When a pandemic and epidemic collide: Lessons learned about how system barriers can interrupt implementation of addiction research.

Background: Telehealth technologies are now featured more prominently in addiction treatment services than prior to the COVID-19 pandemic, but system barriers should be carefully considered for the successful implementation of innovative remote solutions for medication management and recovery coaching support for people with opioid use disorder (OUD). Method: The Centers for Disease Control and Prevention funded a telehealth trial prior to the COVID-19 pandemic with a multi-institution team who attempted to implement an innovative protocol during the height of the pandemic in 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, which integrated remote motivational recovery coaching with daily supervised dosing from secure pill dispensers via videoconference, on medication adherence during buprenorphine treatment. This paper provides a participant case example followed by a reflective evaluation of how the pandemic amplified both an existing research-to-practice gap and clinical system barriers during the implementation of telehealth clinical research intervention for patients with OUD. Findings: Implementation challenges arose from academic institutional requirements, boundaries and role identity, clinical staff burnout and lack of buy-in, rigid clinical protocols, and limited clinical resources, which hampered recruitment and intervention engagement. Conclusions: As the urgency for feasible and effective telehealth solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.

The COVID-19 pandemic coupled with the opioid overdose epidemic has resulted in compounded challenges to the fields of addiction treatment and clinical research. This manuscript describes a CDC (Centers for Disease Control and Prevention)-funded randomized control trial that was initiated prior to the COVID-19 pandemic and implemented during the height of the pandemic through 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, integrating remote recovery coaching with the option of daily supervised buprenorphine dosing from secure pill dispensers via videoconference to reduce barriers and enhance support for medication adherence during treatment. With the sudden emergence of COVID-19, this research, already challenged by a research-to-practice gap and existing clinical system barriers to medications for opioid use disorder (MOUD) treatment (e.g., siloed service delivery, stigmatized staff and community perceptions of buprenorphine, and high staff burnout/turnover), was amplified by the rapidly changing protocols for standards of care during the implementation of an OUD treatment research intervention in the midst of the start of the pandemic. Lessons learned related to challenges from academic institutional requirements, boundaries and role identity, burnout, staff buy-in, and clinical protocols and resources are discussed, and recommendations for future research are provided. As urgency for feasible and effective solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.

Rapid adaptation during the COVID crisis: Challenges experienced in delivering service to those with Opioid Use Disorders.

Background: Adaptation is an accepted part of implementing evidence-based practices. COVID-19 presented a unique opportunity to examine adaptation in evolving contexts. Delivering service to people with opioid use disorder during the pandemic required significant adaptation due to revised regulations and limited service access. This report evaluated changes to addiction medication services caused by the pandemic, challenges encountered in rapidly adapting service delivery, and initial impressions of which changes might be sustainable over time. Methods: Qualitatively-evaluated structured interviews (N = 20) were conducted in late 2020 with key informants in Pinellas County (FL) to assess the pandemic's impact. Interviewees represented a cross-section of the professional groups including direct SUD/HIV service providers, and sheriff's office, Department of Health, and regional clinical program administrative staff. The interview questions examined significant changes necessitated by the pandemic, challenges encountered in adapting to this evolving context, and considerations for sustained change. Results: The most significant changes to service delivery identified were rapid adaptation to a telehealth format, and modifying service consistent with SAMHSA guidance, to allow for 'take-home' doses of methadone. Limitations imposed by access to technology, and the retraining of staff and patients to give and receive service differently were the most common themes identified as challenging adaptation efforts. Respondents saw shifts towards telehealth as most likely to being sustained. Conclusions: COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations identified will only be sustained through multisystem collaboration and validation. Results suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery. Findings will also be integrated with quantitative data to help inform local policy decisions. Plain Language Summary: Adaptation is an accepted part of implementing evidencebased practices. COVID-19 presented a unique opportunity to examine rapid adaptation necessitated within evolving contexts. Delivering services to people with opioid use disorder required significant adaptation due to changing regulations and limited access to lifesaving services. This study examined changes in service delivery due to the pandemic, challenges encountered in rapid adaptation, and initial impressions of which changes might be sustainable over time. Qualitatively-evaluated structured interviews were conducted with a cross-section of professional groups (direct substance use disorder (SUD) and human immunodeficiency virus (HIV) service providers, and sheriff's office, Department of Health, and clinical program administrative staff) in Pinellas County (FL). The most significant changes to service delivery were rapid adaptation to a telehealth format and increased allowance for 'takehome' doses of methadone medication. Limitations imposed by access to technology, as well as the education of and staff and patients were the most common themes identified as challenges. Respondents saw shifts towards telehealth as most likely to be sustained. COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations will only be sustained through multisystem collaboration and validation. Findings suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery.

Protecting patients and staff in residential treatment centers during exposure to COVID-19: commentary.

BACKGROUND: The COVID-19 pandemic has created a crisis in access to addiction treatment. Programs with residential components have been particularly impacted as they try to keep infection from spreading in facilities and contributing to further community spread of the virus. This crisis highlights the ongoing daily trade-offs that organizations must weigh as they balance the risks and benefits of individual patients with those of the group of patients, staff and the community they serve. MAIN BODY: The COVID-19 pandemic has forced provider organizations to make individual facility level decisions about how to manage patients who are COVID-19 positive while protecting other patients, staff and the community. While guidance documents from federal, state, and trade groups aimed to support such decision making, they often lagged pandemic dynamics, and provided too little detail to translate into front line decision making. In the context of incomplete knowledge to make informed decisions, we present a way to integrate guidelines and local data into the decision process and discuss the ethical dilemmas faced by provider organizations in preventing infections and responding to COVID positive patients or staff. CONCLUSION AND COMMENTARY: Provider organizations need decision support on managing the risk of COVID-19 positive patients in their milieu. While useful, guidance documents may not be capable of providing support with the nuance that local data and simulation modeling may be able to provide.

Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality.

Background: A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing to provide appropriate care for people with opioid use disorder (OUD) diagnoses, and to assess disparities in receipt of medication for OUD (MOUD).Objective: Using a CoC framework, assess treatment quality and outcomes for OUD in the Florida Medicaid population in 2017/2018 by demographics and primary vs. secondary diagnosis.Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began MOUD, were retained on medication for a minimum of 180 days, and who died.Results: Only 28% of those diagnosed with OUD began treatment with an FDA approved MOUD (buprenorphine, methadone, or injectable naltrexone). Once on medication, 38% of newly diagnosed enrollees were retained in treatment for180 days. Those who remained on MOUD for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate MOUD, a reduction in mortality from 10% without MOUD to 2% with MOUD.Conclusions: Initiating medication after OUD diagnosis offers the greatest opportunity for intervention to reduce overdose deaths, though efforts to increase retention are also warranted. Analyzing claims data with CoC identifies system functioning for specific populations, and suggests policies and clinical pathways to target for improvement.

Assessing the Knowledge, Attitudes and Behaviors of Human and Animal Health Students towards Antibiotic Use and Resistance: A Pilot Cross-Sectional Study in the UK.

The Global Action Plan on Antimicrobial Resistance highlights the importance of training all healthcare professionals. No study has assessed patterns of students' knowledge, attitudes and practices concerning antibiotic use simultaneously across different healthcare course types. We conducted a cross-sectional multi-center survey among UK students. The survey was advertised through local survey coordinators at 25 universities. The online survey was accessible from 10th October to 17th November 2016 (before European Antibiotic Awareness Day). A total of 255 students from 25 universities participated, including students on medicine, pharmacy, nursing, physician associate, dentistry and veterinary medicine courses. Antibiotic resistance was considered to be a more important global challenge than climate change, obesity or food security (p < 0.001). Most students (95%) believed that antibiotic resistance will be a problem for their future practice, but fewer (69%) thought that the antibiotics they will prescribe, administer or dispense will contribute to the problem. A fifth of students felt they had sufficient knowledge of antibiotic use for their future work. Our exploratory study suggests that UK human and animal healthcare students are aware of the importance of antibiotic resistance, but many still have certain misconceptions. Campaigns and improved educational efforts applying behavioral insights methodology could address these.

Modeling interdisciplinary research to advance behavioral health care.

Over the past 15 years, scientists have become increasingly interested in interdisciplinary research collaborations. The integration of multiple perspectives to provide input into the most complex issues in science is thought to offer the best opportunity to find real-world answers to difficult problems. In this review and introduction to the special section on interdisciplinary research in behavioral health care, the value of a collaborative strategy is explored. Examples from the research presented in the special section are described to identify how processes were modified and interpretations made richer by these collaborations. Also discussed are potential impediments to researchers choosing to work from an interdisciplinary perspective. Conditions that are thought to encourage collaborative, interdisciplinary perspectives are also described.

A community planning process for the implementation of evidence-based practice.

Over the past 10 years, increasing attention has been paid to the development and implementation of 'evidence-based' practices or EBPs. In 1998, the National Academy of Sciences' Institute of Medicine began drawing attention to the discrepancy between research findings and practice patterns in the treatment of substance abuse. The community coalition described in this study was developed to create a partnership between substance abuse treatment providers, policy makers, university-based researchers, and consumers to examine treatment advances and evaluate their possible application in local community settings. In the first year the community coalition conducted a needs assessment, with the goal of prioritizing areas for practice change. The needs assessment process included focus groups, key informant interviews, and a survey of substance abuse treatment providers. The questions addressed at each stage of the assessment varied, but collectively all methods formed the basis for consensus-building for a change in practice in substance abuse treatment. The results of the needs assessment were further refined and influenced the development and implementation of two evidence-based practices (EBPs) within multiple agencies. Implications for using a community needs assessment to highlight coalition building and identify and adopting EBPs are discussed.

Characteristics of opinion leaders in substance abuse treatment agencies.

OBJECTIVE: This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence-based treatment of co-occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of "opinion leaders" as technology transfer agents. METHOD: A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co-occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co-occurring disorders. RESULTS: The analyses demonstrate that opinion leaders differed from other counselors in competency-related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co-occurring disorders as well as a greater willingness and confidence in working with such clients. CONCLUSION: These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence-based treatment practices in community treatment settings.