-19 on methadone programme operations, OUD patient and provider experiences, and patient health outcomes. We interpret the findings in the context of the federal rule-making process and discuss avenues by which these findings can be incorporated and implemented into US policies on substance use treatment going forward

Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology

Abstract Background Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes

Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms

Intersecting substance use treatment and harm reduction services: exploring the characteristics and service needs of a community-based sample of people who use drugs.

BACKGROUND Substance use treatment and harm reduction services are essential components of comprehensive strategies for reducing the harms of drug use and overdose. However, these services have been historically siloed, and there is a need to better understand how programs that serve people who use drugs (PWUD) are integrating these services. In this study, we compared treatment and harm reduction services offered by a multistate sample of substance use service providers and assessed how well they align with characteristics and needs of clients they serve early in the COVID-19 pandemic. METHODS We recruited a convenience sample of programs that deliver harm reduction and/or treatment services in ten US states. Program directors participated in a survey assessing the services offered at their program. We also recruited clients of these programs to participate in a survey assessing a range of sociodemographic and health characteristics, substance use behaviors, and health service utilization. We then cross-compared client characteristics and behaviors relative to services being offered through these programs. RESULTS We collected and analyzed data from 511 clients attending 18 programs that we classified as either offering treatment with medications for opioid use disorder (MOUD) (N = 6), syringe service programs (SSP) (N = 8), or offering both MOUD and SSP (N = 4). All programs delivered a range of treatment and harm reduction services, with MOUD & SSP programs delivering the greatest breadth of services. There were discrepancies between services provided and characteristics and behaviors reported by clients: 80% of clients of programs that offered MOUD without SSP actively used drugs and 50% injected drugs; 40% of clients of programs that offered SSP without MOUD sought drug treatment services. Approximately half of clients were unemployed and unstably housed, but few programs offered direct social services. CONCLUSIONS In many ways, existing programs are not meeting the service needs of PWUD. Investing in innovative models that empower clients and integrate a range of accessible and flexible treatment, harm reduction and social services can pave the way for a more effective and equitable service system that considers the long-term health of PWUD