The Impact on Caregivers of Young Adult Opioid Use

Sarah Bagley MDAddiction Medicine Fellow

Clinical Addiction Research and Education UnitBoston University School of Medicine

CREST Fellows PresentationsFebruary 24, 2015

Supported by the Research in Addiction Medicine Scholars programNIDA R25DA033211

Thanks to Alex Walley for background slides

Outline of Presentation

• CREST project

• Proposed K23 Specific Aims

National Vital Statistics System. Drug overdose death rates by state. 2008.

Drug Overdose Deaths in U.S. 1990-2008More Than Tripled

Strategies to Address OverdosePrescription monitoring programs1

Prescription drug disposal2

Safe opioid prescribing education3

Opioid agonist treatment4

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.

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 1996-20101

• Overdose education and naloxone distribution (OEN) effective response to reduce deaths2, 3

• Study in 2010 indicated that caregivers may also be interested in receiving OEN4

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.

Research AimsAim 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 2Describe the motivations and benefits for family members of opioid users to receive OEN.

Aim 3Describe the number of times trained family members have used naloxone to reverse an opioid overdose.

Methods

• Cross sectional study conducted between July 2013-September 2013

• Convenience Sample

• Setting: community support group for family members affected by addiction

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

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

Procedure

• Attendees at meeting given option to participate in an anonymous 15 minute survey

• $5 gift card for compensation

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

Aim One: Characteristics of Attendees

TotalN=125

OEN Trained

N=99

UntrainedN=26

P-value

Age (mean)53.1 52.3 55.0 0.20

Female78% 79% 77% 0.84

White95% 94% 100% 0.44

Married74% 75% 73% 0.99

Parent85% 91% 65% 0.0056

Aim One: Characteristics of AttendeesTotal

(N=125)OEN Trained

(n= 99)Untrained

(n=26)P-value

Provide financial support

52% 58% 30% 0.0086

Daily contact 50% 54% 33% 0.0041Applied 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

Aim Two: Motivations for Receipt of OENOEN 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 OD 18%

Experienced Death of Loved One

1.1%

Aim Two: Reported benefits of OEN

BENEFITS OEN Trained(n=92)

Greater sense of security 74%

Improved confidence to handle OD

62%

Greater understanding of prevention and management of OD

60%

Educate others about OEN 33%

Ability to reverse an OD 29%

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 OD 7.7%

Experienced death of loved one

0%

Aim Three: Use of NaloxoneN

Total Rescues 5

RELATIONSHIP Parent Grandparent Stranger Other

2111

SETTING Public Private

14

CHARACTERISTICS Survived Called 911 Rescue Breathing

554

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

Limitations

• Cross-sectional• Convenience sample• Self-selected population • Missing data

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?

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?

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

Research Question

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

AimsAim OneIdentify 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 TwoDesign 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.

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