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Dewey JM, Hibbard P, Watson DP, Konchak JN, Hinami K. A qualitative investigation into the effectiveness of a housing navigator program linking justice-involved clients with recovery housing. HEALTH & JUSTICE 2024; 12:37. [PMID: 39276243 PMCID: PMC11401402 DOI: 10.1186/s40352-024-00293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/05/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND Roughly 24-36% of people who are incarcerated in the U.S. are formally diagnosed with opioid use disorder (OUD). Once released, individuals involved with the criminal legal system (CLS) face increased risks of return to use and fatality and are 129 times more likely to die from an overdose within the first two weeks of release compared to those without CLS involvement. People who are CLS-involved and who are seeking a recovery living environment can access temporary stable housing through recovery homes. However, entering a recovery home can be difficult due to fragmentation among recovery housing organizations and their non-uniform application and screening procedures. A navigation pilot program was implemented to provide clients with recovery home placement advice, pre-screening, and referrals in Cook County, IL. Existing research on recovery homes has rarely examined the importance of recovery housing navigation for enhancing service engagement among CLS-involved individuals receiving medications for OUD. METHODS Semi-structured qualitative interviews were conducted with 22 clients and three recovery housing navigators as part of a program evaluation of the navigation program pilot. Qualitative software was used to organize and qualitatively analyze transcripts through several rounds of coding producing emergent themes, which were then triangulated, and expanded using navigator data. RESULTS Clients seeking recovery home services reported multiple prior challenges securing safe and supportive recovery living environments. Despite low initial expectations, clients described their interactions with housing navigators in favorable terms and felt navigators worked with them effectively to identify and meet their housing and substance use needs in a timely manner. Clients also commented on their partnerships with the navigator throughout the process. Interactions with navigators also calmed fears of rejection many clients had previously experienced and still harbored about the process, which bolstered client-navigator relationships and client motivation to engage with additional services. CONCLUSION Evidence from this study suggests recovery home navigation can improve the speed and efficiency with which clients are connected to appropriate services that are tailored to their specific needs as well as increase client motivation to engage with a myriad of recovery services.
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Affiliation(s)
- Jodie M Dewey
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL, 60610, USA.
| | - Patrick Hibbard
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL, 60610, USA
| | - Dennis P Watson
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL, 60610, USA
| | | | - Keiki Hinami
- Cook County Health, 1950 W. Polk Street, Chicago, IL, 60612, USA
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Jack HE, Arif SA, Moore MA, Bhatraju EP, Thompson JL, Stewart MT, Hawk KF, Bartlett E. Peer support for patients with opioid use disorder in the emergency department: A narrative review. J Am Coll Emerg Physicians Open 2024; 5:e13253. [PMID: 39144727 PMCID: PMC11322658 DOI: 10.1002/emp2.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Faced with a growing opioid overdose crisis, emergency departments (EDs) are increasingly hiring peers-people with lived experiences of addiction and recovery-to work with patients in the ED who have opioid use disorders (OUDs) or who have experienced an opioid overdose. Despite a clear need for more support for patients with OUD and rapid expansion in grant funding for peer programs, there are limited data on how these programs affect clinical outcomes and how they are best implemented within the ED. In this narrative review, we synthesize the existing evidence on how to develop and implement peer programs for OUD in the ED setting. We describe the key activities peers can undertake in the ED, outline requirements of the peer role and best practices for peer supervision and hiring, detail how ED administrators have built financial and political support for peer programs, and summarize the limited evidence on clinical and care linkage outcomes of peer programs. We highlight key resources that ED clinicians and administrators can use to develop peer programs and key areas where additional research is needed.
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Affiliation(s)
- Helen E. Jack
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Shaheer A. Arif
- College of Arts and SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Michael A. Moore
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Elenore P. Bhatraju
- Division of General Internal MedicineDepartment of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jennifer L. Thompson
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Maureen T. Stewart
- Institute for Behavioral HealthThe Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Kathryn F. Hawk
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Emily Bartlett
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
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Drazdowski TK, Castedo de Martell S, Sheidow AJ, Chapman JE, McCart MR. Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch. JMIR Res Protoc 2024; 13:e60671. [PMID: 39037768 DOI: 10.2196/60671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. OBJECTIVE This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. METHODS Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. RESULTS Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. CONCLUSIONS While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study's strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. TRIAL REGISTRATION ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/60671.
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Affiliation(s)
- Tess K Drazdowski
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
| | | | - Ashli J Sheidow
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
| | - Jason E Chapman
- Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States
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Abram MD, Marzano M, Caniano L, Searby A. Nurse led models of care for outpatient substance use disorder treatment: A scoping review. J Clin Nurs 2024. [PMID: 39020508 DOI: 10.1111/jocn.17377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
AIM To map key characteristics and describe nurse led models of care for the treatment of persons with substance use disorders (SUDs) in the outpatient setting. DESIGN A scoping review. METHODS Conducted in accordance with the JBI methodology. The PRISMA-ScR checklist was used. DATA SOURCES Pubmed, CINAHL Complete (EBSCOhost), Cochrane Library, APA PsycNet and Scopus were searched from 1999 to May 2022 and updated on 28 November 2023. A handsearch and a grey literature search was conducted. RESULTS Title and abstract screening was performed on 774 articles resulting in 88 articles for full text screening. Full text screening yielded 13 articles that met inclusion criteria. CONCLUSION Existing nurse-led models of care for SUDS are scarce and limited in scope, with the majority focused on treating opioid use disorder. Additional research is needed to develop, test, and implement efficacious nurse-led models of care for the treatment and management of SUDs. IMPLICATIONS TO CLINICAL PRACTICE Nurse led models of care have demonstrated their efficacy and quality in the management of other chronic diseases. As we move forward with innovative solutions for individuals with addiction, nurse led models of care can be a mechanism to deliver high quality, evidence-based care for SUDs. IMPACT SUDs are chronic diseases that impact individuals, families, and communities. SUDs require a biopsychosocial approach to treatment. Globally, nurses are well positioned to provide high quality care to mitigate the impact of SUDs. This scoping review mapped the extant literature on nurse led models of care for substance use disorder treatment in the outpatient setting finding that additional research is needed to develop, test and implement evidence-based interventions to care for individuals, families, and communities experiencing SUDs. REPORTING METHOD PRISMA checklist for scoping reviews. No patient or public contribution were part of this study. PROTOCOL REGISTRATION Open Science Framework accessible at: https://doi.org/10.17605/OSF.IO/NSW7V.
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Affiliation(s)
- Marissa D Abram
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Maryta Marzano
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
- Stony Brook Population and Preventive Medicine, East Setauket, New York, USA
| | - Lori Caniano
- University Libraries, Adelphi University, Garden City, New York, USA
| | - Adam Searby
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Sonoda K, Sales J, Bello JK, Grucza RA, Scherrer JF. Colorectal Cancer Screening Among Individuals With a Substance Use Disorder: A Retrospective Cohort Study. AJPM FOCUS 2024; 3:100218. [PMID: 38596162 PMCID: PMC11001631 DOI: 10.1016/j.focus.2024.100218] [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: 04/11/2024]
Abstract
Introduction There is limited evidence on colorectal cancer screening among individuals with a substance use disorder. This study aims to investigate the association between personal history of a substance use disorder and colorectal cancer colonoscopy screening completion rates. Methods This retrospective cohort study analyzed 176,300 patients, of whom 171,973 had no substance use disorder and 4,327 had a substance use disorder diagnosis from electronic health record data (January 1, 2008-December 31, 2022) in a Midwestern healthcare system. Baseline was January 1, 2013, and a 10-year follow-up period ran through December 31, 2022. The outcome was receipt of colonoscopy in the 10-year follow-up period. Patients were aged 50-65 years at baseline, meaning that they were eligible for a colonoscopy through the entirety of the 10-year follow-up period. Covariates included demographics (age, race, and neighborhood SES), health services utilization, psychiatric and physical comorbidities, and prior colonoscopy or fecal occult blood testing. Entropy balancing was used to control for confounding in weighted log-binomial models calculating RR and 95% CIs. Results Patients were on average aged 57.1 (±4.5) years, 58.2% were female, 81.0% were White, and 16.9% were of Black race. The most prevalent comorbidities were obesity (29.6%) and hypertension (29.4%), followed by smoking/nicotine dependence (21.0%). The most prevalent psychiatric comorbidity was depression (6.4%), followed by anxiety disorder (4.5%). During the 10-year follow-up period, 40.3% of eligible patients completed a colorectal cancer colonoscopy screening test, and individuals with a substance use disorder diagnosis were significantly less likely to receive a colorectal cancer colonoscopy screening test both prior to and after controlling for confounding (RR=0.73; 95% CI=0.70, 0.77 and RR=0.81; 95% CI=0.74, 0.89, respectively). Results were not modified by sex, race, psychiatric comorbidity, or neighborhood SES. Conclusions Personal history of substance use disorder was independently associated with lower screening completion rates. Healthcare professionals should recognize unique barriers among individuals with substance use disorder and then address them individually as a multidisciplinary team in the outpatient setting to reduce this health disparity.
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Affiliation(s)
- Kento Sonoda
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Joanne Sales
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri
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Ramakrishnan A, Fujita AW, Mehta CC, Wilson TE, Shoptaw S, Carrico A, Adimora AA, Eaton EF, Jones DL, Chandran A, Sheth AN. Brief Report: Substance Use Care Continuum in Women With and Without HIV in the Southern United States. J Acquir Immune Defic Syndr 2024; 95:424-430. [PMID: 38133580 PMCID: PMC10927302 DOI: 10.1097/qai.0000000000003373] [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: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use (SU) contributes to poor outcomes among persons living with HIV. Women living with HIV (WWH) in the United States are disproportionately affected in the South, and examining SU patterns, treatment, and HIV outcomes in this population is integral to addressing HIV and SU disparities. METHODS WWH and comparable women without HIV (WWOH) who enrolled 2013-2015 in the Women's Interagency HIV Study Southern sites (Atlanta, Birmingham/Jackson, Chapel Hill, and Miami) and reported SU (self-reported nonmedical use of drugs) in the past year were included. SU and treatment were described annually from enrollment to the end of follow-up. HIV outcomes were compared by SU treatment engagement. RESULTS At enrollment, among 840 women (608 WWH, 232 WWOH), 18% (n = 155) reported SU in the past year (16% WWH, 24% WWOH); 25% (n = 38) of whom reported SU treatment. Over time, 30%, 21%, and 18% reported SU treatment at 1, 2, and 3 years, respectively, which did not significantly differ by HIV status. Retention in HIV care did not differ by SU treatment. Viral suppression was significantly higher in women who reported SU treatment only at enrollment ( P = 0.03). CONCLUSIONS We identified a substantial gap in SU treatment engagement, with only a quarter reporting treatment utilization, which persisted over time. SU treatment engagement was associated with viral suppression at enrollment but not at other time points or with retention in HIV care. These findings can identify gaps and guide future strategies for integrating HIV and SU care for WWH.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ayako W. Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ellen F. Eaton
- Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL; and
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Dacosta-Sánchez D, Fernández-Calderón F, Díaz-Batanero C, Mancheño-Velasco C, Lozano ÓM. Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission. Eur Addict Res 2024; 30:80-93. [PMID: 38437822 DOI: 10.1159/000535689] [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: 07/14/2023] [Accepted: 11/29/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. METHOD A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. RESULTS Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. DISCUSSION/CONCLUSION Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.
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Affiliation(s)
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Amaro H, Kong Y, Marsh JC, Khachikian T, Guerrero EG. Identifying gender differences in risk profiles and in opioid treatment outcomes in Los Angeles County. EVALUATION AND PROGRAM PLANNING 2023; 97:102240. [PMID: 36702006 PMCID: PMC10121834 DOI: 10.1016/j.evalprogplan.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients' risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1035 clients), 2013 (77 programs, 3671 clients), 2015 (75 programs, 4625 clients), and 2017 (69 programs, 4106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.
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Affiliation(s)
- Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, FL 33199, United States
| | - Yinfei Kong
- California State University, Fullerton College of Business and Economics, 800 N State College Blvd, Fullerton CA 92831, United States
| | - Jeanne C Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, United States
| | - Erick G Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025, United States.
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Enich M, Treitler P, Swarbrick M, Belsky L, Hillis M, Crystal S. Peer Health Navigation Experiences Before and After Prison Release Among People With Opioid Use Disorder. Psychiatr Serv 2023:appips20220310. [PMID: 36820527 DOI: 10.1176/appi.ps.20220310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Recently incarcerated people with opioid use disorder are at high risk of overdose and adverse outcomes as a result of biopsychosocial risk factors. Peer support models aiming to improve these outcomes have expanded in recent years. This qualitative study aimed to document participants' experiences with peer health navigation before and after prison release, examine participants' perspectives on the role of peer health navigators, and understand participants' views on service improvements. METHODS The authors conducted in-depth, semistructured interviews with 39 recipients of peer health navigation at release, 30 of whom also completed a follow-up interview 3 months later. Interviews were analyzed via cross-case analysis. RESULTS Interviewees differently valued the various types of support they received. Participants appreciated working with someone with shared lived experience with whom they could establish a trusting relationship. Nevertheless, structural and policy barriers meant that certain key needs-such as housing and employment-could not always be met. CONCLUSIONS Peer health navigators can connect participants to evidence-based treatment and help them address their psychosocial needs and develop skills to support long-term wellness. Further research is needed to assess the impact of peer health navigation on participant outcomes, such as overdose reduction, treatment engagement, and sustained recovery.
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Affiliation(s)
- Michael Enich
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Margaret Swarbrick
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Leigh Belsky
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Micah Hillis
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, and School of Social Work, Rutgers, the State University of New Jersey, New Brunswick (Enich, Treitler, Belsky, Crystal); Center of Alcohol and Substance Use Studies, Graduate School of Allied and Professional Psychology, Rutgers University, Piscataway, New Jersey, and Collaborative Support Programs of New Jersey, Freehold (Swarbrick); University Behavioral Health Care, Rutgers Health, Piscataway, New Jersey (Hillis); School of Public Health, Rutgers University, New Brunswick, New Jersey (Crystal)
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Banks DE, Duello A, Paschke ME, Grigsby SR, Winograd RP. Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers. Harm Reduct J 2023; 20:5. [PMID: 36639769 PMCID: PMC9839206 DOI: 10.1186/s12954-023-00734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders. METHODS Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations. RESULTS A core theme was identified from participants' narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities. CONCLUSIONS Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.
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Affiliation(s)
- Devin E. Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Alex Duello
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Maria E. Paschke
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Sheila R. Grigsby
- grid.266757.70000000114809378College of Nursing, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA ,grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
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Yakovlyeva A, Griffin W, Worden A, Roth S, DeChant P, Butler D, Tang Q, Litzelman DK. Racial Differences in Retention in a Community-based Addiction Reduction Program Implemented by Peer Recovery Coaches for Women of Reproductive Age. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231218644. [PMID: 38145320 PMCID: PMC10750526 DOI: 10.1177/00469580231218644] [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: 06/02/2023] [Revised: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023]
Abstract
To identify program characteristics that influence the retention of women of reproductive age in the Community-based Addiction Reduction program (CARE), mixed-method analyses of CARE survey data and CARE Peer Recovery Coach (PRC) narrative entries of participant encounters were performed. About 251 women were enrolled in this prospective community-based implementation science intervention. We compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups using Chi-square/T-tests. Qualitative analysis of PRC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods. White compared with Black women in CARE were significantly more likely to be in treatment at intake (P < .001) and more motivated to engage in recovery treatment (P < .001). However, Black women were retained longer in CARE at 2- (P < .006), 6- (P < .011), and 9- (P < .004) months. PRC narrative entries were coded, and emergent themes mapped well to the 4 types of supports provided by PRC as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Analysis of narrative entries by race revealed that Black women were given more detailed information, communications with PRC were more encouraging and proactive in identifying and meeting needs, and PRC took a more hands-on approach when assisting and linking to resources. The inclusion of PRC as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention.
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Affiliation(s)
| | | | | | - Sarah Roth
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Dawn Butler
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Qing Tang
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Debra K. Litzelman
- Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Indiana University Clinical Translational Science Institute, Indianapolis, IN, USA
- IU Center for Global Health Equity, Indianapolis, IN, USA
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Palis H, Gan W, Xavier C, Desai R, Scow M, Sedgemore KO, Greiner L, Nicholls T, Slaunwhite A. Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration. JAMA Netw Open 2022; 5:e2243653. [PMID: 36416821 PMCID: PMC9685494 DOI: 10.1001/jamanetworkopen.2022.43653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Studies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk. OBJECTIVE To examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022. EXPOSURES Substance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events. RESULTS The study identified 6816 people (5980 male [87.7%]; 2820 aged <30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses. CONCLUSIONS AND RELEVANCE This cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.
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Affiliation(s)
- Heather Palis
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wenqi Gan
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington
| | - Chloe Xavier
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Roshni Desai
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marnie Scow
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kali-olt Sedgemore
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Coalition of Peers Dismantling the Drug War, Vancouver, British Columbia, Canada
| | | | - Tonia Nicholls
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Medina S, Van Deelen A, Tomaszewski R, Hager K, Chen N, Palombi L. Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment. Subst Abuse 2022; 16:11782218221097396. [PMID: 35664045 PMCID: PMC9160899 DOI: 10.1177/11782218221097396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing.
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Affiliation(s)
- Stephany Medina
- South Dakota State University – University of South Dakota Joint Master of Public Health Program, Brookings, SD, USA
| | - Anna Van Deelen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Robyn Tomaszewski
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Keri Hager
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Nathaniel Chen
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
| | - Laura Palombi
- Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, Duluth, MN, USA
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Davis SM, Stover AN, Linn H, Dower J, McCawley D, Winstanley EL, Feinberg J. Establishing Peer Recovery Support Services to Address the Central Appalachian Opioid Epidemic: The West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS) Pilot Program. JOURNAL OF APPALACHIAN HEALTH 2021; 3:36-50. [PMID: 35770037 PMCID: PMC9192111 DOI: 10.13023/jah.0303.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Central Appalachia has been disproportionately affected by the opioid epidemic and overdose fatalities. We developed West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS), a program based on peer recovery support, to engage individuals using opioids and link them with a range of services. Methods Community partners providing services to individuals with opioid use disorder (OUD) were identified and collaborations were formalized using a standardized memorandum of understanding. The program was structured to offer ongoing peer recovery support specialist (PRSS) services, not just a one-time referral. A website and cards describing the WV PEERS program were developed and disseminated via community partners and community education sessions. Results Overall, 1456 encounters with individuals with OUD (mean= 2 encounters per individual) occurred in a variety of community settings over 8 months. The majority of referrals were from harm reduction programs. Overall, 63.9% (n=931) of individuals served by WV PEERS accessed services for substance use disorders and/or mental health problems. Over half (52.3%; n = 487) of individuals entered substance use and/or mental health treatment, and nearly a third (30.4%; n = 283) remained in treatment over six months. Implications Using the WV PEERS model, PRSSs effectively engaged and linked individuals with OUD to mental health and substance use treatment in rural central Appalachia. Future research is needed to determine whether these services reduce the risk of overdose mortality.
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Affiliation(s)
| | | | - Herb Linn
- School of Public Health, West Virginia University
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