"I was 15 when I started doing drugs with my dad": Victimization, Social Determinants of Health, and Criminogenic Risk Among Women Opioid Intervention Court Participants

Women and opioid use disorder treatment: A scoping review of experiences, use of patient-reported experience measures, and integration of person-centred care principles

BACKGROUND

Patient-reported experience measures (PREMs) are an important aspect of assessing and improving women's experiences of person-centred care during treatment for Opioid Use Disorder (OUD). This scoping review aimed to 1) examine the extent, type, and characteristics of evidence regarding women's OUD treatment experiences, and 2) describe the extent to which PREMs and person-centred care principles are incorporated within research methods.

METHODS

Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review to identify peer-reviewed articles on women's OUD treatment experiences. Data were extracted from 39 included studies and synthesised based on study design, method of assessment/analysis (including use of PREMs), key findings, and the integration of person-centred care principles.

RESULTS

Analysis of included studies revealed a predominance of qualitative research focused on women's experiences of pharmacological OUD treatment (methadone and/or buprenorphine) in Western countries. Women in these studies reported predominantly negative or mixed experiences of treatment. Few studies used validated PREMs and there was a lack of direct assessment or focus on recognised person-centred care principles. However, common categories of outcomes/findings identified in results across studies broadly aligned with person-centred care principles (e.g., fast access to reliable healthcare, effective treatment by trusted professionals), emphasising their applicability to women's experiences of treatment.

CONCLUSIONS

Although there has been an increased focus on women's experiences of treatment for OUD in recent years, results highlighted room for improvement regarding the systematic and comprehensive assessment of women's experiences across different contexts. Given the often negative or mixed experiences reported by women, an increased focus on assessing service provision through a person-centred care lens (including utilising PREMs) may allow for service improvements or adaptations targeted towards the needs and experiences of women.

The Influences of Adverse Childhood Experiences and Social Support on Male Teenagers' Gaming Motivation: A Moderated Network Analysis

INTRODUCTION

Strong gaming motivations can lead to gaming-related health problems, but how gaming motivations are formed is unclear. Therefore, we examined the impact of early life experiences on gaming motivations.

METHODS

Questionnaire data on the gaming motivations, adverse childhood experiences, and social support of 2,171 teenaged online game players were modeled using moderated network analysis.

RESULTS

All adverse childhood experience components positively correlated with achievement and escapism motivations (weight range: 0.08-0.40). Social support from friends (weight = -0.04) negatively moderated the relationship between achievement motivation and other adverse childhood experiences and positively moderated (weight = 0.01) the relationship between escapism motivation and familial dysfunction.

DISCUSSION

The findings indicate that adverse childhood experiences foster negative gaming motivations. Additionally, social support moderates the relationship between adverse childhood experiences and gaming motivations. These findings offer valuable insights that nursing practitioners can apply to gaming-related health problem interventions and prevention in teenagers.

Adolescent child custody loss and substance use treatment as predictors of young adult substance use trajectories among females with foster care and juvenile justice involvement

This study aimed to identify trajectories of substance use from adolescence to young adulthood among 166 females with dual child welfare and juvenile justice system involvement, and to explore the influence of adolescent child custody status and substance use treatment on substance use trajectories. Results identified four substance use trajectory groups (stable moderate substance use, decreasing substance use, increasing substance use, stable high substance use). Custody loss during adolescence predicted membership in the stable high substance use trajectory group (log odds estimate = 2.99, p = < 0.01). No significant associations were found with adolescent substance use treatment. The findings can inform policymakers, foster care professionals, and law enforcement officers to promote the delivery of timely and appropriate substance use services that respond to the unique needs of females across the child welfare and juvenile justice system populations.

Illicit Fentanyl Exposure Among Victims of Violence Treated at a Trauma Center

INTRODUCTION

Opioid overdoses and violent injury are leading causes of death in the United States, yet testing for novel opioids like fentanyl remains uncommon. The purpose of this investigation is to characterize a population of victims of violence who test positive for illicit fentanyl.

METHODS

Retrospective cohort study of patients treated at a level-one trauma center between January 31, 2019 and February 21, 2020. Data were extracted from the electronic medical record. Subjects were included if they had an encounter diagnosis for a violent or intentional injury, using the International Classification of Diseases, v10 (X92-Y09). We excluded patients who received licit fentanyl as a part of their care before testing. Those who tested positive for fentanyl exposure on our standard hospital urine drug screen were considered to have been exposed to illicit fentanyl. Those testing negative for fentanyl were considered controls.

RESULTS

Of the 1132 patients treated for intentional injuries during the study period, 366 were included in the study (32.3%). Of these, 133 (36.3%) subjects were exposed to illicit fentanyl prehospital. There were no demographic differences between cases and controls. Cases had a lower GCS voice score on arrival (median = 4, interquartile range [IQR] = 4-5 versus median = 5, IQR = 4-5, P = 0.02), higher rates of ventilator usage (32.3% versus 21.5%, P = 0.02), and more intensive care unit admissions (27.1% versus 12.0%, P = 0.005). More than half of cases tested negative for opiates (78/133, 58.6%). Cases had more trauma center encounters (26.3% had ≥2 visits versus 15.5%).

CONCLUSIONS

Exposure to illicit fentanyl was common among victims of violence in this single-center study. These patients are at increased risk of being admitted to intensive care units and repeated trauma center visits, suggesting fentanyl testing may help identify those who could benefit from violence prevention and substance abuse treatment.

Female Opioid Court Participants' Narratives of Siloed Medical, Legal, and Social Service Sector Interactions to Inform Future Integrated Interventions

A gap exists regarding how to design gender-specific interventions for women charged with opioid use disorder (OUD)-related crimes. National recent efforts include opioid courts. Treatment courts present opportunities for earlier intervention for women under judicial supervision. We interviewed 31 female participants in the first known opioid court so they could inform cross-sector integrated approaches to address their needs. Data reveal the complexity of participants' involvement with myriad cross-sector organizations, given the duality of their roles as simultaneous lifetime victims and as OUD-related perpetrators. Participants have difficulty trusting systems intended to help them due to systematic failures to prevent or address abuse and neglect over their lifetimes. The opioid crisis cannot be solved without an understanding of early missed intervention opportunities and a cross-sector approach.

Women's Motivators to Engage in Opioid Use Disorder Treatment While Enrolled in an Opioid Intervention Court

IntroductionTo address the rising presence of opioid use disorder in the United States, states have begun to implement specialized opioid intervention courts to provide immediate support for individuals at risk of opioid overdose. The present study sought to understand the motivations of women to engage in treatment while enrolled in an opioid intervention court. MethodsWe conducted 31 in-depth, qualitative interviews with women enrolled in an opioid intervention court in Buffalo, NY, to better understand their motivation regarding opioid use treatment. The data indicated a combined social-ecological and self-determination theory framework. ResultsThematic analysis revealed four themes across the Social-Ecological Model that aligned with motivation-related needs of autonomy, competence, and relatedness, as defined by Self-Determination Theory. Themes at each level of the Social-Ecological Model described either support for or undermining of women's motivation for treatment: (1) individual level: personal motivation for change, (2) interpersonal level: support for OUD treatment-related autonomy, competence, and relatedness, (3) community level: court systems provide pathways to treatment, and (4) society level: insufficient social resources can undermine competence. ConclusionsThe findings provide new insights into various factors across all levels of the Social-Ecological Model that influence motivation for opioid use disorder treatment among women enrolled in opioid intervention court. Results support the possibility to integrate programs rooted in Self-Determination Theory to support opioid use disorder treatment among justice-involved persons.