Browsing by Author "McNeely, Jennifer"
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Item Open Access A Brief Screening and Assessment Tool for Opioid Use in Adults: Results from a Validation Study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.(Journal of addiction medicine, 2023-02) Bunting, Amanda M; Schwartz, Robert P; Wu, Li-Tzy; Wahle, Aimee; Kline, Margaret; Subramaniam, Geetha; McNeely, JenniferObjectives
This secondary analysis evaluated opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care.Methods
This study is a secondary data analysis of the TAPS validation study. Performance of the TAPS tool for screening for unhealthy opioid use (with a score of 1+ for heroin and/or prescription opioids representing a positive screen) was evaluated. Discriminative ability was examined in comparison with reference standard measures across the spectrum of unhealthy opioid use: timeline follow-back with and without oral fluid testing identifying past-month use and the modified Composite International Diagnostic Interview for past-year problem use, opioid use disorder (OUD), and moderate-severe OUD.Results
In a sample of 2000 primary care patients, 114 screened positive for opioids on the TAPS tool. With a TAPS cutoff equal to 1+, the TAPS accurately identified past-month use, problem use, any OUD, and moderate-severe OUD (sensitivities = 68%-85%, specificities = 97%-98%, area under the curve = 0.80-0.91). When past-month use was expanded to include timeline follow-back with oral fluid testing, accuracy declined (52% sensitivity [95% confidence interval, 43%-60%], 98% specific [95% confidence interval, 97%-98%]).Conclusions
While further testing in a larger population sample may be warranted, given their brevity, simplicity, and accuracy when self-administered, the TAPS opioid items can be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings.Item Open Access A Brief Screening and Assessment Tool for Opioid Use in Adults: Results from a Validation Study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.(Journal of addiction medicine, 2023-07) Bunting, Amanda M; Schwartz, Robert P; Wu, Li-Tzy; Wahle, Aimee; Kline, Margaret; Subramaniam, Geetha; McNeely, JenniferObjectives
This secondary analysis evaluated opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care.Methods
This study is a secondary data analysis of the TAPS validation study. Performance of the TAPS tool for screening for unhealthy opioid use (with a score of 1+ for heroin and/or prescription opioids representing a positive screen) was evaluated. Discriminative ability was examined in comparison with reference standard measures across the spectrum of unhealthy opioid use: timeline follow-back with and without oral fluid testing identifying past-month use and the modified Composite International Diagnostic Interview for past-year problem use, opioid use disorder (OUD), and moderate-severe OUD.Results
In a sample of 2000 primary care patients, 114 screened positive for opioids on the TAPS tool. With a TAPS cutoff equal to 1+, the TAPS accurately identified past-month use, problem use, any OUD, and moderate-severe OUD (sensitivities = 68%-85%, specificities = 97%-98%, area under the curve = 0.80-0.91). When past-month use was expanded to include timeline follow-back with oral fluid testing, accuracy declined (52% sensitivity [95% confidence interval, 43%-60%], 98% specific [95% confidence interval, 97%-98%]).Conclusions
While further testing in a larger population sample may be warranted, given their brevity, simplicity, and accuracy when self-administered, the TAPS opioid items can be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings.Item Open Access Comparison of timeline follow-back self-report and oral fluid testing to detect substance use in adult primary care patients.(Drug and alcohol dependence, 2020-02-22) Nordeck, Courtney D; Gryczynski, Jan; O'Grady, Kevin E; Polak, Kathryn; Svikis, Dace S; McNeely, Jennifer; Wu, Li-Tzy; Schwartz, Robert PBACKGROUND:Timeline Follow-back (TLFB) interviews using self-report are often used to assess substance use. Oral fluid testing (OFT) offers an objective measure of substance use. There are limited data on the agreement between TLFB and OFT. METHODS:In this secondary analysis from a multisite study in five primary care sites, self-reported TLFB and OFT data collected under confidential conditions were compared to assess concordance (N=1799). OFT samples were analyzed for marijuana, heroin, cocaine, and non-medical use of prescription opioids. Demographic differences in discordance relative to TLFB and OFT concordant results for marijuana, the only substance with an adequate sample size in this analysis, were examined using multinomial logistic regression. RESULTS:Overall concordance rates between TLFB and OFT were 94.9 % or higher for each substance, driven by large subgroups with no use. Among participants with discordant use, marijuana was the only substance with lower detection on OFT than self-report (27.6 % OFT-positive only vs 32.2 % TLFB-positive only), whereas cocaine (65.6 % vs 8.6 %), prescription opioids (90.4 % vs 6.0 %), and heroin (40.7 % vs 26.0 %) all had higher detection via OFT than TLFB. Participants who reported marijuana use but had a negative OFT were more likely to be younger, Hispanic, and White compared to those with TLFB and OFT concordant positive results. CONCLUSIONS:TLFB and OFT show disparate detection of different substances. Researchers should consider the implications of using either self-report or oral fluid testing in isolation, depending on the substance and collection setting. Triangulating multiple sources of information may improve detection of drug use.Item Open Access Corrigendum to "Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool" [Contemporary Clinical Trials. 2016 Jul. 19; 50: 90-97].(Contemp Clin Trials, 2016-11) Wu, Li-Tzy; McNeely, Jennifer; Subramaniam, Geetha A; Sharma, Gaurav; VanVeldhuisen, Paul; Schwartz, Robert PItem Open Access Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool.(Contemporary clinical trials, 2016-09) Wu, Li-Tzy; McNeely, Jennifer; Subramaniam, Geetha A; Sharma, Gaurav; VanVeldhuisen, Paul; Schwartz, Robert PSubstance use and its associated use disorders are under-detected and under-treated in primary care. There is a need for a clinically useful brief screening and assessment instrument to identify primary care patients with substance use, sub-threshold substance use disorder (SUD), and SUD to facilitate brief intervention and treatment.We describe the design of the recently completed National Drug Abuse Treatment Clinical Trials Network's tobacco, alcohol, prescription medications, and substance use/misuse screen and brief assessment tool validation study. Study aims included to: develop a 2-stage screening and brief assessment tool (TAPS Tool) to detect substance use, problem use, and SUD among adult primary care patients; examine the validity of both the screen component and the TAPS Tool by comparing them to reference standard screening and assessment measures of no use, problem use, and SUD; and determine the feasibility and acceptability of the self-administration and interviewer-administration of the tool. The design included a pilot testing phase (n=30) and the main study of 2000 adult primary care participants who were randomly assigned in counter-balanced order to have the interviewer-administration or the self-administration of the TAPS Tool followed by the other administration format. Participants' views of feasibility, acceptability and preference for format of self-administration versus interviewer-administration of the TAPS Tool were assessed. Criterion measures of use and DSM-5 SUDs were administered.The TAPS Tool study builds on prior work to develop a 2-stage clinical tool for facilitating the adoption of screening, brief assessment and treatment for SUDs in primary care.Item Open Access DSM-5 substance use disorders among adult primary care patients: Results from a multisite study.(Drug and alcohol dependence, 2017-10) Wu, Li-Tzy; McNeely, Jennifer; Subramaniam, Geetha A; Brady, Kathleen T; Sharma, Gaurav; VanVeldhuisen, Paul; Zhu, He; Schwartz, Robert PBACKGROUND:There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients. METHODS:This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined. RESULTS:Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD. CONCLUSION:These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.Item Open Access Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool(Addiction Science & Clinical Practice, 2019-12) Adam, Angéline; Schwartz, Robert P; Wu, Li-Tzy; Subramaniam, Geetha; Laska, Eugene; Sharma, Gaurav; Mili, Saima; McNeely, JenniferItem Open Access Interpretation and integration of the federal substance use privacy protection rule in integrated health systems: A qualitative analysis.(Journal of substance abuse treatment, 2019-02) Campbell, Aimee NC; McCarty, Dennis; Rieckmann, Traci; McNeely, Jennifer; Rotrosen, John; Wu, Li-Tzy; Bart, GavinBACKGROUND:Federal regulations (42 CFR Part 2) provide special privacy protections for persons seeking treatment for substance use disorders. Primary care providers, hospitals, and health care organizations have struggled to balance best practices for medical care with adherence to 42 CFR Part 2, but little formal research has examined this issue. The aim of this study was to explore institutional variability in the interpretation and implementation of 42 CFR Part 2 regulations related to health systems data privacy practices, policies, and information technology architecture. METHODS:This was a cross-sectional qualitative study using purposive sampling to conduct interviews with privacy/legal officers (n = 17) and information technology specialists (n = 10) from 15 integrated healthcare organizations affiliated with three research nodes of the National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN). Trained staff completed a short survey and digitally recorded semi-structured qualitative interview with each participant. Interviews were transcribed and coded within Atlas.ti. Framework analysis was used to identify and organize key themes across selected codes. RESULTS:Participants voiced concern over balancing patient safety with 42 CFR Part 2 privacy protections. Although similar standards of protection regarding release of information outside of the health system was described, numerous workarounds were used to manage intra-institutional communication and care coordination. To align 42 CFR Part 2 restrictions with electronic health records, health systems used sensitive note designation, "break the glass" technology, limited role-based access for providers, and ad hoc solutions (e.g., provider messaging). CONCLUSIONS:In contemporary integrated care systems, substance-related EHR records (e.g., patient visit history, medication logs) are often accessible internally without specific consent for sharing despite the intent of 42 CFR Part 2. Recent amendments to 42 CFR Part 2 have not addressed information sharing needs within integrated care settings.Item Metadata only Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.(Ann Intern Med, 2016-11-15) McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha; Sharma, Gaurav; Cathers, Lauretta A; Svikis, Dace; Sleiter, Luke; Russell, Linnea; Nordeck, Courtney; Sharma, Anjalee; O'Grady, Kevin E; Bouk, Leah B; Cushing, Carol; King, Jacqueline; Wahle, Aimee; Schwartz, Robert PBackground: Substance use, a leading cause of illness and death, is underidentified in medical practice. Objective: The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients. Design: Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693). Setting: 5 adult primary care clinics. Participants: 2000 adult patients consecutively recruited from clinic waiting areas. Measurements: Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD). Results: Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower. Limitations: The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI. Conclusion: In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening. Primary Funding Source: National Institute on Drug Abuse.Item Open Access Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco.(Drug and alcohol dependence, 2019-01) John, William S; Zhu, He; Mannelli, Paolo; Subramaniam, Geetha A; Schwartz, Robert P; McNeely, Jennifer; Wu, Li-TzyBACKGROUND:Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. METHODS:Data were derived from a sample of 2000 adult (aged ≥18) primary care patients across 5 distinct clinics. Among past-year tobacco users (n = 882), we assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use. Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership. RESULTS:Past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14.0% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78.0%), a tobacco-cannabis use group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics. CONCLUSIONS:Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users.Item Open Access Proceedings of the 13th annual conference of INEBRIA.(Addiction science & clinical practice, 2016-09) Watson, Rod; Morris, James; Isitt, John; Barrio, Pablo; Ortega, Lluisa; Gual, Antoni; Conner, Kenneth; Stecker, Tracy; Maisto, Stephen; Paroz, Sophie; Graap, Caroline; Grazioli, Véronique S; Daeppen, Jean-Bernard; Collins, Susan E; Bertholet, Nicolas; McNeely, Jennifer; Kushnir, Vlad; Cunningham, John A; Crombie, Iain K; Cunningham, Kathryn B; Irvine, Linda; Williams, Brian; Sniehotta, Falko F; Norrie, John; Melson, Ambrose; Jones, Claire; Briggs, Andrew; Rice, Peter; Achison, Marcus; McKenzie, Andrew; Dimova, Elena; Slane, Peter W; Grazioli, Véronique S; Collins, Susan E; Paroz, Sophie; Graap, Caroline; Daeppen, Jean-Bernard; Baggio, Stéphanie; Dupuis, Marc; Studer, Joseph; Gmel, Gerhard; Magill, Molly; Grazioli, Véronique S; Tait, Robert J; Teoh, Lucinda; Kelty, Erin; Geelhoed, Elizabeth; Mountain, David; Hulse, Gary K; Renko, Elina; Mitchell, Shannon G; Lounsbury, David; Li, Zhi; Schwartz, Robert P; Gryczynski, Jan; Kirk, Arethusa S; Oros, Marla; Hosler, Colleen; Dusek, Kristi; Brown, Barry S; Finnell, Deborah S; Holloway, Aisha; Wu, Li-Tzy; Subramaniam, Geetha; Sharma, Gaurav; Wallhed Finn, Sara; Andreasson, Sven; Dvorak, Robert D; Kramer, Matthew P; Stevenson, Brittany L; Sargent, Emily M; Kilwein, Tess M; Harris, Sion K; Sherritt, Lon; Copelas, Sarah; Knight, John R; The Partnership for Adolescent Substance Use Research; Mdege, Noreen D; McCambridge, Jim; Bischof, Gallus; Bischof, Anja; Freyer-Adam, Jennis; Rumpf, Hans-Juergen; Fitzgerald, Niamh; Schölin, Lisa; Toner, Paul; Böhnke, Jan R; Veach, Laura J; Currin, Olivia; Dongre, Leigh Z; Miller, Preston R; White, Elizabeth; Williams, Emily C; Lapham, Gwen T; Bobb, Jennifer J; Rubinsky, Anna D; Catz, Sheryl L; Shortreed, Susan; Bensley, Kara M; Bradley, Katharine A; Milward, Joanna; Deluca, Paolo; Khadjesari, Zarnie; Watson, Rod; Fincham-Campbell, Stephanie; Drummond, Colin; Angus, Kathryn; Bauld, Linda; Baumann, Sophie; Haberecht, Katja; Schnuerer, Inga; Meyer, Christian; Rumpf, Hans-Jürgen; John, Ulrich; Gaertner, Beate; Barrault-Couchouron, Marion; Béracochéa, Marion; Allafort, Vincent; Barthélémy, Valérie; Bonnefoi, Hervé; Bussières, Emmanuel; Garguil, Véronique; Auriacombe, Marc; Saint-Jacques, Marianne; Dorval, Michel; M’Bailara, Katia; Segura-Garcia, Lidia; Ibañez-Martinez, Nuria; Mendive-Arbeloa, Juan Manuel; Anoro-Perminger, Manel; Diaz-Gallego, Pako; Piñar-Mateos, Mª Angeles; Colom-Farran, Joan; Deligianni, Marianthi; Yersin, Bertrand; Adam, Angeline; Weisner, Constance; Chi, Felicia; Lu, Wendy; Sterling, Stacy; Kraemer, Kevin L; McGinnis, Kathleen A; Fiellin, David A; Skanderson, Melissa; Gordon, Adam J; Robbins, Jonathan; Zickmund, Susan; Korthuis, P Todd; Edelman, E Jennifer; Hansen, Nathan B; Cutter, Christopher J; Dziura, James; Fiellin, Lynn E; O’Connor, Patrick G; Maisto, Stephen A; Bedimo, Roger; Gilbert, Cynthia; Marconi, Vincent C; Rimland, David; Rodriguez-Barradas, Maria; Simberkoff, Michael; Justice, Amy C; Bryant, Kendall J; Berman, Anne H; Shorter, Gillian W; Bray, Jeremy W; Barbosa, Carolina; Johansson, Magnus; Hester, Reid; Campbell, William; Souza Formigoni, Maria Lucia O; Andrade, André Luzi Monezi; Sartes, Laisa Marcorela Andreoli; Sundström, Christopher; Eék, Niels; Kraepelien, Martin; Kaldo, Viktor; Fahlke, Claudia; Hernandez, Lynn; Becker, Sara J; Jones, Richard N; Graves, Hannah R; Spirito, Anthony; Diestelkamp, Silke; Wartberg, Lutz; Arnaud, Nicolas; Thomasius, Rainer; Gaume, Jacques; Grazioli, Véronique; Fortini, Cristiana; Malan, Zelra; Mash, Bob; Everett-Murphy, Katherine; Grazioli, Véronique S; Studer, Joseph; Mohler-Kuo, M; Bertholet, Nicolas; Gmel, Gerhard; Doi, Lawrence; Cheyne, Helen; Jepson, Ruth; Luna, Vanesa; Echeverria, Leticia; Morales, Silvia; Barroso, Teresa; Abreu, Ângela; Aguiar, Cosma; Stewart, Duncan; Abreu, Angela; Brites, Riany M; Jomar, Rafael; Marinho, Gerson; Parreira, Pedro; Seale, J Paul; Johnson, J Aaron; Henry, Dena; Chalmers, Sharon; Payne, Freida; Tuck, Linda; Morris, Akula; Gonçalves, Cátia; Besser, Bettina; Casajuana, Cristina; López-Pelayo, Hugo; Balcells, María Mercedes; Teixidó, Lídia; Miquel, Laia; Colom, Joan; Hepner, Kimberly A; Hoggatt, Katherine J; Bogart, Andy; Paddock, Susan M; Hardoon, Sarah L; Petersen, Irene; Hamilton, Fiona L; Nazareth, Irwin; White, Ian R; Marston, Louise; Wallace, Paul; Godfrey, Christine; Murray, Elizabeth; Sovinová, Hana; Csémy, LadislavItem Open Access Reference periods in retrospective behavioral self-report: A qualitative investigation.(The American journal on addictions, 2015-12) Gryczynski, Jan; Nordeck, Courtney; Mitchell, Shannon Gwin; O'Grady, Kevin E; McNeely, Jennifer; Wu, Li-Tzy; Schwartz, Robert PSelf-report questions in substance use research and clinical screening often ask individuals to reflect on behaviors, symptoms, or events over a specified time period. However, there are different ways of phrasing conceptually similar time frames (eg, past year vs. past 12 months).We conducted focused, abbreviated cognitive interviews with a sample of community health center patients (N = 50) to learn how they perceived and interpreted questions with alternative phrasing of similar time frames (past year vs. past 12 months; past month vs. past 30 days; past week vs. past 7 days).Most participants perceived the alternative time frames as identical. However, 28% suggested that the "past year" and "past 12 months" phrasings would elicit different responses by evoking distinct time periods and/or calling for different levels of recall precision. Different start and end dates for "past year" and "past 12 months" were reported by 20% of the sample. There were fewer discrepancies for shorter time frames.Use of "past 12 months" rather than "past year" as a time frame in self-report questions could yield more precise responses for a substantial minority of adult respondents.Subtle differences in wording of conceptually similar time frames can affect the interpretation of self-report questions and the precision of responses.Item Open Access Subthreshold opioid use disorder prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.(Addiction science & clinical practice, 2023-11) Liebschutz, Jane M; Subramaniam, Geetha A; Stone, Rebecca; Appleton, Noa; Gelberg, Lillian; Lovejoy, Travis I; Bunting, Amanda M; Cleland, Charles M; Lasser, Karen E; Beers, Donna; Abrams, Catherine; McCormack, Jennifer; Potter, Gail E; Case, Ashley; Revoredo, Leslie; Jelstrom, Eve M; Kline, Margaret M; Wu, Li-Tzy; McNeely, JenniferBackground
Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with subthreshold OUD.Methods
The STOP trial is a cluster randomized controlled trial, randomized at the PCP level, conducted in 5 distinct geographic sites. STOP tests the efficacy of the STOP intervention in comparison to enhanced usual care (EUC) in adult primary care patients with risky opioid use that does not meet criteria for moderate-severe OUD. The STOP intervention consists of (1) a practice-embedded nurse care manager (NCM) who provides patient participant education and supports primary care providers (PCPs) in engaging and monitoring patient-participants; (2) brief advice, delivered to patient participants by their PCP and/or prerecorded video message, about health risks of opioid misuse; and (3) up to 6 sessions of telephone health coaching to motivate and support behavior change. EUC consists of primary care treatment as usual, plus printed overdose prevention educational materials and an educational video on cancer screening. The primary outcome measure is self-reported number of days of risky (illicit or nonmedical) opioid use over 180 days, assessed monthly via text message using items from the Addiction Severity Index and the Current Opioid Misuse Measure. Secondary outcomes assess other substance use, mental health, quality of life, and healthcare utilization as well as PCP prescribing and monitoring behaviors. A mixed effects negative binomial model with a log link will be fit to estimate the difference in means between treatment and control groups using an intent-to-treat population.Discussion
Given a growing interest in interventions for the management of patients with risky opioid use, and the need for primary care-based interventions, this study potentially offers a blueprint for a feasible and effective approach to improving outcomes in this population.Trial registration
Clinicaltrials.gov, identifier NCT04218201, January 6, 2020.Item Open Access VALIDATION OF THE 4-ITEM SCREENING COMPONENT OF THE TAPS TOOL TO IDENTIFY UNHEALTHY SUBSTANCE USE AMONG PRIMARY CARE PATIENTS(JOURNAL OF GENERAL INTERNAL MEDICINE, 2017-04-01) Schwartz, Robert; Gryczynski, Jan; McNeely, Jennifer; Wu, Litzy; Sharma, Gaurav; King, Jacquie; Jelstrom, Eve M; Nordeck, Courtney; Sharma, Anjalee; Mitchell, Shannon; O'Grady, Kevin; Svikis, Dace; Cathers, Lauretta; Subramaniam, GeethaItem Open Access Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.(Journal of general internal medicine, 2017-09) Gryczynski, Jan; McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha A; Svikis, Dace S; Cathers, Lauretta A; Sharma, Gaurav; King, Jacqueline; Jelstrom, Eve; Nordeck, Courtney D; Sharma, Anjalee; Mitchell, Shannon G; O'Grady, Kevin E; Schwartz, Robert PBACKGROUND:The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. OBJECTIVE:To validate the TAPS-1 in primary care patients. DESIGN:Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). PARTICIPANTS:Two thousand adult patients at five primary care sites. MAIN MEASURES:DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use. KEY RESULTS:Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker. CONCLUSIONS:The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy, and may have utility in primary care for rapid triage.