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The Impact on Caregivers of Young Adult Opioid Use Sarah Bagley MD Addiction Medicine Fellow Clinical Addiction Research and Education Unit Boston University.

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Presentation on theme: "The Impact on Caregivers of Young Adult Opioid Use Sarah Bagley MD Addiction Medicine Fellow Clinical Addiction Research and Education Unit Boston University."— Presentation transcript:

1 The Impact on Caregivers of Young Adult Opioid Use Sarah Bagley MD Addiction Medicine Fellow Clinical Addiction Research and Education Unit Boston University School of Medicine CREST Fellows Presentations February 24, 2015 Supported by the Research in Addiction Medicine Scholars program NIDA R25DA033211 Thanks to Alex Walley for background slides

2 Outline of Presentation CREST project Proposed K23 Specific Aims

3 National Vital Statistics System. Drug overdose death rates by state. 2008. Drug Overdose Deaths in U.S. 1990- 2008 More Than Tripled

4 Strategies to Address Overdose Prescription monitoring programs 1 Prescription drug disposal 2 Safe opioid prescribing education 3 Opioid agonist treatment 4 1.Paulozzi LJ, et al. Pain Med. 2011 May;12(5):747-54. 2.Gray NE and Hagemeier JA. Arch Intern Med. 2012;172(15):1186-1187. 3.Albert S, et al. Pain Med. 2011 Jun;12 Suppl 2:S77-85. 4.Clausen T, et al. Addiction. 2009 Aug;104(8):1356-62.

5 Overdose Education and Naloxone Distribution Initial efforts to implement OEN with people with use drugs >50,000 people trained to recognize and respond to an overdose between 1996-2010 1 Overdose education and naloxone distribution (OEN) effective response to reduce deaths 2, 3 Study in 2010 indicated that caregivers may also be interested in receiving OEN 4 1. CDC. MMWR. 2012;61(6):101-105 2. Walley AY, Xuan Z, Hackman HH, et al. BMJ. 2013;346:f174. 3. Coffey PO and Sullivan SD. Annals Int Med. 2013;158(1):1-9 4. Strang et al. Drugs, Education and Policy. 2008;15(2):211-218.

6 Research Aims Aim 1 Describe the characteristics of family members of opioid users who attend a support group for families affected by addiction who participate in OEN and those who do not. Aim 2 Describe the motivations and benefits for family members of opioid users to receive OEN. Aim 3 Describe the number of times trained family members have used naloxone to reverse an opioid overdose.

7 Methods Cross sectional study conducted between July 2013-September 2013 Convenience Sample Setting: community support group for family members affected by addiction

8 Setting Learn to Cope: founded in 2004 by mother whose son had an opioid addiction Provides support and nonprofessional advice to family members In 2011, OEN offered at every meeting 10 meetings in Massachusetts in 2013

9 Methods Massachusetts Opioid Overdose Prevention Pilot Program – Started in 2006 – Provides OEN to community groups throughout MA – More than 28,000 people trained and > 3,300 rescues

10 Procedure Attendees at meeting given option to participate in an anonymous 15 minute survey $5 gift card for compensation

11 Instrument 42 items 5 domains: demographics, relationship to opioid user, experience with overdose, motivations to receive OEN, and naloxone rescue kit use Piloted with 5 Learn to Cope members prior to starting study

12 Aim One: Characteristics of Attendees Total N=125 OEN Trained N=99 Untrained N=26 P-value Age (mean) 53.152.355.00.20 Female 78%79% 77%0.84 White 95%94%100%0.44 Married 74%75%73%0.99 Parent 85%91%65%0.0056

13 Aim One: Characteristics of Attendees Total (N=125) OEN Trained (n= 99) Untrained (n=26) P-value Provide financial support 52%58%30%0.0086 Daily contact 50%54%33%0.0041 Applied for court- mandated treatment 35%41%15%0.04 Witnessed overdoes in past 30%35%12%0.07 Heard about naloxone before L2C 47%43%59%0.14

14 Aim Two: Motivations for Receipt of OEN OEN Trained (n=93) Wanted to have in the House 72% Encouraged by Education Provided at L2C 60% Heard About Benefits from L2C Members 57% Wanted More Information about OD 26% Wanted Kit for Someone Else 19% Previously Witnessed OD18% Experienced Death of Loved One 1.1%

15 Aim Two: Reported benefits of OEN BENEFITSOEN Trained (n=92) Greater sense of security74% Improved confidence to handle OD 62% Greater understanding of prevention and management of OD 60% Educate others about OEN33% Ability to reverse an OD29%

16 Aim Two: Motivations for OEN among untrained OEN Not Trained (n=13) Encouraged by education provided at L2C 69% Wanted to have in the house 31% Heard about benefits from L2C members 31% Wanted more information about OD 23% Wanted kit for someone else 7.7% Previously witnessed OD7.7% Experienced death of loved one 0%

17 Aim Three: Use of Naloxone N Total Rescues5 RELATIONSHIP Parent Grandparent Stranger Other 21112111 SETTING Public Private 1414 CHARACTERISTICS Survived Called 911 Rescue Breathing 554554

18 Conclusions High uptake of overdose education and naloxone rescue kits offered at the meetings. Trainees were parents who provided financial support, had daily contact, had applied for court- mandated treatment, and had witnessed an overdose. Among the minority who had not received OEN, almost half wanted to be trained. Several attendees had administered naloxone successfully

19 Limitations Cross-sectional Convenience sample Self-selected population Missing data

20 Implications Family members should be included in the response to the opioid related overdose epidemic More work needed to determine the most effective way to implement OEN programs in community settings How to expand OEN to families who are not coming to meetings?

21 Next Steps Observed consistent high burden of stress that family members experience Caregiver populations of patients with other chronic diseases find high levels of stress, poorer physical health outcomes  should we be focusing on engaging families?

22 Next Steps Family members whose loved one use substances have higher morbidity and health care costs No data about specifically about impact of opioid use Treatment of addiction increasingly integrated into primary care settings Strategies exist to provide support for families but are not necessarily well implemented/disseminated in primary care

23 Research Question What is the impact on caregivers of transitional age youth with opioid use disorders?

24 Aims Aim One Identify the physical and emotional impact on the primary caregivers of transitional age youth who use opioids. Design and conduct a mixed methods study of caregivers of transitional age youth with opioid use disorders to identify the physical and emotional impact and to identify strategies to address the impact. Aim Two Design and conduct a statewide survey of medical directors at community health centers that provide integrated primary care and addiction care to understand if and how primary caregivers are engaged in treatment. (Aim Three or R03) Develop and implement a pilot intervention using data gathered from Aims 1 and 2 for caregivers whose transitional age youth who use opioids to be delivered in primary care settings.

25 Acknowledgements Joanne Peterson and Learn to Cope Alex Walley MD, MSc Charlie Jose MPH Debbie Cheng ScD Emily Quinn MPH Patrick O’Connor MD, MPH Jeffrey Samet MD, MPH, MA Michael Silverstein MD


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