News from the Nodes
The CTN Health Systems Node is pleased to report on progress in the PRimary care Opioid Use Disorders (PROUD) Treatment Trial, CTN-0074, which received DSMB approval in the fall and central IRB approval in December.
Sites have ceded to the central IRB and we officially randomized on 2/28/2018. The sites are now working on hiring their nurse care managers who will support the treatment of opioid use disorder in the intervention primary care clinics. Find a list of the participating sites here.
Papers from PROUD Phase 1 are in progress, with 3 being selected for oral presentations at CPDD, and Dr. Volkow was recently briefed on Phase 1 findings.
PROUD is the HSN’s first opportunity to lead a pragmatic, cluster-randomized, quality improvement trial in the CTN, in which all outcome data will come from health systems’ electronic health records and other data systems. The trial is assessing whether the Massachusetts Model of collaborative care--which uses a nurse care manager to support treatment of opioid use disorder (OUD) in primary care--is effective in diverse health systems. We continue to be incredibly appreciative of all the support we have received from the C-CTN, the DSC, and the CCC.
The Health Systems Node also recently received DSMB approval for CTN-0077: Medical Cannabis Use Among Primary Care Patients: Using Electronic Health Records to Study Large Populations, led by Gwen Lapham at Kaiser Permanente Washington with Kathy Bradley as Co-lead. This mixed methods study will use EHR data and patient surveys to characterize medical and non-medical use of cannabis in a defined health care system population in which cannabis screening is a standard component of primary care. This study is currently in its start-up phase and will be taking place in Kaiser Permanente Washington.
From CTN-0061: Campbell CI, et al. Use of a prescription opioid registry to examine opioid misuse and overdose in an integrated health system. Prev Med 2018;110:31-37.
First publication from CTN-0065: Lapham GT, et al. Frequency of Cannabis Use Among Primary care Patients in Washington State. J Am Board Fam Med 2017;30(6):795-805.
New England Consortium
Roger D. Weiss, M.D. led a well-attended webinar through the Providers Clinical Support System (PCSS) titled "The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment" on February 20, 2018. The webinar was sponsored by the American Psychiatric Association. Find the slides, a recording of the webinar, and more information here.
Dr. Weiss also presented a Grand Rounds lecture at McLean Hospital in Belmont, Massachusetts on February 22, 2018 reviewing Treatment of Prescription Opioid Dependence based on the research results from the CTN-0030 POATS clinical trial and the CTN-0030 long-term follow-up study.
Kathryn McHugh, Ph.D. has been awarded the Theodore Blau Early Career Award for Outstanding Contribution to Professional Clinical Psychology from the American Psychological Foundation. The award honors a clinical psychologist for accomplishments and promise in clinical psychology. Congratulations, Dr. McHugh!
The CTN-0067 Lead Team would like to congratulate Tarzana Treatment Center (Western States Node), Bluegrass Clinic - UKy (Ohio Valley Node) and Jackson Memorial (Florida Node) on their recent protocol endorsements.
The 67 protocol will be implemented in a total of seven clinics and builds on lessons learned from the CHOICES pilot study (CTN-0055). The remaining four sites plan to be endorsed within the next two weeks. We are all excited to move into enrolling participants into the trial.
Update on CTN-0068: ADAPT-2: We are near 40% of our enrollment target and sites continue to work on creative recruitment methods and even more creative retention strategies.
As of February 27th we have randomized 145 participants into the study. CODA in Portland, OR is leading with 25 randomizations, followed closely by UT Health in Houston with 24 randomizations and UCLA with 23 randomizations. The study overall is keeping a tighter ratio of 7.7 prescreens to get 2.5 consented to get 1 participant randomized.
We’d like to recognize CODA, SURU, and UCLA for increasing their treatment exposure over the last few months, improving the overall treatment exposure for the study. We are excited to be launching our first ever national ad campaign across all study sites, which includes branding materials (e.g., brochures, print ads) and piloting a central toll-free call in number to help all site with their recruitment efforts.
A special shout out goes to our sites who are always going above and beyond to accommodate our study participants by doing off study site visits, sometimes driving over 2 hours to meet the participants halfway! Now that’s dedication!
The Northeast Node was pleased to kick off the 2018 calendar year with a Science Series presentation by Ryan McCormack, MD, MS, and Kathryn Hawk, MD, MHS, on "Initiating Treatment of Opioid Use Disorder in the Emergency Room."
The Emergency Department (ED) is a critical venue for initiating substance use disorder (SUD) interventions because ED patients have a disproportionately high prevalence of SUD, are at an elevated risk of overdose, and many do not access healthcare elsewhere. Despite this, SUD interventions are rarely initiated in EDs.
In their presentation, Dr. Hawk and Dr. McCormack reviewed common barriers to initiating treatment in the ED, including stigma, lack of resources, and perceptions of SUD as being a choice rather than a chronic disease with a biological basis.
For example, Dr. Hawk spoke about how using language like "addict, alcoholic, and dirty" versus "person with an alcohol or drug use disorder" reinforces negative perceptions.
Drawing on recent and ongoing research, they also described best practices for the treatment of opioid use disorder (OUD) and alcohol use disorder in the ED, including ED-initiated buprenorphine, extended-release naltrexone, and naloxone distribution. ED patients with OUD who received ED-initiated buprenorphine were twice as likely to be engaged in treatment at a 30-day follow-up than those who were given a referral or brief intervention.
While the current federal regulations may make it challenging for ED providers to administer medication-assisted treatment for OUD, Dr. McCormack and the CTN are exploring the role that buprenorphine, including injectable extended release buprenorphine formulations, could play.
Read more about this presentation and its 2 speakers. . .
Their full presentation can be viewed on the Northeast Node’s website. If you would like to join the Science Series mailing list, please email Bethany McLeman.
Patient-Centered Care for Patients in OTPs was the 2nd in a new monthly webinar series from the NW Addiction Technology Transfer Center (located at the UW Alcohol & Drug Abuse Institute, home of PNW Node).
Presenter Michelle Peavy, PhD, described a treatment model that leverages patient-centered care components and enhances retention among individuals who struggle with ongoing drug use, and clinical implications of that model. Dr. Peavy is a licensed clinical psychologist at Evergreen Treatment Services, one of the PNW Node clinical partners, and has had an active role in numerous CTN protocols and publications.
View a recording of this webinar and find out about future NWATTC webinars on the NWATTC Webinars page.
Mental Health Services for U.S. Veterans
PNW Node PI, ADAI Director Dr. Dennis Donovan helped to review and evaluate mental health services available to U.S. veterans, resulting in a report from the National Academies of Sciences, Engineering, and Medicine. The committee conducted site visits and sought input on the use of VA mental health services directly from veterans of the wars in Afghanistan and Iraq, their families and caregivers, health care providers, and others at each of the Veterans Integrated Service Networks across the U.S. The report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn.
The survey found a lack of awareness about how to connect with the VA for mental health care; not knowing how to apply for VA mental health care benefits; being unsure if they are eligible; and lack of awareness that the VA offers these benefits.
Other barriers to seeking VA mental health care services include lack of transportation options to and convenience of medical facility locations; concerns about taking time off work and potentially harming their careers; and fears that discrimination could lead to a loss of contact with or custody of their children, or lead to a loss of medical or disability benefits. Read the full report online: https://doi.org/10.17226/24915
Find a list of recent publications from the PNW Node here. . .
From the ATTC
ATTC Messenger February 2018: Behavioral Healthcare in the Digital Age, by Nancy Roget, Joyce Hartje, Wendy Woods, and Terra Hamblin of NFAR, CASAT, University of Nevada, Reno.
ATTC/NIATx Service Improvement Blog
Everything you need to know about medications for treating opioid use disorders: SAMHSA TIP 63
Understanding Substance Use Disorders: New online course covers the basics