SSN Research/Scientific Articles & Activities
- The impact of COVID-19 on opioid treatment programs in the United States. SSN collaborated with New York University to study the impact of COVID-19 on OTPs with particular attention to relaxation of requirements for take-home medications and the expansion of telehealth services. Qualitative interviews were conducted with 25 OTP directors. Clinics reacted very quickly to make the necessary changes, and (after an initial adjustment period) many program directors were pleasantly surprised by how well these changes were received by both staff and patients, although some directors observed that telehealth group counseling was difficult to implement. Some directors reported that employing less restrictive protocols would benefit patients by reducing the burden and stigma associated with being a methadone patient. There was a general agreement that these less restrictive practices should continue although some respondents were cautious about drawing conclusions prematurely and recommended collecting more systematic outcome data. For the published report see: Goldsamt LA, Rosenblum A, Appel P, Paris P, Nazia N. Drug Alcohol Depend. 228 (2021).
- SSN is currently seeking funding to conduct a follow-up study of these same 25 OTPs which would assess the long-term impact of expansion of take-home privileges and telehealth services.
- SSN satisfaction survey. In 2022 at the American Association for the Treatment of Opioid Dependence (AATOD) conference in Baltimore, MD and the National Association Conference of Drug Court Professionals (NADCP) in Nashville, TN SSN distributed a 3-item survey to visitors at our exhibit booth. Visitors were asked: 1) whether they learned more about MOUD after reviewing SSN materials; 2) learned about negative effects of stigma; and 3) whether they intended to share SSN materials with their co-workers. More than 95% of respondents answered “Yes” to each of these items. These results strengthen the importance of SSN’s work to end stigma toward MOUD and persons with OUD.
- Survey of OTPs’ to the community. Results from an SSN survey conducted at the previous AATOD conference. In that survey providers reported that outreach to the community was a critical method to address MOUD stigma. In this 2018 survey, more than four-fifths of MAT programs reached out to the community and that 61% reported that outreach resulted in a positive outcome. Consistent with positive community interactions, nearly half of the programs reached out to a local official to address a concern and half reported a positive outcome.
- Review and commentary of methadone treatment terminology. Various stigmatizing descriptions have been used to characterize MOUD. This is especially evident with methadone where the term ‘substitution’ is erroneously used (on scientific and semantic grounds). Stigmatizing terminology has adverse health consequences although declining in use, stigmatizing terminology has continued to persist. Published: Appel, P. Despite repeated criticism, medications (methadone, Suboxone) for opioid use disorder continue being called “substitution” treatments. Heroin Addict Relat Clin Probl. 2020.
- Development of a rationale for clinical trials of new formulations of the LAAM. The increased flexibility in providing take-home medication for eligible methadone patients, under the Covid-19 SAMHSA waivers, and the highly positive responses of patients and providers, underscores the burdens treatment poses in its requirement of frequent, onsite clinic attendance, especially early in treatment. The agonist medication levo-alpha-acetylmethadol (LAAM) may offer another option as it has a 48 – 72 hour period of effectiveness, requiring 3 days of onsite clinic attendance from the outset of treatment rather than the 6-7 days of methadone. (A small percentage of LAAM patients need but two days a week). Five cardiac-related patient deaths over five years led LAAM to be withdrawn in 2003, but a review shows regulatory and financial factors to have been decisive. A NIDA grantee, Virginia Commonwealth University, has succeeded in developing new formulations of LAAM and SSN’s official position is that NIDA, CSAT and FDA authorize and support clinical trials. The urgency of supporting trials derives from the ongoing and worsening opioid epidemic (> 75,000 deaths in the 12-month period ending in April 2021), and that LAAM may be especially effective with the more powerful illicit opioids fentanyl and nitazine, especially common among recent admissions.
- Past relevant research by SSN Board members. When affiliated with other institutions several SSN Board members have conducted research that is directly relevant to SSN’s mission to end stigma and advance knowledge about MOUD. Samples of this work include:
- A survey of MAT practices and attitudes among drug courts (Matusow et al., 2013) which led NADCP to issue a unanimous resolution “[…] directing Drug Courts to learn the facts about MAT and obtain expert consultation from duly trained [medical professionals]” (NADCP, 2018, pp. 43-45);
- two mixed-methods studies on OTPs that highlighted the role that stigma and misconceptions about MOUD play in compromising disaster preparedness and response (Elliott et al., 2017; Matusow et al., 2017);
- a study of commuting distance to OTPs among OUD patients which demonstrated the significant burden that frequent OTP attendance imposed upon patients (Rosenblum et al., 2011);
- a study on barriers to drug treatment enrollment (Appel et al., 2004);
- A review of the published research literature on post-discharge outcomes after extended methadone tapering that found that virtually all studies document high rates of relapse to opioid use after methadone treatment is discontinued (Magura & Rosenblum, 2001).
- Several studies documenting the safety and effectiveness of methadone maintenance for selected patients in general medical practice. Under an exemption from federal methadone regulations methadone-maintained patients would typically be dispensed methadone and see a physician once a month in an office-based setting. (Novick et al., 2015; 1994; 1993; 1991; 1988.
