Posters Examine Programs to Treat Patients With Substance Use Disorders

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As the United States continues to grapple with the ongoing opioid epidemic, the healthcare system is trying to set up programs to address the epidemic. A poster presented at the American Psychiatric Association 2018 Annual Meeting outlined 3 different programs initiated at the University of Maryland Medical System (UMMS).¹

In Maryland, the number of heroin-related deaths increased 62%, prescription opioid-related deaths increased 19%, and fentanyl-related deaths increased 76% from 2015 to 2016. The programs aimed to engage opioid-dependent patients who showed up in the emergency department (ED) in substance abuse treatment.

“Working in Baltimore has given us the opportunity to gain ample clinical experience working with individuals with opioid use disorders and have helped us identify some innovative strategies for engaging these individuals in treatment,” the authors wrote.

The programs include a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program, an ED buprenorphine initiative, and a buprenorphine bridge clinic.

The SBIRT program was a city-wide initiative for patients in the ED and used peer recovery coaches to screen and provide interventions to patients in the ED who are at risk for substance use disorder (SUD). Patients who are identified are referred to treatment and are closely followed. The SBIRT has been effective in certain populations, but is only marginally effective in patients with severe SUD.

In the program utilizing buprenorphine in the ED, UMMS trained ED physicians to identify appropriate patients and begin buprenorphine in the ED. The goal is to begin buprenorphine treatment early, which can decrease opioid use and increase engagement in substance abuse treatment, the authors wrote.

The third program was developed in conjunction with the Psychiatric Emergency Services to create a buprenorphine bridge clinic to address the shortages of community providers available to treat patients with opioid agonist therapy.

“The bridge clinic allows patients to receive continued opioid agonist treatment in the period between [ED] visit and outpatient intake, thus increasing the likelihood of successfully engaging in treatment,” the authors explained.

A second poster reviewed studies that have investigated mindfulness-based interventions (MBIs) as an alternative therapy that can achieve long-term recovery among patients with substance use disorder (SUD).²

“MBIs focus on developing patients’ non-judgmental awareness of present experience so that they recognize cognitive or affective states that have previously triggered relapse and avoid the habitual response of substance use,” the authors wrote.

The researchers searched for publications on PubMed using “mindfulness” and “substance use disorder” or “addiction” and reviewed 28 studies, including 23 primary studies (16 of which were randomized controlled trials) and 5 secondary analyses.

The studies tested a range of MBIs including brief mindfulness-based instruction and weekly group sessions taking place over several months. While several studies found a positive relationship between MBIs and decreased stress and increased social functioning, a few showed limited or no efficacy of MBIs in treating SUDs.

In addition, some of the studies found MBIs had larger positive impacts on some populations more than others. In some cases, there were more pronounced positive impacts in ethnic or racial minorities and women. One study found the benefits were restricted to patients with co-occurring psychiatric conditions.

The authors did notice what they called a “running theme” in all the studies, which was that “frequent formal practice at home is key to maximizing the benefits of MBIs, which tend to develop over time.”

The researchers suggested that additional studies are needed to confirm the benefits of MBIs and determine which ones promote long-term recovery.

References

1. Sathe C, Aggarwal R. Mind over substance? The role of mindfulness-based interventions in treating substance use disorders. Presented at the American Psychiatric Association 2018 meeting, May 5, 2018; New York, New York. Abstract #P1-9.

2. Sreedharan D, Faris ME, Laddaran L, Ramprashad A, Weintraub E, Welsh CJ. Measures undertaken at the University of Maryland Medical System in response to the opioid endemic in baltimore. Presented at the American Psychiatric Association 2018 meeting, May 5, 2018; New York, New York. Abstract #P1-10.