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HCV testing in substance use disorder treatment programs
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Multiple sources of payment and risky opioid therapy among military/VA William Becker 1,∗ , Erin Doyle 4 , Brenda Fenton 3 , Joe Francis 5 , Cynthia Brandt 3 , Brent A. Moore 2 , Robert Kerns 3 , Peter Kreiner 4 1
Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, United States 2 Psychiatry, Yale University School of Medicine, New Haven, CT, United States 3 VA Connecticut Healthcare System, West Haven, CT, United States 4 Brandeis University, Waltham, MA, United States 5 VA Central Office, Washington, DC, United States Aims: Opioid overdose and other harms are a major source of morbidity and mortality among US military and veterans (VA), in part due to risky opioid therapy. In response, military/VA health systems have implemented myriad intra-system approaches to limiting access to risky opioid therapy, but have limited control over outside-system access. We sought to determine whether multiple sources of payment are associated with risky opioid therapy among military/VA. Methods: Using data supplied by the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, we grouped individuals receiving controlled substance prescriptions in Kentucky during fiscal year 2014–15 into two categories: A (source of payment = military/VA only) and B (source of payment = military/VA + other sources: Medicare, Medicaid, private insurance, cash). We used t-tests to compare differences between groups on proportion with risky opioid therapy, defined by three independent metrics: combination opioid/benzodiazepine therapy, morphine equivalent daily dose (MEDD) ≥100 mg, and overlapping opioid prescriptions. Results: Among 16,497 individuals, 10,393 were category A and 6104 were category B. Regarding combination therapy: A = 10.6% vs. B = 17.6% (p < 0.0001); MEDD ≥ 100: A = 3.0% vs. B = 5.6% (p < 0.0001); and overlapping opioid prescriptions: A = 14.4% vs. B = 19.3% (p < 0.0001). We also performed Satterthwaite and Cochran tests, which assume unequal variances, with no material difference in significance. Conclusions: In this ecological analysis among individuals with military/VA sources of payment, additional sources of payment were associated with risky opioid therapy. Person-level demographic and clinical data are needed to further explore variance. Financial support: VA HSR&D: CIN 13-047, CDA 08-276, PEC244 and Prescription Behavior Surveillance System. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.061 The affordable care act and HIV/HCV testing in substance use disorder treatment programs Czarina N. Behrends 5,∗ , Jemima A. Frimpong 1 , Thomas D’Aunno 2 , Harold Pollack 4 , Bruce Schackman 5 , Peter Friedmann 3 1
Columbia University, New York, NY, United States New York University, New York, NY, United States 3 Baystate Health, Springfield, MA, United States 4 University of Chicago, Chicago, IL, United States 5 Weill Cornell Medical College, New York, NY, United States 2
Aims: Persons with substance use disorders are at higher risk for HIV and HCV infection. Yet, many substance use disorder (SUD) treatment programs do not offer HIV or HCV testing to their clients.
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Inadequate reimbursement and lack of financial resources for testing have been cited as possible explanations for the lack of availability of testing services. Aspects of the Affordable Care Act (ACA), including state Medicaid expansions, promotion of Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), may address these barriers and increase access to HIV and HCV testing. Methods: We examined the extent to which ACA implementation is associated with the offer of HIV and HCV testing in SUD treatment programs. Data came from the 2014 National Drug Abuse Treatment System Survey (NDATSS). The NDATSS is a nationally representative probability sample of SUDs that was supplemented with data from Single State Agencies (organizations overseeing addiction treatment programs). Multivariate regression models examined ACA-related correlates of HIV and HCV testing, controlling for program and client characteristics. Results: Of the SUD treatment programs surveyed (N = 598), 10.7% offered HCV testing only, 15.4% offered HIV testing only, 32.9% offered both HIV and HCV testing, and 41% did not offer testing. Approximately 16.7% of programs participated in ACO or PCMH and 63.6% were located in a state that had implemented Medicaid expansion. ACO or PCMH participation was significantly associated with offering both HIV and HCV testing (OR: 2.2, 95% CI: 1.1–4.2). There were no significant associations between testing and Medicaid expansion. Conclusions: ACO/PCMH participation may increase the availability of joint HIV/HCV testing in treatment programs. Medicaid expansion on its own is insufficient to address barriers to HIV and HCV testing in SUD programs. Financial Support: R01DA027379, R01DA034634, P30DA040500, R34DA038530. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.062 Activity based reward processing among opiate users: Validation of the behavioral incentive delay task Ryan Patrick Bell ∗ , Jennifer Youngshin Yi, Yun Chen, Antonio Petruzzella, Ian Jiang, Kimberley A.T. Johnson, Elizabeth Danielle Reese, Stacey B. Daughters Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States Aims: Behavioral activation (BA) treatment for substance use and depression is designed to improve outcomes via enhancement in environmental reward. To examine neural response to environmental reward, we designed a novel non-monetary reward version of the Monetary Incentive Delay Task (MID) task, called the Behavioral Incentive Delay (BID) Task, that utilizes images of engagement in daily activities. Methods: Male opiate users (OU; n = 13) (M age = 39.3; 74.1% Non-Hispanic White, 18.5% AA) and healthy controls (HC; n = 14) completed the BID and MID tasks while undergoing fMRI. Activation profiles were examined within and between groups during reward anticipation (RA) and reward outcome (RO). A 2 (task) × 2 (group) ANOVA examined neural activation profiles unique to the BID. Results: During the BID RA phase, OU displayed activations in the ACC and left precentral gyrus while HC displayed activations bilaterally in the caudate and thalamus. During the BID RO phase, OU displayed activation in the left caudate, bilateral hippocampus, right frontal pole, ACC, and right putamen. OU displayed less RO
Multiple sources of payment and risky opioid therapy among military/VA William Becker 1,∗ , Erin Doyle 4 , Brenda Fenton 3 , Joe Francis 5 , Cynthia Brandt 3 , Brent A. Moore 2 , Robert Kerns 3 , Peter Kreiner 4 1
Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, United States 2 Psychiatry, Yale University School of Medicine, New Haven, CT, United States 3 VA Connecticut Healthcare System, West Haven, CT, United States 4 Brandeis University, Waltham, MA, United States 5 VA Central Office, Washington, DC, United States Aims: Opioid overdose and other harms are a major source of morbidity and mortality among US military and veterans (VA), in part due to risky opioid therapy. In response, military/VA health systems have implemented myriad intra-system approaches to limiting access to risky opioid therapy, but have limited control over outside-system access. We sought to determine whether multiple sources of payment are associated with risky opioid therapy among military/VA. Methods: Using data supplied by the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, we grouped individuals receiving controlled substance prescriptions in Kentucky during fiscal year 2014–15 into two categories: A (source of payment = military/VA only) and B (source of payment = military/VA + other sources: Medicare, Medicaid, private insurance, cash). We used t-tests to compare differences between groups on proportion with risky opioid therapy, defined by three independent metrics: combination opioid/benzodiazepine therapy, morphine equivalent daily dose (MEDD) ≥100 mg, and overlapping opioid prescriptions. Results: Among 16,497 individuals, 10,393 were category A and 6104 were category B. Regarding combination therapy: A = 10.6% vs. B = 17.6% (p < 0.0001); MEDD ≥ 100: A = 3.0% vs. B = 5.6% (p < 0.0001); and overlapping opioid prescriptions: A = 14.4% vs. B = 19.3% (p < 0.0001). We also performed Satterthwaite and Cochran tests, which assume unequal variances, with no material difference in significance. Conclusions: In this ecological analysis among individuals with military/VA sources of payment, additional sources of payment were associated with risky opioid therapy. Person-level demographic and clinical data are needed to further explore variance. Financial support: VA HSR&D: CIN 13-047, CDA 08-276, PEC244 and Prescription Behavior Surveillance System. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.061 The affordable care act and HIV/HCV testing in substance use disorder treatment programs Czarina N. Behrends 5,∗ , Jemima A. Frimpong 1 , Thomas D’Aunno 2 , Harold Pollack 4 , Bruce Schackman 5 , Peter Friedmann 3 1
Columbia University, New York, NY, United States New York University, New York, NY, United States 3 Baystate Health, Springfield, MA, United States 4 University of Chicago, Chicago, IL, United States 5 Weill Cornell Medical College, New York, NY, United States 2
Aims: Persons with substance use disorders are at higher risk for HIV and HCV infection. Yet, many substance use disorder (SUD) treatment programs do not offer HIV or HCV testing to their clients.
e17
Inadequate reimbursement and lack of financial resources for testing have been cited as possible explanations for the lack of availability of testing services. Aspects of the Affordable Care Act (ACA), including state Medicaid expansions, promotion of Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), may address these barriers and increase access to HIV and HCV testing. Methods: We examined the extent to which ACA implementation is associated with the offer of HIV and HCV testing in SUD treatment programs. Data came from the 2014 National Drug Abuse Treatment System Survey (NDATSS). The NDATSS is a nationally representative probability sample of SUDs that was supplemented with data from Single State Agencies (organizations overseeing addiction treatment programs). Multivariate regression models examined ACA-related correlates of HIV and HCV testing, controlling for program and client characteristics. Results: Of the SUD treatment programs surveyed (N = 598), 10.7% offered HCV testing only, 15.4% offered HIV testing only, 32.9% offered both HIV and HCV testing, and 41% did not offer testing. Approximately 16.7% of programs participated in ACO or PCMH and 63.6% were located in a state that had implemented Medicaid expansion. ACO or PCMH participation was significantly associated with offering both HIV and HCV testing (OR: 2.2, 95% CI: 1.1–4.2). There were no significant associations between testing and Medicaid expansion. Conclusions: ACO/PCMH participation may increase the availability of joint HIV/HCV testing in treatment programs. Medicaid expansion on its own is insufficient to address barriers to HIV and HCV testing in SUD programs. Financial Support: R01DA027379, R01DA034634, P30DA040500, R34DA038530. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.062 Activity based reward processing among opiate users: Validation of the behavioral incentive delay task Ryan Patrick Bell ∗ , Jennifer Youngshin Yi, Yun Chen, Antonio Petruzzella, Ian Jiang, Kimberley A.T. Johnson, Elizabeth Danielle Reese, Stacey B. Daughters Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States Aims: Behavioral activation (BA) treatment for substance use and depression is designed to improve outcomes via enhancement in environmental reward. To examine neural response to environmental reward, we designed a novel non-monetary reward version of the Monetary Incentive Delay Task (MID) task, called the Behavioral Incentive Delay (BID) Task, that utilizes images of engagement in daily activities. Methods: Male opiate users (OU; n = 13) (M age = 39.3; 74.1% Non-Hispanic White, 18.5% AA) and healthy controls (HC; n = 14) completed the BID and MID tasks while undergoing fMRI. Activation profiles were examined within and between groups during reward anticipation (RA) and reward outcome (RO). A 2 (task) × 2 (group) ANOVA examined neural activation profiles unique to the BID. Results: During the BID RA phase, OU displayed activations in the ACC and left precentral gyrus while HC displayed activations bilaterally in the caudate and thalamus. During the BID RO phase, OU displayed activation in the left caudate, bilateral hippocampus, right frontal pole, ACC, and right putamen. OU displayed less RO