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Symposium: Rapid Initiation of MOUD in Acute Care Settings: Findings from the SWIFT and ED-INNOVATION trials from the NIDA Clinical Trials Network (CTN)
Abstract

Despite effective medications for opioid use disorder (MOUD), most people with opioid use disorder (OUD) are not on one of the effective medications that protect against the risk of relapse and overdose. The opportunity to increase the uptake of MOUD exists across the continuum of care, including inpatient substance use disorder treatment units and emergency departments, settings where numerous people with opioid use disorder are seen, affording a “reachable moment” where MOUD can be initiated. This symposium will present data from two multisite trials, conducted in the NIDA Clinical Trials Network, focused on expanding MOUD use: CTN-0097, the SWIFT trial, conducted on inpatient substance use disorder treatment units and focused on the initiation of extended-release injection naltrexone, and CTN 0099, the ED-Innovation trial, conducted in emergency departments and focused on initiation of either sublingual or extended-release injection buprenorphine. These trials had a strong implementation focus and provide important clinical guidance and lessons learned around how to rapidly initiate MOUD in these acute clinical settings.


SWIFT and ED-INNOVATION, also present an opportunity to explore the impact of fentanyl on buprenorphine induction. It is becoming extremely common for fentanyl to be found in illicit opioid supplies and anecdotal reports suggest that fentanyl-using individuals have greater difficulty initiating treatment with buprenorphine. Providers are seeking guidance on buprenorphine initiation in patients who are using fentanyl. Data will be presented on withdrawal symptoms during initiation of buprenorphine, comparing withdrawal between those with and without fentanyl use.

Learning Objectives
  • Be able to explain the rapid procedure for XR-naltrexone induction.
  • Understand implementation considerations for ED based buprenorphine induction.
  • Describe the clinical factors associated with successful induction in fentanyl positive individuals.
Keywords / Topics
  • Medication for Opioid Use Disorder
  • Fentanyl
  • Buprenorphine Initiation
  • Extended-release naltrexone
  • Opioid Use Disorder
  • Clinical implementation
Presenters
Matisyahu Shulman, MD, Chairperson



Matisyahu Shulman is a clinician researcher focusing on opioid use disorder multisite clinical trials. He is a lead investigator on the CTN-0126 trial, a long term follow up/registry trial to follow long term recovery outcomes in individuals with OUD. He is also a co-investigator on the lead team of CTN-100: Optimizing Retention, Duration and Discontinuation Strategies for OUD Pharmacotherapy (LIs: Nunes, Rotrosen, Weiss, CO-I Shulman), a two phase multi-site (N=20) randomized controlled trial to test strategies to improve retention on buprenorphine and XR-naltrexone. He is also a lead team member of the CTN-097: Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT) (LIs: Bisaga & Nunes, CO-I Shulman) which is a multi-site (N=6) hybrid effectiveness-implementation, stepped wedge cluster randomized trial to foster widespread adoption of a rapid (5-7 day) protocol for detoxification and initiation of treatment with XR-naltrexone (XR-NTX) at inpatient/residential programs.


Udi Ghitza, PhD, Co-Chair

 

Udi Ghitza, Ph.D., is a Health Scientist Administrator and Scientific Officer at the National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN). Dr. Ghitza oversees the scientific aspects of clinical trials testing the effectiveness of pharmacological and behavioral treatments for substance use disorders in multisite nationwide studies that enroll large samples of diverse participants in general medical settings and community-based treatment programs. In addition, some studies examine approaches and strategies for how to best implement treatment with medications for opioid use disorder in various medical settings. Dr. Ghitza is also CCTN’s leader in its stimulant research program, to identify and test the efficacy and safety of medications and their combinations as repurposed candidate pharmacotherapies to treat stimulant use disorders, including methamphetamine, cocaine and other stimulant use disorders. Dr. Ghitza also helps to develop cohesive strategic plans prioritizing objectives and directions to be accomplished in these research programs.

Adam Bisaga, MD, Presenter

 

Dr. Adam Bisaga is a Professor of Psychiatry at Columbia University Irving Medical Center, and a Research Scientist at New York State Psychiatric Institute. His NIDA-funded research is focused on development of new medications to treat opioid and other substance use disorders, particularly improving outcomes of treatment with long-acting naltrexone. In addition to his research, Dr. Bisaga has been involved in training and mentoring of medical providers locally, nationally, and internationally. This includes co-directing the SAMHSA-funded national training and mentoring program “Providers’ Clinical Support System (PCSS)” aiming to expand and improve treatment for opioid use disorder. Dr. Bisaga is a member of UN Office of Drugs and Crime Expert Panel, contributing to UN and WHO addiction treatment guidances and conducting trainings and addiction treatment program developments internationally.

Miranda Greiner, MD, MPH, Presenter

 

Dr. Greiner is an addiction psychiatrist and a NIDA-funded T32 research fellow in substance use disorders at Columbia University Irving Medical Center and New York State Psychiatric Institute. Her main research interest is improving uptake and delivery of medications for opioid use disorder (MOUD) in community treatment settings through the study of implementation strategies and economic evaluation. Her background as a practicing clinician and previous training in healthcare consulting informs my approach to implementation science. She has developed financial models paired with strategic recommendations at the organizational level for delivery of evidence-based healthcare interventions. She aims to incorporate costing tools into future implementation research to support adoption, scale up, and sustainability of MOUD, as well as other substance use disorder treatments.

Gail D’Onofrio, MD, MS, Presenter

 

Dr. D’Onofrio is the Albert E. Kent Professor of Emergency Medicine, and Professor of Medicine and Public Health at Yale School of Medicine. She is boarded in emergency medicine and Addiction Medicine. An independent NIH-funded physician-scientist with over two decades of experience designing and implementing clinical trials in the ED setting related to alcohol and drug use, her work (JAMA, 2015) demonstrating that ED-initiated buprenorphine increases engagement in addiction treatment for individuals with OUD, has changed clinical practice.

Dr. D’Onofrio has a long track record of mentoring physician scientists in independent research careers. She is the PI of a NIDA K12 establishing the Yale Drug Use, Addiction and HIV Research Scholars (Yale-DAHRS) program, a Mentored Career Development Program with focused training in prevention and treatment of drug use, addiction, and HIV in general medical settings with scholars in multiple medical specialties. Dr. D’Onofrio is the PI of the New England Consortium Node, for the NIDA Clinical Trials Network.

Dr. D’Onofrio is a founding Board member of the Board of Addiction Medicine now recognized by ABMS as a Specialty, Sub-specialty under Preventive Medicine. She partners with multiple agencies regionally and nationally to change policies and introduce interventions to combat the opioid crisis.

Marc Fishman, MD, Discussant

 

Marc Fishman MD is an addiction psychiatrist, and leads Maryland Treatment Centers / Mountain Manor, a regional behavioral healthcare provider, which offers programs for residential and outpatient SUD and co-occurring treatment for youth and adults. He is a member of the psychiatry faculty at Johns Hopkins University School of Medicine. His academic and research work has focused on addiction pharmacotherapy; models of care for youth, particularly with OUD; and treatment placement and matching strategies. Dr. Fishman served as a co-editor for the most recent editions of the ASAM Criteria for the Treatment of Substance-Related Disorders. He served as a past President (2010-12) of the Maryland Society of Addiction Medicine, and is a current member of its Board.

Edward Nunes, MD, Discussant

 

Dr. Nunes is a Professor of Psychiatry at Columbia University Irving Medical Center and Research Psychiatrist at New York State Psychiatric Institute. He is an internationally recognized leader in research on treatments for opioid use disorder and other substance use disorders, and on co-occurring psychiatric and substance use disorders. For the past thirty years with continuous funding from NIH, mainly National Institute on Drug Abuse (NIDA), including a series of Career Development Awards, he has led clinical trials on medication and behavioral treatments for cocaine and opioid use disorders. He has over 250 peer-reviewed scientific publications, including papers in JAMA, New England Journal of Medicine, and Lancet, in addition to numerous book chapters and a textbook on diagnosis and treatment of co-occurring psychiatric disorders among patients with substance use disorders. His group was among the first to demonstrate that depression could be identified with careful clinical diagnosis and successfully treated among patients with alcohol, opioid or cocaine use disorders, and to demonstrate that behavioral intervention could improve the effectiveness of naltrexone as a treatment for opioid use disorder.

For the past 20 years he has served as a Principal Investigator in the NIDA Clinical Trials Network (CTN, New York Node), focused on clinical trials to demonstrate the effectiveness of new treatments in real-world clinical settings.

Summary
Availability: On-Demand
Cost: FREE
Credit Offered:
No Credit Offered
Recommended
 
American Academy of Addiction Psychiatry
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