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Slocum S, Paquette CE, Walley AY, Pollini RA. Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104074. [PMID: 37244144 DOI: 10.1016/j.drugpo.2023.104074] [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: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. RESULTS While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. CONCLUSIONS Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States.
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Apsley HB, Vest N, Knapp KS, Santos-Lozada A, Gray J, Hard G, Jones AA. Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers. Drug Alcohol Depend 2023; 242:109715. [PMID: 36495652 PMCID: PMC9847351 DOI: 10.1016/j.drugalcdep.2022.109715] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women with substance use disorders experience multifaceted barriers in accessing substance use treatment. Little is known about how these barriers may aggregate. Using a person-centered approach, this study evaluates patterns of treatment barriers and the factors associated with experiencing distinct sets of barriers among women. METHODS Data were from the NSDUH (2015-2019). 461 adult women with an unmet need for substance use treatment in the last year reported on 14 treatment barriers. Latent class analysis examined classes of barriers; multinomial logistic regression assessed predictors of class membership. RESULTS Three classes were identified: just not ready to abstain (71.2%), logistical barriers and stigmatization (18.2%), and barriers across all dimensions (10.6%). Higher education (aOR:1.94, p = 0.03) and psychological distress (aOR:2.19, p = 0.02) predicted higher odds-and identifying as African American predicted lower odds (aOR:0.17, p = 0.02)-of belonging to the "Logistics and Stigma Barriers" class relative to the "Just Not Ready" class. Similarly, higher education (aOR: 2.57, p = 0.02) and having children (aOR:2.28, p = 0.03) predicted higher odds-and marriage predicted lower odds (aOR:0.22, p = 0.02)-of belonging to the "High and Diverse Barriers" class relative to the "Just Not Ready" class. Having children predicted higher odds (aOR: 2.93, p = .02), and marriage predicted lower odds (aOR:0.19, p = 0.02) of belonging to the "High and Diverse Barriers" class relative to the "Logistics and Stigma" class. CONCLUSION A lack of readiness to abstain, socioeconomic circumstances, and family obligations are main barriers to SUD treatment among women. Interventions incorporating motivational interviewing, family systems, and social networks are needed.
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Affiliation(s)
- Hannah B Apsley
- Department of Human Development and Family Studies, Pennsylvania State University, USA.
| | - Noel Vest
- School of Public Health, Boston University, USA
| | - Kyler S Knapp
- Department of Human Development and Family Studies, Pennsylvania State University, USA; Edna Bennett Pierce Prevention Research Center at Pennsylvania State University, USA
| | - Alexis Santos-Lozada
- Department of Human Development and Family Studies, Pennsylvania State University, USA
| | - Joy Gray
- Department of Educational Psychology, Counseling, & Special Education, College of Education, Pennsylvania State University, USA
| | - Gregory Hard
- Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA 02478, USA
| | - Abenaa A Jones
- Department of Human Development and Family Studies, Pennsylvania State University, USA
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Early NK, Buckley K, Entsuah N, Fairman KA. Association of Cardiovascular Disease and Military Veteran Status With Impairments in Physical and Psychological Functioning: Retrospective Cross-Sectional Analysis of US National Survey Data. J Cardiovasc Pharmacol Ther 2022; 27:10742484221091015. [PMID: 35377773 DOI: 10.1177/10742484221091015] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) provides multidisciplinary team-based care with peer-to-peer support for diabetes and obesity, but not for most heart diseases. OBJECTIVE To inform disease-care models, assess physical and psychological functioning in veterans with, or at high risk of, heart disease. METHODS Retrospective, cross-sectional cohort analysis of data from the National Survey on Drug Use and Health, 2015-2019, based on standard measures of functioning: self-rated health, serious psychological distress, and high-risk substance use. Cohorts were veterans with respondent-reported heart disease, or at high risk of cardiovascular disease based on age/comorbidity combinations (HD/risk); nonveterans with HD/risk; and veterans without HD/risk. Ordinal logistic regression models adjusted for demographics, social determinants of health, and chronic conditions. A priori alpha was set to 0.01 because of large sample size (N = 28,314). RESULTS Among those with HD/risk, veterans (n = 3,483) and nonveterans (n = 16,438) had similar physical impairments, but distress trended higher among veterans (adjusted odds ratio = 1.36, 99% confidence interval [CI] = 0.99-1.86). Among those with comorbid HD/risk and behavioral health problems, regression-adjusted treatment rates were similar for veterans and nonveterans with psychological symptoms (55.9% vs. 55.2%, respectively, P = 0.531) or high-risk substance use (18.7% vs. 19.4%, P = .547); veterans were more likely to receive outpatient mental health treatment (36.1% [CI = 34.4%-37.8%] vs. 28.9% [CI = 28.2%-29.6%]). CONCLUSION An upward trend in distress among veterans compared with nonveterans with HD/risk was not explained by differences in behavioral health treatment utilization. Further research should test multidisciplinary team-based care for veterans with HD/risk, similar to that used for other chronic diseases.
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Affiliation(s)
- Nicole K Early
- Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ, USA. Entsuah is now with School of Pharmacy and Pharmaceutical Sciences, 8788University of California Irvine, Irvine, CA, USA
| | - Kelsey Buckley
- Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ, USA. Entsuah is now with School of Pharmacy and Pharmaceutical Sciences, 8788University of California Irvine, Irvine, CA, USA
| | - Nana Entsuah
- Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ, USA. Entsuah is now with School of Pharmacy and Pharmaceutical Sciences, 8788University of California Irvine, Irvine, CA, USA
| | - Kathleen A Fairman
- Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ, USA. Entsuah is now with School of Pharmacy and Pharmaceutical Sciences, 8788University of California Irvine, Irvine, CA, USA
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Hall N, Le L, Majmudar I, Teesson M, Mihalopoulos C. Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis. PLoS One 2021; 16:e0258620. [PMID: 34653220 PMCID: PMC8519451 DOI: 10.1371/journal.pone.0258620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine treatment seeking behaviour in those with opioid use disorder (OUD) in the high-income countries. METHODS Five databases were searched in November 2019 for quantitative studies that reported OUD treatment seeking behaviour. Data analysis involved determining an overall pooled proportion estimate of treatment seeking behaviour for the two base groups, lifetime treatment and past 12-month or less treatment using the IVhet effect model. Subgroup analysis included heroin OUD, prescription OUD and general OUD. The sensitivity analysis included removal of outliers, separating adults and adolescents and the metaXL sensitivity analysis (studies are excluded if outside the pooled proportion confidence interval of the base case). Systematic review Prospero database registration number [CRD42020159531]. RESULTS There were 13 quantitative studies included in the systematic review, with all studies being from the United States of America (USA). IVhet models showed that 40% (95% CI: 23%, 58%) and 21% (95% CI: 16%, 26%) sought treatment in their lifetime and past 12 months respectively. Sub-group analysis found that lifetime treatment seeking for prescription OUD, 29% (95% CI: 27%, 31%), was less than for heroin plus combined OUD, 54% (95% CI: 26%, 82%). Most of the pooled results had high heterogeneity statistics except for results of lifetime treatment seeking for prescription OUD and past 12-month treatment seeking for prescription OUD. CONCLUSION All included studies in this meta-analysis were from the USA and indicate modest levels of treatment seeking for those with OUD. In particular, this review found that in the USA one in five people with OUD sought OUD treatment in the previous 12 months and two in five people with OUD sought OUD treatment in their lifetime. Further research is urgently required to explore the barriers and facilitators that can improve this low treatment seeking in those with OUD.
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Affiliation(s)
- Natasha Hall
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Long Le
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Maree Teesson
- Director Matilda Centre for Research in Mental Health and Substance Use, Sydney University, Sydney, Australia
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Burwood, Australia
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Walsh SL, El-Bassel N, Jackson RD, Samet JH, Aggarwal M, Aldridge AP, Baker T, Barbosa C, Barocas JA, Battaglia TA, Beers D, Bernson D, Bowers-Sword R, Bridden C, Brown JL, Bush HM, Bush JL, Button A, Campbell AN, Cerda M, Cheng DM, Chhatwal J, Clarke T, Conway KP, Crable EL, Czajkowski A, David JL, Drainoni ML, Fanucchi LC, Feaster DJ, Fernandez S, Freedman D, Freisthler B, Gilbert L, Glasgow LM, Goddard-Eckrich D, Gutnick D, Harlow K, Helme DW, Huang T, Huerta TR, Hunt T, Hyder A, Kerner R, Keyes K, Knott CE, Knudsen HK, Konstan M, Larochelle MR, Craig Lefebvre R, Levin F, Lewis N, Linas BP, Lofwall MR, Lounsbury D, Lyons MS, Mann S, Marks KR, McAlearney A, McCollister KE, McCrimmon T, Miles J, Miller CC, Nash D, Nunes E, Oga EA, Oser CB, Plouck T, Rapkin B, Freeman PR, Rodriguez S, Root E, Rosen-Metsch L, Sabounchi N, Saitz R, Salsberry P, Savitsky C, Schackman BR, Seiber EE, Slater MD, Slavova S, Speer D, Martinez LS, Stambaugh LF, Staton M, Stein MD, Stevens-Watkins DJ, Surratt HL, Talbert JC, Thompson KL, Toussant K, Vandergrift NA, Villani J, Walker DM, Walley AY, Walters ST, Westgate PM, Winhusen T, Wu E, Young AM, Young G, Zarkin GA, Chandler RK. The HEALing (Helping to End Addiction Long-term SM) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices. Drug Alcohol Depend 2020; 217:108335. [PMID: 33248391 PMCID: PMC7568493 DOI: 10.1016/j.drugalcdep.2020.108335] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. METHODS The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) a community engagement strategy with local coalitions to guide and implement the intervention; 2) a compendium of EBPs coupled with technical assistance; and 3) a series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. DISCUSSION The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.
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Afuseh E, Pike CA, Oruche UM. Individualized approach to primary prevention of substance use disorder: age-related risks. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:58. [PMID: 32795372 PMCID: PMC7427884 DOI: 10.1186/s13011-020-00300-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022]
Abstract
Background The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention. Methods A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989–2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors. Results More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease. Conclusions The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.
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Affiliation(s)
- Eric Afuseh
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Caitlin A Pike
- Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.
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Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM Perspect 2020; 2020:202004b. [PMID: 35291732 PMCID: PMC8916813 DOI: 10.31478/202004b] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.
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Affiliation(s)
| | - N Jia Ahmad
- Johns Hopkins Bloomberg School of Public Health
| | - Jenny Wen
- Johns Hopkins University School of Medicine
| | - Joshua Sharfstein Sharfstein
- Johns Hopkins Bloomberg School of Public Health; and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
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Chan K, Moller M, Marsack-Topolewski C, Winston P, Jennings R, Prifti A. Age Differences in Non-Medical Prescription Opioid Use and Psychological Distress. Subst Use Misuse 2020; 55:1808-1816. [PMID: 32441182 DOI: 10.1080/10826084.2020.1765808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background/Purpose: Prescription opioid use has been recognized as an epidemic in the United States and globally. More research is needed to understand the association of opioids and mental health for older adults. This study examined age differences in the association of non-medical prescription opioid use (NMPOU) and psychological distress, with a focus on older adult populations. Methods: This study used the 2016 National Survey on Drug Use and Health (NSDUH), and included 37,842 adults aged 18 and older. Weighted multiple regression and logistic regression analyses were used to examine the association of NMPOU and psychological distress, measured by the Kessler Psychological Distress Scale (K6). Results: NMPOU was associated with higher psychological distress (b = 0.48, SE = 0.16, p < .01). For those 50 and older, NMPOU was associated with 224% increased odds of meeting the clinical threshold for having a serious mental illness (SMI; OR = 2.24, p < .01, 95% CI: 1.23, 4.09). Conclusions: Although the prevalence of NMPOU and psychological distress trended downward throughout the lifespan, the association of NMPOU on SMI was highest among the youngest and oldest adults. These findings highlight the need for services and supports that are tailored for older adult populations. Future research is needed to investigate vulnerabilities from life stage stressors specific to older adults, which may account for the disproportionate odds of opioid use on mental health pathology. Interprofessional collaboration is needed among geriatric professionals to provide effective mental health treatment for this at-risk population.
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Affiliation(s)
- Keith Chan
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA.,School of Social Work, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Mary Moller
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | | | - Priya Winston
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Rubin Jennings
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Andriana Prifti
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
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