Sarah Bagley MD Addiction Medicine Fellow Clinical Addiction Research and Education Unit Boston University School of Medicine CREST Fellows Presentations February 24 2015 S upported by the Research in Addiction Medicine Scholars program ID: 758437
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The Impact on Caregivers of Young Adult Opioid Use
Sarah Bagley MDAddiction Medicine FellowClinical Addiction Research and Education UnitBoston University School of MedicineCREST Fellows PresentationsFebruary 24, 2015Supported by the Research in Addiction Medicine Scholars programNIDA R25DA033211Thanks to Alex Walley for background slidesSlide2
Outline of Presentation
CREST projectProposed K23 Specific AimsSlide3
National Vital Statistics System. Drug overdose death rates by state. 2008.
Drug Overdose Deaths in U.S. 1990-2008More Than Tripled Slide4
Strategies to Address Overdose
Prescription monitoring programs
1
Prescription drug
disposal
2
Safe opioid prescribing education
3
Opioid agonist treatment
4
Paulozzi
LJ, et
al. Pain Med. 2011 May;12(5):747-54.
Gray
NE and Hagemeier JA. Arch
Intern Med. 2012;172(15):1186-1187.
Albert
S, et
al. Pain Med. 2011 Jun;12 Suppl 2:S77-85.
Clausen
T, et
al. Addiction. 2009 Aug;104(8):1356-62
.Slide5
Overdose Education and Naloxone Distribution
Initial efforts to implement OEN with people with use drugs>50,000 people trained to recognize and respond to an overdose between 1996-20101 Overdose education and naloxone distribution (OEN) effective response to reduce deaths2, 3 Study in 2010 indicated that caregivers may also be interested in receiving OEN41. CDC. MMWR. 2012;61
(6):101-105 2. Walley AY,
Xuan Z, Hackman HH, et al. BMJ. 2013;346:f174. 3. Coffey PO and Sullivan SD. Annals Int Med. 2013;158(1):1-9
4. Strang et al. Drugs, Education and Policy. 2008;15(2):211-218. Slide6
Research Aims
Aim 1 Describe the characteristics of family members of opioid users who attend a support group for families affected by addiction who participate in OEN and those who do not.Aim 2Describe the motivations and benefits for family members of opioid users to receive OEN.Aim 3Describe the number of times trained family members have used naloxone to reverse an opioid overdose.Slide7
Methods
Cross sectional study conducted between July 2013-September 2013Convenience SampleSetting: community support group for family members affected by addiction Slide8
Setting
Learn to Cope: founded in 2004 by mother whose son had an opioid addiction Provides support and nonprofessional advice to family membersIn 2011, OEN offered at every meeting10 meetings in Massachusetts in 2013Slide9
Methods
Massachusetts Opioid Overdose Prevention Pilot ProgramStarted in 2006Provides OEN to community groups throughout MAMore than 28,000 people trained and > 3,300 rescuesSlide10
Procedure
Attendees at meeting given option to participate in an anonymous 15 minute survey $5 gift card for compensationSlide11
Instrument
42 items5 domains: demographics, relationship to opioid user, experience with overdose, motivations to receive OEN, and naloxone rescue kit use Piloted with 5 Learn to Cope members prior to starting studySlide12
Aim One: Characteristics of Attendees
TotalN=125OEN TrainedN=99UntrainedN=26P-valueAge (mean)
53.1
52.3
55.0 0.20
Female
78
%
79
%
77
%
0.84
White
95
%
94
%100%0.44
Married
74%
75%73%0.99Parent85%91%
65
%0.0056Slide13
Aim One: Characteristics of Attendees
Total(N=125)OEN Trained(n= 99)Untrained(n=26)P-valueProvide financial support52
%
58%
30%
0.0086
Daily contact
50
%
54
%
33
%
0.0041
Applied for court-mandated treatment
35
%
41%15%
0.04
Witnessed overdoes in past30
%35%12%0.07Heard about naloxone before L2C47% 43
%
59%
0.14Slide14
Aim Two: Motivations for Receipt of OEN
OEN Trained (n=93)Wanted to have in the House 72%Encouraged by Education Provided at L2C
60%
Heard About Benefits from L2C Members
57% Wanted More Information about OD
26%
Wanted Kit for Someone Else
19%
Previously Witnessed OD
18%
Experienced Death of Loved One
1.1% Slide15
Aim Two: Reported benefits of OEN
BENEFITSOEN Trained(n=92)Greater sense of security74%
Improved confidence to handle OD
62% Greater understanding of prevention and management of OD
60%
Educate others about OEN
33%
Ability to reverse an OD
29% Slide16
Aim Two: Motivations for OEN among untrained
OEN Not Trained (n=13)Encouraged by education provided at L2C 69% Wanted to have in the house
31%Heard about benefits from L2C members
31%
Wanted more
i
nformation
about OD
23%
Wanted kit for someone
else
7.7%
Previously witnessed OD
7.7%Experienced death of loved one 0%Slide17
Aim Three: Use of Naloxone
NTotal Rescues5RELATIONSHIP Parent Grandparent Stranger Other2111SETTING
Public Private
14CHARACTERISTICS Survived Called 911 Rescue Breathing
554Slide18
Conclusions
High uptake of overdose education and naloxone rescue kits offered at the meetings. Trainees were parents who provided financial support, had daily contact, had applied for court-mandated treatment, and had witnessed an overdose.Among the minority who had not received OEN, almost half wanted to be trained. Several attendees had administered naloxone successfullySlide19
Limitations
Cross-sectionalConvenience sampleSelf-selected population Missing dataSlide20
Implications
Family members should be included in the response to the opioid related overdose epidemicMore work needed to determine the most effective way to implement OEN programs in community settingsHow to expand OEN to families who are not coming to meetings?Slide21
Next Steps
Observed consistent high burden of stress that family members experienceCaregiver populations of patients with other chronic diseases find high levels of stress, poorer physical health outcomes should we be focusing on engaging families? Slide22
Next Steps
Family members whose loved one use substances have higher morbidity and health care costsNo data about specifically about impact of opioid useTreatment of addiction increasingly integrated into primary care settingsStrategies exist to provide support for families but are not necessarily well implemented/disseminated in primary careSlide23
Research Question
What is the impact on caregivers of transitional age youth with opioid use disorders? Slide24
Aims
Aim OneIdentify the physical and emotional impact on the primary caregivers of transitional age youth who use opioids. Design and conduct a mixed methods study of caregivers of transitional age youth with opioid use disorders to identify the physical and emotional impact and to identify strategies to address the impact.Aim TwoDesign and conduct a statewide survey of medical directors at community health centers that provide integrated primary care and addiction care to understand if and how primary caregivers are engaged in treatment.
(Aim Three or R03)Develop and implement a pilot intervention using data gathered from Aims 1 and 2 for caregivers whose transitional age youth
who use opioids to be delivered in primary care settings. Slide25
Acknowledgements
Joanne Peterson and Learn to Cope Alex Walley MD, MSc Charlie Jose MPH Debbie Cheng ScDEmily Quinn MPHPatrick O’Connor MD, MPHJeffrey Samet MD, MPH, MAMichael Silverstein MD