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Article ; Online: Novel Uses of Methadone Under the "72-Hour Rule" to Facilitate Transitions of Care and Low-Dose Buprenorphine Induction in an Outpatient Bridge Clinic.

Shahlapour, Minaliza / Singh, Sabetta / Christine, Paul J / Laks, Jordana / Evans, James / Farrell, Natalija M / Khan, G Karim / Taylor, Jessica L / Rozansky, Hallie

Journal of addiction medicine

2024

Abstract: Background: Federal regulations restrict methadone for opioid use disorder (OUD) treatment to licensed opioid treatment programs (OTPs). However, providers in other settings can administer methadone for opioid withdrawal under the "72-hour rule" while ... ...

Abstract	Background: Federal regulations restrict methadone for opioid use disorder (OUD) treatment to licensed opioid treatment programs (OTPs). However, providers in other settings can administer methadone for opioid withdrawal under the "72-hour rule" while linking to further care. Prior work has demonstrated that methadone initiation in a low-barrier bridge clinic is associated with high OTP linkage and 1-month retention rates. We describe 2 other novel applications of the 72-hour rule in which methadone withdrawal management facilitated linkage to inpatient hospitalization and outpatient buprenorphine induction. Case presentations: Patient 1 was a 46-year-old woman with OUD complicated by serious injection-related infections. Severe opioid withdrawal limited her ability to tolerate emergency department wait times and receive inpatient care. We administered methadone for opioid withdrawal in an outpatient bridge clinic immediately before emergency department referral; this enabled hospital admission for intravenous antibiotics and anticoagulation. Patient 2 was a 36-year-old man with OUD desiring buprenorphine treatment. He had been unable to complete traditional buprenorphine induction without experiencing precipitated withdrawal. Thus, we recommended a low-dose buprenorphine induction overlapping with a full opioid agonist. Given the patient's preference to stop using fentanyl immediately, he received 72 hours of methadone for withdrawal treatment during the induction phase and successfully transitioned to buprenorphine without significant concomitant fentanyl use. Conclusion: In addition to facilitating OTP linkage, on-demand 72-hour methadone administration for opioid withdrawal can reduce barriers to acute medical care and buprenorphine treatment.
Language	English
Publishing date	2024-02-08
Publishing country	Netherlands
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000001281
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Critical medication shortages further dwindling hospital resources during COVID-19.

Farrell, Natalija M / Hayes, Bryan D / Linden, Judith A

The American journal of emergency medicine

2020 Volume 40, Page(s) 202–203

MeSH term(s)	Analgesics, Opioid/supply & distribution ; Anti-Bacterial Agents/supply & distribution ; COVID-19 ; Health Resources ; Hospitals ; Humans ; Hypnotics and Sedatives/supply & distribution ; Neuromuscular Blocking Agents/supply & distribution ; Prescription Drugs/supply & distribution
Chemical Substances	Analgesics, Opioid ; Anti-Bacterial Agents ; Hypnotics and Sedatives ; Neuromuscular Blocking Agents ; Prescription Drugs
Keywords	covid19
Language	English
Publishing date	2020-05-23
Publishing country	United States
Document type	Letter
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2020.05.059
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Article ; Online: Gender inequality in PGY1 residency leadership positions and conferral of health-system pharmacy professional awards.

Payne-Cardona, Monique / Arnold, Lindsay M / Jaiprasert, Sorraya / Leonard, Joy / Panahi, Sara / Farrell, Natalija M

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2022 Volume 79, Issue 13, Page(s) 1096–1102

Abstract: Purpose: To address gender inequality, the American Society of Health-System Pharmacists (ASHP) created a steering committee that recommended the collection of baseline and ongoing metrics of pharmacy leadership. The purpose of this study was to ... ...

Abstract	Purpose: To address gender inequality, the American Society of Health-System Pharmacists (ASHP) created a steering committee that recommended the collection of baseline and ongoing metrics of pharmacy leadership. The purpose of this study was to quantify gender inequality in distributions of residency program director (RPD) and director of pharmacy (DOP) positions and to investigate gender distributions among recipients of ASHP professional leadership awards. Methods: RPD and DOP information for postgraduate year 1 (PGY1) programs included in the online ASHP residency directory were collected in December of 2020. Publicly available records were used to collect information on recipients of the Harvey A.K. Whitney Award and John W. Webb Award during the periods 1950-2020 and 1985-2020, respectively. Gender information for RPDs, DOPs, and award recipients was collected from listed pronouns available in public records. A χ 2 test was used for analysis of the collected data. Results: A total of 1,176 PGY1 residency programs were included. Of the RPD positions assessed, 66% (n = 775) were filled by women pharmacists (P < 0.0001), while the percentage of DOP leadership positions held by women was 42% (n = 496) (P < 0.0001). Evaluation of data on recipients of the Harvey A.K. Whitney Award and John W. Webb Award revealed the occurrence of female recipients is 19.7% (n = 14) and 16.7% (n = 6), respectively (P < 0.0001). Conclusion: RPD positions have a higher prevalence of being filled by women. DOP positions remain male-dominated and revealed gender inequality among senior-level leadership roles. Pharmacy leadership award analysis identified further gender inequality. The results from the study serve as a baseline of current gender metrics for pharmacy leaderships in hospital systems with PGY1 residency programs.
MeSH term(s)	Awards and Prizes ; Female ; Humans ; Internship and Residency ; Leadership ; Male ; Pharmacy ; Pharmacy Residencies ; United States
Language	English
Publishing date	2022-03-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxac084
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Article ; Online: Presence of "One Pill Can Kill" Medications in Medication Organizers: Implications for Child Safety.

Farrell, Natalija M / Hamilton, Sebastian / Gendron, Bryan J / Corio, Jessica L / Lookabill, Sara K

Journal of pharmacy practice

2021 Volume 35, Issue 6, Page(s) 898–902

Abstract: Background: Medication organizers increased compliance, but they do not contain child protective packaging. Medications organizers have been involved in some pediatric exposures; however, previous reports do not describe if "one pill can kill" (1PCK) ... ...

Abstract	Background: Medication organizers increased compliance, but they do not contain child protective packaging. Medications organizers have been involved in some pediatric exposures; however, previous reports do not describe if "one pill can kill" (1PCK) medications were involved in the exposures. 1PCK medications may cause toxicity even with a single tablet. Objective: The purpose of this study is to describe the type and presence of 1PCK medications dispensed in medication organizers at a single center. Methods: Adult patients who received blister packed medications from September 1, 2017 to September 30, 2017 were included in this retrospective review. Medications were excluded if dispensed traditionally during this time. The primary outcome described included 1PCK medications (quantity and type). Secondary outcomes included total number of tablets dispensed, delayed- (DR) and extended-release (ER) formulations, average age of those dispensed 1PCK medications versus those without. Results: A total of 450 patients received 486 blister packs and 75.5% of which found to include 1PCK medications. Most commonly included 1PCK medications were beta-blockers and calcium channel blockers (42.4 and 49.4%, respectively). Patients receiving 1PCK medications were older (69.1 ± 12.6 vs 62.6 ± 16.7 years old, p < 0.0001) and included more medications (8.5 ± 2.9 vs 5.7 ± 2.9 medications, p < 0.0001). DR and ER formulations were in 150 packs. Conclusion: The majority of dispensed medication organizers included 1PCK medications. Upon dispensing, patients should be questioned for possible proximity exposures. Additionally, they should receive education on medication safety for children that may be in proximity of the medications during home, work, or social activities.
MeSH term(s)	Adult ; Humans ; Child ; Middle Aged ; Aged ; Drug Packaging ; Retrospective Studies ; Delayed-Action Preparations
Chemical Substances	Delayed-Action Preparations
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1027474-1
ISSN	1531-1937 ; 0897-1900
ISSN (online)	1531-1937
ISSN	0897-1900
DOI	10.1177/08971900211017491
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Zs.A 2893: Show issues

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Article: Critical medication shortages further dwindling hospital resources during COVID-19

Farrell, Natalija M / Hayes, Bryan D / Linden, Judith A

Am. j. emerg. med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #343194
Database	COVID19

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Article ; Online: Critical medication shortages further dwindling hospital resources during COVID-19

Farrell, Natalija M. / Hayes, Bryan D. / Linden, Judith A.

The American Journal of Emergency Medicine ; ISSN 0735-6757

2020

Keywords	Emergency Medicine ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
DOI	10.1016/j.ajem.2020.05.059
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: A Comparison of Etomidate, Ketamine, and Methohexital in Emergency Department Rapid Sequence Intubation.

Farrell, Natalija M / Killius, Kelly / Kue, Ricky / Langlois, Breanne K / Nelson, Kerrie P / Golenia, Peter

The Journal of emergency medicine

2020 Volume 59, Issue 4, Page(s) 508–514

Abstract: Background: Rapid sequence intubation (RSI) is routinely used for emergent airway management in the emergency department (ED). It involves the use of induction, and paralytic agents help facilitate endotracheal tube placement.: Objective: In response ...

Abstract	Background: Rapid sequence intubation (RSI) is routinely used for emergent airway management in the emergency department (ED). It involves the use of induction, and paralytic agents help facilitate endotracheal tube placement. Objective: In response to a previous national drug shortage resulting in the use of alternative induction agents for RSI, we describe the effectiveness and safety of ED RSI with ketamine or methohexital compared with etomidate. Methods: We conducted a retrospective, single-center observational study from March 1-August 31, 2012 describing RSI with etomidate, ketamine, and methohexital. All adult patients undergoing RSI in the ED who received etomidate prior to its shortage and methohexital or ketamine during the shortage were included. Results: The study included 47, 9, and 26 patients in the etomidate, ketamine, and methohexital groups, respectively. Successful intubation on the first attempt occurred in 74.5%, 55.6%, and 73.1% of the etomidate, ketamine, and methohexital groups, respectively. The mean number of intubation attempts and time to intubation seemed to be similar in all groups. At least three intubation attempts were required in 22.2% and 7.7% of the ketamine and methohexital groups, respectively, compared with none in the etomidate group. Two aspirations were observed in the etomidate group. Conclusion: Methohexital and etomidate had similar rates of successful intubation on the first attempt and seem to be more effective than ketamine. Etomidate may reduce the need for three or more intubation attempts. Larger, prospective studies are needed to determine if ketamine or methohexital are more effective than etomidate for RSI.
MeSH term(s)	Adult ; Emergency Service, Hospital ; Etomidate/pharmacology ; Etomidate/therapeutic use ; Humans ; Intubation, Intratracheal ; Ketamine/therapeutic use ; Methohexital ; Prospective Studies ; Rapid Sequence Induction and Intubation ; Retrospective Studies
Chemical Substances	Ketamine (690G0D6V8H) ; Methohexital (E5B8ND5IPE) ; Etomidate (Z22628B598)
Language	English
Publishing date	2020-07-29
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2020.06.054
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Article ; Online: Operationalizing influenza vaccination in an urban safety-net emergency department.

Farrell, Natalija M / Lamb, Matthew / Baker, William E / Gendron, Bryan J / Fett, David / Figueroa, Nelson / Margetak, Danielle / Schechter-Perkins, Elissa M

The American journal of emergency medicine

2021 Volume 52, Page(s) 179–183

Abstract: Introduction: Influenza vaccination is a recommended tool in preventing influenza-related illnesses, medical visits, and hospitalizations. With many patients remaining unvaccinated each year, the Emergency Department (ED) represents a unique opportunity ...

Abstract	Introduction: Influenza vaccination is a recommended tool in preventing influenza-related illnesses, medical visits, and hospitalizations. With many patients remaining unvaccinated each year, the Emergency Department (ED) represents a unique opportunity to provide vaccinations to patient not yet vaccinated. However, busy urban safety-net EDs maybe challenged to safely execute such a vaccination program. The aim of this quality improvement project was to assess influenza vaccination feasibility in the ED and improve influenza vaccination rates in our community. Methods: The quality improvement work-group, comprised of ED physicians, nurses, and pharmacists, designed and implemented an influenza vaccination protocol that aligned with the ED workflow. The outcome measure was the total number of patients vaccinated per month and per influenza season. Process measures included the type of influenza vaccine administered and type of care area within ED. Balancing measures were also included. Results: Following the initiative, a total of 337 patients received influenza vaccinations in the ED between September 1, 2018 and December 31, 2020 compared to none during the previous influenza season. With each influenza season, the number of vaccinated patients increased from 61 to 134 and 142, respectively. The average age of the patients was 48.23 ± 15.29, 52.89 ± 15.91, and 44.92 ± 18.97 years old. Most patients received the vaccination while roomed in the high acuity section of the adult ED. No adverse effects or automated dispensing cabinet stockouts were observed. Conclusion: Our structured program indicates that influenza vaccine administration to eligible patients is feasible in a busy urban safety-net ED. Piloting new and further developing existing ED-based influenza vaccination programs have the potential to significantly benefit public health.
MeSH term(s)	Adult ; Emergency Service, Hospital/statistics & numerical data ; Feasibility Studies ; Humans ; Immunization Programs/organization & administration ; Influenza Vaccines/administration & dosage ; Influenza Vaccines/adverse effects ; Influenza, Human/prevention & control ; Middle Aged ; Quality Improvement ; Safety-net Providers/organization & administration ; Vaccination/statistics & numerical data
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2021-12-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2021.12.021
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Article ; Online: Methadone initiation in a bridge clinic for opioid withdrawal and opioid treatment program linkage: a case report applying the 72-hour rule.

Laks, Jordana / Kehoe, Jessica / Farrell, Natalija M / Komaromy, Miriam / Kolodziej, Jonathan / Walley, Alexander Y / Taylor, Jessica L

Addiction science & clinical practice

2021 Volume 16, Issue 1, Page(s) 73

Abstract: Background: In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The "72-hour rule" allows non-OTP providers to administer methadone ... ...

Abstract	Background: In the United States, methadone for opioid use disorder (OUD) is limited to highly regulated opioid treatment programs (OTPs), rendering it inaccessible to many patients. The "72-hour rule" allows non-OTP providers to administer methadone for emergency opioid withdrawal management while arranging ongoing care. Low-barrier substance use disorder (SUD) bridge clinics provide rapid access to buprenorphine but offer an opportunity to treat acute opioid withdrawal while facilitating OTP linkage. We describe the case of a patient with OUD who received methadone for opioid withdrawal in a bridge clinic and linked to an OTP within 72 h. Case presentation: A 54-year-old woman with severe OUD was seen in a SUD bridge clinic requesting OTP linkage and assessed with a clinical opiate withdrawal scale (COWS) score of 12. She reported daily nasal use of 1 g heroin/fentanyl. Prior OUD treatment included buprenorphine-naloxone, which was only partially effective. Her acute opioid withdrawal was treated with a single observed oral dose of methadone 20 mg. She returned the following day with persistent opioid withdrawal (COWS score 11) and was treated with methadone 40 mg. On day 3, the patient was successfully admitted to a local OTP, where she remained engaged 3 months later. Conclusions: While patients continue to face substantial access barriers, bridge clinics can play an important role in treating opioid withdrawal, building partnerships with OTPs to initiate methadone on demand, and preventing life-threatening delays to methadone treatment. Federal policy reform is urgently needed to make methadone more accessible to people with OUD.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Buprenorphine/therapeutic use ; Female ; Humans ; Methadone/therapeutic use ; Middle Aged ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; United States
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2021-12-28
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2492632-2
ISSN	1940-0640 ; 1940-0640
ISSN (online)	1940-0640
ISSN	1940-0640
DOI	10.1186/s13722-021-00279-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Bridge clinic implementation of "72-hour rule" methadone for opioid withdrawal management: Impact on opioid treatment program linkage and retention in care.

Taylor, Jessica L / Laks, Jordana / Christine, Paul J / Kehoe, Jessica / Evans, James / Kim, Theresa W / Farrell, Natalija M / White, Cedric S / Weinstein, Zoe M / Walley, Alexander Y

Drug and alcohol dependence

2022 Volume 236, Page(s) 109497

Abstract: Background: Methadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal ... ...

Abstract	Background: Methadone for opioid use disorder (OUD) treatment is restricted to licensed opioid treatment programs (OTPs) with substantial barriers to entry. Underutilized regulations allow non-OTP providers to administer methadone for opioid withdrawal for up to 72 h while arranging ongoing care. Our low-barrier bridge clinic implemented a new pathway to treat opioid withdrawal and facilitate OTP linkage utilizing the "72-hour rule." Methods: Patients presenting to a hospital-based bridge clinic were evaluated for OUD, opioid withdrawal, and treatment goals. Eligible patients were offered methadone opioid withdrawal management with rapid OTP referral. OTPs accepted patients as direct admissions. We described bridge clinic patients who received at least one dose of methadone between March-August 2021 and key clinical outcomes including OTP referral completion within 72 h. For the subset of patients referred to our two primary OTP partners, we described OTP linkage (i.e., attended at least one OTP visit within one month) and OTP retention at one month. Results: Methadone was administered during 150 episodes of care for 142 unique patients, the majority of whom were male (73%), white (67%), and used fentanyl (85%). In 92% of episodes (138/150), a plan for ongoing care was in place within 72 h. Among 121 referrals to two primary OTP partners, 87% (105/121) linked and 58% (70/121) were retained at one month. Conclusions: Methadone administration for opioid withdrawal with direct OTP admission under the "72-hour rule" is feasible in an outpatient bridge clinic and resulted in high OTP linkage and 1-month retention rates. This model has the potential to improve methadone access.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Female ; Humans ; Male ; Methadone/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/drug therapy ; Retention in Care ; Substance Withdrawal Syndrome/drug therapy
Chemical Substances	Analgesics, Opioid ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2022-05-14
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2022.109497
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