Papers by Jane Liebschutz
BMJ Open, 2021
ObjectivesTo prospectively characterise: (1) postoperative opioid analgesic prescribing practices... more ObjectivesTo prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management.DesignLongitudinal survey of patients 7 days before and 7–14 days after surgery.SettingAcademic urban safety-net hospital.Participants181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years.InterventionsNone.Primary and secondary outcome measuresTotal morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids.ResultsSurgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (−2.05 to –0.35)) tota...
Journal of Adolescent Health, 2022
Journal of General Internal Medicine, 2022
Inpatient addiction medicine consultation services (AMCS) have grown rapidly, but there is limite... more Inpatient addiction medicine consultation services (AMCS) have grown rapidly, but there is limited research of their impact on patient outcomes. To examine whether AMCS is associated with all-cause mortality and hospital utilization post-discharge. This was a propensity-score-matchedcase-control study from 2018 to 2020. The intervention group included patients referred to the AMCS from October 2018 to March 2020. Matched control participants included patients hospitalized from October 2017 to September 2018 at an urban academic hospital with a large suburban and rural catchment area. The effect of treatment was estimated as the difference between the proportion of subjects experiencing the event (7-day and 30-day readmission, emergency department visits, and mortality within 90 days) for each group in the matched sample. There were 711 patients in the intervention group and 2172 patients in the control group. The most common substance use disorders among the intervention group were primary alcohol use disorder (n=181; 25.5%) and primary opioid use disorder (n=175, 24.6%) with over a third with polysubstance use (n=257, 36.1%). Intervention patients showed a reduction in 90-day mortality post-hospital discharge (average treatment effect [ATE]: −2.35%, 95% CI: −3.57, −1.13; p-value <0.001) compared to propensity-matched controls. We found a statistically significant reduction in 7-day hospital readmission by 2.15% (95% CI: −3.65, −0.65; p=0.005) and a nonsignificant reduction in 30-day readmission (ATE: −2.38%, 95% CI: −5.20, 0.45; p=0.099). There was a statistically significant increase in 30-day emergency department visits (ATE: 5.32%, 95% CI: 2.19, 8.46; 0.001) compared to matched controls. There was a reduction in 90-day all-cause mortality for the AMCS intervention group compared to matched controls, although the impact on hospital utilization was mixed. AMCS are systems interventions that are effective tools to improve patient health and reduce all-cause mortality.
This study examines the relationship between a history of physical and sexual abuse (PhySexAbuse)... more This study examines the relationship between a history of physical and sexual abuse (PhySexAbuse) and drug and alcohol related consequences. We performed a cross-sectional analysis of data from 359 male and 111 female subjects recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences (InDUC), measured negative life consequences of substance use. Eighty-one percent of women and 69 % of men report past PhySexAbuse, starting at a median age of 13 and 11, respectively. In bivariate and mul-tivariable analyses, PhySexAbuse was significantly associated with more substance abuse consequences ( p < 0.001). For men, age 17 years at first PhySexAbuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse ( p = 0.048). For women, the association of PhySexAbuse with substance use consequences was similar across all ages ( p = 0.59). Future
AIDS and Behavior, 2021
Authors' contributions JOL originated the study, guided data analyses, led the writing of the art... more Authors' contributions JOL originated the study, guided data analyses, led the writing of the article, and coordinated drafting of the manuscript among co-authors; YY finalized the literature review, conducted analyses, and drafted the method and result sections, including tables; BI contributed to the data collection, organized the database, and contributed to the analysis framework; TK, OM, YS, and SB designed and led implementation of data collection and management; KC conducted the literature search with a focus on intimate partner violence and outcome measures; SFS conducted the literature search with a focus on police violence and outcome measures; PSN, NH, TF, JHS, and JL contributed to the interpretation of the study findings and provided important intellectual input; KL contributed to the conceptualization of the study, secured the funding, and led the data collection and interpretation of findings. In addition, all authors have been involved in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.
Journal of General Internal Medicine, 2021
BACKGROUND: The average length of buprenorphine treatment for opioid use disorder is less than 6 ... more BACKGROUND: The average length of buprenorphine treatment for opioid use disorder is less than 6 months. OBJECTIVE: We conducted a systematic review to determine what factors were associated with longer retention in buprenorphine treatment. DESIGN: We searched Medline, Embase, and Cochrane Database of Systematic Reviews in February 2018. Articles were restricted to randomized controlled trials on human subjects, written in English, which contained ≥ 24 weeks of objective data on retention in buprenorphine treatment. MAIN MEASURES: We assessed whether dose of buprenorphine, treatment setting, or co-administration of behavioral therapy was associated with retention rates. KEY RESULTS: Over 14,000 articles were identified. Thirteen articles (describing 9 studies) met inclusion criteria. Measures of retention varied widely. Three studies compared doses of buprenorphine between 1 and 8 mg and showed significantly higher rates of retention with higher doses (p values < 0.01). All other studies utilized buprenorphine doses between 8 and 24 mg daily, without comparison. No study found a significant difference in r e t e n t i o n b e t w e e n b u p r e n o r p h i n e a l o n e a n d buprenorphine plus behavioral therapy (p values > 0.05). Initiating buprenorphine while hospitalized or within criminal justice settings prior to outpatient treatment programs was significantly associated with retention in buprenorphine treatment (p values < 0.01 respectively). CONCLUSIONS: Setting of treatment initiation and a higher buprenorphine dose are associated with improved long-term treatment retention. More objective data on buprenorphine treatment programs are needed, including a standardized approach to defining retention in buprenorphine treatment programs. REGISTRATION: This review was registered with PROS-PERO (#CRD42019120336) in March 2019.
JAMA Internal Medicine, 2014
IMPORTANCE-Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opi... more IMPORTANCE-Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known. OBJECTIVE-To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.
Pain Medicine, 2012
Objective. No evidence-based methods exist to identify prescription drug use disorder (PDUD) in p... more Objective. No evidence-based methods exist to identify prescription drug use disorder (PDUD) in primary care (PC) patients prescribed controlled substances. Aberrant drug-related behaviors (ADRBs) are suggested as a proxy. Our objective was to determine whether ADRBs documented in electronic medical records (EMRs) of patients prescribed opioids and benzodiazepines could serve as a proxy for identifying PDUD. Design. A cross-sectional study of PC patients at an urban, academic medical center. Subjects. Two hundred sixty-four English-speaking patients (ages 18-60) with chronic pain (Ն3 months), receiving Ն1 opioid analgesic or benzodiazepine prescription in the past year, were recruited during outpatient PC visits. Outcome Measures. Composite International Diagnostic Interview defined Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of past year PDUD and no disorder. EMRs were reviewed for 15 prespecified ADRBs (e.g., early refill, stolen medications) in the year before and after study entry. Fisher's exact test compared bs_bs_banner
Journal of General Internal Medicine, 2003
To identify characteristics that facilitate trust in the patient-provider relationship among surv... more To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV). DESIGN: Semistructured, open-ended interviews were conducted to elicit participants' beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyzed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview exerpts. Together, key components of trust were identified. SETTING: Eastern Massachusetts. PARTICIPANTS: Twenty-seven female survivors of IPV recruited from community-based IPV organizations. MAIN RESULTS: Participants' ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend. CONCLUSIONS: These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.
BMC Public Health, 2008
Background: Despite endorsement by national organizations, the impact of screening for intimate p... more Background: Despite endorsement by national organizations, the impact of screening for intimate partner violence (IPV) is understudied, particularly as it occurs in different clinical settings. We analyzed interviews of IPV survivors to understand the risks and benefits of disclosing IPV to clinicians across specialties. Methods: Participants were English-speaking female IPV survivors recruited through IPV programs in Massachusetts. In-depth interviews describing medical encounters related to abuse were analyzed for common themes using Grounded Theory qualitative research methods. Encounters with health care clinicians were categorized by outcome (IPV disclosure by patient, discovery evidenced by discussion of IPV by clinician without patient disclosure, or non-disclosure), attribute (beneficial, unhelpful, harmful), and specialty (emergency department (ED), primary care (PC), obstetrics/gynecology (OB/GYN)). Results: Of 27 participants aged 18-56, 5 were white, 10 Latina, and 12 black. Of 59 relevant health care encounters, 23 were in ED, 17 in OB/GYN, and 19 in PC. Seven of 9 ED disclosures were characterized as unhelpful; the majority of disclosures in PC and OB/GYN were characterized as beneficial. There were no harmful disclosures in any setting. Unhelpful disclosures resulted in emotional distress and alienation from health care. Regardless of whether disclosure occurred, beneficial encounters were characterized by familiarity with the clinician, acknowledgement of the abuse, respect and relevant referrals. Conclusion: While no harms resulted from IPV disclosure, survivor satisfaction with disclosure is shaped by the setting of the encounter. Clinicians should aim to build a therapeutic relationship with IPV survivors that empowers and educates patients and does not demand disclosure. Background The extensive physical and mental health burden of intimate partner violence (IPV) exposure has been documented in various settings [1-6]. In response, the medical community has prioritized IPV identification. In fact, the Joint Commission on Accreditation of Healthcare Organ
JAMA Network Open, 2021
IMPORTANCE Although prescription opioids are the most common way adolescents and young adults ini... more IMPORTANCE Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks. OBJECTIVE To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020. MAIN OUTCOMES AND MEASURES This study used group-based trajectory modeling and defined trajectory status by opioid fill. RESULTS Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001). CONCLUSIONS AND RELEVANCE This study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.
Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2018
Guidelines recommend careful monitoring of patients on long-term opioid therapy for chronic pain ... more Guidelines recommend careful monitoring of patients on long-term opioid therapy for chronic pain to assess for concerning medication-taking behaviors that may signal opioid misuse or the presence of a substance use disorder. However, specific management strategies to guide providers if concerning medication-taking behaviors emerge are lacking. Therefore, we recruited a Delphi paneld42 experts in chronic pain and opioid prescribingdto develop consensus-based treatment approaches to guide management of the 6 most common and concerning behaviors identified: missing prescriber appointments, taking opioids for symptoms other than pain, using more opioid medication than prescribed, asking for an increase in opioid dose, aggressive behavior, and alcohol and other substance use. The results of that process are published as a separate study. The purpose of the present study was to present clinical cases in which concerning medication-taking behaviors arise in the course of long-term opioid therapy and demonstrate for readers how the Delphi panel's consensus-based approaches could be applied.
New England Journal of Medicine, 2012
Journal of Pain and Symptom Management
Current Opinion in Nephrology & Hypertension
Journal of Addiction Medicine
Journal of Pain and Symptom Management
adults on two medical-surgical units with delirium (Confusion Assessment Method [CAM] +) unable t... more adults on two medical-surgical units with delirium (Confusion Assessment Method [CAM] +) unable to self-report pain were screened by two data collectors with the PAINAD and the Critical Care Pain Observation Tool (CPOT) between 2015-2016. Patients with a PAINAD score $3 or a CPOT score $2 received a pain intervention. Pain assessments were repeated 30 minutes post baseline or pain intervention. Results. Patients were predominately female (58.8%), with dementia (71%), and had a mean age of 85.4 years. Thirty-nine patients screened positive for pain and received a pain intervention. PAINAD reliability was strong (Cronbach's a ¼ 0.81-0.87; interrater intraclass coefficients [ICC] ¼ 0.91-0.94; test-retest ICC ¼ 0.76-0.77). Construct validity was supported by a statistically significant interaction effect between time (baseline verses follow-up) and condition (pain intervention versus no pain group; Rater 1: F(1, 66)¼8.31, p¼0.005, hp2¼0.11; Rater 2: (F(1,66) ¼ 8.22, p¼0.006, hp2¼0.11). Conclusion. The PAINAD is a reliable and valid pain screening tool for older adults with delirium in medical-surgical settings.
Journal of Adolescent Health
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Papers by Jane Liebschutz