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Hanson BL, Finley K, Otto J, Ward NJ, Banik S. Community Support for Harm Reduction and Treatment of Opioid Use Disorder. J Community Health 2024; 49:724-731. [PMID: 38409628 DOI: 10.1007/s10900-023-01278-6] [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] [Accepted: 08/22/2023] [Indexed: 02/28/2024]
Abstract
As the opioid epidemic continues, availability of evidence-based strategies for harm reduction and treatment in communities is critical to reduce overdose and other consequences of opioid use disorder. Community members' support of harm reduction and treatment services is needed for new programs and to maintain existent programs. This study sought to understand beliefs and attitudes associated with support for three community-based strategies to address opioid misuse and addiction: naloxone, needle exchange, and medication-assisted treatment. We conducted a cross-sectional online survey with 545 adults. Results of the survey showed that participants supported all three strategies, with the strongest support for medication-assisted treatment. Multiple regression showed that stigma and perceived stigma were significant predictors for all three strategies, with inverse relationships. Stigmatizing beliefs predicted less support while perceiving stigma among others was associated with greater support for the strategies. Normative beliefs also significantly predicted support for all three strategies, such that stronger belief that others were supportive of each strategy was associated with greater support for that strategy. Other predictors varied across the three strategies. Support for harm reduction and treatment programs in communities affected by the opioid epidemic may be bolstered by reducing stigma and increasing normative beliefs. Stronger support for medication-assisted treatment may be leveraged and extended to harm reduction strategies. Results of our study contribute insights for bolstering community support for harm reduction and treatment, which is vital for adoption and maintenance of these important programs.
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Affiliation(s)
- Bridget L Hanson
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA.
| | - Kari Finley
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA
| | - Jay Otto
- Center for Health and Safety Culture, Montana State University, P.O. Box 170548, Bozeman, MT, 59717, USA
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Freet CS, Evans B, Brick TR, Deneke E, Wasserman EJ, Ballard SM, Stankoski DM, Kong L, Raja-Khan N, Nyland JE, Arnold AC, Krishnamurthy VB, Fernandez-Mendoza J, Cleveland HH, Scioli AD, Molchanow A, Messner AE, Ayaz H, Grigson PS, Bunce SC. Ecological momentary assessment and cue-elicited drug craving as primary endpoints: study protocol for a randomized, double-blind, placebo-controlled clinical trial testing the efficacy of a GLP-1 receptor agonist in opioid use disorder. Addict Sci Clin Pract 2024; 19:56. [PMID: 39061093 PMCID: PMC11282646 DOI: 10.1186/s13722-024-00481-7] [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: 11/28/2023] [Accepted: 06/07/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Despite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment. METHOD This preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2-19), and following (Study Days 20-21) residential treatment. DISCUSSION This manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. TRIAL REGISTRATION ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728 . PROTOCOL VERSION 10 May 2023.
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Affiliation(s)
- Christopher S Freet
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Brianna Evans
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Erin Deneke
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | - Emily J Wasserman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Sarah M Ballard
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Dean M Stankoski
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nazia Raja-Khan
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Obstetrics & Gynecology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jennifer E Nyland
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amy C Arnold
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Venkatesh Basappa Krishnamurthy
- Department of Medicine and Psychiatry, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julio Fernandez-Mendoza
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Adam D Scioli
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | | | | | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Patricia S Grigson
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Scott C Bunce
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
- Penn State University College of Medicine, Milton S. Hershey Medical Center, H073, 500 University Drive, Hershey, PA, 17033-0850, USA.
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Attarabeen OF, Alkhateeb F, Rudolph M, Babcock CC, Hanif A, Moawad R, Mohamed R, Patel I, Truong HA, Khanfar NM. Using the social cognitive theory to examine spontaneous attempts to quit illicit substance use. Health Mark Q 2024:1-17. [PMID: 39008119 DOI: 10.1080/07359683.2024.2380118] [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: 07/16/2024]
Abstract
Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.
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Affiliation(s)
| | | | - Michael Rudolph
- School of Medical Sciences, Lincoln Memorial University, Harrogate, TN, USA
| | | | - Ahmad Hanif
- West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Rowida Mohamed
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Isha Patel
- Lewis College of Business, Marshall University, Huntington, WV, USA
| | - Hoai-An Truong
- University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Nile M Khanfar
- College of Pharmacy, Nova Southeastern University, Palm Beach, FL, USA
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Han BH, Orozco MA, Miyoshi M, Doland H, Moore AA, Jones KF. Experiences of Aging with Opioid Use Disorder and Comorbidity in Opioid Treatment Programs: A Qualitative Analysis. J Gen Intern Med 2024; 39:1673-1680. [PMID: 38436883 PMCID: PMC11255154 DOI: 10.1007/s11606-024-08676-z] [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: 11/13/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined. OBJECTIVE To explore the aging experience with OUD and barriers to medical care for older adults who receive care in OTPs. DESIGN From November 2021 to July 2022, we conducted 1-to-1, semi-structured qualitative interviews in English and Spanish, audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding the challenges of aging with OUD and managing chronic diseases. PARTICIPANTS Thirty-six adults aged ≥ 55 enrolled in OTPs in San Diego, California. APPROACH A descriptive qualitative approach was used. Major themes and subthemes were identified through thematic analysis until thematic saturation was reached. KEY RESULTS All participants were on methadone and had a mean age of 63.4 (SD 5.1) years; 11 (30.6%) identified as female, 14 (39%) as Hispanic/Latino, and 11 (36%) as Black, with a mean duration of methadone treatment of 5.6 years. Chronic diseases were common, with 21 (58.3%) reporting hypertension, 9 (25%) reporting untreated hepatitis C, and 32 (88.9%) having ≥ 2 chronic diseases. Three major themes emerged: (1) avoidance of medical care due to multiple intersectional stigmas, including those related to drug use, substance use disorder (SUD) treatment, ageism, and housing insecurity; (2) increasing isolation with aging and loss of family and peer groups; (3) the urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges. CONCLUSIONS Older adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Mirella A Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mari Miyoshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Heidi Doland
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alison A Moore
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, MA, USA
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5
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Giorgi S, Isman K, Liu T, Fried Z, Sedoc J, Curtis B. Evaluating generative AI responses to real-world drug-related questions. Psychiatry Res 2024; 339:116058. [PMID: 39059040 DOI: 10.1016/j.psychres.2024.116058] [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: 12/26/2023] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024]
Abstract
Generative Artificial Intelligence (AI) systems such as OpenAI's ChatGPT, capable of an unprecedented ability to generate human-like text and converse in real time, hold potential for large-scale deployment in clinical settings such as substance use treatment. Treatment for substance use disorders (SUDs) is particularly high stakes, requiring evidence-based clinical treatment, mental health expertise, and peer support. Thus, promises of AI systems addressing deficient healthcare resources and structural bias are relevant within this domain, especially in an anonymous setting. This study explores the effectiveness of generative AI in answering real-world substance use and recovery questions. We collect questions from online recovery forums, use ChatGPT and Meta's LLaMA-2 for responses, and have SUD clinicians rate these AI responses. While clinicians rated the AI-generated responses as high quality, we discovered instances of dangerous disinformation, including disregard for suicidal ideation, incorrect emergency helplines, and endorsement of home detox. Moreover, the AI systems produced inconsistent advice depending on question phrasing. These findings indicate a risky mix of seemingly high-quality, accurate responses upon initial inspection that contain inaccurate and potentially deadly medical advice. Consequently, while generative AI shows promise, its real-world application in sensitive healthcare domains necessitates further safeguards and clinical validation.
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Affiliation(s)
- Salvatore Giorgi
- National Institute on Drug Abuse, Baltimore, MD, USA; University of Pennsylvania, Philadelphia, PA, USA
| | - Kelsey Isman
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Tingting Liu
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Zachary Fried
- National Institute on Drug Abuse, Baltimore, MD, USA
| | | | - Brenda Curtis
- National Institute on Drug Abuse, Baltimore, MD, USA.
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6
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Peart A, Horn F, Petukhova R, Barnett A, Lubman DI. Web-Based Forums for People Experiencing Substance Use or Gambling Disorders: Scoping Review. JMIR Ment Health 2024; 11:e49010. [PMID: 38885012 PMCID: PMC11217707 DOI: 10.2196/49010] [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: 05/15/2023] [Revised: 03/08/2024] [Accepted: 04/26/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND For people experiencing substance use or gambling disorders, web-based peer-supported forums are a space where they can share their experiences, gather around a collective goal, and find mutual support. Web-based peer support can help to overcome barriers to attending face-to-face meetings by enabling people experiencing addiction to seek support beyond their physical location and with the benefit of anonymity if desired. Understanding who participates in web-based peer-supported forums (and how), and the principles underpinning forums, can also assist those interested in designing or implementing similar platforms. OBJECTIVE This study aims to review the literature on how people experiencing substance use or gambling disorders, and their family, friends, and supporters, use and participate in web-based peer-supported forums. Specifically, we asked the following research questions: (1) What are the characteristics of people who use web-based peer-supported substance use or gambling-focused forums? (2) How do people participate in web-based peer-supported forums? (3) What are the key principles reportedly underpinning the web-based peer-supported forums? (4) What are the reported outcomes of web-based peer-supported forums? METHODS Inclusion criteria for our scoping review were peer-reviewed primary studies reporting on web-based addiction forums for adults and available in English. A primary search of 10 databases occurred in June 2021, with 2 subsequent citation searches of included studies in September 2022 and February 2024. RESULTS Of the 14 included studies, the majority of web-based peer-supported forums reported were aimed specifically for, or largely used by, people experiencing alcohol problems. Results from the 9 studies that did report demographic data suggest forum users were typically women, aged between 40 years and early 50 years. Participation in web-based peer-supported forums was reported quantitatively and qualitatively. The forums reportedly were underpinned by a range of key principles, mostly mutual help approaches and recovery identity formation. Only 3 included studies reported on outcomes for forum users. CONCLUSIONS Web-based peer-supported forums are used by people experiencing addiction in a number of ways, to share information and experiences, and give and receive support. Seeking web-based support offers an alternative approach to traditional face-to-face support options, and may reduce some barriers to engaging in peer support.
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Affiliation(s)
- Annette Peart
- Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Freya Horn
- Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Rachel Petukhova
- Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Anthony Barnett
- Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
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7
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Eckhardt A, Waller DE, Shull S, Lovejoy TI, Morasco BJ, Gordon AJ, Wyse JJ. "They Ask Questions, But They Don't Want the Answers"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241251761. [PMID: 38767274 DOI: 10.1177/29767342241251761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients' care experiences, potentially having an impact on treatment retention and care decision-making. METHODS This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants. RESULTS Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment. CONCLUSIONS Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.
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Affiliation(s)
- Alison Eckhardt
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Dylan E Waller
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Eschliman EL, Choe K, DeLucia A, Addison E, Jackson VW, Murray SM, German D, Genberg BL, Kaufman MR. First-hand accounts of structural stigma toward people who use opioids on Reddit. Soc Sci Med 2024; 347:116772. [PMID: 38502980 PMCID: PMC11031276 DOI: 10.1016/j.socscimed.2024.116772] [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: 01/25/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures-including governmental programs and policies, the pharmaceutical industry, and healthcare systems-stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids "legitimately" versus "illegitimately," and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.
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Affiliation(s)
- Evan L Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Karen Choe
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, USA
| | - Alexandra DeLucia
- Center for Language and Speech Processing, Johns Hopkins University, USA
| | | | - Valerie W Jackson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
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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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Eschliman EL, Choe K, Fei YC, Kang C, Koetje J, Harocopos A, Harris MN, DeWalt J, Christopher SA, Jackson VW, Yang LH. Evaluation of Two Videos that Apply Evidence-Based Strategies to Increase Self-Efficacy and Reduce Opioid-Related Stigma Among Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:123-134. [PMID: 38388788 PMCID: PMC10954387 DOI: 10.1007/s40596-024-01945-3] [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: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE This study evaluated the video-based application of evidence-based stigma reduction strategies to increase medical students' screening-diagnostic self-efficacy for opioid use disorder (OUD) and reduce stigma toward opioid use. METHODS Formative qualitative research informed development of two videos for medical students. One uses an education strategy by including education regarding non-stigmatizing language use and OUD screening and diagnosis (Video A); the other uses an interpersonal contact strategy by presenting narratives regarding opioid use from three people who have a history of opioid use and three physicians (Video B). Both videos were administered to all respondents, with video order randomized. Effects on outcomes were evaluated using a pre-/post-test design with a 1-month follow-up. Participants also provided feedback on video content and design. RESULTS Medical students (N = 103) watched the videos and completed the pre-/post-test, with 99% (N = 102) completing follow-up 1 month after viewing both videos. Self-efficacy increased directly following viewing Video A, and this increase was sustained at 1-month follow-up. Stigma toward opioid use decreased directly following viewing Video B, and this decrease was sustained at 1-month follow-up for participants who watched Video B first. Statistically significant improvements were observed in most secondary outcomes (e.g., harm reduction acceptability) directly following watching each video and most were sustained at 1-month follow-up. Feedback about the videos suggested the delivery of evidence-based strategies in each video was appropriate. CONCLUSIONS Video-based applications of these evidence-based strategies were found acceptable by medical students and have potential to elicit sustained improvement in their screening-diagnostic self-efficacy and opioid-related stigma.
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Affiliation(s)
- Evan L Eschliman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karen Choe
- School of Global Public Health, New York University, New York, NY, USA
| | - Y Christine Fei
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Kang
- School of Global Public Health, New York University, New York, NY, USA
| | - Jeffrey Koetje
- American Medical Student Association, Washington, DC, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Melanie N Harris
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Julia DeWalt
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA
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11
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Caro-Cañizares I, López Carpintero N, Carmona-Camacho R. The Elephant in the Room: A Systematic Review of the Application and Effects of Psychological Treatments for Pregnant Women with Dual Pathology (Mental Health and Substance-Related Disorders). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:392. [PMID: 38673305 PMCID: PMC11050033 DOI: 10.3390/ijerph21040392] [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: 02/16/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Maternal mental health and substance use, referred to as dual pathology, represent significant concerns associated with adverse pregnancy and birth outcomes, a prevalence higher than commonly anticipated. Nonetheless, a notable dearth exists ofevidence-based treatment protocols tailored for pregnant women with dual pathology. METHODS A systematic review, adhering to the PRISMA methodology, was conducted. RESULTS Out of the 57 identified papers deemed potentially relevant, only 2were ultimately included. Given the limited number of studies assessing the efficacy of psychological interventions utilizing randomized controlled trials (RCTs) for both mental health and substance misuse, and considering the diverse objectives and measures employed, definitive conclusions regarding the effectiveness of psychological interventions in this domain prove challenging. CONCLUSIONS Maternal mental health appears to be the proverbial "elephant in the room". The development of specialized and integrated interventions stands as an imperative to effectively address this pressing issue. As elucidated in the present review, these interventions ought to be grounded in empirical evidence. Furthermore, it is essential that such interventions undergo rigorous evaluation through RCTs to ascertain their efficacy levels. Ultimately, the provision of these interventions by psychology/psychiatric professionals, both within clinical practice and the RCTs themselves, is recommended to facilitate the generalizability of the results to specialized settings.
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Affiliation(s)
- Irene Caro-Cañizares
- Facultad de Ciencias de la Salud y la Educación, Universidad a Distancia de Madrid, UDIMA, 28400 Collado Villalba, Spain
| | - Nayara López Carpintero
- Departamento de Obstetricia y Ginecología, Hospital Universitario del Tajo, 28300 Aranjuez, Spain
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12
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Nall SK, Jurecka C, Ammons A, Rodriguez A, Craft B, Waleed C, Dias D, Henderson J, Boyer J, Yamkovoy K, Swathi PA, Patil P, Behne F, LeMasters K, Brinkley-Rubinstein L, Barocas JA. Identifying structural risk factors for overdose following incarceration: a concept mapping study. HEALTH & JUSTICE 2024; 12:11. [PMID: 38472497 DOI: 10.1186/s40352-024-00265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities. People with lived experiences in the criminal legal system and with substance use disorder hold unique perspectives and must be involved in the research process. OBJECTIVE To identify perceived factors that impact overdose following release from incarceration among people with direct criminal legal involvement and experience with substance use. METHODS Within a community-engaged approach to research, we used concept mapping to center the perspectives of people with personal experience with the carceral system. The following prompt guided our study: "What do you think are some of the main things that make people who have been in jail or prison more and less likely to overdose?" Individuals participated in three rounds of focus groups, which included brainstorming, sorting and rating, and community interpretation. We used the Concept Systems Inc. platform groupwisdom for our analyses and constructed cluster maps. RESULTS Eight individuals (ages 33 to 53) from four states participated. The brainstorming process resulted in 83 unique factors that impact overdose. The concept mapping process resulted in five clusters: (1) Community-Based Prevention, (2) Drug Use and Incarceration, (3) Resources for Treatment for Substance Use, (4) Carceral Factors, and (5) Stigma and Structural Barriers. CONCLUSIONS Our study provides critical insight into community-identified factors associated with overdose following incarceration. These factors should be accounted for during resource planning and decision-making.
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Affiliation(s)
- Samantha K Nall
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Cole Jurecka
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Anthony Ammons
- The Ahimsa Collective, Oakland, CA, USA
- Third City Community Advisory Board, Chapel Hill, NC, USA
| | - Avel Rodriguez
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
| | - Betsy Craft
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
- Colorado Drug Policy Coalition, Denver, CO, USA
| | - Craig Waleed
- Third City Community Advisory Board, Chapel Hill, NC, USA
- Disability Rights North Carolina (DRNC), Raleigh, NC, USA
| | - Daniel Dias
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
- Denver Dream Center, Denver, CO, USA
| | - Jessie Henderson
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
- WORTH CAB (Wellness, Opportunity, Resilience Through Health Community Advisory Board), Aurora, CO, USA
| | - Joshua Boyer
- Third City Community Advisory Board, Chapel Hill, NC, USA
- Hopwood and Singhal PLLC, Alexandria, VA, USA
| | - Kristina Yamkovoy
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Pallavi Aytha Swathi
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA
| | - Prasad Patil
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Joshua A Barocas
- School of Medicine, University of Colorado, Anschutz Medical Campus, 8th Floor, Academic Office 1 Mailstop B180 12631 E 17th Ave, Aurora, CO, 80045, USA.
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13
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Stewart MT, Daily SM, Thomas CP, Panas L, Ritter G, Reif S. Expanding access to medication treatment for opioid use disorders: Findings from the Washington State hub and spoke effort. Drug Alcohol Depend 2024; 256:111125. [PMID: 38368666 PMCID: PMC10922849 DOI: 10.1016/j.drugalcdep.2024.111125] [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: 10/26/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) is a leading cause of preventable death and injury nationwide. Efforts to increase the use of medication for opioid use disorder (MOUD) are needed. In 2017, Washington State implemented a Hub and Spoke (HS) model of care with the primary goal of expanding access to MOUD. We examined changes in MOUD utilization among Washington State Medicaid beneficiaries before and after HS implementation. METHODS We used Medicaid claims data to examine longitudinal changes in MOUD use for beneficiaries with OUD. We conducted a comparative interrupted time series analysis to examine the association between HS policy implementation and rates of MOUD utilization, overall and by type of medication. RESULTS Between 2016 and 2019, a period of increasing OUD prevalence, rates of MOUD utilization among Washington Medicaid beneficiaries increased overall from 39.7 to 50.5. Following HS implementation, rates of MOUD use grew at a significantly greater rate in the HS cohort than in the non-HS cohort (β=0.54, SE=0.02, p< 0.0001, 95% CI 0.49, 0.59). Analyses by medication type show that this rate increase was primarily due to buprenorphine use (β= 0.61, SE= 0.02, p< 0.0001, 95% CI 0.57, 0.65). CONCLUSION Improved systems of care are needed to make MOUD accessible to all patients in need. The Washington HS model is one strategy that may facilitate and expand MOUD use, particularly buprenorphine. Over the study period, Washington State saw increased use of buprenorphine, which was an emphasis of their HS model.
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Affiliation(s)
- Maureen T Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA.
| | - Shay M Daily
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA
| | - Cindy Parks Thomas
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA
| | - Lee Panas
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA
| | - Grant Ritter
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA
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14
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Kontos N, Rao V. Clinical harm reduction in substance use: An ethics-oriented primer and critique for hospital-based providers. J Eval Clin Pract 2024; 30:260-267. [PMID: 38018023 DOI: 10.1111/jep.13941] [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: 05/24/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
AIMS AND OBJECTIVES Substance use-targeted harm reduction (HR) has successfully expanded from public health into clinical settings. Hospital-based providers are in positions to encounter, precipitate and/or mediate ethically fraught situations that can arise around clinical HR-informed interventions. We examine why these situations occur and how they might be better addressed. METHOD Literature focused on principles, ethics, and clinical implementation of HR are reviewed to identify core elements of this approach. Next, ethical vulnerabilities within those elements are identified and critiqued. A more productive discourse for acknowledging, voicing and addressing ethical dilemmas in HR is sought. RESULTS Public health orientation and humane concern for substance users, along with a strong anti-stigmatization mission and occasional aversion to a rigid medical model and 'establishment' contributed to HR's successes but can also frame any dissent over its methods as being stigma-fuelled. Practically distilled concepts from moral philosophy and the medical humanities can inform good faith discussions based on common-ground concern for patients. CONCLUSION HR's use in the general hospital and other clinical settings is a positive development, but one that brings with it new ethical demands. Broader knowledge of the principles of HR, of the application of those principles to the hospital setting, and of common-ground concepts from outside of HR could help facilitate productive ethical engagement around substance-using patients.
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Affiliation(s)
- Nicholas Kontos
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vinod Rao
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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15
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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California-San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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16
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Mayer M, Mejia Urieta Y, Martinez LS, Komaromy M, Hughes U, Chatterjee A. Encampment Clearings And Transitional Housing: A Qualitative Analysis Of Resident Perspectives. Health Aff (Millwood) 2024; 43:218-225. [PMID: 38315933 DOI: 10.1377/hlthaff.2023.01040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The number of people experiencing homelessness in tent encampments in the US has increased significantly. Citing concerns over health and safety, many cities have pursued highly visible encampment removals. In January 2022, a major tent encampment in Boston, Massachusetts, was cleared using a unique approach: Most encampment residents were placed in transitional harm reduction housing. We conducted interviews between July 2022 and February 2023 with thirty former encampment residents to explore how the encampment clearing affected their health and sense of safety. We also explored participants' perspectives on harm reduction housing. Of those interviewed, fourteen people had been placed in such housing. Among those not placed, the encampment clearing tended to exacerbate health and safety concerns, especially those related to mental health conditions and risk for violence. Among people successfully placed, harm reduction housing improved health and safety and allowed participants to make meaningful progress toward long-term goals such as addiction recovery, management of chronic health conditions, and permanent housing. Our findings suggest that encampments can have safety-promoting characteristics, but if encampment removal is pursued, offering harm reduction housing after removal can be beneficial.
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Affiliation(s)
- Michael Mayer
- Michael Mayer , Boston Medical Center, Boston, Massachusetts
| | | | | | | | - Ursel Hughes
- Ursel Hughes, Dimmock Community Health Center, Boston, Massachusetts
| | - Avik Chatterjee
- Avik Chatterjee, Boston Medical Center and Boston University
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17
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Mitchell MM, Angelo S, Akinwolere OG, Perkins MM, Bender AA. Latent class analysis of perceived stigma among older adults receiving medications for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209187. [PMID: 37858796 PMCID: PMC10843650 DOI: 10.1016/j.josat.2023.209187] [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: 02/01/2023] [Revised: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
RATIONALE Public stigma surrounds individuals who use medication for their recovery from a substance use disorder. However, we know little about subgroups of individuals with varying levels of perceived stigma and how these levels may be associated with physical and mental health-related quality of life (HRQOL) and social support. METHODS We used latent class analysis to define subgroups of people aged 50-72 years of age (N = 104) who were enrolled in eight medication for opioid use disorder (MOUD) programs to explore subgroupings and correlates of group membership. RESULTS We found evidence for three distinct classes of individuals and named the classes 1) the high stigma class, 2) the embarrassed class, and 3) the low stigma class. We found that people in the high-stigma class reported more rejection, more abstinence-based support group involvement, and reduced mental HRQOL. CONCLUSIONS Results suggest reducing stigma among people on MOUD may help to boost mental HRQOL and improve social support receipt. The results are consistent with iatrogenic effects of AA/NA support groups such that these treatment modalities may increase stigma due to their focus on abstinence-only treatment for substance use disorders.
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Affiliation(s)
| | - Sahil Angelo
- Georgetown University Hospital, United States of America
| | | | - Molly M Perkins
- Emory University School of Medicine, United States of America; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, United States of America
| | - Alexis A Bender
- Emory University School of Medicine, United States of America.
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18
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Scherzer C, Jiménez Muñoz P, Ramsey S, Carey KB, Ranney ML, Clark S, Rich J, Langdon KJ. Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder. J Addict Dis 2024; 42:24-32. [PMID: 36325942 PMCID: PMC10154429 DOI: 10.1080/10550887.2022.2126273] [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] [Indexed: 11/06/2022]
Abstract
Background: Nearly two million adults in the US currently live with an Opioid Use Disorder (OUD) diagnosis. Recent efforts have encouraged and facilitated widespread adoption of empirically supported medications for opioid use disorder (MOUD), yet MOUD and OUD behavioral health interventions remain dramatically underutilized. Fear of discrimination and judgment, compounded by systemic and regulatory barriers, hinder individuals' access to specialty treatment.Objectives: The goal of the current study was to (1) reveal how perspectives toward OUD treatment may differ across medication types, program settings, and drug use history; (2) address systemic and regulatory components that potentially foster and propagate positive or negative attributions to OUD; and (3) understand how experiences reduce patients' willingness to pursue and/or maintain long term treatment.Methods: Twenty-four adults engaged in buprenorphine treatment at two outpatient addiction treatment centers participated in in-depth, qualitative interviews between 2019 and 2020 in Providence, Rhode Island.Results: Thematic analysis revealed negative attributions toward OUD across all participants. Three key themes developed from the coding and analysis: (1) differential perceptions of therapeutic medications (2) negative perceptions of treatment programs and (3) perceptions of drugs and people who use drugs.Conclusions: Stigmatizing language remains a major public health issue that needs to be addressed to facilitate treatment for individuals for OUD and other drug use disorders. Incorporating strategies targeting labeling across medication types, program settings, and drug use may improve treatment outcomes by reducing the inaccurate beliefs surrounding OUD and connecting patients to evidence-based support.
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Affiliation(s)
- Caroline Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, United States
- Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, United States
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- School of Public Health, Brown University, Providence, RI, United States
| | - Seth Clark
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Josiah Rich
- Department of Medicine and Epidemiology, Brown University, Providence, RI, United States
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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19
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Jones KF, Khodyakov D, Han BH, Arnold RM, Dao E, Morrison J, Kapo J, Meier DE, Paice JA, Liebschutz JM, Ritchie CS, Merlin JS, Bulls HW. Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use. Cancer 2023; 129:3978-3986. [PMID: 37691479 PMCID: PMC10910244 DOI: 10.1002/cncr.34921] [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: 02/13/2023] [Revised: 03/19/2023] [Accepted: 04/17/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. METHODS The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. RESULTS Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. CONCLUSION Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. PLAIN LANGUAGE SUMMARY Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.
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Affiliation(s)
- Katie Fitzgerald Jones
- New England Geriatric Research, Education and Clinical Center and Division of Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Benjamin H. Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego, California, USA
| | - Robert M. Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily Dao
- RAND Corporation, Santa Monica, California, USA
| | - Jeni Morrison
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Kapo
- Palliative Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Diane E. Meier
- Department of Geriatrics and Palliative Medicine, Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith A. Paice
- Division Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica S. Merlin
- Challenges in Managing and Preventing Pain Clinical Research Center, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hailey W. Bulls
- Challenges in Managing and Preventing Pain Clinical Research Center, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Winograd RP, Coffey B, Nance M, Carpenter R. The association of medical providers' attitudes about naloxone and people with opioid use disorder and their self-reported "low-barrier" treatment practices. Addict Behav Rep 2023; 18:100514. [PMID: 37680698 PMCID: PMC10480593 DOI: 10.1016/j.abrep.2023.100514] [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: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
Opioid-involved overdose deaths continue to climb, in part because of suboptimal access to and retention on medications for opioid use disorder (MOUD), including buprenorphine. Low barrier buprenorphine treatment aims to reduce or eliminate the threshold for getting and staying on medication by providing immediate and long-term access to buprenorphine without strict rules or requirements. This study examines associations between medical providers' beliefs about treating people with opioid use disorder (OUD) and naloxone access with their self-reported low-barrier buprenorphine prescribing practices. We surveyed and analyzed responses from providers (N = 86) who completed X-waiver courses in Missouri between March 2017 and September 2019, of which 55% (n = 47) both completed the full survey and endorsed prescribing buprenorphine since the training. The survey included questions about buprenorphine prescribing behaviors as well as the Naloxone-Related Risk Compensation Beliefs (NaRCC-B) scale and the Attitudes toward Patients with OUD scale. Analyses consisted of a series of linear and logistic regressions with the NaRCC-B and OUD Attitudes scales predicting various domains of low-barrier prescribing behaviors. Findings indicate medical providers' beliefs about treating people with OUD are associated with their practice of addiction medicine, with individuals with more favorable views being more likely to endorse low-barrier buprenorphine prescribing practices including offering telemedicine and at-home inductions, prescribing higher doses of buprenorphine, treating larger caseloads, and discussing overdose risk and protective factors with their patients. Providers' beliefs about naloxone being enabling were less related to their buprenorphine practices but strongly related to their likelihood of providing naloxone. Future research may examine which strategies effectively change prescriber attitudes and their adoption of lower-barrier prescribing practices.
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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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22
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Jaiswal J, Griffin M, LoSchiavo C, Cox A, Hascher K, Dunlap K, Walters S, Burton WM, Grin B, Mumba M, Eaton E. Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma. Subst Use Misuse 2023; 58:1866-1873. [PMID: 37818832 PMCID: PMC10873058 DOI: 10.1080/10826084.2023.2257308] [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] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. METHODS Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. CONCLUSION To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.
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Affiliation(s)
- Jessica Jaiswal
- Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Caleb LoSchiavo
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Amanda Cox
- Institute of Data and Analytics, University of Alabama, Tuscaloosa, AL, USA
| | | | - Kandyce Dunlap
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
| | | | - Wanda M Burton
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Benjamin Grin
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Mercy Mumba
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Ellen Eaton
- Division of Infectious Diseases, University of Alabama-Birmingham, Birmingham, AL, USA
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Becker TD, Eschliman EL, Thakrar AP, Yang LH. A conceptual framework for how structural changes in emerging acute substance use service models can reduce stigma of medications for opioid use disorder. Front Psychiatry 2023; 14:1184951. [PMID: 37829763 PMCID: PMC10565357 DOI: 10.3389/fpsyt.2023.1184951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Stigma toward people taking medication for opioid use disorder (MOUD) is prevalent, harmful to the health and well-being of this population, and impedes MOUD treatment resource provision, help-seeking, and engagement in care. In recent years, clinicians have implemented new models of MOUD-based treatment in parts of the United States that integrate buprenorphine initiation into emergency departments and other acute general medical settings, with post-discharge linkage to office-based treatment. These service models increase access to MOUD and they have potential to mitigate stigma toward opioid use and MOUD. However, the empirical literature connecting these emerging service delivery models to stigma outcomes remains underdeveloped. This paper aims to bridge the stigma and health service literatures via a conceptual model delineating how elements of emerging MOUD service models can reduce stigma and increase behavior in pursuit of life goals. Specifically, we outline how new approaches to three key processes can counter structural, public, and self-stigma for this population: (1) community outreach with peer-to-peer influence, (2) clinical evaluation and induction of MOUD in acute care settings, and (3) transition to outpatient maintenance care and early recovery. Emerging service models that target these three processes can, in turn, foster patient empowerment and pursuit of life goals. There is great potential to increase the well-being of people who use opioids by reducing stigma against MOUD via these structural changes.
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Affiliation(s)
- Timothy D. Becker
- Department of Psychiatry, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, United States
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ashish P. Thakrar
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Whipple CR, Kaynak Ö, Kruis NE, Saylor E, Bonnevie E, Kensinger WS. Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties. Subst Use Misuse 2023; 58:1818-1828. [PMID: 37622487 DOI: 10.1080/10826084.2023.2250434] [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] [Indexed: 08/26/2023]
Abstract
Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.
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Affiliation(s)
- Christopher R Whipple
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Övgü Kaynak
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Nathan E Kruis
- Department of Criminal Justice, Penn State Altoona, Altoona, Pennsylvania, USA
| | - Erica Saylor
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | | | - Weston S Kensinger
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
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25
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Jones KF, Broglio K, Ho JJ, Rosa WE. Compassionate Care for People with Cancer and Opioid Use Disorder. Am J Nurs 2023; 123:56-61. [PMID: 37498041 PMCID: PMC10619200 DOI: 10.1097/01.naj.0000947480.74410.06] [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] [Indexed: 07/28/2023]
Abstract
ABSTRACT Opioid use disorder (OUD) is an important comorbidity to assess and manage in people with cancer. In this article, the authors discuss strategies for safe opioid management in individuals with OUD and cancer-related pain using a composite case example. They highlight core approaches to pain management, including motivational interviewing, harm reduction, and evidence-based treatments, as well as advocacy for person-centered end-of-life care.
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Affiliation(s)
- Katie Fitzgerald Jones
- Katie Fitzgerald Jones is a palliative and addiction NP and researcher in the VA Boston Healthcare System. Kathleen Broglio is associate professor of medicine in the Geisel School of Medicine at Dartmouth, Hanover, NH. J. Janet Ho is a palliative and addiction medicine physician at the University of California, San Francisco. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Contact author: Katie Fitzgerald Jones, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Victor G, Ray B, Del Pozo B, Jaffe K, King A, Huynh P. Buprenorphine and opioid analgesics: Dispensation and discontinuity among accidental overdose fatalities in the Indianapolis metropolitan area, 2016-2021. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209053. [PMID: 37105266 PMCID: PMC10330395 DOI: 10.1016/j.josat.2023.209053] [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: 09/28/2022] [Revised: 11/28/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND This study describes overall trends and sociodemographic disparities in buprenorphine and opioid analgesic uptake and prescribing patterns prior to fatal overdose events. METHODS We examined toxicology data from all accidental overdose deaths from 2016 to 2021 (N = 2682) in a large metropolitan area. These data were linked at the individual-level with a prescription drug monitoring program (PDMP). RESULTS Fewer than half of all deaths had any kind of PDMP record (39.9 %, n = 1070). Among those with a buprenorphine prescription, 10.6 % (n = 35) of decedents had a buprenorphine dispensation within 7 days of their death, while the majority (64.7 %, n = 214) were dispensed buprenorphine more than 30 days prior to death. Evidence existed of racial disparities among those with any buprenorphine uptake, whereby Black individuals (7.3 %, n = 24) had significantly fewer any dispensations compared to White individuals (92.7 %, n = 307). Among those with an opioid analgesic prescription, about 12.2 % (n = 90) were dispensed within 7 days of death, with the majority (68.5 %, n = 506) occurring more than 30 days prior to death. Like buprenorphine dispensations, Black individuals were prescribed a significantly smaller proportion of opioid analgesics (21.9 %, n = 162) versus White individuals (77.7 %, n = 574). Buprenorphine was detected in 78.5 % of deaths where fentanyl was present in the toxicology record, significantly greater when compared to opioid analgesics (57.5 %). CONCLUSION Consistent with prior research, our findings suggest prescription opioid analgesics may protect against fatal overdoses. Access to buprenorphine treatment did not keep pace with the rising lethality of the overdose crisis, and in recent years, a smaller percentage of the people at risk of fatal overdose availed themselves of MOUD preceding their death.
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Affiliation(s)
- Grant Victor
- School of Social Work, Rutgers, The State University of New Jersey, 120 Albany St, New Brunswick, NJ 08901, United States of America.
| | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States of America
| | - Brandon Del Pozo
- Miriam Hospital/Warren Alpert Medical School of Brown University, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road Bldg. 14, G016, Ann Arbor, MI 48109, United States of America
| | - Andy King
- School of Emergency Medicine, Wayne State University, 4201 St. Antoine, University Health Center - 6G, Detroit, MI 48201, United States of America
| | - Philip Huynh
- Center for Behavioral Health and Justice, Wayne State University, Detroit, MI 48208, United States of America
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27
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Chhatwal J, Mueller PP, Chen Q, Kulkarni N, Adee M, Zarkin G, LaRochelle MR, Knudsen AB, Barbosa C. Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States. JAMA Netw Open 2023; 6:e2314925. [PMID: 37294571 PMCID: PMC10257094 DOI: 10.1001/jamanetworkopen.2023.14925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/08/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In 2021, more than 80 000 US residents died from an opioid overdose. Public health intervention initiatives, such as the Helping to End Addiction Long-term (HEALing) Communities Study (HCS), are being launched with the goal of reducing opioid-related overdose deaths (OODs). Objective To estimate the change in the projected number of OODs under different scenarios of the duration of sustainment of interventions, compared with the status quo. Design, Setting, and Participants This decision analytical model simulated the opioid epidemic in the 4 states participating in the HCS (ie, Kentucky, Massachusetts, New York, and Ohio) from 2020 to 2026. Participants were a simulated population transitioning from opioid misuse to opioid use disorder (OUD), overdose, treatment, and relapse. The model was calibrated using 2015 to 2020 data from the National Survey on Drug Use and Health, the US Centers for Disease Control and Prevention, and other sources for each state. The model accounts for reduced initiation of medications for OUD (MOUDs) and increased OODs during the COVID-19 pandemic. Exposure Increasing MOUD initiation by 2- or 5-fold, improving MOUD retention to the rates achieved in clinical trial settings, increasing naloxone distribution efforts, and furthering safe opioid prescribing. An initial 2-year duration of interventions was simulated, with potential sustainment for up to 3 additional years. Main Outcomes and Measures Projected reduction in number of OODs under different combinations and durations of sustainment of interventions. Results Compared with the status quo, the estimated annual reduction in OODs at the end of the second year of interventions was 13% to 17% in Kentucky, 17% to 27% in Massachusetts, 15% to 22% in New York, and 15% to 22% in Ohio. Sustaining all interventions for an additional 3 years was estimated to reduce the annual number of OODs at the end of the fifth year by 18% to 27% in Kentucky, 28% to 46% in Massachusetts, 22% to 34% in New York, and 25% to 41% in Ohio. The longer the interventions were sustained, the better the outcomes; however, these positive gains would be washed out if interventions were not sustained. Conclusions and Relevance In this decision analytical model study of the opioid epidemic in 4 US states, sustained implementation of interventions, including increased delivery of MOUDs and naloxone supply, was found to be needed to reduce OODs and prevent deaths from increasing again.
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Affiliation(s)
- Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Peter P. Mueller
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park
| | - Neeti Kulkarni
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Madeline Adee
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Gary Zarkin
- RTI International, Research Triangle Park, North Carolina
| | - Marc R. LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Amy B. Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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28
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Moore KE, Wyatt JP, Phillips S, Burke C, Bellamy C, McKee SA. The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis. HEALTH & JUSTICE 2023; 11:25. [PMID: 37191937 PMCID: PMC10186797 DOI: 10.1186/s40352-023-00225-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma. METHODS This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach. RESULTS Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants' self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration. CONCLUSIONS Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.
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Affiliation(s)
- Kelly E Moore
- East Tennessee State University, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN, 37614, USA.
| | - Janan P Wyatt
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sarah Phillips
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Catherine Burke
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Chyrell Bellamy
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sherry A McKee
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
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Moore KE, Johnson JE, Luoma JB, Taxman F, Pack R, Corrigan P, Hart J, Slone JD. A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol. HEALTH & JUSTICE 2023; 11:24. [PMID: 37184615 PMCID: PMC10184076 DOI: 10.1186/s40352-023-00224-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Stigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients. METHODS This paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up. DISCUSSION Stigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described. TRIAL REGISTRATION This clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx .
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN, 37614, USA.
| | - Jennifer E Johnson
- College of Human Medicine, Division of Public Health, Michigan State University, 200 E. 1St Street, Flint, MI, 48502, USA
| | - Jason B Luoma
- Portland Psychotherapy Institute, 3700 N Williams Ave., Portland, OR, 97227, USA
| | - Faye Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
| | - Robert Pack
- College of Public Health, East Tennessee State University, 277 Lamb Hall, P.O. Box 70623, Johnson City, TN, 37614, USA
| | - Patrick Corrigan
- Department of Psychology, Llinois Institute of Technology, 3424 S State St., Chicago, IL, 60616, USA
| | - Jim Hart
- Tennessee Institute for Public Service, 1610 University Avenue, Knoxville, TN, 37921, USA
| | - Judge Duane Slone
- Fourth Judicial District of Tennessee, 854 South Hwy. 92, P.O. Box 858, Dandridge, TN, 37725, USA
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Kasson E, Filiatreau LM, Kaiser N, Davet K, Taylor J, Garg S, El Sherief M, Aledavood T, De Choudhury M, Cavazos-Rehg P. Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators. Subst Use Misuse 2023; 58:920-929. [PMID: 37021375 PMCID: PMC10464934 DOI: 10.1080/10826084.2023.2196574] [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] [Indexed: 04/07/2023]
Abstract
Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Lindsey M. Filiatreau
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Kevin Davet
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Jordan Taylor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Talayeh Aledavood
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
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Nagle LE, Moses TEH, Chitale A, Chou JS, Lien IC, Waineo E, Greenwald MK. Building a strong foundation from the ground up: the impact of a medical student substance use disorder organization on curriculum and community. J Addict Dis 2023; 41:156-166. [PMID: 35470767 PMCID: PMC9745562 DOI: 10.1080/10550887.2022.2068907] [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] [Indexed: 12/15/2022]
Abstract
Due to the increasing rates of substance use disorders (SUDs), accidental overdoses, and associated high mortality rates, there is an urgent need for well-trained physicians who can grasp these complex issues and help struggling patients. Preparing these physicians occurs through targeted education and clinical exposure in conjunction with medical school curricula in the field of addiction medicine. Medical students can often feel overwhelmed by the medical school curriculum and changes to the curriculum take time, money, and administrative commitment to ratify. Implementing a student organization dedicated to SUD education can be a solution to provide clinical exposure, education and student autonomy in their medical school experience. At Wayne State University School of Medicine, Detroit vs. Addiction (DvA) is a student-run organization that is filling the gap in SUD education for medical students whilst providing assistance to the community. DvA not only extends clinical education for physicians in training, but it also provides the medical school with an opportunity to allow students to create a blueprint for education initiatives that can be incorporated as a mainstay in the school's technical trainings. Herein, we describe the evolution of this organization and its activities.
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Affiliation(s)
- Luz E. Nagle
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
| | - Tabitha E. H. Moses
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
| | - Anirudh Chitale
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
| | - Jody S. Chou
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
| | - Irvin C. Lien
- Department of Internal Medicine, Kaiser Permanente, Oakland, CA
| | - Eva Waineo
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
| | - Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, Detroit, MI
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Health and correctional staff acceptability of depot buprenorphine in NSW prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103978. [PMID: 36870227 DOI: 10.1016/j.drugpo.2023.103978] [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: 09/15/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Provision of opioid agonist treatment (OAT) in custodial settings is resource-intensive and may be associated with diversion, non-medical use, and violence. A clinical trial of a new OAT, depot buprenorphine (the UNLOC-T study), provided the opportunity to obtain health and correctional staff perspectives regarding this treatment prior to widespread roll-out. METHODS Sixteen focus groups with 52 participants were conducted, including 44 health staff (nurses, nurse practitioners, doctors, and operational staff) and eight correctional staff. RESULTS Key challenges to providing OAT identified as potentially being addressed by depot buprenorphine included 1) patient access, 2) OAT program capacity, 3) treatment administration procedures, 4) medication diversion and other safety issues and, 5) impact on other service delivery. CONCLUSIONS The introduction of depot buprenorphine into correctional settings was considered to have the potential to increase safety for patients, improve staff / patient relations and advance patient health outcomes via expanded treatment coverage and efficiencies gained through enhanced health service delivery. Support was almost universal from both correctional and health staff participating in this study. These findings build on emerging research regarding the positive impact of more flexible OAT programs and could be used to engage support for the implementation of depot buprenorphine from staff in other secure settings.
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Roy PJ, Callaway Kim K, Suda K, Luo J, Wang X, Olejniczak D, Liebschutz JM. Impact of COVID-19-related regulatory changes on nationwide access to buprenorphine: An interrupted time series design. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100135. [PMID: 36694665 PMCID: PMC9851915 DOI: 10.1016/j.dadr.2023.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Background The impact of COVID-19-related healthcare changes on access to buprenorphine (BUP) nationwide in the US is unknown. Methods We conducted an interrupted time series with the IQVIA LRx database. The study timeline included BUP prescriptions from 52 weeks before (2/23/19-2/21/20) to 52 weeks after (4/4/20-4/2/21) the initial pandemic period (2/22/20-4/3/20). Segmented regression estimated relative changes in total milligrams (MG) of BUP available per week nationwide at 1, 26, and 52 weeks post-initial-pandemic. We evaluated treatment disruptions in previously stable patients, defined as ≥6 months of BUP prescriptions. Results A total of 31 617 849 prescriptions were included. Total MG BUP dispensed increased at 1 and 26 weeks and then returned to baseline trends at 52 weeks post-initial pandemic period (4.1% [95% CI: 3.7,4.5], 2.1% [1.5,2.6], 0.1% [-0.6,0.9]). Stably-treated patients saw a decrease in 7-, 14-, and 28-day treatment disruptions at 52 weeks post-initial-pandemic period (-21.6% [-25.6,-17.7]; -10.8% [-16.3,-5.3]; -27.3% [-33.0,-21.6]). Men retained an increase in MG BUP compared to women at 52 weeks (0.7% [0.01,1.4] versus -0.6% [-1.5,0.2]). Younger age groups (18-29 years and 30-39 years) had a decrease in MG BUP at 52 weeks compared to expected baseline trend (-16.6 [-24.2, -9.0]; -1.6 [-3.0, -0.1). Patients with Medicaid demonstrated an increase in MG BUP at 52 weeks (8.3% [6.3,10.3]). MG BUP prescribed by APP prescribing increased by over 140 000 mg per week prior to the pandemic and continued to increase. Conclusions Regulatory changes around buprenorphine prescribing facilitated patient access to buprenorphine during the pandemic.
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Affiliation(s)
- Payel Jhoom Roy
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine Callaway Kim
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katie Suda
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Jing Luo
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Xiaoming Wang
- National Institute on Drug Abuse, Bethesda, MD, United States
| | - Donna Olejniczak
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Jane M Liebschutz
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
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Hooker SA, Crain AL, LaFrance AB, Kane S, Fokuo JK, Bart G, Rossom RC. A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians. Addict Sci Clin Pract 2023; 18:10. [PMID: 36774521 PMCID: PMC9922036 DOI: 10.1186/s13722-023-00366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 02/02/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs' stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary). METHODS PCCs from 15 primary care clinics were invited to complete a 30 min online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression. RESULTS A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma = 48; Control = 40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t = - 0.48, p = .64, Cohen's d = - 0.11), intention to get waivered (t = 1.11, p = .27, d = 0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t = 0.90, p = 0.37, d = 0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r = - 0.25, p = 0.03) and to prescribe buprenorphine with no waiver (r = - 0.25, p = 0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use. CONCLUSIONS Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs. TRIAL REGISTRATION ClinicalTrials.gov NCT04867382. Registered 30 April 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04867382.
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Affiliation(s)
- Stephanie A. Hooker
- grid.280625.b0000 0004 0461 4886Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN 55440 USA
| | - A. Lauren Crain
- grid.280625.b0000 0004 0461 4886Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN 55440 USA
| | - Amy B. LaFrance
- grid.280625.b0000 0004 0461 4886Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN 55440 USA
| | - Sheryl Kane
- grid.280625.b0000 0004 0461 4886Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN 55440 USA
| | - J. Konadu Fokuo
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Gavin Bart
- Division of Addiction Medicine, Hennepin Healthcare, Minneapolis, MN USA
| | - Rebecca C. Rossom
- grid.280625.b0000 0004 0461 4886Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN 55440 USA
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Scott CK, Grella CE, Dennis ML, Carnevale J, LaVallee R. Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. HEALTH & JUSTICE 2022; 10:36. [PMID: 36538121 PMCID: PMC9763789 DOI: 10.1186/s40352-022-00197-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD "best practices" in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources. RESULTS Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff. CONCLUSIONS Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release.
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Affiliation(s)
- Christy K. Scott
- Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | | | | | - John Carnevale
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
| | - Robin LaVallee
- Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
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Tomko C, Olfson M, Mojtabai R. Gaps and barriers in drug and alcohol treatment following implementation of the affordable care act. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100115. [PMID: 36644223 PMCID: PMC9835109 DOI: 10.1016/j.dadr.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background This study examines changes in the substance use disorder (SUD) treatment gap and barriers to treatment for low-income adults following Affordable Care Act (ACA) implementation. Methods National Survey on Drug Use and Health (NSDUH) data were pooled to assess pre-ACA (2009-2013) and post-ACA (2015-2019) implementation. The sample (n = 44,622) included respondents 18-64 years old, income <200% federal poverty level, and meeting SUD criteria for abuse or dependence of heroin, powdered cocaine, crack cocaine, marijuana, or alcohol. The primary outcome was NSDUH-defined past-year illicit drug or alcohol treatment gap (needing but not receiving SUD specialty treatment). A secondary analysis assessed barriers to SUD treatment including insurance-related barriers, stigma, barriers to access, priority of treatment, and no interest in stopping substance use. Results Ninety-three percent of respondents reported a drug or alcohol treatment gap before and after ACA implementation. No interest in stopping use was the greatest barrier (40%), followed by insurance-related barriers (39%) and stigma (20%). After adjusting for covariates, results did not show a significant change in SUD treatment gap post-ACA compared to pre-ACA (adjusted odds ratio [aOR]=1.11, 95% confidence interval [CI]=0.97, 1.28, p = 0.13). Compared to pre-ACA, odds of reporting stigma-related barriers (aOR=1.66, 95% CI=1.17, 2.37, p = 0.01) and access-related barriers (aOR=1.79, 95% CI=1.34, 2.38, p < 0.001) increased post-ACA. Conclusions There was no significant change in the prevalence of SUD treatment gap after ACA implementation. Increasing access to SUD treatment for low-income individuals will require intervening at multiple socioecological levels beyond reforming treatment financing.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 161, Baltimore, MD 21205, USA,Corresponding author. (C. Tomko)
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York NY 10032, USA,Mailman School of Public Health, Columbia University, 722 W 168th St., New York, NY 10032, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 161, Baltimore, MD 21205, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21205, USA
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Metz VE, Leibowitz A, Satre DD, Parthasarathy S, Jackson-Morris M, Cocohoba J, Sterling SA. Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial. Contemp Clin Trials 2022; 123:107004. [PMID: 36379437 PMCID: PMC9729439 DOI: 10.1016/j.cct.2022.107004] [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: 07/18/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Alcohol use problems are associated with serious medical, mental health and socio-economic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of the Alcohol Telemedicine Consult (ATC) Service, a novel, personalized telehealth intervention approach for primary care patients with alcohol use problems. METHODS This cluster-randomized pragmatic trial, supplemented by qualitative interviews, will include adults with a primary care visit between 9/10/21-3/10/23 from 16 primary care clinics at two large urban medical centers within Kaiser Permanente Northern California, a large, integrated healthcare system. Clinics are randomized to the ATC Service (intervention), including alcohol pharmacotherapy and SBIRT (screening, MI (Motivational Interviewing)-based brief intervention and referral to addiction treatment) delivered by clinical pharmacists, or the Usual Care (UC) arm that provides systematic alcohol SBIRT. Primary outcomes include a comparison of the ATC and UC arms on 1) implementation outcomes (alcohol pharmacotherapy prescription rates, specialty addiction treatment referrals); and 2) patient outcomes (medication fills, addiction treatment initiation, alcohol use, healthcare services utilization) over 1.5 years. A general modeling approach will consider clustering of patients/providers, and a random effects model will account for intra-class correlations across patients within providers and across clinics. Qualitative interviews with providers will examine barriers and facilitators to implementation. DISCUSSION The ATC study examines the effectiveness of a pharmacist-provided telehealth intervention that combines pharmacotherapy and MI-based consultation. If effective, the ATC study could affect treatment models across the spectrum of alcohol use problems. CLINICAL TRIALS REGISTRATION This study has been registered on ClinicalTrials.gov (NCT05252221).
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Affiliation(s)
- Verena E Metz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA.
| | - Amy Leibowitz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Derek D Satre
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA
| | - Sujaya Parthasarathy
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Melanie Jackson-Morris
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Jennifer Cocohoba
- School of Pharmacy, University of California, San Francisco, 521 Parnassus Avenue, San Francisco 94117, CA, USA
| | - Stacy A Sterling
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Avenue, Pasadena 91101, CA, USA.
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Jaiswal J, Mumba MN. The Role of Nursing in Loosening the Pervasive Grip of Intersectional Stigma. J Psychosoc Nurs Ment Health Serv 2022; 60:9-15. [DOI: 10.3928/02793695-20221109-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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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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Pashchenko O, Bromberg DJ, Dumchev K, LaMonaca K, Pykalo I, Filippovych M, Esserman D, Polonsky M, Galvez de Leon SJ, Morozova O, Dvoriak S, Altice FL. Preliminary analysis of self-reported quality health indicators of patients on opioid agonist therapy at specialty and primary care clinics in Ukraine: A randomized control trial. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000344. [PMID: 36962514 PMCID: PMC10021202 DOI: 10.1371/journal.pgph.0000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
International agencies recommend integrating addiction treatment into primary care for people who inject drugs (PWID) with opioid use disorder (OUD). Empirical data supporting integration that incorporates comprehensive health outcomes, however, are not known. For this randomized controlled trial in Ukraine, adult PWID with OUD were randomized to receive opioid agonist therapy (OAT) in specialty addiction treatment clinics (SATC) or to primary care clinics (PCCs). For those randomized to PCC, they were subsequently allocated to PCCs where clinicians received pay-for-performance (P4P) incentives (PCC with P4P) or not (PCC without P4P). Participating cities had one of each of the three intervention sites to control for geographic variation. Ongoing tele-education specialty training (OAT, HIV, tuberculosis) was provided to all PCCs. While the primary outcome for the parent trial focuses on patient medical record data, this preliminary analysis focuses on assessment of self-reported achievement of nationally recommended quality health indicators (QHIs) which is summed as a composite QHI score. Secondary outcomes included specialty and primary care QHI subscores. This study occurred from 01/20/2018-11/1/2020 with 818 of 990 randomized participants having complete self-reported data for analysis. Relative to SATC (treatment as usual), the mean composite QHI score was 12.7 (95% CI: 10.1-15.3; p<0.001) percentage points higher at PCCs; similar and significantly higher scores were observed in PCCs compared to SATCs for both primary care (PCC vs SATC: 18.4 [95% CI: 14.8-22.0; p<0.001] and specialty (PCC vs SATC: 5.9 [95% CI: 2.6-9.2; p<0.001] QHI scores. Additionally, the mean composite QHI score was 4.6 (95% CI: 2.0-7.2; p<0.001) points higher in participants with long term (>3 months) experience with OAT compared to participants newly initiating OAT. In summary, PWID with OUD receive greater primary care and specialty healthcare services when receiving OAT at PCCs supported by tele-education relative to treatment as usual provided in SATCs. Clinical trial registration: This trial was registered at clinicaltrials.gov and can be found using the following registration number: NCT04927091.
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Affiliation(s)
| | - Daniel J. Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
| | | | - Katherine LaMonaca
- Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Iryna Pykalo
- Yale School of Medicine, Yale University, New Haven, CT, United States of America
- European Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maxim Polonsky
- Keck Graduate Institute, Claremont, CA, United States of America
| | | | - Olga Morozova
- Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, IL, United States of America
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
- Yale School of Medicine, Yale University, New Haven, CT, United States of America
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O'Brien PL, Stewart MT, Shields MC, White M, Dubenitz J, Dey J, Mulvaney-Day N. Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100087. [PMID: 36157615 PMCID: PMC9495301 DOI: 10.1016/j.dadr.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. METHODS Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. RESULTS We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. CONCLUSIONS State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.
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Affiliation(s)
| | - Maureen T. Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, United States
| | - Morgan C. Shields
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA; Washington University in St. Louis, Brown School, 1 Brookings Dr, St. Louis, MO, United States (Present address)
| | - Mackenzie White
- IBM Watson Health, 75 Binney St, Cambridge, MA, United States
| | - Joel Dubenitz
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United States
| | - Judith Dey
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United States
| | - Norah Mulvaney-Day
- IBM Watson Health, 75 Binney St, Cambridge, MA, United States; Dept. of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA (Present address)
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Ray B, Hedden BJ, Carroll JJ, Del Pozo B, Wagner K, Kral AH, O'Donnell D, Victor G, Huynh P. Prevalence and correlates of incarceration following emergency medical services response to overdose. Drug Alcohol Depend 2022; 238:109571. [PMID: 35868181 DOI: 10.1016/j.drugalcdep.2022.109571] [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] [Received: 04/06/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. METHODS Administrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. RESULTS Among all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. CONCLUSION Incarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.
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Affiliation(s)
- Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Bethany J Hedden
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Jennifer J Carroll
- North Carolina State University, Department of Sociology and Anthropology, 10 Current Drive, Suite 334, Raleigh, NC 27606-8017, USA
| | - Brandon Del Pozo
- The Warren Alpert School of Medicine of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Karla Wagner
- University of Nevada, Reno, School of Public Health, 1644 N. Virginia St., Reno, NV 89557, USA
| | | | - Daniel O'Donnell
- Indiana University School of Medicine, Indianapolis Emergency Medical Services, 3930 Georgetown Rd., Indianapolis, IN 46254, USA
| | - Grant Victor
- Rutgers University, School of Social Work, 120 Albany St, New Brunswick, NJ 08901, USA
| | - Phil Huynh
- Center for Behavioral Health and Justice, Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, USA
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Janet Ho J, Jones KF, Sager Z, Neale K, Childers JW, Loggers E, Merlin JS. Barriers to Buprenorphine Prescribing for Opioid Use Disorder in Hospice and Palliative Care. J Pain Symptom Manage 2022; 64:119-127. [PMID: 35561938 DOI: 10.1016/j.jpainsymman.2022.05.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
CONTEXT Hospice and palliative care (HPC) clinicians increasingly care for patients with concurrent painful serious illness and opioid use disorder (OUD) or opioid misuse; however, only a minority of HPC clinicians have an X-waiver license or actively use it to prescribe buprenorphine as medication treatment for OUD. OBJECTIVES To understand barriers for HPC clinicians to obtaining an X-waiver and prescribing buprenorphine as medication treatment for OUD. METHODS We performed content analysis on 100 survey responses from members of the national Buprenorphine Peer Support Network, a group of HPC clinicians interested in buprenorphine, on X-waiver status, barriers to obtaining an X-waiver, and barriers to active prescribing. RESULTS Of 100 HPC clinicians surveyed, only 26 of 57 HPC clinicians with X-waivers had ever prescribed. Prominent barriers included discomfort managing concurrent pain, buprenorphine, and OUD; concerns about impacts on practice; unsupportive practice culture; insufficient practice support; patient facing challenges; and cumbersome regulatory policies. CONCLUSION Despite HPC clinicians' interest in buprenorphine prescribing for OUD, several steps are needed to facilitate the practice, including clinician education tailored to pain and to clinical challenges faced by HPC clinicians, mentorship on buprenorphine use, and cultural and practice changes to dismantle systemic stigma towards addiction. We propose evidence-based steps derived from our survey findings that individual clinicians, HPC leaders, and national HPC organizations can take to improve care for patients with painful serious illness and OUD.
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Affiliation(s)
- Jiunling Janet Ho
- Division of Palliative Medicine (J.J.H.), University of California, San Francisco and Addiction Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
| | - Katie Fitzgerald Jones
- Boston College Connell School of Nursing (K.F.J.), VA Boston Healthcare System; Boston, Massachusetts, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care (Z.S.), VA Boston Healthcare System, Dana Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Neale
- Department of Palliative Medicine and Supportive Care (K.N.), The Lois U. and Harry R. Horvitz Palliative Medicine Program, Taussig Cancer Institute, Cleveland Clinic; Cleveland, Ohio, USA
| | - Julie W Childers
- Division of General Internal Medicine (J.W.C., J.S.M.), Section of Palliative Care and Medical Ethics; Section of Treatment, Research, and Education in Addiction Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, USA
| | - Elizabeth Loggers
- Clinical Research Division (E.L.), Fred Hutchinson Cancer Research Center, Division of Oncology, University of Washington School of Medicine; Seattle, Washington, USA
| | - Jessica S Merlin
- Division of General Internal Medicine (J.W.C., J.S.M.), Section of Palliative Care and Medical Ethics; Section of Treatment, Research, and Education in Addiction Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, USA
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Baumgart M, Chiarello E, Slay T. Reluctant Saviors: Professional ambivalence, cultural imaginaries, and deservingness construction in naloxone provision. Soc Sci Med 2022; 309:115230. [DOI: 10.1016/j.socscimed.2022.115230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
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Hoang BL, Sledge D. The association between medication for opioid use disorder and employment outcomes in the U.S.: The relevance of race and ethnicity. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100081. [PMID: 36846575 PMCID: PMC9948818 DOI: 10.1016/j.dadr.2022.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
•White admissions given MOUD were less likely to become unemployed at discharge.•Blacks and Hispanics given MOUD were more likely to remain unemployed at discharge.•Racial disparities associated with MOUD have notable implications for policy.
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Banta-Green CJ, Owens MD, Williams JR, Sears JM, Floyd AS, Williams-Gilbert W, Kingston S. The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State. Addict Sci Clin Pract 2022; 17:34. [PMID: 35799210 PMCID: PMC9261214 DOI: 10.1186/s13722-022-00315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all-let alone the majority-who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. We describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model. METHODS We are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program. DISCUSSION Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers.
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Affiliation(s)
- Caleb J Banta-Green
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA. .,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA. .,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - Jason R Williams
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - Jeanne M Sears
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.,Institute for Work and Health, Toronto, ON, Canada
| | - Anthony S Floyd
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | | | - Susan Kingston
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
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Lin Q, Kolak M, Watts B, Anselin L, Pollack H, Schneider J, Taylor B. Individual, interpersonal, and neighborhood measures associated with opioid use stigma: Evidence from a nationally representative survey. Soc Sci Med 2022; 305:115034. [PMID: 35636049 PMCID: PMC9288898 DOI: 10.1016/j.socscimed.2022.115034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Abstract
Despite growing awareness of opioid use disorder (OUD), fatal overdoses and downstream health conditions (e. g., hepatitis C and HIV) continue to rise in some populations. Various interrelated structural forces, together with social and economic determinants, contribute to this ongoing crisis; among these, access to medications for opioid use disorder (MOUD) and stigma towards people with OUD remain understudied. We combined data on methadone, buprenorphine, and naltrexone providers from SAMHSA’s 2019 directory, additional naltrexone providers from Vivitrol’s location finder service, with a nationally representative survey called “The AmeriSpeak survey on stigma toward people with OUD.” Integrating the social-ecological framework, we focus on individual characteristics, personal and family members’ experience with OUD, and spatial access to MOUD at the community level. We use nationally representative survey data from 3008 respondents who completed their survey in 2020. Recognizing that stigma is a multifaceted construct, we also examine how the process varies for different types of stigma, specifically perceived dangerousness and untrustworthiness, as well as social distancing measures under different scenarios. We found a significant association between stigma and spatial access to MOUD — more resources are related to weaker stigma. Respondents had a stronger stigma towards people experiencing current OUD (versus past OUD), and they were more concerned about OUD if the person would marry into their family (versus being their coworkers). Additionally, respondents’ age, sex, education, and personal experience with OUD were also associated with their stigma, and the association can vary depending on the specific type of stigma. Overall, stigma towards people with OUD was associated with both personal experiences and environmental measures.
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Affiliation(s)
- Qinyun Lin
- Center for Spatial Data Science, University of Chicago, USA.
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, USA
| | | | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, USA
| | - Harold Pollack
- School of Social Service Administration, University of Chicago, USA
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Moore KE, Siebert SL, Kromash R, Owens MD, Allen DC. Negative attitudes about medications for opioid use disorder among criminal legal staff. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100056. [PMID: 36845981 PMCID: PMC9948914 DOI: 10.1016/j.dadr.2022.100056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stigma is a barrier to the treatment of opioid use disorder (OUD) in the criminal legal system. Staff sometimes have negative attitudes about medications for OUD (i.e., MOUD), but there is little research on what drives these attitudes. How staff think about criminal involvement and addiction may explain their attitudes toward MOUD. METHODS A convenience sample of U.S. criminal legal staff (e.g., correctional/probation officers, nurses, psychologists, court personnel) were recruited via online methods (N = 152). Participants completed an online survey of their attitudes about justice-involved people and addiction, and these were entered as predictors of an adapted version of the Opinions about Medication Assisted Treatment survey (OAMAT) in a linear regression, controlling for sociodemographics (cross-sectional design). RESULTS At the bivariate level, measures capturing more stigmatizing attitudes toward justice-involved people, believing addiction represents a moral weakness, and believing people with addiction are responsible for their actions and their recovery were related to more negative attitudes about MOUD, whereas higher educational attainment and believing addiction has a genetic basis were related to more positive attitudes about MOUD. In a linear regression, only stigma toward justice-involved people significantly predicted negative attitudes about MOUD (B = -.27, p = .010). CONCLUSION Criminal legal staff's stigmatizing attitudes about justice-involved people, such as believing they are untrustworthy and cannot be rehabilitated, contributed significantly to negative attitudes about MOUD, above their beliefs about addiction. The stigma tied to criminal involvement needs to be addressed in attempts to increase MOUD adoption in the criminal legal system.
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Shania L Siebert
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Rachelle Kromash
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Diamond C Allen
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
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van den Berk Clark C, Pickard JG, Drallmeier T. The role of age and opioid agonist treatment on substance use treatment completion in the United States. Aging Ment Health 2022; 26:1295-1302. [PMID: 33999741 DOI: 10.1080/13607863.2021.1925223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a large body of research indicating that substance use disorder treatment completion leads to higher rates of sustained recovery. However, not much is known about how age and opioid treatment programs (OTPs) OTPinteract to affect treatment completion. The purpose of this article is to better understand the pathway between age, OTP, and treatment completion. METHODS Data from the US 2017 Treatment Episodes Data Set was analyzed. Seemingly unrelated bivariate probit regression was used to determine whether OTP access mediates the relationship between age and treatment completion. We used propensity score matching to simulate the effects of a randomized control trial and to attenuate the likelihood of a Type 1 error. RESULTS Older adults have a higher likelihood than their younger counterparts of completing treatment regardless of OTP status in inpatient and outpatient settings. Those who received OTP in inpatient treatment had a 45% increased probability of completing treatment in detox settings and a 41% increased probability of completing treatment in inpatient settings. Older adults (age 50+) were more likely to receive OTP than their younger counterparts. There is a small but significant indirect effect of age on treatment completion in inpatient settings. CONCLUSIONS Older adults are more likely to receive OTP in both inpatient and outpatient settings. However, age does not appear to affect the probability of treatment completion when individuals receive OTP, except in inpatient settings. Implications are discussed.
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Affiliation(s)
- Carissa van den Berk Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joseph G Pickard
- School of Social Work, University of Missouri St. Louis, St. Louis, MO, USA
| | - Theresa Drallmeier
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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Caro-Cañizares I, Carmona Camacho R, Vidal Mariño C, López Carpintero N, Baca-García E. Barriers to Obstetric Prenatal Care Among Pregnant Women at Risk for Dual Pathology. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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