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Article ; Online: "You're Always Jumping Through Hoops": Journey Mapping the Care Experiences of Individuals With Opioid Use Disorder-associated Endocarditis.

Bearnot, Benjamin / Mitton, Julian A

Journal of addiction medicine

2020 Volume 14, Issue 6, Page(s) 494–501

Abstract: Objectives: Serious infectious complications of opioid use disorder (OUD), and specifically endocarditis, are becoming more common in the US. Individuals with OUD-associated endocarditis require long periods of complex medical care, often face recurrent ...

Abstract	Objectives: Serious infectious complications of opioid use disorder (OUD), and specifically endocarditis, are becoming more common in the US. Individuals with OUD-associated endocarditis require long periods of complex medical care, often face recurrent addiction- and infection-related complications, and have dismal clinical outcomes. The objective of this study was to perform journey mapping analysis to capture common trajectories and patterns of care for people with OUD-associated endocarditis. Methods: This was an analysis of qualitative semi-structured interviews of individuals who received care for OUD-associated endocarditis. Interviews were conducted among individuals receiving care at a single academic healthcare system in Boston, Massachusetts. Ten participants meeting DSM-5 criteria for at least mild OUD and a culture-positive diagnosis of endocarditis who had previously completed care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Details of participant's care episodes were extracted and visualized in an iterative journey mapping process. A grounded theory approach was then used to identify shared themes and care patterns among participants' journey maps. Results: Common patterns of care included early addiction treatment and intensive outpatient care preceding periods without rehospitalization, while leaving outpatient care and return to drug use often directly preceded rehospitalization. Participants frequently left care by choice and proactively reengaged with care. Conclusions: Journey mapping is a novel, patient-centered approach to capturing the care experiences and trajectories of a patient population experiencing significant stigma, who engage with the healthcare system in unexpected and fragmented ways. For individuals with OUD-associated endocarditis, we identified critical moments to support and engage patients to prevent return to drug use and rehospitalization.
MeSH term(s)	Boston ; Endocarditis ; Humans ; Massachusetts ; Opioid-Related Disorders ; Social Stigma
Language	English
Publishing date	2020-03-05
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000000648
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Treatment of Refractory Opioid Use Disorder.

Yen Li, Mimi / Mitton, Julian A / Bearnot, Benjamin I

Journal of general internal medicine

2021 Volume 36, Issue 6, Page(s) 1792

MeSH term(s)	Analgesics, Opioid/therapeutic use ; Canada ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; United States
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-04-07
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-021-06718-4
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Article ; Online: Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder: a retrospective cohort study.

Yen Li, Mimi / Alba, George A / Mitton, Julian / Bearnot, Benjamin

Addiction science & clinical practice

2021 Volume 16, Issue 1, Page(s) 57

Abstract: Background: Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that ... ...

Abstract	Background: Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment. Objectives: To characterize care-engaged individuals who use methamphetamine to guide harm reduction and treatment strategies. Methods: Retrospective cohort study of individuals at a large academic medical center in Massachusetts with ≥ 2 positive methamphetamine oral fluid toxicology tests between August 2019 and January 2020. We performed descriptive analysis of sociodemographic, medical, and drug use characteristics and a comparative analysis of injection methamphetamine use versus other routes of use. Results: Included were 71 individuals [56 male (80%), 66 non-Hispanic white (94%), median age 36 (IQR 30-42)]. Nearly all had opioid (94%) and stimulant use disorder (92%). Most had (93%) or were (83%) being treated with medications for opioid use disorder, but few received pharmacologic treatment for methamphetamine use disorder (24%). None received contingency management treatment. People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have HCV (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes. Both groups had prevalent homelessness (88% vs. 73%; p = 0.15), incarceration (81% vs. 64%; p = 0.11), depression (94% vs. 87%; p = 0.34), and bacteremia (27% vs. 22%; p = 0.63). Conclusions: Individuals in our study had high prevalence of polysubstance use, particularly concomitant methamphetamine and opioid use. Individuals who were well connected to substance use treatment for their opioid use were still likely to be undertreated for their methamphetamine use disorder and would benefit from greater access to contingency management treatment, harm reduction resources, and resources to address adverse social determinants of health.
MeSH term(s)	Adult ; Analgesics, Opioid/therapeutic use ; Central Nervous System Stimulants/adverse effects ; Cohort Studies ; Drug Overdose/drug therapy ; Humans ; Male ; Methamphetamine/adverse effects ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Retrospective Studies
Chemical Substances	Analgesics, Opioid ; Central Nervous System Stimulants ; Methamphetamine (44RAL3456C)
Language	English
Publishing date	2021-09-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2492632-2
ISSN	1940-0640 ; 1940-0640
ISSN (online)	1940-0640
ISSN	1940-0640
DOI	10.1186/s13722-021-00267-1
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Article ; Online: Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder

Mimi Yen Li / George A. Alba / Julian Mitton / Benjamin Bearnot

Addiction Science & Clinical Practice, Vol 16, Iss 1, Pp 1-

a retrospective cohort study

2021 Volume 9

Abstract: Abstract Background Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known ... ...

Abstract	Abstract Background Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment. Objectives To characterize care-engaged individuals who use methamphetamine to guide harm reduction and treatment strategies. Methods Retrospective cohort study of individuals at a large academic medical center in Massachusetts with ≥ 2 positive methamphetamine oral fluid toxicology tests between August 2019 and January 2020. We performed descriptive analysis of sociodemographic, medical, and drug use characteristics and a comparative analysis of injection methamphetamine use versus other routes of use. Results Included were 71 individuals [56 male (80%), 66 non-Hispanic white (94%), median age 36 (IQR 30–42)]. Nearly all had opioid (94%) and stimulant use disorder (92%). Most had (93%) or were (83%) being treated with medications for opioid use disorder, but few received pharmacologic treatment for methamphetamine use disorder (24%). None received contingency management treatment. People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have HCV (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes. Both groups had prevalent homelessness (88% vs. 73%; p = 0.15), incarceration (81% vs. 64%; p = 0.11), depression (94% vs. 87%; p = 0.34), and bacteremia (27% vs. 22%; p = 0.63). Conclusions Individuals in our study had high prevalence of polysubstance use, particularly concomitant methamphetamine and opioid use. Individuals who were well connected to substance use treatment for their opioid ...
Keywords	Methamphetamine ; Opioid crisis ; Harm reduction ; Stimulants ; Drug overdose ; Medicine (General) ; R5-920 ; Social pathology. Social and public welfare. Criminology ; HV1-9960
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Stop Posturing and Start Problem Solving: A Call for Research to Prevent Gun Violence.

Hills-Evans, Kelsey / Mitton, Julian / Sacks, Chana A

AMA journal of ethics

2018 Volume 20, Issue 1, Page(s) 77–83

Abstract: Gun violence is a major cause of preventable injury and death in the United States, leading to more than 33,000 deaths each year. However, gun violence prevention is an understudied and underfunded area of research. We review the barriers to research in ... ...

Abstract	Gun violence is a major cause of preventable injury and death in the United States, leading to more than 33,000 deaths each year. However, gun violence prevention is an understudied and underfunded area of research. We review the barriers to research in the field, including restrictions on federal funding. We then outline potential areas in which further research could inform clinical practice, public health efforts, and public policy. We also review examples of innovative collaborations among interdisciplinary teams working to develop strategies to integrate gun violence prevention into patient-doctor interactions in order to interrupt the cycle of gun violence.
MeSH term(s)	Cooperative Behavior ; Federal Government ; Financing, Government ; Firearms ; Health Services Needs and Demand ; Humans ; Physician-Patient Relations ; Practice Patterns, Physicians' ; Problem Solving ; Public Health ; Public Policy ; Research/economics ; Violence/prevention & control
Language	English
Publishing date	2018-01-01
Publishing country	United States
Document type	Journal Article
ISSN	2376-6980
ISSN (online)	2376-6980
DOI	10.1001/journalofethics.2018.20.1.pfor1-1801
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Disruptive Resilience: Harnessing Leadership to Build a More Equitable Health Care System After COVID-19.

Mitton, Julian A / Urquieta de Hernandez, Brisa / Pasupuleti, Nisha / Hurley, Kimm / John, Reena / Cole, Alisahah

Population health management

2021 Volume 24, Issue 6, Page(s) 646–647

MeSH term(s)	COVID-19 ; Delivery of Health Care ; Humans ; Leadership ; SARS-CoV-2
Language	English
Publishing date	2021-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2454546-6
ISSN	1942-7905 ; 1942-7891
ISSN (online)	1942-7905
ISSN	1942-7891
DOI	10.1089/pop.2021.0041
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Article ; Online: Opioid and Amphetamine Treatment Trends Among American Indians in the Great Plains.

Mitton, Julian A / Jackson, Sean / Ho, J Janet / Tobey, Matthew

Journal of addiction medicine

2019 Volume 14, Issue 4, Page(s) e100–e102

Abstract: Objectives: Traditionally underserved populations in the United States, particularly rural and American Indian/Alaska Native (AI/AN) communities, are disproportionately impacted by the opioid and amphetamine epidemics and have a higher risk for ... ...

Abstract	Objectives: Traditionally underserved populations in the United States, particularly rural and American Indian/Alaska Native (AI/AN) communities, are disproportionately impacted by the opioid and amphetamine epidemics and have a higher risk for substance use disorders. AI/AN communities in the American Great Plains face exceptional health risks. We aim to describe recent trends in opioid and amphetamine treatment admissions for AI/ANs living in the Great Plains relative to that of the general population. Methods: We used data from the 2014 to 2016 Substance Abuse and Mental Health Services Administration (SAMHSA) Drug and Alcohol Services Information System (DASIS) Treatment Episode Data Set (TEDS) for Admissions. We extracted opioid and amphetamine treatment admissions for self-identified AI/AN and non-AI/AN patients living in the Great Plains: North Dakota, South Dakota, Nebraska, and Iowa. Average annual admission rates were calculated and compared from 2014 to 2016 for AI/AN versus non-AI/AN populations. Results: While opioid and amphetamine treatment admissions from 2014 to 2016 increased in both AI/AN (49 vs 80 per 10,000) and non-AI/AN (20 vs 26 per 10,000) populations, the rate of increase was significantly greater among AI/ANs (64% vs 32%; P < 0. 01). These trends are largely reflective of increased amphetamine use treatment admissions observed in both AI/AN and non-AI/AN populations. Conclusions: Treatment admissions for opioid and amphetamine use have increased from 2014 to 2016 for both AI/AN and non-AI/AN individuals in the Great Plains, driven largely by amphetamine use. AI/AN individuals were observed to seek care at a much higher rate. This increase in treatment admissions suggests increasing demand for services, which, in turn, necessitates greater investment of resources into AI/AN health facilities to address opioid and amphetamine use disorder in this underserved population.
MeSH term(s)	American Natives ; Amphetamine ; Analgesics, Opioid ; Humans ; Indians, North American ; Nebraska ; United States/epidemiology
Chemical Substances	Analgesics, Opioid ; Amphetamine (CK833KGX7E)
Language	English
Publishing date	2019-11-14
Publishing country	United States
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000000594
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Article ; Online: Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study.

Bearnot, Benjamin / Mitton, Julian A / Hayden, Margaret / Park, Elyse R

Journal of substance abuse treatment

2019 Volume 102, Page(s) 16–22

Abstract: Purpose: Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences ... ...

Abstract	Purpose: Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences of care for patients with OUD-associated endocarditis and the healthcare providers who deliver that care. Study design: This qualitative study was conducted through semi-structured interviews of patients and providers at a single academic hospital using a grounded theory approach. Patients meeting DSM-5 criteria for at least mild OUD who had previously completed an episode of care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Multidisciplinary care providers who regularly care for patients with OUD-associated endocarditis were also recruited. Interviews were conducted until thematic saturation was achieved. Principle results: Of 11 patient participants, six were recruited from outpatient settings. Of 12 provider participants, seven cared for patients with OUD "almost always." Five major themes emerged across patient and provider interviews: stigma-related inequity and delays in care, the social and medical comorbidities of individuals with OUD-associated endocarditis, addiction as a chronic and relapsing disease, differing experiences of prolonged hospitalizations between patients and providers, and a lack of integration or discontinuity of care. Opportunities for care innovation and improvement were identified. Conclusions: This qualitative analysis highlights multiple patient and health system factors that may explain poor clinical outcomes experienced by individuals with OUD-associated endocarditis. A sick, complex, stigmatized patient population was noted, with new physical and mental comorbidities often developing on top of pre-existing ones. Perceived barriers to effective treatment of OUD-associated endocarditis included the complexity of managing two life threatening illness simultaneously, external stigma towards individuals with OUD, and discontinuity in longitudinal care.
MeSH term(s)	Adult ; Continuity of Patient Care ; Delivery of Health Care/organization & administration ; Delivery of Health Care/standards ; Endocarditis/etiology ; Endocarditis/therapy ; Female ; Grounded Theory ; Health Personnel/statistics & numerical data ; Healthcare Disparities ; Hospitalization/statistics & numerical data ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Opioid-Related Disorders/complications ; Social Stigma
Language	English
Publishing date	2019-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	605923-5
ISSN	1873-6483 ; 0740-5472
ISSN (online)	1873-6483
ISSN	0740-5472
DOI	10.1016/j.jsat.2019.04.008
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Article ; Online: Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial.

Latimer, Eric A / Rabouin, Daniel / Cao, Zhirong / Ly, Angela / Powell, Guido / Aubry, Tim / Distasio, Jino / Hwang, Stephen W / Somers, Julian M / Bayoumi, Ahmed M / Mitton, Craig / Moodie, Erica E M / Goering, Paula N

Psychiatric services (Washington, D.C.)

2020 Volume 71, Issue 10, Page(s) 1020–1030

Abstract: Objective: The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of ... ...

Abstract	Objective: The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of Housing First with ACT and treatment as usual. Methods: Between October 2009 and June 2011, a total of 950 homeless individuals with serious mental illness were recruited in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. Participants were randomly assigned to Housing First (N=469) or treatment as usual (N=481) and followed up for up to 24 months. The intervention consisted of scattered-site Housing First, using rent supplements, with ACT. The treatment-as-usual group had access to all other services. The perspective of society was adopted for the cost-effectiveness analysis. Days of stable housing served as the outcome measure. Retrospective questionnaires captured service use data. Results: Most (69%) of the costs of the intervention were offset by savings in other costs, such as emergency shelters, reducing the net annual cost of the intervention to about Can$6,311 per person. The incremental cost-effectiveness ratio was Can$41.73 per day of stable housing (95% confidence interval=Can$1.96-$83.70). At up to Can$60 per day, Housing First had more than an 80% chance of being cost-effective, compared with treatment as usual. Cost-effectiveness did not vary by participant characteristics. Conclusions: Housing First with ACT appeared about as cost-effective as Housing First with intensive case management for people with moderate needs. The optimal mix between the two remains to be determined.
MeSH term(s)	Canada ; Community Mental Health Services ; Cost-Benefit Analysis ; Homeless Persons ; Housing ; Humans ; Mental Disorders/therapy ; Retrospective Studies
Language	English
Publishing date	2020-08-25
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.202000029
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Article ; Online: Smoking cessation after engagement in HIV care in rural Uganda.

Mitton, Julian A / North, Crystal M / Muyanja, Daniel / Okello, Samson / Vořechovská, Dagmar / Kakuhikire, Bernard / Tsai, Alexander C / Siedner, Mark J

AIDS care

2018 Volume 30, Issue 12, Page(s) 1622–1629

Abstract: People living with HIV (PLWH) are more likely to smoke compared to HIV-uninfected counterparts, but little is known about smoking behaviors in sub-Saharan Africa. To address this gap in knowledge, we characterized smoking cessation patterns among people ... ...

Abstract	People living with HIV (PLWH) are more likely to smoke compared to HIV-uninfected counterparts, but little is known about smoking behaviors in sub-Saharan Africa. To address this gap in knowledge, we characterized smoking cessation patterns among people living with HIV (PLWH) compared to HIV-uninfected individuals in rural Uganda. PLWH were at least 40 years of age and on antiretroviral therapy for at least three years, and HIV-uninfected individuals were recruited from the clinical catchment area. Our primary outcome of interest was smoking cessation, which was assessed using an adapted WHO STEPS smoking questionnaire. We fit Cox proportional hazards models to compare time to smoking cessation between PLWH pre-care, PLWH in care, and HIV-uninfected individuals. We found that, compared to HIV-uninfected individuals, PLWH in care were less likely to have ever smoked (40% vs. 49%, p = 0.04). The combined sample of 267 ever-smokers had a median age of 56 (IQR 49-68), 56% (n = 150) were male, and 26% (n = 70) were current smokers. In time-to-event analyses, HIV-uninfected individuals and PLWH prior to clinic enrollment ceased smoking at similar rates (HR 0.8, 95% CI 0.5-1.2). However, after enrolling in HIV care, PLWH had a hazard of smoking cessation over twice that of HIV-uninfected individuals and three times that of PLWH prior to enrollment (HR 2.4, 95% CI 1.3-4.6, p = 0.005 and HR 3.0, 95% CI 1.6-5.5, p = 0.001, respectively). In summary, we observed high rates of smoking cessation among PLWH after engagement in HIV care in rural Uganda. While we hypothesize that greater access to primary care services and health counseling might contribute, future studies should better investigate the mechanism of this association.
MeSH term(s)	Adult ; Female ; HIV Infections/complications ; HIV Infections/psychology ; Humans ; Male ; Proportional Hazards Models ; Rural Population ; Smoking Cessation ; Surveys and Questionnaires ; Uganda
Language	English
Publishing date	2018-06-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1012651-x
ISSN	1360-0451 ; 0954-0121
ISSN (online)	1360-0451
ISSN	0954-0121
DOI	10.1080/09540121.2018.1484070
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