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Meyerson BE, Russell DM, Mahoney A, Garnett I, Samorano S. SI-CBPAR: Towards structural indicators of community-based participatory action research. Drug Alcohol Rev 2024; 43:1049-1061. [PMID: 37872867 DOI: 10.1111/dar.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/06/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Structural aspects of community-engaged research are not well measured yet have critical implications for community research empowerment. This is particularly so with people who use drugs. We introduce the Structural Indicators of Community-Based Participatory Action Research (SI-CBPAR) to measure structural indicators of community-research entity relationships. METHODS A three-phased process of iterative development, feasibility and applicability assessment was used to examine the instrument with community-engaged studies as a first stage of instrument development. The development team included people with university, non-government organisation and lived/ing drug use experience. Four studies on the health of people who use drugs were reviewed for indicator evidence followed by iterative discussion about construct and item discrepancies. Indicators were measured for the degree to which they were observed using a three-point scale. RESULTS All but two constructs were confirmed for meaning. Constructs of 'community' and 'coalition' required revision and explanation. The need for further exploration of power differentials between community and community-based organisations was identified. Indicator evidence was found for all six categories across studies. The instrument was deemed applicable and easy to use. It was observed that categories could apply to studies with various degrees of community engagement and to other research focal areas. DISCUSSION AND CONCLUSIONS SI-CBPAR applicability testing and initial category confirmation indicate its potential utility for community research collaboratives. The next phase of development involves cognitive interviewing with researchers from across community engaged research orientations, and with communities engaged in research beyond drug user health.
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Affiliation(s)
- Beth E Meyerson
- Harm Reduction Research Lab, University of Arizona, Tucson, USA
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, USA
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, USA
| | - Danielle M Russell
- Harm Reduction Research Lab, University of Arizona, Tucson, USA
- Justice Studies, Tempe, USA
- Drug Policy Research and Advocacy Board, Harm Reduction Research Lab, University of Arizona, Tucson, USA
| | - Arlene Mahoney
- Harm Reduction Research Lab, University of Arizona, Tucson, USA
- Drug Policy Research and Advocacy Board, Harm Reduction Research Lab, University of Arizona, Tucson, USA
- Southwest Recovery Alliance, Phoenix, USA
| | - Irene Garnett
- Drug Policy Research and Advocacy Board, Harm Reduction Research Lab, University of Arizona, Tucson, USA
| | - Savannah Samorano
- Drug Policy Research and Advocacy Board, Harm Reduction Research Lab, University of Arizona, Tucson, USA
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Budesa Z, Vance K, Smith R, Carpenter R, Banks D, Green L, Marshall BDL, Schackman BR, Zang X, Winograd R. Missouri's overdose field report: descriptive analysis, survival trends, and naloxone dosing patterns from a community-based survey tool, 2018-2022. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-13. [PMID: 38917333 DOI: 10.1080/00952990.2024.2358046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
Background: Missouri's Overdose Field Report (ODFR) is a community-based reporting system which intends to capture overdoses which may not be otherwise recorded.Objectives: Describe the factors related to non-fatal overdoses reported to Missouri's ODFR.Methods: This study used a descriptive epidemiological approach to examine the demographics and circumstances of overdoses reported to the ODFR. We used binary logistic regression to evaluate factors associated with survival and ordinal logistic regression to evaluate factors associated with number of doses used. Factors were chosen based on their relevance to overdose education and survival, and naloxone distribution.Results: Between 2018 and 2022, 12,225 overdoses (67% male; 78% White) were reported through the ODFR, with a 96% (n = 11,225) survival rate. Overdose survival (ps < .02) was associated with younger age (OR = .58), no opioid and stimulant co-involvement (OR = .61), and private location (OR = .48). Intramuscular naloxone in particular was associated with a significantly higher odds of survival compared to nasal naloxone (OR = 2.11). An average of 1.6 doses of naloxone per incident were administered. Additional doses were associated (ps < .02) with being older (OR = .45), female (OR = .90), nasal naloxone (versus intravenous) (OR = .65), and the belief fentanyl was present (OR = 1.49).Conclusion: Our reporting form provides a comprehensive picture of the events surrounding reported overdoses, including factors associated with survival, how much naloxone was used, and the effects of respondents believing fentanyl was involved. Missouri's report can provide support for current naloxone dosing, contextualize refusing post-overdose transport, and can be used to improve overdose response by community and first responders.
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Affiliation(s)
- Zach Budesa
- Advocates for Human Potential, Inc., Sudbury, MA, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Ryan Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Devin Banks
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Xiao Zang
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
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Smith LR, Perez-Brumer A, Nicholls M, Harris J, Allen Q, Padilla A, Yates A, Samore E, Kennedy R, Kuo I, Lake JE, Denis C, Goodman-Meza D, Davidson P, Shoptaw S, El-Bassel N. A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities. Implement Sci 2024; 19:39. [PMID: 38831415 PMCID: PMC11149235 DOI: 10.1186/s13012-024-01363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. METHODS We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. RESULTS Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. CONCLUSIONS Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. TRIAL REGISTRATION ClincalTrials.gov, Registration Number: NCT04804072 . Registered 18 February 2021.
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Affiliation(s)
- Laramie R Smith
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melanie Nicholls
- School of Social Work, San Diego State University, San Diego, USA
| | - Jayla Harris
- HIV Prevention Trials Network, Family Health International 360, Durham, USA
| | - Qiana Allen
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Alan Padilla
- Columbia University, ICAP, Mailman School of Public Health, New York, USA
| | - Autumn Yates
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eliza Samore
- Center for Behavioral and Addiction Medicine at UCLA, Los Angeles, USA
| | - Rebecca Kennedy
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Jordan E Lake
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Cecile Denis
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | | | - Peter Davidson
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Kay ES, Creasy SL, Townsend J, Hawk M. A qualitative exploration of health care workers' approaches to relational harm reduction in HIV primary care settings. Harm Reduct J 2024; 21:97. [PMID: 38760824 PMCID: PMC11100089 DOI: 10.1186/s12954-024-01021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Structural harm reduction is an approach to care for people who use drugs (PWUD) that incorporates services and resources (e.g., naloxone, sterile syringes). As conceptualized in our previous research, harm reduction is also "relational," encompassing a patient-provider relationship that is non-judgmental and respectful of patients' autonomy. Little is known about health care workers' (HCW) knowledge or attitudes towards harm reduction beyond structural strategies, whose availability and legality vary across geographical settings. To operationalize how relational harm reduction is both characterized and employed in HIV care settings, where nearly half of patients have a diagnosed substance use disorder, we qualitatively explored HCWs' knowledge of and use of harm reduction via individual in-depth interviews. METHODS Our study sample included three HIV clinics, one in Birmingham, Alabama (AL) and two in Pittsburgh, Pennsylvania (PA). We conducted individual interviews with n = 23 health care workers via Zoom, using a semi-structured interview guide to probe for questions around health care workers' attitudes towards and experiences with providing care to PWH who use drugs and their knowledge of and attitudes towards relational and structural harm reduction. Data was analyzed in Dedoose using thematic analysis. RESULTS Qualitative analyses revealed two primary themes, Continuum of Relational Harm Reduction in Practice and Limited Harm Reduction Training. Nearly all HCWs (n = 19, 83%) described a patient interaction or expressed a sentiment that corresponded with the principles of relational harm reduction. Yet, over half of participants (n = 14, 61%) used language to describe PWH who use drugs that was stigmatizing or described an interaction that was antithetical to the principles of relational harm reduction. Five HCWs, all from Birmingham, were unaware of the term 'harm reduction.' Few HCWs had any harm reduction training, with most learning about harm reduction from webinars/conferences or on the job. CONCLUSION Our findings suggest that relational harm reduction in HIV care settings is practiced along a continuum, and that a range of behaviors exist even within individual HCWs (e.g., used stigmatizing terms such as "addict" but also described patient interactions that reflected patients' autonomy). Given that harm reduction is typically described as a structural approach, a broader definition of harm reduction that is not dependent on policy-dependent resources is needed.
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Affiliation(s)
- Emma Sophia Kay
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, Alabama, AL, 35294, USA.
| | - Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica Townsend
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, Alabama, AL, 35294, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Lamb R, Kougiali ZG. Women and shame: narratives of recovery from alcohol dependence. Psychol Health 2024:1-38. [PMID: 38736242 DOI: 10.1080/08870446.2024.2352191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Existing literature indicates distinct pathways and the key role of shame and stigma into alcohol dependence (AD) and recovery for women. Internationally, there is a paucity of research exploring these factors from women's perspectives. METHODS AND MEASURES Taking a critical realist epistemological position, unstructured life story interviews were analysed via narrative analysis to explore how seven women from the UK, storied shame in their recovery from AD. RESULTS Shame followed a common trajectory across participants' stories, appearing as a reoccurring factor throughout AD and recovery. Participants narrated shame as gendered, contributing to a loss of personal control in defining a valued personal identity. Drinking began as a shame-management strategy but evolved into a source of shame, compounded by fears of being labelled an 'alcoholic woman'. Recovery involved reclaiming the self through de-shaming a shame-based identity and developing a positive, non-drinking identity. By evaluating 'shaming' recovery frameworks, sharing stories and reconstructing their own, participants were able to work through shame, resist pathologising identity labels and internalise esteemed 'sober' identities. CONCLUSION This research provides important insights into the intersection between shame, identity, gender and culture in women's recovery from AD. Implications for clinical practice, future research and policy are considered.
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Affiliation(s)
- Robin Lamb
- Department of Psychology, University of East London, London, UK
| | - Zetta G Kougiali
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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Sundaram G, Sato T, Goodman-Meza D, Haddad M, Thakarar K, Feinberg J, Springer SA, Barton K, Butler N, Eaton EF, Wurcel AG. Perspectives on benefits and risks of creation of an "injection drug use" billing code. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209392. [PMID: 38735482 DOI: 10.1016/j.josat.2024.209392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
People with substance use disorder (SUD) face barriers to prevention and treatment services, increasing risk for hospitalization and death. Injection drug use (IDU) can lead to an increased risk of overdose and infections. However, identifying people who inject drugs (PWID) within healthcare systems is challenging. International Classification of Disease (ICD-10) codes are used for billing and tracking healthcare utilization. In this commentary, experts in the field weigh the benefits and risks of creating an IDU-specific ICD-10 code. Potential benefits include earlier identification, better access to health services, and improved systems of resource allocation. Potential risks include further stigmatization of PWID and, if not tied to financial reimbursement, low rates of code utilization. As the current systems of identifying PWID are lacking, we feel that a guided operationalization of an ICD code to identify PWID could improve quantitative and epidemiological research accuracy and, therefore, support the health and well-being of PWID.
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Affiliation(s)
- Gayathri Sundaram
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Taisuke Sato
- Tufts Medical Center, Boston, MA, United States of America
| | - David Goodman-Meza
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Marwan Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown, CT, United States of America
| | - Kinna Thakarar
- Tufts University School of Medicine, Boston, MA, United States of America; Maine Health Institute of Research, Portland, ME, United States of America; Maine Medical Center, Portland, ME, United States of America; Maine Medical Partners Adult Infectious Diseases, South Portland, ME, United States of America; West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Judith Feinberg
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, CT, United States of America; Yale University School of Public Health, New Haven, CT, United States of America
| | - Kerri Barton
- Harm Reduction Program Coordinator, Portland Public Health, Portland, ME, United States of America
| | - Nikki Butler
- Maine Access Points, Portland, ME, United States of America
| | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Alysse G Wurcel
- Tufts University School of Medicine, Boston, MA, United States of America; Tufts Medical Center, Boston, MA, United States of America.
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Lenton E, Kagan D, Seear K, Mulcahy S, Farrugia A, Valentine K, Edwards M, Jeffcote D. Troubling complaint: Addressing hepatitis C-related stigma and discrimination through complaint mechanisms. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38594217 DOI: 10.1111/1467-9566.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Abstract
The need to grapple with hepatitis C-related stigma and discrimination in Australian health-care settings has been recognised in public policy, and work is underway to address it. But how likely are people to raise a complaint when they experience stigma or discrimination? And how effective and accessible are complaints mechanisms? Given complaint procedures are considered important parts of the delivery of safe and ethical health care, these are important questions that have yet to be substantially explored. Drawing on interviews with people with lived experience of hepatitis C (n = 30), this article considers how affected people feel about complaints processes and the act of complaining. Alongside these perspectives, we discuss complaint mechanisms, and the views of stakeholders who work with hepatitis C-affected communities in policy, health, legal and advocacy roles (n = 30) on the institutional and cultural dynamics of complaint. We draw on Sara Ahmed's Complaint! and Fraser et al.'s work on drug-related stigma to analyse these concerns that have yet to be researched, and argue that the (unlikely) prospect of successful complaint is a key part of the network of forces that perpetuate stigma, discrimination and disadvantage among people who have (lived with) hepatitis C. Although people with lived experience are often powerful advocates and acutely aware of the deficiencies in the quality of their treatment, our interviews suggest that the obstacles they face to accessing health care are seen as commonplace, intractable and insurmountable; and, that mechanisms for addressing them-where they exist at all-treat complaints in narrowly individualising terms and expose complainants to dismissal. Following Ahmed, we call for a 'troubling' of complaints-responding to them not as individual problems but rather as collective, structural concerns, necessitating new approaches.
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Affiliation(s)
- Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Dion Kagan
- Health+Law, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kylie Valentine
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Edwards
- Faculty of Addiction Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Victoria, Australia
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Dunham K, Rivas C, Medina Blanco P, Kolod B, Salvati C, Clark K, Sue KL, Hagaman A, Weiss JJ. "It's Like A Partnership": Exploring the Primary Care Experiences and Patient-Defined Goals of People Who Use Drugs. J Gen Intern Med 2024:10.1007/s11606-024-08743-5. [PMID: 38578536 DOI: 10.1007/s11606-024-08743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies have identified important aspects of primary care for people who use drugs (PWUD) and have found patient involvement in healthcare decisions and goal-setting to be especially critical. However, there has been limited research describing the primary care goals of PWUD. In harm reduction settings, where it is imperative that PWUD set their own goals, this research gap becomes especially relevant. OBJECTIVE To explore how PWUD navigate primary care with a focus on understanding their primary care goals. DESIGN A qualitative study using semi-structured interviews. PARTICIPANTS PWUD currently engaged in primary care at the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, a harm reduction-based primary care program in New York City. APPROACH Between June 2022 and August 2022, we conducted 17 semi-structured interviews. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed using thematic analysis approaches. KEY RESULTS Phenomenological analysis identified four core components that, together, created an experience that participants described as "a partnership" between patient and provider: (1) patient-provider collaboration around patient-defined healthcare goals; (2) support provided by harm reduction-based approaches to primary care anchored in incrementalism and flexibility; (3) care teams' ability to address healthcare system fragmentation; and (4) the creation of social connections through primary care. This holistic partnership fostered positive primary care experiences and supported participants' self-defined care goals, thereby facilitating meaningful care outcomes. CONCLUSIONS To best meet the primary care goals of PWUD, these findings underscore the importance of primary care providers and programs facilitating such partnerships through organizational-level support anchored in harm reduction. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately shaping best practices in the provision of high-quality primary care for PWUD.
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Affiliation(s)
- Katherine Dunham
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA.
| | - Catherine Rivas
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, USA
| | - Paula Medina Blanco
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, USA
| | - Betty Kolod
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, USA
| | - Carli Salvati
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, USA
| | - Katie Clark
- Clark Health Education and Research Solutions, Branford, USA
| | - Kimberly L Sue
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Jeffrey J Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, USA
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Wenger LD, Morris T, Knight KR, Megerian CE, Davidson PJ, Suen LW, Majano V, Lambdin BH, Kral AH. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104366. [PMID: 38492432 PMCID: PMC11160962 DOI: 10.1016/j.drugpo.2024.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.
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Affiliation(s)
- Lynn D Wenger
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States.
| | - Terry Morris
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Kelly R Knight
- University of California, San Francisco, San Francisco, CA, United States
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Peter J Davidson
- Univerity of California, San Diego, San Francisco, CA, United States
| | - Leslie W Suen
- University of California, San Francisco, San Francisco, CA, United States
| | - Veronica Majano
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Barrot H Lambdin
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Alex H Kral
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
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Chatterjee A, Baker T, Rudorf M, Walt G, Stotz C, Martin A, Kinnard EN, McAlearney AS, Bosak J, Medley B, Pinkhover A, Taylor JL, Samet JH, Lunze K. Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209272. [PMID: 38128649 PMCID: PMC10947870 DOI: 10.1016/j.josat.2023.209272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Medications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. METHODS Program staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. RESULTS Mobile MOUD units sought to improve immediate access to MOUD ("Our answer is pretty much always, 'Yes, we'll get you started right here, right now,'"), advance equity ("making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,"), and decrease opioid overdose deaths. Salient program characteristics included diverse staff, including staff with lived experience of substance use ("She just had that personal knowledge of where we should be going"). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access. Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours. Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement ("It's not really possible that billing in and of itself is going to be able to sustain it"), and community stigma toward addiction services generally. CONCLUSIONS Despite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.
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Affiliation(s)
- Avik Chatterjee
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America.
| | - Trevor Baker
- Boston Medical Center, Boston, MA, United States of America
| | - Maria Rudorf
- Boston Medical Center, Boston, MA, United States of America
| | - Galya Walt
- Boston Medical Center, Boston, MA, United States of America
| | - Caroline Stotz
- Boston Medical Center, Boston, MA, United States of America
| | - Anna Martin
- Boston Medical Center, Boston, MA, United States of America
| | | | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Bosak
- Boston Medical Center, Boston, MA, United States of America
| | - Bethany Medley
- Columbia University School of Social Work, New York, NY, United States of America
| | - Allyson Pinkhover
- Brockton Neighborhood Health Center, Brockton, MA, United States of America; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jessica L Taylor
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Jeffrey H Samet
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
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11
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Monari EN, Booth R, Forchuk C, Csiernik R. Black family members' cultural beliefs and experiences regarding substance use and misuse by relatives: A focused ethnography. J Ethn Subst Abuse 2024:1-31. [PMID: 38557270 DOI: 10.1080/15332640.2024.2331634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Research explored substance use in Black communities in Canada, but a gap exists about the experiences of Black family members, caring for relatives with substance misuse within the Canadian context. Black family members are defined as African Canadians, Caribbean Canadian or Caribbean Blacks. This paper explores Black family members' beliefs and experiences regarding their relatives' psychoactive substance use and misuse. A focused ethnography was conducted with 26 Black family members with 17 participants originated from various parts of Africa, and nine participants originated from parts of the Caribbean. Participants comprised of mothers (n = 5), fathers (n = 2), step-fathers (n = 1), husbands (n = 1), wives (n = 2), uncles (n = 5), aunties (n = 2), siblings (n = 5), in-laws (n = 2), and guardians (n = 1). Three themes were generated: cultural beliefs and perceptions regarding substance use and misuse of family relatives; "When he starts drinking, hell breaks loose": Perceived impact of substance misuse on family safety and stability; and, the experiences of stigma and the keeping of secrets. Prioritizing public health approaches, such as public policies and campaigns that dismantle stigma and systemic barriers, and increase awareness about substance use and harm reduction interventions among Black communities.
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Affiliation(s)
- Esther N Monari
- Memorial University of Newfoundland, St. John's, Canada
- Western University, London, Canada
| | | | - Cheryl Forchuk
- Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Parkwood Institute Research, London, Canada
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12
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Carroll JJ. Xylazine-Associated Wounds and Related Health Concerns Among People Who Use Drugs: Reports From Front-Line Health Workers in 7 US States. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:222-231. [PMID: 38258791 DOI: 10.1177/29767342231214472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Xylazine, an adrenergic alpha-2 agonist increasingly present in the US drug supply, is associated with severe skin ulcers and other harms. Expert knowledge from front-line harm reduction and healthcare professionals is an essential component of evidence-based practice. The purpose of this study is to describe the progression and treatment of xylazine-associated wounds, other xylazine-related health concerns, and the most urgent research priorities as reported by front-line harm reduction and healthcare professionals serving people who use drugs. METHODS A convenience sample of 17 healthcare and harm reduction professionals who serve people who use drugs in the US states of Maryland, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, and Texas participated in semi-structured interviews. Participants were asked about the appearance and progression of xylazine-associated wounds; preferred treatment strategies; other xylazine-related harms experienced by people who use drugs; and the most urgent priorities for xylazine-related research. FINDINGS Xylazine-associated wounds were broadly described as small lesions appearing mostly on extremities both at and away from injection sites, often within hours or days of exposure, that quickly developed into large, complex, chronic wounds. Reported risk of secondary infection was generally low but appeared more common among unhoused populations. Most participants preferred conservative treatment strategies that included regular wound care, enzymatic debridement, and hygiene. Xylazine-associated wounds and xylazine withdrawal reportedly act as significant barriers to care, including addiction treatment. Participants reported urgent need for scientific research and evidence-based guidance on the management of xylazine-associated wounds and withdrawal. CONCLUSIONS High-quality scientific evidence on risk factors for xylazine-associated wounds and on their biologic mechanisms is needed. Such studies could inform new strategies for the prevention and treatment of these wounds. Efforts to improve the management of xylazine withdrawal and to reduce stigma by incorporating harm reduction professionals into healthcare settings may improve access to and retention in care.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology and Anthropology, NC State University, Raleigh, NC, USA
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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13
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Santos J, Camplain C, Pollitt AM, Baldwin JA. A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona. J Eval Clin Pract 2024; 30:243-250. [PMID: 37933799 DOI: 10.1111/jep.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona. AIM This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC) services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments. METHODS The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022. RESULTS Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD), 23.74% had a substance use disorder (SUD), and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments. CONCLUSION Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Amanda Marie Pollitt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Julie Ann Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
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14
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Russell DM, Meyerson BE, Mahoney AN, Garnett I, Ferrell C, Newgass K, Agley JD, Crosby RA, Bentele KG, Vadiei N, Frank D, Linde-Krieger LB. Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023. Harm Reduct J 2024; 21:49. [PMID: 38388463 PMCID: PMC10885601 DOI: 10.1186/s12954-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. METHODS A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. RESULTS Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. CONCLUSIONS Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales, limiting pharmacist discretion for syringe sales, and targeting pharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.
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Affiliation(s)
- Danielle M Russell
- Arizona State University, Tempe, AZ, USA
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Beth E Meyerson
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA.
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA.
| | - Arlene N Mahoney
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Irene Garnett
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Ferrell
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- CAN Community Health, Phoenix, AZ, USA
| | - Kylee Newgass
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Jon D Agley
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Richard A Crosby
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Keith G Bentele
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Institute for Research On Women, University of Arizona, Tucson, AZ, USA
| | - Nina Vadiei
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - David Frank
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- School of Global Public Health, New York University, New York, USA
| | - Linnea B Linde-Krieger
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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15
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Hughes T, Nasser N, Mitra A. Overview of best practices for buprenorphine initiation in the emergency department. Int J Emerg Med 2024; 17:23. [PMID: 38373992 PMCID: PMC10877824 DOI: 10.1186/s12245-024-00593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
In recent decades, opioid overdoses have increased dramatically in the United States and peer countries. Given this, emergency medicine physicians have become adept in reversing and managing complications of acute overdose. However, many remain unfamiliar with initiating medication for opioid use disorder such as buprenorphine, a high-affinity partial opioid agonist. Emergency department-based buprenorphine initiation is supported by a significant body of literature demonstrating a marked reduction in mortality in addition to increased engagement in care. Buprenorphine initiation is also safe, given both the pharmacologic properties of buprenorphine that reduce the risk of diversion or recreational use, and previously published literature demonstrating low rates of respiratory depression, sedation, and precipitated withdrawal. Further, barriers to emergency department-based initiation have been reduced in recent years, with publicly available dosing and up-titration schedules, numerous publications overviewing best practices for managing precipitated withdrawal, and removal of USA policies previously restricting patient access and provider prescribing, with the removal of the X-waiver via the Medication Access and Training Expansion Act. Despite reductions in barriers, buprenorphine initiation in the emergency room remains underutilized. Poor uptake has been attributed to numerous individual and systemic barriers, including inadequate education, provider stigma, and insufficient access to outpatient follow-up care. The following practice innovation aims to summarize previously published evidence-based best practices and provide an accessible, user-friendly initiation guide to increase emergency physician comfortability with buprenorphine initiation going forward.
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Affiliation(s)
- Terence Hughes
- The Mount Sinai Hospital, 1 Gustav Levy Place, New York, NY, 10029-6574, USA
| | - Nicholas Nasser
- The Mount Sinai Hospital, 1 Gustav Levy Place, New York, NY, 10029-6574, USA.
| | - Avir Mitra
- Mount Sinai Beth Israel, 281 1st Ave, New York, NY, 10003, USA
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16
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Ostrach B, Hixon V, Bryce A. "When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies. HEALTH & JUSTICE 2024; 12:3. [PMID: 38319474 PMCID: PMC10848405 DOI: 10.1186/s40352-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Community-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data. RESULTS The evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants' risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD. CONCLUSIONS Overall, the evaluation research found that participants' experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.
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Affiliation(s)
- Bayla Ostrach
- Boston University School of Medicine; Fruit of Labor Action Research & Technical Assistance, LLC, Fairview, NC, USA.
| | - Vanessa Hixon
- Appalachian Medical Solidarity, Asheville, North Carolina, USA
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17
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Santos J, Acevedo-Morales A, Jones L, Bautista T, Camplain C, Keene CN, Baldwin J. Client perspectives on primary care integration in a rural-serving behavioral health center. JOURNAL OF INTEGRATED CARE 2024; 32:31-44. [PMID: 38516678 PMCID: PMC10954248 DOI: 10.1108/jica-08-2023-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Purpose Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona. Design/methodology/approach Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview. Findings The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes. Originality/value This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Lillian Jones
- Department of Clinical Psychology, Northern Arizona University, Flagstaff, AZ
| | | | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, PA
| | | | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
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18
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Long C, Guimond T, Bayoumi AM, Firestone M, Strike C. The multiple makings of a supervised consumption service in a hospital setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104260. [PMID: 38035448 DOI: 10.1016/j.drugpo.2023.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Whereas supervised consumption services (SCSs) are common in many community settings, they are seldomly found in acute care hospitals. As hospitals present unique circumstances that can shape the impacts of an SCS, careful consideration of local implementation contexts and practices is required. We explored the pre-implementation stage of an SCS, to examine how an SCS is made and made differently in relation to the material-discursive context of the hospital. METHODS We conducted 11 focus groups with 83 staff and clinicians at an inner-city hospital in Toronto, Canada. Data analysis followed principles of grounded theory and was informed by an 'evidence making interventions' framework. RESULTS While most participants indicated they would support the establishment of an SCS at the hospital, multiple enactments of an SCS emerged. An SCS was enacted: as a means to reduce drug-related risks for all people who use drugs, as an opportunity to intervene on patients' drug use, as a means to centralize drug use, and as a transformative intervention for the hospital. In our findings, harm reduction, abstinence, security, and risk mitigation goals existed closely together, yielding overlaying realities. CONCLUSION Our findings revealed various enactments of an SCS, some of which are likely to negatively affect people who use drugs and service access. As more hospitals consider the implementation of an SCS, understanding how an SCS is made in practice will be key to building a service that focuses on the needs of people who use drugs.
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Affiliation(s)
- Cathy Long
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
| | - Tim Guimond
- Addictions Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada; Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, 36 Queen Street East, Toronto, ON, M5B 1W8
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada
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Roberts K, Smith E, Sousa C, Young JE, Corley AG, Szczotka D, Sepanski A, Hartoch A. Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders. SOCIAL WORK IN HEALTH CARE 2024; 63:19-34. [PMID: 37929597 DOI: 10.1080/00981389.2023.2278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.
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Affiliation(s)
- Kate Roberts
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - Emily Smith
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Cindy Sousa
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - J Elaina Young
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna Grace Corley
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Darin Szczotka
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Abby Sepanski
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Ashley Hartoch
- Psychiatry, Stanford Health Care, Palo Alto, California, USA
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Crowther D, Curran J, Somerville M, Sinclair D, Wozney L, MacPhee S, Rose AE, Boulos L, Caudrella A. Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review. PLoS One 2023; 18:e0294804. [PMID: 38100469 PMCID: PMC10723714 DOI: 10.1371/journal.pone.0294804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. METHODS A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. FINDINGS The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. CONCLUSION This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.
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Affiliation(s)
- Daniel Crowther
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Doug Sinclair
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shannon MacPhee
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | | | - Leah Boulos
- The Maritime Strategy for Patient Oriented Research SUPPORT Unit, Halifax, NS, Canada
| | - Alexander Caudrella
- Mental Health and Addictions Service, St Michael’s Hospital, Toronto, Ontario, Canada
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21
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Fallin-Bennett A, Elswick A. A harm reduction journey: Connection, family support, and engagement in health care. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209179. [PMID: 37797938 DOI: 10.1016/j.josat.2023.209179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/22/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Amanda Fallin-Bennett
- University of Kentucky College of Nursing, United States of America; Voices of Hope Lexington, Inc, United States of America.
| | - Alex Elswick
- Voices of Hope Lexington, Inc, United States of America; University of Kentucky Department of Family Sciences, United States of America
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Keegan GE, Alexander R, Ogunnowo S, Brown I, Zakrison TL, Hoefer LE. Trauma as a Public Health Moment: Addressing Vaccine Uptake in Trauma Patients. ANNALS OF SURGERY OPEN 2023; 4:e356. [PMID: 38144493 PMCID: PMC10735124 DOI: 10.1097/as9.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Our objective was to identify factors associated with COVID-19 vaccination in trauma patients and to provide an opportunity for patients to engage in conversations about vaccination. Background The trauma surgery service offers a unique opportunity to promote preventative health interventions in hard-to-reach populations. Methods Trauma inpatients in Chicago, IL were recruited for this mixed-methods study from February 2022 to April 2022. Participants completed a survey on demographics, COVID-19 vaccination status, and Experiences of Discrimination Scale adapted for medical settings. Differences between vaccinated and unvaccinated patients were analyzed using the Wilcoxon-rank sum test. A semistructured, qualitative interview was completed. Qualitative data was transcribed and analyzed using Grounded Theory Methodology. Results Fifty-eight trauma patients were surveyed, representing 88% of patients approached. Only 23 (40%) patients reported full vaccination to COVID-19. Previous vaccination (at least 1 dose) was associated with greater concern for COVID-19 (OR 3.47, 95% CI 1.987-6.964, P < 0.001) and higher income (OR 1.21, 95% CI 1.02-1.44, P = 0.03). Higher Experiences of Discrimination Scale scores were associated with decreased likelihood of prior vaccination (OR 0.97, 95% CI 0.95-0.99, P = 0.04). On qualitative analysis, recurrent themes included vaccination motivated by either community-based or personal health-related values, and disinterest in vaccination based on perceived low need or skepticism of experimentation. Fifteen patients (26%) eligible for a vaccine dose consented to onsite vaccination after the survey. Conclusions Trauma patients who have experienced more discrimination in medical settings have lower rates of COVID-19 vaccination. Vaccination rates in our population were over 2 times lower than citywide rates, but admission to the trauma service can increase comprehensive care.
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Affiliation(s)
- Grace E Keegan
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Rachel Alexander
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Simi Ogunnowo
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Isaiah Brown
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Lea E Hoefer
- Department of Surgery, University of Chicago, Chicago, IL
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23
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Frank D, Elliott L, Cleland CM, Walters SM, Joudrey PJ, Russell DM, Meyerson BE, Bennett AS. "As safe as possible": a qualitative study of opioid withdrawal and risk behavior among people who use illegal opioids. Harm Reduct J 2023; 20:158. [PMID: 37891630 PMCID: PMC10605476 DOI: 10.1186/s12954-023-00893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Opioid withdrawal is a regular occurrence among many people who use illicit opioids (PWUIO) that has also been shown to increase their willingness to engage in risk-involved behavior. The proliferation of fentanyl in the illicit opioid market may have amplified this relationship, potentially putting PWUIO at greater risk of negative health outcomes. Understanding the relationship between withdrawal and risk-involved behavior may also have important implications for the ways that problematic drug use is conceptualized, particularly in disease models of addiction, which position risk behavior as evidence of pathology that helps to justify ontological distinctions between addicts and non-addicts. Examining withdrawal, and its role in PWUIO's willingness to engage in risk, may aid in the development of alternative theories of risk involvement and create discursive spaces for de-medicalizing and de-othering people who use illegal drugs. METHODS This article is based on 32 semi-structured interviews with PWUIO in the New York City area who also reported recent withdrawal experience. Interviews were conducted remotely between April and August 2022 and recorded for later transcription. Data were then coded and analyzed based on a combination of inductive and deductive coding strategies and informed by the literature. RESULTS Participants described a strong relationship between withdrawal and their willingness to engage in risk-involved behavior that was exacerbated by the proliferation of fentanyl. Yet, their descriptions did not align with narratives of risk as a product of bad decisions made by individuals. Rather, data demonstrated the substantial role of social and structural context, particularly drug policies like prohibition and criminalization, in the kinds of risks that PWUIO faced and their ability to respond to them. CONCLUSIONS Withdrawal should be taken more seriously both from an ethical perspective and as an important catalyst of risk behavior. However, theories that position activities taken to avoid withdrawal as irrational and as evidence of pathology are poorly aligned with the complexity of PWUIO's actual lives. We recommend the use of less deterministic and less medicalized theories of risk that better account for differences between how people view the world, and for the role of socio-structural forces in the production of risk.
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Affiliation(s)
- David Frank
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA.
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, 10003, USA.
- , Woodside, NY, 11377, USA.
| | - Luther Elliott
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Charles M Cleland
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, 10003, USA
| | - Suzan M Walters
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Paul J Joudrey
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Danielle M Russell
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 85711, USA
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, 85711, USA
| | - Beth E Meyerson
- Harm Reduction Research Lab, Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, 85711, USA
| | - Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, 10003, USA
- Center for Anti-Racism, Social Justice, and Public Health, 708 Broadway, 9th floor, New York, NY, 10003, USA
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24
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Bardach SH, Perry AN, Eccles E, Carpenter-Song EA, Fowler R, Miers EM, Ovalle A, de Gijsel D. Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report. J Particip Med 2023; 15:e47395. [PMID: 37728975 PMCID: PMC10551795 DOI: 10.2196/47395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs. OBJECTIVE This study aimed to analyze the process of a multidisciplinary team-encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs-that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges. METHODS Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. RESULTS Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. CONCLUSIONS While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.
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Affiliation(s)
- Shoshana H Bardach
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Amanda N Perry
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Elizabeth Eccles
- Section of Infectious Diseases & International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | | | - Ryan Fowler
- HIV/HCV Resource Center, Lebanon, NH, United States
| | - Erin M Miers
- Park Nicollet Health Services, Minneapolis, MN, United States
| | | | - David de Gijsel
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- Section of Infectious Diseases & International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Better Life Partners, Manchester, NH, United States
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25
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Helmert C, Fleischer T, Speerforck S, Ulke C, Altweck L, Hahm S, Muehlan H, Schmidt S, Grabe HJ, Völzke H, Schomerus G. An explorative cross-sectional analysis of mental health shame and help-seeking intentions in different lifestyles. Sci Rep 2023; 13:10825. [PMID: 37402843 PMCID: PMC10319876 DOI: 10.1038/s41598-023-37955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
To identify und support particular target groups for mental health prevention, we explore the links between shame and help-seeking intentions concerning mental health in different lifestyles (based on socioeconomic status as well as health-related behaviors). Lifestyles were operationalized by nine confirmatory, homogenous clusters of the sample. These clusters are based on individuals' similarities in sociodemographic aspects and health behavior. Analyses included t tests, Chi-square, ANOVA, regressions investigating in sociodemographic characteristics. Hierarchical linear models examining cross-sectional associations of shame and willingness to seek help for different lifestyles of participants of the Study of Health in Pomerania (SHIP-START-1 and SHIP-START-3, data collected 2002-2006 and 2014-2016; n = 1630). Hierarchical linear models showed small context effects for lifestyle-related associations of shame and willingness to seek help. For younger as well as male participants, lifestyles indicated different associations of shame and help-seeking intentions: Especially the lifestyles with unhealthy behaviors and high as well as low socioeconomic status resulted in higher shame being associated with low help-seeking intentions in case of mental illness. Lifestyle clusters might be a useful tool to identify marginalized groups with unhealthy behaviors, which should be addressed by interventions and prevention programs.
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Affiliation(s)
- Claudia Helmert
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany.
| | - Toni Fleischer
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
| | - Laura Altweck
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Stefanie Hahm
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Holger Muehlan
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Silke Schmidt
- Department of Health and Prevention, Greifswald University, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, Greifswald University, Medical Center, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, Greifswald University, Medical Center, Greifswald, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig, Medical Center, Leipzig, Germany
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Banka-Cullen SP, Comiskey C, Kelly P, Zeni MB, Gutierrez A, Menon U. Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): a scoping review. Harm Reduct J 2023; 20:78. [PMID: 37353762 DOI: 10.1186/s12954-023-00812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD. METHODS This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included. RESULTS A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy. CONCLUSION The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from 'hard to reach' cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment.
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Affiliation(s)
| | - Catherine Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Peter Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Ana Gutierrez
- Health College of Nursing, University of South Florida, Tampa, USA
| | - Usha Menon
- Health College of Nursing, University of South Florida, Tampa, USA
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Nolen S, Wilson T, Jacka BP, Li Y, Beaudoin FL, Marshall BD. Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose. Addict Behav Rep 2023; 17:100496. [PMID: 37249941 PMCID: PMC10213175 DOI: 10.1016/j.abrep.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Our objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED). Methods We conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behavioral interventions in the ED for people at risk of an opioid overdose. Participants included adult patients presenting to two Rhode Island EDs. Eligible participants included those high risk for an opioid overdose, resided or received most of their healthcare in Rhode Island, and were able to provide consent. The primary outcome of this analysis was self-reported feelings of drug-related discrimination by the medical community. The independent variables of interest included race/ethnicity, gender identity, and sexual orientation. Log-binomial multivariable regression models were constructed with all three independent variables of interest and a selection of sociodemographic covariates. Results Of 620 eligible participants, 251 (40.5%) reported ever experiencing drug-related discrimination in their lifetime. In the adjusted model, participants who identified as women and participants who identified as LGBQIA+ were more likely to report experiencing drug-related discrimination from the medical community in EDs. Racial/ethnic minority groups were less likely than White (non-Hispanic) participants to report drug-related discrimination. Discussion In this study population, White participants reported more drug-related discrimination than their minority counterparts, although female and LGBQIA+ patients reported more discrimination. Future studies should further assess the significance of these intersecting identities on self-reported discrimination. This knowledge could improve ED-based interventions, policies, and services for PWUD.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Taneisha Wilson
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Brendan P. Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
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28
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Glick JL, Zhang L, Rosen JG, Yaroshevich K, Atiba B, Pelaez D, Park JN. A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs: Formative Research and Intervention Development. JMIR Form Res 2023; 7:e42418. [PMID: 37052977 PMCID: PMC10141312 DOI: 10.2196/42418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. OBJECTIVE We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. METHODS Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. RESULTS The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. CONCLUSIONS This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide.
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Affiliation(s)
- Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Bakari Atiba
- Charm City Care Connection, Baltimore, MD, United States
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
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29
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Meyerson BE, Russell DM, Downer M, Alfar A, Garnett I, Lowther J, Lutz R, Mahoney A, Moore J, Nuñez G, Samorano S, Brady BR, Bentele KG, Granillo B. Opportunities and Challenges : Hepatitis C Testing and Treatment Access Experiences Among People in Methadone and Buprenorphine Treatment During COVID-19, Arizona, 2021. AJPM FOCUS 2023; 2:100047. [PMID: 37789937 PMCID: PMC10546500 DOI: 10.1016/j.focus.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The purpose of this study was to characterize hepatitis C virus screening and treatment access experiences among people in treatment for opioid use disorder in Arizona during COVID-19. Methods Arizonans receiving treatment for opioid use disorder from methadone clinics and buprenorphine providers during COVID-19 were interviewed about hepatitis C virus testing, curative treatment, and knowledge about screening recommendations. Interviews were conducted with 121 people from August 4, 2021 to October 10, 2021. Qualitative data were coded using the categories of hepatitis C virus testing, knowledge of screening recommendations, diagnosis, and experiences seeking curative treatment. Data were also quantitated for bivariate testing with outcome variables of last hepatitis C virus test, diagnosis, and curative treatment process. Findings were arrayed along an adapted hepatitis C virus cascade framework to inform program and policy improvements. Results Just over half of the sample reported ever having tested for hepatitis C virus (51.2%, n=62) and of this group, 58.1% were tested in the past 12 months. Among those who were ever tested, 54.8% reported a hepatitis C virus diagnosis and 16.1% reported either being in treatment or having been declared cured of the hepatitis C virus. Among those who were diagnosed with hepatitis C, 14.7% indicated that they unsuccessfully tried to access curative treatment and would not attempt to again. Reasons cited for not accessing or receiving curative treatment included beliefs about treatment safety, barriers created by access requirements, natural resolution of the infection, and issues with healthcare coverage and authorization. Conclusions Structural barriers continue to prevent curative hepatitis C virus treatment access. Given that methadone and buprenorphine treatment providers serve patients who are largely undiagnosed or treated for hepatitis C virus, opportunities exist for them to screen their patients regularly and provide support for and/or navigation to hepatitis C virus curative treatment.
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Affiliation(s)
- Beth E. Meyerson
- Family & Community Medicine, College of Medicine Tucson, The University of Arizona, Tucson, Arizona
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | | | | | - Amirah Alfar
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Irene Garnett
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - John Lowther
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | | | | | - Julie Moore
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Greg Nuñez
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Savannah Samorano
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
| | - Benjamin R. Brady
- Comprehensive Pain and Addiction Center, The University of Arizona, Tucson, Arizona
- Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson; Arizona
| | - Keith G. Bentele
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Brenda Granillo
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
| | - Arizona Drug Policy Research & Advocacy Board
- Family & Community Medicine, College of Medicine Tucson, The University of Arizona, Tucson, Arizona
- Southwest Institute for Research on Women, College of Social & Behavioral Sciences, The University of Arizona, Tucson, Arizona
- School of Social Transformation, Arizona State University, Tempe, Arizona
- Southwest Recovery Alliance, Phoenix, Arizona
- Drug Policy Research & Advocacy Board, The University of Arizona, Tucson, Arizona
- CAN Community Health Services, Phoenix, Arizona
- Comprehensive Pain and Addiction Center, The University of Arizona, Tucson, Arizona
- Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson; Arizona
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Williams LD, Lee E, Kristensen K, Mackesy-Amiti ME, Boodram B. Community-, network-, and individual-level predictors of uptake of medication for opioid use disorder among young people who inject drugs and their networks: A multilevel analysis. Drug Alcohol Depend 2023; 244:109782. [PMID: 36738633 PMCID: PMC10041678 DOI: 10.1016/j.drugalcdep.2023.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Opioid use has been increasing at alarming rates over the past 15 years, yet uptake of medication for opioid use disorder (MOUD) remains low. Much of the research on individual characteristics predicting MOUD uptake is equivocal, and there is a dearth of research on setting-level and network-level characteristics that predict MOUD uptake. Towards a more holistic, multilevel understanding, we explore individual-level, network-level, and community-level characteristics associated with MOUD uptake. METHODS Baseline data from a longitudinal study of young people who inject drugs and their injection and support network members living in Chicago (N = 165) was used to conduct cross-sectional multilevel logistic regression analyses to examine associations between MOUD uptake and a set of potential predictors at the individual-, network-, and community-levels that were chosen based on theoretical relevance or support from previous empirical studies. RESULTS Stigma at both the individual and community levels was significantly associated with MOUD uptake (though in different directions). Greater individual-level stigma was associated with a higher likelihood of MOUD uptake, while having a more normatively stigmatizing community environment was associated with a lower likelihood of MOUD uptake. Using heroin and cocaine simultaneously and having a larger support network were associated with a greater likelihood of MOUD uptake. CONCLUSIONS The present study's holistic, multilevel approach identified three individual-level characteristics, one network-level characteristic, and one community-level characteristic associated with MOUD uptake. However, more research is needed examining multilevel predictors, to help with developing interventions addressing barriers to MOUD use at multiple levels of influence.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
| | - Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Kathleen Kristensen
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Mary Ellen Mackesy-Amiti
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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Ray B, Richardson NJ, Attaway PR, Smiley-McDonald HM, Davidson P, Kral AH. A national survey of law enforcement post-overdose response efforts. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:199-205. [PMID: 36820614 DOI: 10.1080/00952990.2023.2169615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Law enforcement agencies in the US have provided naloxone to officers and developed initiatives to follow-up after a non-fatal overdose. However, the prevalence and characteristics of these efforts have yet to be documented in research literature.Objectives: We sought to understand the national prevalence of naloxone provision among law enforcement and examine the implementation of post-overdose follow-up.Methods: We administered a survey on drug overdose response initiatives using a multimodal approach (online and mail) to a nationally representative sample of law enforcement agencies (N = 2,009; 50.1% response rate) drawn from the National Directory of Law Enforcement Administrators database. We further examine a subsample of agencies (N = 1,514) that equipped officers with naloxone who were also asked about post-overdose follow-up.Results: We found 81.7% of agencies reported officers were equipped with naloxone; among these, approximately one-third (30.3%) reported follow-up after an overdose. More than half (56.8%) of agencies indicated partnership in follow-up with emergency medical services as the most common partner (68.8%). There were 21.4% of agencies with a Quick Response Team, a popular national post-overdose model, and were more likely to indicate partnership with a substance use disorder treatment provider than when agencies were asked generally about partners in follow-up (74.5% and 26.2% respectively).Conclusion: Many law enforcement agencies across the US have equipped officers with naloxone, and about one-third of those are conducting follow-up to non-fatal overdose events. Post-overdose follow-up models and practices vary in ways that can influence treatment engagement and minimize harms against persons who use drugs.
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Affiliation(s)
- Bradley Ray
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Pete Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, CA, USA
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Gazzola MG, Maclean E, Beitel M, Carmichael ID, Cammack KM, Eggert KF, Roehrich T, Madden LM, Jegede O, Zheng X, Bergman E, Barry DT. What's in a Name? Terminology Preferences Among Patients Receiving Methadone Treatment. J Gen Intern Med 2023; 38:653-660. [PMID: 36163526 PMCID: PMC9971370 DOI: 10.1007/s11606-022-07813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite recognition of the importance of substance use disorder (SUD) terminology, few studies examine terminology preferences among patients with SUDs. OBJECTIVE To examine preferences of patients with opioid use disorder (OUD) concerning the terminology used by addiction counselors. DESIGN From January 1, 2019, to February 28, 2020, participants were recruited consecutively from 30-day treatment review sessions at outpatient methadone treatment programs in the Northeastern United States to complete a cross-sectional survey. PARTICIPANTS Participants were English-speaking adult patients with OUD enrolled in methadone treatment. MAIN MEASURES Participants completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate their preferences for (a) the presenting problem, (b) collective nouns referring to those with the presenting problem, and (c) personal descriptors. We used univariate analysis of covariance (ANCOVA) to examine the associations between demographics (i.e., age, sex, and race) and terminology preferences and ordinal logit regression to explore the association between 12-step program partiality and preference for the term "addict." KEY RESULTS We surveyed 450 patients with mean age of 38.5 (SD = 11.1) years; 59.6% self-identified as male, 77.6% as White, and 12.7% as Hispanic. The highest-rated preferences for presenting problem were "addiction," "substance use," and "substance abuse." The highest-rated collective noun terms were "client," "patient," and "guest." "Person with an addiction," "person with substance use disorder," and "substance-dependent person" were the highest-rated personal descriptors. There were significant differences in terminological preference based on race and age. Twelve-step program partiality was associated with greater preference for the term "addict" (F = 21.22, p < .001). CONCLUSIONS Terminology preferences among people receiving methadone treatment aligned with existing guidelines recommending that clinicians use medically accurate and destigmatizing terminology when referring to substance use disorders and the persons who have them. Demographic differences emerged in terminological preferences, warranting further examination.
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Affiliation(s)
- Marina Gaeta Gazzola
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Emma Maclean
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- The University of the South, Sewanee, TN, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Iain D Carmichael
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Kathryn F Eggert
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Teresa Roehrich
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Xiaoying Zheng
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Yale University, New Haven, CT, USA
| | - Emma Bergman
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Quinnipiac School of Medicine, Hamden, CT, USA
| | - Declan T Barry
- Yale School of Medicine, New Haven, CT, USA.
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study. Addict Sci Clin Pract 2023; 18:8. [PMID: 36747268 PMCID: PMC9902242 DOI: 10.1186/s13722-023-00363-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. METHODS Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. RESULTS Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team's advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing. CONCLUSION Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.
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Grieb SM, Harris R, Rosecrans A, Zook K, Sherman SG, Greenbaum A, Lucas GM, Page KR. Awareness, perception and utilization of a mobile health clinic by people who use drugs. Ann Med 2022; 54:138-149. [PMID: 36799361 PMCID: PMC8741230 DOI: 10.1080/07853890.2021.2022188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION People who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs. METHODS Semi-structured interviews were conducted with 31 PWUD - 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) - to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory. RESULTS Clients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients. DISCUSSION MHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.KEY MESSAGESPeople who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Harris
- Baltimore City Health Department, Baltimore, MD, USA
| | - Amanda Rosecrans
- Baltimore City Health Department, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Zook
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen R Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Patient experiences of prescription drug monitoring programs: a qualitative analysis from an Australian pharmaceutical helpline. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103847. [PMID: 36067724 DOI: 10.1016/j.drugpo.2022.103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prescription Drug Monitoring Programs (PDMP) are electronic databases that are used to track and monitor the prescribing and dispensing of controlled substances, such as opioid analgesics and benzodiazepines. PDMP have been used widely throughout North America and have recently been implemented in Australia. Several unintended harms have been associated with PDMP in North America, including increased stigma, discrimination, and dismissal from care for patients prescribed these medications. AIMS This study aimed to better understand how people who use prescription medications extramedically and their loved ones give meaning to their consumption and their treatment experiences and concerns in the context of a newly implemented real-time PDMP in Victoria, Australia. METHOD Nineteen audio recordings of telephone calls made to the PDMP Pharmaceutical Helpline were transcribed and thematically analysed. RESULTS Patients and their families were hopeful that PDMP would stop the extra medical use of medications. However, many were deeply concerned about how they would cope with withdrawal or life stressors without the support these medications afforded. Patients reported experiences of stigma and strained therapeutic relationships associated with PDMP implementation. CONCLUSION PDMP have the potential to both assist and harm patients whose prescription medication use has been identified as 'risky' by the PDMP. The findings from this study suggest that clear and open communication, as well as reflection on unconscious bias and stigma may assist healthcare providers to facilitate better patient experiences and outcomes in the context of prescription medication dependence.
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Shin SS, LaForge K, Stack E, Pope J, Leichtling G, Larsen JE, Leahy JM, Seaman A, Hoover D, Chisholm L, Blazes C, Baker R, Byers M, Branson K, Korthuis PT. "It wasn't here, and now it is. It's everywhere": fentanyl's rising presence in Oregon's drug supply. Harm Reduct J 2022; 19:76. [PMID: 35818072 PMCID: PMC9275036 DOI: 10.1186/s12954-022-00659-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00659-9.
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Affiliation(s)
- Sarah S Shin
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA.
| | - Kate LaForge
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Erin Stack
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Justine Pope
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | | | - Jessica E Larsen
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Judith M Leahy
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Andrew Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,Old Town Clinic/Central City Concern, Portland, OR, USA.,Better Life Partners, Hanover, NH, USA
| | - Daniel Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Laura Chisholm
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Christopher Blazes
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robin Baker
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | | | - Katie Branson
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
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Self and professional treatment of skin and soft tissue infections among women who inject drugs: Implications for wound care provision to prevent endocarditis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35813351 PMCID: PMC9262139 DOI: 10.1016/j.dadr.2022.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Skin and soft tissue infections (SSTI) are common among people who inject drugs and can result in severe health consequences, including infective endocarditis. Numerous barriers to accessing care often prevent people who inject drugs from seeking healthcare including past negative healthcare experiences, transportation, and shame around drug use. These barriers can lead some people who inject drugs to self-care instead of seeking formal treatment. Methods: We explored the prevalence of SSTIs and associated treatment behaviors among women who inject drugs and sell sex (N = 114). Women reported their drug use and SSTI histories. Those who experienced an SSTI reported if they self-treated their SSTIs and/or sought formal treatment. Results: Half (50.0%) experienced at least one SSTI in the past 6 months. SSTIs were more common among those who injected painkillers (24.6% vs 8.8%, p = 0.02) and who had ever been treated for endocarditis (28.1% vs 10.5%, p = 0.02). SSTIs were less common among those who injected multiple times per day (17.9% vs 38.6%, p = 0.01) and always injected with a sterile syringe (19.3% vs 42.1%, p = 0.01). Among those who experienced an SSTI, most (85.7%) reported self-treating, and half (52.6%) sought formal care. The emergency room was the most common source of care (73.3%). Conclusions: When experiencing SSTIs, women often opted to self-treat rather than seek formal healthcare. A lack of formal care can lead to infections progressing to serious conditions, like endocarditis. Self-treatment with non-prescribed antibiotics may further result in antibiotic-resistant infections. Low threshold, stigma free, community-based wound care programs are warranted.
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Acceptability of a HIV self-testing program among people who use illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
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Tomko C, Schneider KE, Rouhani S, Urquhart GJ, Nyeong Park J, Morris M, Sherman SG. Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk? Addict Behav 2022; 127:107215. [PMID: 34953432 DOI: 10.1016/j.addbeh.2021.107215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Significant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose. METHODS We conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily "long-lasting psychological or mental pain" (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose. RESULTS 30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05). DISCUSSION Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.
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Affiliation(s)
- Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Glenna J Urquhart
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Miles Morris
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
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Smiley-McDonald HM, Attaway PR, Richardson NJ, Davidson PJ, Kral AH. Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone. HEALTH & JUSTICE 2022; 10:9. [PMID: 35212812 PMCID: PMC8874742 DOI: 10.1186/s40352-022-00172-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/02/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer's perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. METHODS The qualitative study examined officers' experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. RESULTS Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. CONCLUSION These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.
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Affiliation(s)
- Hope M Smiley-McDonald
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA.
| | - Peyton R Attaway
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Nicholas J Richardson
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Peter J Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, Berkeley, California, USA
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41
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Kepner W, Meacham MC, Nobles AL. Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit. Subst Use Misuse 2022; 57:1511-1522. [PMID: 35815614 PMCID: PMC9937434 DOI: 10.1080/10826084.2022.2091786] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Digitally-mediated peer support may improve opioid use disorder (OUD) recovery. Our objective was to examine the types and sources of stigma that people seek support for in online OUD recovery communities (subreddits) on Reddit. Methods: We extracted all posts containing stigma keywords from three subreddits as well as a random sample that do not contain stigma keywords. We conducted deductive content analysis to confirm that the post self-described an experience of stigma and identify the type (condition, intervention) and source (provider-based, public, self, structural) of stigma. Results: Two-hundred and fifty-nine posts self-reported a stigmatizing experience. The majority of posts described an intervention stigma associated with medications for OUD. Posts discussing intervention stigma acknowledged the role of stigma in their treatment decision-making and quality of their treatment program. The most frequent sources of stigma were the public (including family members), provider-based (healthcare and pharmacy workers), structural (workplace, law enforcement, child protective services, and abstinence-based self-help groups), and self. No posts mentioned courtesy stigma. Posts sought assistance in navigating their experiences and participating in advocacy to counter stigmatized narratives. Conclusions: Our study indicates that people in online communities seek support to disclose and manage experiences of stigma on Reddit in similar ways to people in offline communities with the noted exception of an absence of discussions of courtesy stigma. Since each subreddit is a microcosm of varying needs, we suggest areas of future work for collaborative resources developed between stakeholders of these subreddits and public health that work within the preexisting Reddit social norms.
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Affiliation(s)
- Wayne Kepner
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, California
| | - Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, California
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42
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French R, Aronowitz SV, Carthon JMB, Schmidt HD, Compton P. Interventions for hospitalized medical and surgical patients with opioid use disorder: A systematic review. Subst Abus 2022; 43:495-507. [PMID: 34283698 PMCID: PMC8991391 DOI: 10.1080/08897077.2021.1949663] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.
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Affiliation(s)
- Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
| | - Shoshana V. Aronowitz
- Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J. Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
| | - Heath D. Schmidt
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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43
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Medina S, Van Deelen A, Tomaszewski R, Hager K, Chen N, Palombi L. Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment. Subst Abuse 2022; 16:11782218221097396. [PMID: 35664045 PMCID: PMC9160899 DOI: 10.1177/11782218221097396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing.
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Affiliation(s)
- Stephany Medina
- South Dakota State University – University of South Dakota Joint Master of Public Health Program, Brookings, SD, USA
| | - Anna Van Deelen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Robyn Tomaszewski
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Keri Hager
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Nathaniel Chen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Laura Palombi
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
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Lasmanovich R, Shaked O, Sivan A, Barak I, Nahari M, Mor O, Katchman H. Hepatitis C Virus Prevalence, Medical Status Awareness and Treatment Engagement among Homeless People Who use Drugs: Results of a Street Outreach Study. Subst Abuse 2022; 16:11782218221095871. [PMID: 35651594 PMCID: PMC9149611 DOI: 10.1177/11782218221095871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Hepatitis C virus (HCV) infection is a primary health concern among people
who use drugs (PWUDs). Homeless PWUDs that constitute a key population for
HCV transmission remain underrepresented in many surveys. Objectives: We performed a proactive street outreach to evaluate HCV infection prevalence
among homeless PWUDs in Tel Aviv, identify risk factors associated with HCV
infection, awareness of disease status and linkage to care rate. Results: Thirty-eight percent of approached PWUD were willing to participate in the
study. Out of 53 subjects who got tested for anti HCV by rapid test, 29
(54.72%) had a positive result, 20 of 29 anti-HCV positive (69%) patients
had positive HCV PCR. Risk factors were investigated using structured
questionnaires. Heroin use was reported significantly more frequently in the
HCV-positive group (P = .05, CI 95%),
whereas other established risk factors did not reach significance in our
cohort. While 21 of 29 (72%) HCV-positive participants were aware of their
condition, only 4 of 21 (19%) received treatment in the past, and 2 of 4
(50%) failed to achieve treatment goals, as assessed by HCV PCR. Conclusions: Our data indicate a high prevalence of HCV infection among homeless PWUDs.
Importantly, despite relatively high awareness of HCV status in this
population, we found strikingly low access to care. These findings motivate
novel interventional approaches targeted at improving patient access, and
compliance among homeless PWUDs, in an effort to reduce HCV
transmission.
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Affiliation(s)
| | - Or Shaked
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Sivan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mor Nahari
- Faculty of Humanities and Social Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Helena Katchman
- Department of Gastroenterology Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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45
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Levander XA, Vega TA, Seaman A, Korthuis PT, Englander H. Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 PMCID: PMC8568624 DOI: 10.1016/j.drugpo.2021.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States.
| | - Taylor A Vega
- School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States
| | - Andrew Seaman
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Central City Concern, 232 NW 6th Ave., Portland, OR, 97209, United States
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
| | - Honora Englander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Department of Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
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46
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Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The Past, Present, and Future of PrEP implementation Among People Who Use Drugs. Curr HIV/AIDS Rep 2021; 18:328-338. [PMID: 33907971 PMCID: PMC8286349 DOI: 10.1007/s11904-021-00556-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Recent HIV outbreaks among people who use drugs (PWUD) necessitate additional HIV prevention tools. Pre-exposure prophylaxis (PrEP) is highly efficacious yet uptake among PWUD remains exceedingly low. To address multilevel, complex barriers to PrEP use among PWUD, a range of intervention strategies are needed. RECENT FINDINGS The literature on interventions to optimize PrEP use among PWUD is nascent, comprising small pilots and demonstration projects in early phases of intervention development. Initial studies suggest that structural, healthcare, interpersonal, and individual-level interventions can improve PrEP use for PWUD, and a number of efficacy trials are underway. Future studies are needed to optimize the use of new PrEP modalities (e.g., injectable PrEP), simultaneously target multilevel challenges to PrEP use, and evaluate the integration of PrEP into other service settings and substance use treatment modalities.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Center for LGBTQ Advocacy, Research, and Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Nimish Saxena
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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47
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Vargas EA, Mahalingam R, Marshall RA. Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals. J Patient Exp 2021; 8:23743735211028092. [PMID: 34263026 PMCID: PMC8252437 DOI: 10.1177/23743735211028092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research has examined instances of incivility witnessed by physicians, nurses, or employees in hospitals. Although patients and visitors are members in hospitals, witnessed incivility from their perspective has rarely been empirically investigated. The aims of the current study are 2-fold: (1) to investigate the forms of incivility patients/visitors witness in hospitals and (2) to examine whether these patients/visitors believe these incivilities impact the target’s sense of perceived control. An integration of interpretative phenomenological analysis and thematic analysis was used to code qualitative data (N = 77). Eight themes of witnessed incivility and 3 themes for impact on perceived control were identified. The results illuminate patterns of incivility targeted at marginalized groups, historically underrepresented in hospital-focused incivility research (eg, homeless individuals, incarcerated individuals, the elderly individuals). The majority of witnesses believed the incident of incivility would negatively impact the target’s perception of control, possibly affecting their experience and health. The current study demonstrates that empirically investigating witnessed incivility from the patient/visitor perspective provides critical information about the unique patterns of mistreatment occurring within hospital contexts.
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Affiliation(s)
- Emily A Vargas
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Riley A Marshall
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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48
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Frank D. "I'm pretty sure it's either food poisoning or Covid-19": Lived experience versus medical knowledge in diagnosing substance use problems. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103348. [PMID: 34183237 PMCID: PMC8200310 DOI: 10.1016/j.drugpo.2021.103348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 06/08/2021] [Indexed: 11/12/2022]
Abstract
People who use drugs, or who have in the past, often report that doctors and/or treatment providers devalue, or are unwilling to believe their claims in regards to substance use issues, in particular the presence and severity of withdrawal. In the case of benzodiazepine withdrawal this can not only lead to significant discomfort, frustration, and trauma for patients, but can lead to serious medical problems. This commentary uses the authors’ recent first-person experience with a disbelieving doctor in order to illustrate the lack of value often given to the claims and narratives of people with lived substance use experience. I outline some of the potential problems with this approach, including the effects on patients themselves and the loss of an important source of evidence-based knowledge. It also discusses potential risks associated with the recent increase in benzodiazepine prescription due to Covid-19 and offers suggestions for improving treatment outcomes.
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49
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Watts T, Lauver D, Snedden T, Zahner S. Risks for acquiring hepatitis C virus among women in the United States. Public Health Nurs 2021; 38:309-320. [PMID: 33749074 DOI: 10.1111/phn.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/10/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To conduct a literature review about the breadth of risks for acquiring hepatitis C virus (HCV) among women who are living in the United States. DESIGN A mixed research synthesis of qualitative, quantitative, and mixed-methods studies guided by the Socioecological Model and Theory of Gender and Power. SAMPLE AND ANALYTIC STRATEGY The sample consisted of 29 studies: 10 qualitative, 18 quantitative, and one mixed-methods studies. Data were analyzed using a segregated approach and integrated into a narrative synthesis of themes by components of the Socioecological Model. RESULTS Individual risks themes were drug use as a coping strategy, transition to injection drug use, and lack of awareness about HCV. Interpersonal risks themes were social norms of drug use and drug use and sexual activities. Community risks themes were community re-entry, housing instability, and community HCV resources. Societal risks themes are policies affecting drug markets and social construct of "worthlessness." CONCLUSIONS Findings highlight the need for comprehensive gender-specific HCV prevention strategies built around harm reduction. In partnership with women with lived experience, public health nurses can apply findings to build harm reduction collaborations aimed at implementing HCV risk-reduction or risk-elimination strategies.
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Affiliation(s)
- Theresa Watts
- Orvis School of Nursing, University of Nevada-Reno, Reno, NE, USA
| | - Diane Lauver
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Traci Snedden
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Susan Zahner
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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