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Wheeler PB, Miller-Roenigk B, Jester J, Stevens-Watkins D. Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians. Ann Med 2024; 56:2322051. [PMID: 38442301 PMCID: PMC10916927 DOI: 10.1080/07853890.2024.2322051] [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: 10/20/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.
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Affiliation(s)
- Paris B. Wheeler
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Brittany Miller-Roenigk
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Jasmine Jester
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
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O'Reilly LM, Schwartz K, Brown SA, Dir A, Gillenwater L, Adams Z, Zapolski T, Hulvershorn LA, Aalsma M. Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers. Subst Abuse Treat Prev Policy 2024; 19:32. [PMID: 38907286 PMCID: PMC11193280 DOI: 10.1186/s13011-024-00614-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: 02/16/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. METHODS Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). RESULTS Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. CONCLUSIONS These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.
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Affiliation(s)
- Lauren M O'Reilly
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Katherine Schwartz
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven A Brown
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, 401 W. 10th St, Indianapolis, IN, 46202, USA
| | - Allyson Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Logan Gillenwater
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika Zapolski
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew Aalsma
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Holeksa J. "In Sweden you are worthless. In Denmark you get an identity again" - on being perceived and received as a person who uses drugs in different drug policy settings. Harm Reduct J 2024; 21:117. [PMID: 38886692 PMCID: PMC11181536 DOI: 10.1186/s12954-024-01035-5] [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: 04/10/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Policies to address substance use differ greatly between settings, where goals may range from zero-tolerance to harm reduction. Different approaches impact formats of care, policing, and even interpersonal interactions, and may play a role in the labelling and stigmatization of people who use drugs (PWUD). Where Sweden has a more restrictive policy, aiming to have a society free from drugs, Denmark has embraced harm reduction principles. The aim of this study was to explore PWUDs' experiences of interpersonal interactions, policing, and service formats in the two countries. METHODS The data consists of 17 qualitative semi-structured interviews with Swedish PWUD who have been in both Sweden and Denmark. Recruitment took place at harm reduction sites in both countries, and through snowball sampling. RESULTS Participants reflected on how they were perceived by those in public spaces, and received by care systems and personnel. In public settings in Sweden, participants felt they were ignored, rendered invisible, and lost their humanity. In Denmark, they were perceived and acknowledged, valued as people. This was simultaneously linked to being embodied by the availability of differing service offerings and policing practices, which solidified their "right to be out" in public. Reflecting on their reception in the treatment system, strict formatting in Sweden caused participants to feel that an identity was projected upon them, limiting their opportunities or growth of new facets of identity. Care relations in Denmark fostered more opportunity for autonomy and trust. CONCLUSION A zero-tolerance policy and associated public discourses could solidify and universalize stigmatizing categorizations as a central feature of PWUD identity and reception from those around them, exacerbating social exclusion. Conversely, harm reduction-centered policies fostered positive interactions between individuals with care providers, public, and police, which may promote inclusion, empowerment, and wellbeing.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Nordenskiöldsgatan 1, Malmö, 211 19, Sweden.
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Pasman E, Lee G, Singer S, Burson N, Agius E, Resko SM. Attitudes toward medications for opioid use disorder among peer recovery specialists. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-10. [PMID: 38640497 DOI: 10.1080/00952990.2024.2332597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/06/2024] [Indexed: 04/21/2024]
Abstract
Background: Peer recovery specialists (PRSs) are substance use service providers with lived experience in recovery. Although a large body of research demonstrates the efficacy of medications for opioid use disorder (MOUD), emerging research suggests PRSs' attitudes toward MOUD are ambivalent or mixed. Few studies have quantitatively assessed factors influencing PRSs' attitudes.Objectives: This study identifies personal and professional characteristics associated with attitudes toward MOUD among PRSs.Methods: PRSs working at publicly funded agencies in Michigan completed a self-administered web-based survey (N = 266, 60.5% women). Surveys assessed socio-demographics, treatment and recovery history, attitudes toward clients, and attitudes toward MOUD. Multiple linear regression was used to identify factors associated with attitudes toward MOUD.Results: A minority of PRSs (21.4%) reported a history of treatment with MOUD, while nearly two-thirds reported current 12-step involvement (62.5%). Compared to PRSs without a history of MOUD treatment, PRSs who had positive (b = 4.71, p < .001) and mixed (b = 3.36, p = .010) experiences with MOUD had more positive attitudes; PRSs with negative experiences with MOUD had less positive attitudes (b = -3.16, p = .003). Current 12-step involvement (b = -1.63, p = .007) and more stigmatizing attitudes toward clients (b = -.294, p < .001) were associated with less positive attitudes toward MOUD. Black PRSs had less positive attitudes than White PRSs (b = -2.50, p = .001), and women had more positive attitudes than men (b = 1.19, p = .038).Conclusion: PRSs' attitudes toward MOUD varied based on the nature of their lived experience. Findings highlight considerations for training and supervising PRSs who serve individuals with opioid use disorder.
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Affiliation(s)
- Emily Pasman
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Guijin Lee
- Department of Counseling and Human Development Services, University of Georgia, Athens, GA, USA
| | - Samantha Singer
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Nick Burson
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Stella M Resko
- School of Social Work, Wayne State University, Detroit, MI, USA
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA
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Poulsen MN, Roe SA, Asdell PB, Rahm AK, Berrettini W. Clinical stakeholders' perceptions of patient engagement in outpatient medication treatment for opioid use disorder: A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209250. [PMID: 38072381 PMCID: PMC10947908 DOI: 10.1016/j.josat.2023.209250] [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: 04/14/2023] [Revised: 07/07/2023] [Accepted: 11/30/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) reduce risk of opioid overdose and promote recovery from opioid use disorder, but poor retention in MOUD limits these positive effects. This study explored patient engagement in MOUD from the perspective of clinical stakeholders within an outpatient addiction medicine program to identify program factors influencing patient engagement with treatment. METHODS We conducted a qualitative case study of a multi-clinic outpatient addiction medicine program embedded within an integrated health system that serves a geographically diverse area of Pennsylvania. Collectively, the program's clinics provide MOUD (primarily buprenorphine) to ~2000 patients annually. From January to March 2021, we conducted semi-structured telephone/video interviews with three stakeholder groups involved in delivering MOUD: administrators (n = 4), providers (n = 7), and addiction care coordinators (n = 5). Data analysis utilized the framework method. RESULTS We identified five themes related to patient engagement. First, participants described health system integration as enhancing quality and offering opportunities for addressing patients' comprehensive health care needs. However, lack of knowledge about addiction and stigma among health system providers was felt to limit patient benefits from this integration, including access to MOUD. Second, participants viewed patient engagement as central to the program's policies, practices, and clinical environment. Adoption of a harm reduction approach and maintenance of a non-stigmatizing clinic environment were described as essential facilitators of engagement. Third, while clinics followed uniform operations, physician leads expressed differing philosophical approaches to treatment, which participants associated with variations in clinical practice and patient engagement. Fourth, participants identified key services that bolstered engagement in MOUD, including psychosocial services, psychiatric care, and telemedicine. Finally, staff well-being emerged as a key consideration for patient engagement. CONCLUSIONS Understanding perceptions of those who administer and deliver care is critical for identifying barriers and facilitators to patient engagement in MOUD. Findings suggest potential opportunities for addiction treatment programs to improve patient engagement and ultimately MOUD retention, including integration with other healthcare services to meet comprehensive healthcare needs; adoption of a harm reduction approach; creation of non-stigmatizing clinical environments; investment in psychosocial services, psychiatric care, and telemedicine; and prioritization of staff wellness.
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Affiliation(s)
- Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA.
| | - Sophie A Roe
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA.
| | - Patrick B Asdell
- Department of Family Medicine, Summa Health, Barberton, OH 44203, USA.
| | | | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Pope E, McCullough M, Smith JG, Kim B. Knowledge, practice and attitudes regarding substance use disorder treatment and harm reduction strategies among pharmacists: a scoping review protocol. BMJ Open 2024; 14:e080338. [PMID: 38418243 PMCID: PMC10910657 DOI: 10.1136/bmjopen-2023-080338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/22/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pharmacists provide a spectrum of services and comprehensive medication management for patients with substance use disorders (SUDs) with many providing timely and increased access to care for patients. Prior studies have evaluated other healthcare professionals' attitudes, knowledge and practice in regard to SUD treatment and harm reduction services. However, no reviews to date summarise the available literature on the attitudes, knowledge and practice in regard to SUD treatment and harm reduction services from the pharmacist perspective. This scoping review aims to systematically map the extent, range and nature of available evidence and identify and describe gaps in knowledge, practice and attitudes towards SUD treatment among pharmacists with the goal of providing information for meaningful integration of pharmacists into SUD care. METHODS AND ANALYSIS We will use the framework proposed by Arksey and O'Malley (2005) updated with recommendations by Levac et al (2010) and the Joanna Briggs Institute (2020). The protocol is registered via Open Science Framework (https://osf.io/92dek). We will search for peer-reviewed literature containing empirical evidence investigating SUD treatment or harm reduction with outcomes pertaining to the knowledge, practice or attitudes of pharmacists. Findings will be guided and assessed by research objectives and summarised using descriptive statistics and thematically for quantitative and qualitative findings, respectively. This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. ETHICS AND DISSEMINATION Our findings will provide crucial information and support for future interventions and programmes which aim to meaningfully integrate pharmacists into SUD care. We will disseminate findings at conferences and publish in a peer-reviewed journal. In addition, we will integrate feedback on search strategy, data extraction and our dissemination approach from multidisciplinary collaborators including those within our team's institution and outside experts with clinical or administrative knowledge in SUD care.
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Affiliation(s)
- Elle Pope
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Megan McCullough
- VA Bedford Healthcare System, Bedford, Massachusetts, USA, Bedford, MA, USA
- University of Massachusetts-Lowell, Lowell, MA, USA
| | - Jason G Smith
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Bo Kim
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Olfson M, Wall MM, Blanco C. Fatal Drug Overdose Risks of Health Care Workers in the United States. Ann Intern Med 2024; 177:eL230472. [PMID: 38373315 DOI: 10.7326/l23-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Melanie M Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
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Janssen E, Vuolo M, Spilka S, Airagnes G. Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years. Harm Reduct J 2024; 21:15. [PMID: 38243253 PMCID: PMC10799399 DOI: 10.1186/s12954-024-00934-x] [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: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. METHODS We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. RESULTS Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. CONCLUSION Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France.
| | - Mike Vuolo
- Department of Sociology, Ohio State University, 238 Townhsend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Stanislas Spilka
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- General Population Surveys Unit, Research Centre on Population Epidemiology and Health (Centre de Recherche en Epidémiologie et Santé des Populations-CESP), Unit 1018, INSERM, Villejuif, France
| | - Guillaume Airagnes
- French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), 69 rue de Varenne, 75007, Paris, France
- UFR de Médecine, Faculté de Santé, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015, Paris, France
- Population-Based Cohorts Unit, UMS 011, INSERM, 16 avenue Paul Vaillant-Couturier, 94800, Villejuif, France
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9
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Brown AR, Walters JE, Harmer B, Cates L, Jones AE. Non-prescribing clinicians' treatment orientations and attitudes toward treatments for opioid use disorder: Rural differences. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209153. [PMID: 37673286 DOI: 10.1016/j.josat.2023.209153] [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: 11/30/2022] [Revised: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION The United States has experienced substantial increases in opioid use for more than two decades. This growth has impacted rural areas where overdoses have risen drastically during this time period and more often involve prescription opioids than in urban areas. Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings due to lack of access, inadequate prescribing, and stigma. METHODS The study collected data using a cross-sectional online survey of nonprescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the United States. The study used multiple recruitment methods to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics including rurality of practice location, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. The study compared treatment preferences for OUD and attitudes toward MOUDs based on rurality of practice location. We tested a mediation model to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation. RESULTS Most of the 636 NPCs surveyed favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment. Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as effective or acceptable compared to those in urban settings. Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly and indirectly influenced attitudes toward MOUDs through an effect on treatment orientation. CONCLUSIONS NPCs play important roles in the implementation of MOUDs, and while efforts to increase their knowledge of and exposure to MOUDs have contributed broadly to more favorable attitudes toward MOUDs among NPCs, this study's findings indicate that additional efforts are still needed, particularly among NPCs who work in rural settings. Findings also indicate that, among rural clinicians, increasing knowledge of and exposure to harm reduction principles may be a necessary prerequisite to engaging them in the implementation of specific harm reduction strategies such as MOUDs.
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Affiliation(s)
- Aaron R Brown
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA.
| | - Jayme E Walters
- Utah State University, Department of Social Work, 0730 Old Main Hill, Logan, UT 84322-0730, USA
| | - Beth Harmer
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Lara Cates
- Western Carolina University, Department of Social Work, 3971 Little Savannah Rd, Cullowhee, NC 28723, USA
| | - Aubrey E Jones
- University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA
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10
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Hohmeier KC, Cernasev A, Leibold C, Moore TM, Schlesinger E, Cochran G, Arce I, Geminn W, Chisholm-Burns M. Community-Centered Patient Journey Map in Opioid Use Disorder: A Tool to Address Compassion Fatigue among Community Pharmacists. PHARMACY 2023; 11:52. [PMID: 36961030 PMCID: PMC10037586 DOI: 10.3390/pharmacy11020052] [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] [Received: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists' awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient's community, and emphasizes three major "pain points" within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel's knowledge, attitudes, and behaviors.
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Affiliation(s)
- Kenneth Charles Hohmeier
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Christina Leibold
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Todd M. Moore
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, USA
| | - Erica Schlesinger
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Gerald Cochran
- Division of Epidemiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Ileana Arce
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Wesley Geminn
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Marie Chisholm-Burns
- Office of the Provost, Oregon Health & Science University, Portland, OR 97239, USA
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11
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Stewart RE, Cardamone NC, Mandell DS, Kwon N, Kampman KM, Knudsen HK, Tjoa CW, Marcus SC. Not in my treatment center: Leadership's perception of barriers to MOUD adoption. J Subst Abuse Treat 2023; 144:108900. [PMID: 36265323 PMCID: PMC10062425 DOI: 10.1016/j.jsat.2022.108900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/04/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Despite their well-established effectiveness, medications for opioid use disorder (MOUD) are widely underutilized across the United States. In the context of a large publicly funded behavioral health system, we examined the relationship between a range of implementation barriers and a substance use disorder treatment agency's level of adoption of MOUD. METHODS We surveyed leadership of publicly funded substance use disorder treatment centers in Philadelphia about the significance of barriers to implementing MOUD related to their workforce, organization, funding, regulations, and beliefs about MOUD's efficacy and safety. We queried leaders on the percentage of their patients with opioid use disorder who receive MOUD and examined associations between implementation barriers and MOUD adoption. RESULTS Ratings of regulatory, organizational, or funding barriers of respondents who led high MOUD adopting agencies (N = 20) were indistinguishable from those who led agencies that were low adopting of MOUD (N = 23). In contrast, agency leaders who denied MOUD-belief or workforce barriers were significantly more likely to lead high-MOUD-adopting organizations. CONCLUSIONS These findings suggest that leadership beliefs about MOUD may be a key factor of the organizational decision to adopt and should be a target of implementation efforts to increase direct provision of these medications.
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Affiliation(s)
- Rebecca E Stewart
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America.
| | - Nicholas C Cardamone
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America.
| | - David S Mandell
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America.
| | - Nayoung Kwon
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America
| | - Kyle M Kampman
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America.
| | - Hannah K Knudsen
- University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, United States of America.
| | - Christopher W Tjoa
- University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA 19104, United States of America; Community Behavioral Health, 801 Market St, Philadelphia, PA 19107, United States of America.
| | - Steven C Marcus
- University of Pennsylvania School of Policy and Practice, 3701 Locust Walk, Philadelphia, PA 19104, United States of America.
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Peavy KM, Adwell A, Owens MD, Banta-Green CJ. Perspectives on Medication Treatment for Opioid Use Disorder in Adolescents: Results from a Provider Learning Series. Subst Use Misuse 2023; 58:160-162. [PMID: 36371698 DOI: 10.1080/10826084.2022.2136493] [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: 11/14/2022]
Abstract
Background: Adolescent opioid use and associated opioid poisoning rates have risen dramatically in the United States, yet this group has disproportionally poorer access to evidence-based medication treatment for opioid use disorder (MOUD). Methods: A transdisciplinary cohort (N = 77) who attended a learning series focused on MOUD for adolescents were surveyed with the purpose of understanding the landscape of current adolescent MOUD practices in Washington State; and needs and barriers to providing care. Results: Results indicated that a higher percentage of prescriber participants endorsed support for MOUD for adolescents than nonprescriber participants. Lack of adjunctive support services (i.e., social work; mental health) were cited as the highest barriers to providing this care. Conclusions: We discuss the importance of continued transdisciplinary training and collaboration, as well as funding ancillary services to address barriers to providing adolescent MOUD.
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Affiliation(s)
- K Michelle Peavy
- Department of Psychiatry & Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington, Seattle, Washington, USA
| | - Addy Adwell
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Mandy D Owens
- Department of Psychiatry & Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington, Seattle, Washington, USA
| | - Caleb J Banta-Green
- Department of Psychiatry & Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington, Seattle, Washington, USA.,Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
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13
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Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Subst Abuse Rehabil 2022; 13:1-12. [PMID: 35115860 PMCID: PMC8800858 DOI: 10.2147/sar.s304566] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/25/2022] Open
Abstract
Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
- Correspondence: Suzanne Nielsen, Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email
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14
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Pasman E, Lee G, Kollin R, Rodriguez B, Agius E, Madden EF, Resko SM. Attitudes toward Medication for Opioid Use Disorder among Substance Use Treatment Providers. Subst Use Misuse 2022; 57:1828-1836. [PMID: 36041008 DOI: 10.1080/10826084.2022.2115853] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Provider attitudes can be a powerful reinforcer of stigma toward medication for opioid use disorder (MOUD). This study examines attitudes toward MOUD among substance use treatment providers and identifies personal and professional characteristics associated with more positive attitudes. Methods: Treatment providers (N = 570) working at publicly-funded substance use programs in Michigan self-administered a web-based survey (November 2020 through July 2021), reporting their socio-demographics, professional experience, and attitudes toward MOUD. Linear regression was used to identify factors associated with general attitudes toward MOUD and three logistic regression models were calculated to identify factors associated with perceptions of each medication. Results: Half of providers considered methadone an effective treatment (53.0%); 62.9% considered buprenorphine effective, and 70.3% considered naltrexone effective. Receipt of training (B = 1.433, p = .009) and serving pregnant women or women with children (B = 1.662, p < .001) were associated with more positive attitudes toward MOUD. Providers with advanced degrees were more likely to consider methadone (OR = 2.264, p = .006), buprenorphine (OR = 2.192, p = .009), and naltrexone (OR = 2.310, p = .011) effective. Rural providers were more likely to consider naltrexone effective (OR = 2.708, p = .003). Providers working with criminal legal populations were more likely to consider buprenorphine (OR = 2.948, p = .041) and naltrexone (OR = 4.108, p = .010) effective, but not methadone. Conclusion: Treatment providers' attitudes remain poorly aligned with the evidence base. Increased efforts are needed to address attitudes toward MOUD among the specialized treatment workforce.
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Affiliation(s)
- Emily Pasman
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Guijin Lee
- School of Social Work, Wayne State University, Detroit, Michigan, USA.,Center for Behavioral Health and Justice, Wayne State University, Detroit, Michigan, USA
| | - Rachel Kollin
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Brooke Rodriguez
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Erin Fanning Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Stella M Resko
- School of Social Work, Wayne State University, Detroit, Michigan, USA.,Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
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