The Devil's in the Depot Details: Case of Iatrogenic Opioid Intoxication After Buprenorphine Injection Requiring Surgical Excision.

ABSTRACT: Monthly long-acting injectable buprenorphine (LAI-BUP) is a treatment option for moderate to severe opioid use disorder. Safe administration of LAI-BUP requires preexisting opioid tolerance to prevent sedation and respiratory depression. In the event of adverse medication effects including oversedation, LAI-BUP can be surgically excised up to 14 days after administration ( https://www.sublocadehcp.com/dosing-administration ). However, the manufacturer does not provide guidance on the proper procedure for excision, and no case reports have been published documenting this procedure. We report a case of a man with methamphetamine use disorder and multiple unintentional fentanyl overdoses who inadvertently received LAI-BUP for overdose protection. This resulted in significant sedation for days, ultimately necessitating excision 5 days after administration. His sedation improved moderately at 24 hours after excision and significantly by 36 hours after excision. Providers seeking to use LAI-BUP to prevent overdose among those with unintentional opioid exposure must ensure sublingual buprenorphine tolerance before injection to avoid iatrogenic harm. Although manufacturer instructions mention that LAI-BUP can be excised under local anesthesia within 14 days of insertion, ideal excision is best performed in a setting with surgical instruments and cautery-such as the operating room-as the depot can adhere strongly to the surrounding subcutaneous tissue.

Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy.

OBJECTIVES: Data regarding treatment outcomes with the use of buprenorphine-naloxone (BUP-NX) in pregnancy are scarce. The objective of this study is to examine the outcomes in a cohort of pregnancies treated with BUP-NX versus buprenorphine (BUP). METHODS: This single-center, retrospective cohort study examined birthing person-infant dyads treated with BUP-NX versus BUP. The primary birthing person outcome was return to opioid use in pregnancy. The primary neonatal outcome was the need for pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). RESULTS: The BUP-NX and the BUP treatment groups included 33 and 73 dyads, respectively. Except for psychiatric medication use, all demographics were similar between groups. In the final regression models, neither the birthing person nor the neonatal outcomes differed. The adjusted odds ratio for return to use during pregnancy for the BUP-NX versus BUP groups was 1.93 (95% confidence interval, 0.78-4.76). The adjusted odds ratio for pharmacologic treatment of NOWS for the BUP-NX versus BUP groups was 0.65 (95% confidence interval, 0.27-1.54). Among a subgroup of persons who transitioned from BUP to BUP-NX mid-pregnancy, there was no proximate return to use or need for dose increase. CONCLUSIONS: Compared with BUP, the use of BUP-NX in pregnancy is not associated with a higher risk of return to opioid use or a higher need for pharmacological treatment for NOWS.

A pilot study: the impact of clinic-provided transportation on missed clinic visits and system costs among teenage mother-child dyads.

Transportation insecurity has profound impacts on the health and wellbeing of teenage parents and their children, who are at particularly high risk for missed clinic visits. In other settings, clinic-offered rideshare interventions have reduced the rates of missed visits. We conducted a one-arm pre-post time series analysis of missed visits before and after a pilot study rideshare intervention within a clinic specializing in the care of teenage parents and their children. We compared the number of missed visits during the study with the number during the preceding year (July 2019-March 2020), as well as the cost difference of missed visits, adjusting for inflation and clinic census. Of 153 rides scheduled, 106 (69.3%) were completed. Twenty-nine (29.9%) of 97 clinic visits were missed during the study period, compared to 145 (32.7%) of 443 comparison period visits (p-value = 0.59). The estimated cost difference of missed visits including intervention costs was a net savings of $90,830.32. However, the standardized cost difference was a net excess of $6.90 per clinic visit. We found no difference in rates of missed visits or costs, though likely impacted by the low census during the SARS-CoV-2 pandemic. Given the potential to improve health disparities exacerbated by the pandemic, further research is warranted into the impact and utility of clinic-offered rideshare interventions.

Pap Smear and Mammogram Screening Rates in a Refugee and General OB/GYN Clinic: A Retrospective Review.

Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and mammograms, a small number have demonstrated the opposite. This retrospective chart review, conducted between January 2017 and October 2018, compares pap smear and mammogram rates of patients seen in a refugee-specific OB/GYN clinic with patients from the general OB/GYN clinic at the same institution. Data from 298 patients (149 refugee and 149 general clinic patients matched by age and date-of-visit) were analyzed. Pap smear screening rates were 90.60% in the refugee group and 73.83% in the general group [p < 0.009, aOR 3.46 (1.36-8.81)], while mammogram screening rates were 36.84% and 38.60%, respectively (p = 0.46). The provision of holistic services meeting refugee women's unique needs can effectively increase pap smear screening rates.

Rethinking Rideshares: A Transportation Assistance Pilot for Pediatric Patients with Sickle Cell Disease.

OBJECTIVE: Transportation barriers can limit health care access. This is particularly problematic for patients with chronic medical conditions such as sickle cell disease (SCD) who require frequent medical visits. This study assesses the efficacy of health care-directed rideshare services for overcoming these barriers at an urban pediatric specialty clinic. METHODS: A pilot study was conducted at Boston Medical Center's Pediatric Hematology Clinic from January to April 2019. Patients whose caregivers reported transportation difficulties were offered rides. Primary outcomes were no-show rates and cost. Secondary outcomes included timeliness and patient experience. RESULTS: Implementation of rideshare services led to an 8.5% decrease in the no-show rate among patients with SCD. The intervention cost $2,175 over three months and generated $40,262 in charges. No adverse experiences were reported. CONCLUSIONS: In an urban, underserved pediatric hematology clinic, the use of rideshare services is a feasible and relatively low-cost strategy for improving health care access.

Rides for Refugees: A Transportation Assistance Pilot for Women's Health.

Transportation barriers can limit access to healthcare for refugee and asylum seeking women. This study assesses the efficacy of a healthcare-directed rideshare application for overcoming these barriers at an urban health clinic. A pilot study was conducted at Boston Medical Center's Refugee Women's Health Clinic from June 2018 to February 2019. Women with gynecologic visits reporting transportation difficulties were offered rides. The primary outcome was no-show rates. Secondary outcomes included cost, and patient/provider experiences. Of 102 eligible visits, 31 reported transportation insecurity and received rides. Those women had a 6% no-show rate, compared to 30% in women denying transportation barriers, and 50% amongst unreachable women (p < 0.0001). The intervention cost $2033 and generated $30,337 in charges. Minimal adverse experiences were reported. Healthcare-directed rideshare applications are an effective and cost-efficient strategy for refugee and asylum seeking women to access essential health services.