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  1. Article ; Online: Pharmacy-based expansion of buprenorphine access.

    Clark, Seth A / Green, Traci C / Rich, Josiah D

    Journal of substance use and addiction treatment

    2023  Volume 157, Page(s) 209195

    Abstract: Introduction: Access to evidence-based medication treatment is a challenge for most Americans with opioid use disorder. New models of collaborative care that actively incorporate pharmacists are being trialed.: Methods: We author a commentary based ... ...

    Abstract Introduction: Access to evidence-based medication treatment is a challenge for most Americans with opioid use disorder. New models of collaborative care that actively incorporate pharmacists are being trialed.
    Methods: We author a commentary based on our experiences providing clinical care as part of a randomized controlled trial of pharmacy-based addiction care.
    Results: This commentary describes some of the experiences of working with a Collaborative Practice Agreement between pharmacists and physicians to provide pharmacy-based, low-threshold buprenorphine access.
    Conclusion: Given that 87 % of Americans with opioid use disorder are not getting access to buprenorphine or methadone, establishing a pharmacy-based buprenorphine treatment program is a promising strategy to address that gap and should be explored promptly.
    MeSH term(s) Humans ; Buprenorphine/therapeutic use ; Analgesics, Opioid/therapeutic use ; Opioid-Related Disorders/drug therapy ; Methadone/therapeutic use ; Pharmacy
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid ; Methadone (UC6VBE7V1Z)
    Language English
    Publishing date 2023-10-17
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2949-8759
    ISSN (online) 2949-8759
    DOI 10.1016/j.josat.2023.209195
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  2. Article ; Online: Towards an Improved Substance Use Disorder Treatment Landscape in Rhode Island - Barriers, Current Progress, and Next Steps.

    Braun, Hannan M / Holtzman, Juliette A / Wunsch, Caroline / Clark, Seth A

    Rhode Island medical journal (2013)

    2022  Volume 105, Issue 3, Page(s) 24–27

    Abstract: Expanding addiction treatment services in Rhode Island has never been more urgent. Today, we face colliding syndemics of COVID-19, preventable drug overdoses, and HIV, with another year of record overdoses. While the treatment of substance use disorder ( ... ...

    Abstract Expanding addiction treatment services in Rhode Island has never been more urgent. Today, we face colliding syndemics of COVID-19, preventable drug overdoses, and HIV, with another year of record overdoses. While the treatment of substance use disorder (SUD) is an essential component of general medical care, numerous barriers prevent broader treatment access for patients in Rhode Island. Buprenorphine and methadone therapy have restrictions that are not applied to other areas in medicine, including for more dangerous medications. In this piece, we highlight existing barriers to care, applaud current progress being made in our state, and provide recommendations for next steps to turn the tide of this deadly epidemic. We hope that these proposed changes will help develop a robust treatment landscape for all patients with SUD in Rhode Island.
    MeSH term(s) COVID-19 ; Drug Overdose/epidemiology ; Epidemics ; Humans ; Rhode Island/epidemiology ; Substance-Related Disorders/epidemiology ; Substance-Related Disorders/therapy
    Language English
    Publishing date 2022-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 419430-5
    ISSN 2327-2228 ; 0363-7913
    ISSN (online) 2327-2228
    ISSN 0363-7913
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  3. Article ; Online: Escalating Overdose Deaths Necessitate an Overdose Prevention Center in Rhode Island.

    Clark, Seth / Yolken, Annajane / DeToy, Steve

    Rhode Island medical journal (2013)

    2021  Volume 104, Issue 2, Page(s) 18–20

    MeSH term(s) Analgesics, Opioid ; Drug Overdose/prevention & control ; Humans ; Rhode Island/epidemiology
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-03-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 419430-5
    ISSN 2327-2228 ; 0363-7913
    ISSN (online) 2327-2228
    ISSN 0363-7913
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  4. Article ; Online: Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies.

    Green, Traci C / Serafinski, Rachel / Clark, Seth A / Rich, Josiah D / Bratberg, Jeffrey

    The New England journal of medicine

    2023  Volume 388, Issue 2, Page(s) 185–186

    MeSH term(s) Humans ; Buprenorphine/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/drug therapy ; Pharmacies ; Patient Care/methods ; Delegation, Professional ; Pharmacists
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Narcotic Antagonists
    Language English
    Publishing date 2023-02-13
    Publishing country United States
    Document type Letter ; Research Support, N.I.H., Extramural
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc2208055
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  5. Article ; Online: Keeping the Fentanyl Narrative Accurate.

    Clark, Seth A / Hack, Jason B

    Rhode Island medical journal (2013)

    2019  Volume 102, Issue 9, Page(s) 11–12

    MeSH term(s) Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/toxicity ; Drug Overdose/mortality ; Fentanyl/administration & dosage ; Fentanyl/toxicity ; Humans ; Practice Guidelines as Topic ; Rhode Island/epidemiology ; Societies, Medical ; United States
    Chemical Substances Analgesics, Opioid ; Fentanyl (UF599785JZ)
    Language English
    Publishing date 2019-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 419430-5
    ISSN 2327-2228 ; 0363-7913
    ISSN (online) 2327-2228
    ISSN 0363-7913
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  6. Article ; Online: Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician.

    Zimmerman, Cara / Clark, Seth / Guerra, Michael E / Bratberg, Jeffrey / Adams, Kathleen K

    Substance abuse

    2023  Volume 44, Issue 3, Page(s) 121–129

    Abstract: Low dose buprenorphine initiation (LDBI) is a dosing strategy used to transition patients from full opioid agonists to buprenorphine. The purpose of LDBI is to circumvent obstacles associated with disruption in analgesia, precipitated withdrawal, and ... ...

    Abstract Low dose buprenorphine initiation (LDBI) is a dosing strategy used to transition patients from full opioid agonists to buprenorphine. The purpose of LDBI is to circumvent obstacles associated with disruption in analgesia, precipitated withdrawal, and prerequisite opioid withdrawal prior to initiating buprenorphine, as not all patients are able to tolerate physical withdrawal symptoms recommended by national guidelines. No literature exists directly comparing traditional buprenorphine initiation to LDBI. Until information on long-term outcomes is available, these dosing strategies should be reserved for patients unable to tolerate traditional buprenorphine initiation. Available published research suggests LDBI strategies will allow some patients to successfully transition to buprenorphine with minimal or no symptoms of withdrawal. Ensuring access to pharmacotherapy during hospital admission is a crucial time for potential intervention and should be considered when appropriate. This narrative review discusses the background of LDBI strategies as well as practical clinical and operational considerations for the inpatient clinician.
    Language English
    Publishing date 2023-09-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1458030-5
    ISSN 1547-0164 ; 0889-7077
    ISSN (online) 1547-0164
    ISSN 0889-7077
    DOI 10.1177/08897077231196417
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  7. Article ; Online: An Evaluation of Differential Reinforcement in the Treatment of Pica.

    Muething, Colin / Call, Nathan A / Clark, Seth

    Developmental neurorehabilitation

    2019  Volume 23, Issue 5, Page(s) 321–327

    Abstract: Common approaches to pica treatment involve intensive staffing and near continuous behavioral monitoring to proactively disrupt any attempts at this potentially life threatening behavior. Including differential reinforcement of discarding pica items as a ...

    Abstract Common approaches to pica treatment involve intensive staffing and near continuous behavioral monitoring to proactively disrupt any attempts at this potentially life threatening behavior. Including differential reinforcement of discarding pica items as a contingency in such interventions has been suggested as a more practical treatment model, but the evidence base for this approach is limited. We replicated this work by evaluating differential reinforcement for discarding pica items in conjunction with response blocking and differential reinforcement of other behavior in the treatment of pica exhibited by two children. We extended this work by evaluating sustained reductions when therapist and caregiver monitoring was reduced.
    MeSH term(s) Adolescent ; Aggression ; Autism Spectrum Disorder/psychology ; Autism Spectrum Disorder/rehabilitation ; Behavior Therapy/methods ; Caregivers ; Child ; Humans ; Male ; Neuropsychological Tests ; Observer Variation ; Pica/psychology ; Pica/therapy ; Reinforcement Schedule ; Reinforcement, Psychology ; Self-Injurious Behavior
    Language English
    Publishing date 2019-11-07
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2280007-4
    ISSN 1751-8431 ; 1751-8423
    ISSN (online) 1751-8431
    ISSN 1751-8423
    DOI 10.1080/17518423.2019.1689436
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    Zs.A 5416: Show issues Location:
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  8. Article ; Online: A Preliminary Test of an mHealth Facilitated Health Coaching Intervention to Improve Medication Adherence among Persons Living with HIV.

    Ramsey, Susan E / Ames, Evan G / Uber, Julia / Habib, Samia / Clark, Seth / Waldrop, Drenna

    AIDS and behavior

    2021  Volume 25, Issue 11, Page(s) 3782–3797

    Abstract: This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and ...

    Abstract This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and 12 months of app access and health coaching via the app (Fitbit Plus) versus single adherence session (SOC). At baseline and 1, 3, 6, and 12 months, we measured ART adherence, substance use, and depressive symptoms. We also conducted individual qualitative interviews. The intervention was found to be largely feasible and highly acceptable, with the health coach spending an average of 2.4 min per month with a participant and 76.5% of Fitbit Plus participants using the app regularly at 12 months. While most comparisons were not significant, the pattern of results was consistent with better adherence in the Fitbit Plus compared to SOC condition. Substance use was significantly associated with poorer ART adherence while depressive symptoms were not.ClinicalTrials.gov Identifier: NCT02676128; Registered: 2/8/2016.
    MeSH term(s) Anti-Retroviral Agents/therapeutic use ; HIV Infections/drug therapy ; Humans ; Medication Adherence ; Mentoring ; Telemedicine
    Chemical Substances Anti-Retroviral Agents
    Language English
    Publishing date 2021-06-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1339885-4
    ISSN 1573-3254 ; 1090-7165
    ISSN (online) 1573-3254
    ISSN 1090-7165
    DOI 10.1007/s10461-021-03342-5
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  9. Article ; Online: Thirty-day Treatment Continuation After Audio-only Buprenorphine Telehealth Initiation.

    Wunsch, Caroline / Wightman, Rachel / Pratty, Claire / Jacka, Brendan / Hallowell, Benjamin D / Clark, Seth / Davis, Corey S / Samuels, Elizabeth A

    Journal of addiction medicine

    2022  Volume 17, Issue 2, Page(s) 206–209

    Abstract: Objectives: Before the coronavirus disease 2019 pandemic, federal law required in-person evaluation before buprenorphine initiation. Regulatory changes during the pandemic allow for buprenorphine initiation by audio-only or audiovisual telehealth. ... ...

    Abstract Objectives: Before the coronavirus disease 2019 pandemic, federal law required in-person evaluation before buprenorphine initiation. Regulatory changes during the pandemic allow for buprenorphine initiation by audio-only or audiovisual telehealth. Little is known about treatment engagement after buprenorphine initiation conducted via audio-only telehealth.
    Methods: A retrospective cohort study of 94 individuals who received initial treatment through an audio-only encounter between April 2020 and February 2021 was performed. Participant demographics, substance use history, withdrawal symptoms, 30-day treatment engagement, and adverse outcomes were determined by an electronic chart and REDcap database review. Subsequent buprenorphine prescriptions filled within 30 days of the initial encounter were tracked through the Rhode Island Prescription Drug Monitoring Program.
    Results: Buprenorphine was prescribed for 94 individuals. Most (92 of 94 [97.9%]) filled their prescription within 30 days. Most had previously taken buprenorphine, including prescribed (42 of 92 [45.7%]) and nonprescribed (58 of 92 [63.0%]). Two thirds were in opioid withdrawal at the time of the call (61 of 92 [66.3%]) with a mean Subjective Opioid Withdrawal Scale of 26.8 (range, 4-57). Four individuals experienced precipitated withdrawal (4 of 94 [4.3%]), and 2 reported persistent withdrawal at their follow-up visit (2 of 94 [2.1%]). More than 70% filled a subsequent prescription for buprenorphine within 30 days of the end of their hotline prescription (65 of 92 [70.7%]), on average of 5.88 days (range, 0-28) after completion of their telehealth prescription.
    Conclusions: Expanding telehealth-delivered buprenorphine care has the potential to address treatment gaps and facilitate delivery of on-demand services during peak motivation. This evaluation of audio-only buprenorphine initiation found high rates of unobserved buprenorphine initiation and treatment continuation with low rates of complications.
    MeSH term(s) Humans ; Buprenorphine/therapeutic use ; Analgesics, Opioid/therapeutic use ; Retrospective Studies ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/complications ; COVID-19 ; Substance Withdrawal Syndrome/drug therapy ; Telemedicine ; Opiate Substitution Treatment
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
    Language English
    Publishing date 2022-09-14
    Publishing country United States
    Document type Journal Article
    ISSN 1935-3227
    ISSN (online) 1935-3227
    DOI 10.1097/ADM.0000000000001077
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  10. Article ; Online: Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder.

    Scherzer, Caroline / Jiménez Muñoz, Paola / Ramsey, Susan / Carey, Kate B / Ranney, Megan L / Clark, Seth / Rich, Josiah / Langdon, Kirsten J

    Journal of addictive diseases

    2022  Volume 42, Issue 1, Page(s) 24–32

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Adult ; Humans ; Behavior Therapy ; Psychiatry ; Buprenorphine/therapeutic use ; Fear ; Opioid-Related Disorders/drug therapy ; Analgesics, Opioid ; Opiate Substitution Treatment
    Chemical Substances Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
    Language English
    Publishing date 2022-11-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1077616-3
    ISSN 1545-0848 ; 1055-0887
    ISSN (online) 1545-0848
    ISSN 1055-0887
    DOI 10.1080/10550887.2022.2126273
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