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Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ. Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2046-2064. [PMID: 37920999 DOI: 10.1177/15248380231205821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.
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Graves RL, Shofer FS, Kayser JB, Perrone J. First-Year Medical Students' Perceptions of Stigma Toward People With Opioid Use Disorder Before and After an Educational Intervention. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:486-492. [PMID: 38456439 DOI: 10.1177/29767342241236302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stigma among medical trainees toward people with opioid use disorder (OUD) compounds the problems associated with opioid addiction. People with OUD who experience overt and implicit stigma from healthcare providers are less likely to seek and receive treatment, further restricting their access to already limited resources. The objective of our study was to assess an educational strategy to mitigate stigma toward people with OUD among first-year medical students. METHODS This study assessed perceptions of stigma toward people with OUD among first-year medical students using an adaptation of a brief, validated opioid stigma scale before and after an educational intervention. The intervention consisted primarily of a recorded panel in which people with a history of OUD shared their experiences with stigma followed by small group discussions. RESULTS After the educational intervention, students were more likely to respond that (1) they believed most people held negative beliefs about people with OUD and (2) they personally disagreed with negative statements about people with OUD. CONCLUSIONS Educational interventions addressing stigma toward people with OUD are potentially effective and should be integrated into medical curricula. Such interventions are a crucial part of the effort to improve the medical care of people with OUD.
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Affiliation(s)
- Rachel L Graves
- Department of Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | - Frances S Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua B Kayser
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Medicine Center for Addiction Medicine and Policy, Philadelphia, PA, USA
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Cheetham A, Grist E, Nielsen S. Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research. Curr Opin Psychiatry 2024; 37:251-257. [PMID: 38726819 DOI: 10.1097/yco.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. RECENT FINDINGS Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. SUMMARY Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Putney J, Halmo R, Collin CR, Abrego-Baltay B, O'Brien M, Thomas KA. The Perceived Impact of Substance Use Education on Social Work Students' Knowledge, Attitudes, and Skills. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:446-452. [PMID: 38294431 DOI: 10.1177/29767342241229051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report revealing that over 46 million individuals in the United States had a substance use disorder (SUD). In the same year, a record number of drug-related overdose deaths were reported. Social workers play an important role in connecting with people who use substances and providing adequate care and treatment; yet, negative attitudes and lack of holistic knowledge about individuals who use substances create challenges in providing effective care. Social work curricula that integrates substance use content has been identified as one way to address this. METHODS A 14-week course was introduced in one institution's Master of Social Work curriculum with the goal of providing students with a comprehensive education on SUDs. Foundational knowledge and practical skill development were covered. Seventeen trained instructors taught a total of 1204 students between May 2020 and January 2022. Quantitative and qualitative data were collected to explore changes in student's self-perceived knowledge, attitudes, and skills related to substance use. RESULTS Among those who completed the survey (N = 553), the majority felt that the course would have a positive impact on their future work and professional development. Specifically, 96.4% reported being satisfied or very satisfied with the course overall. Among those who completed a 30-day follow-up survey (n = 69), data revealed an increase in students' self-perceived knowledge, accompanied by a shift in attitudes and positive changes in self-perceived client-centered care skills. CONCLUSIONS Findings from this article support the development, implementation, and evaluation of evidence-based substance use content within social work curricula. This has implications for improving knowledge, attitudes, and skills among social workers who work with people who use substances.
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Affiliation(s)
- Jennifer Putney
- Department of Social Work, University of Vermont, Burlington, VT, USA
- Simmons University School of Social Work, Boston, MA, USA
| | - Rebekah Halmo
- Simmons University School of Social Work, Boston, MA, USA
| | - Cali-Ryan Collin
- Northeastern University College of Social Sciences and Humanities, Boston, MA, USA
| | | | - Molly O'Brien
- Department of Social Work, University of Vermont, Burlington, VT, USA
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Jadhari R, Pathak N, Shrestha R, Shrestha S, KC B, Gan SH, Paudyal V. Advancing opioid stewardship in low-middle-income countries: challenges and opportunities. J Pharm Policy Pract 2024; 17:2345219. [PMID: 38845626 PMCID: PMC11155429 DOI: 10.1080/20523211.2024.2345219] [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] [Indexed: 06/09/2024] Open
Abstract
The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.
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Affiliation(s)
- Rojita Jadhari
- Drug Discovery and Development, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Nabin Pathak
- Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Bagmati Province, Makwanpur, Hetauda, Nepal
- Department of Pharmacy and Clinical Pharmacology, Madan Bhandari Academy of Health Sciences, Bagmati Province, Makwanpur, Hetauda, Nepal
| | - Rajeev Shrestha
- Palliative Care and Chronic Disease, INF Nepal Green Pastures Hospital and Rehabilitation Centre, Pokhara, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Bhuvan KC
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Vibhu Paudyal
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Koehm K, Rosen JG, Yedinak Gray JL, Tardif J, Thompson E, Park JN. "Politics Versus Policy": Qualitative Insights on Stigma and Overdose Prevention Center Policymaking in the United States. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241253663. [PMID: 38804608 DOI: 10.1177/29767342241253663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Federal, state, and municipal governments in the United States have been reluctant to authorize overdose prevention centers (OPCs), which are evidence-based approaches for preventing overdose deaths and blood-borne pathogen transmission. METHODS From July 2022 to February 2023, we explored how stigma manifests in OPC policymaking by conducting in-depth interviews with 17 advocates, legislators, service providers, and researchers involved with OPC advocacy and policymaking in Rhode Island, California, Pennsylvania, and New York. RESULTS We found that although jurisdictions differed in their OPC policymaking experiences, stigma manifested throughout the process, from planning to authorization. Participants described OPCs as a tool for destigmatizing overdose and substance use, yet confronted institutionalized stigma and discriminatory attitudes toward people who use drugs (PWUD) and harm reduction from multiple sources (eg, politicians, media, and members of the public). Opposition toward OPCs and harm reduction approaches more broadly intersected with public discourse on crime, homelessness, and public disorder. Employed stigma-mitigation strategies included humanizing PWUD, publicizing the benefits of OPCs to the wider community, and strategically engaging media. CONCLUSION These findings illustrate the importance of understanding stigma at different stages of the policymaking process to better facilitate authorization and eventual implementation of OPCs in the United States.
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Affiliation(s)
- Kristin Koehm
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jesse L Yedinak Gray
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
| | - Ju Nyeong Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
- Division of General Internal Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Martin SI, Bennett AS, Elliott L, Gorgens KA. Overdose Risk and Brain Injury (Traumatic Brain Injury/Acquired Brain Injury), A Commentary. Subst Use Misuse 2024:1-4. [PMID: 38803022 DOI: 10.1080/10826084.2024.2359722] [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: 05/29/2024]
Abstract
OBJECTIVE This commentary seeks to evaluate existing knowledge about the relationship between brain injury (BI) and overdose (OD), to unify distant bodies of literature, and to enhance prevention and treatment for opioid OD among individuals with BI. BACKGROUND There is a hidden epidemic of undiagnosed BI in the United States. Due to lack of screening, the vast majority of BI sufferers do not know they have a BI. Not only are those with BI at elevated risk for opioid use, misuse, and opioid use disorder, but also they are at elevated risk for OD. Conversely, those with OUD and those who experienced an OD, are more likely to sustain BI. Key Findings/Conclusions: The existing literature suggests that primary strategies to reduce ABI (Acquired Brain Injury)/TBI (Traumatic Brain Injury) harms involve addressing: screening, stigma, racial disparities, and popular misconceptions about OD. The association between TBI and OD is an underexamined public health issue, exacerbated by the bidirectional nature of the relationship. Not only is TBI a risk factor for opioid OD; opioid OD was also found to be a major cause of ABI, which can have lifelong effects similar to Alzheimer's disease. Screening tools for BI were underutilized and inconsistently implemented across reviewed studies. Enhanced screening population wide is a promising intervention, complemented with expanded treatment and research. Black individuals face worse outcomes in BI and treatment outcomes. Anti-racist strategies must fight inequity while addressing social and structural drivers of overdose and BI within the opioid and opioid overdose crises.
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Affiliation(s)
- Samuel I Martin
- Research Associate, School of Global Public Health, New York University, Doctoral Candidate, Graduate School of Professional Psychology, University of Denver
| | - Alex S Bennett
- Research Associate Professor, Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University
| | - Luther Elliott
- Associate Research Scientist, School of Global Public Health, New York University
| | - Kim A Gorgens
- Professor, Graduate School of Professional Psychology, University of Denver
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Khazaee-Pool M, Naghibi SA, Pashaei T, Ponnet K. Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol. Addict Sci Clin Pract 2024; 19:40. [PMID: 38755676 PMCID: PMC11097512 DOI: 10.1186/s13722-024-00472-8] [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: 08/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs. METHODS/DESIGN The present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants' perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique. DISCUSSION This is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Abolhassan Naghibi
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Department of Health Promotion and Education, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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St Marie BJ, Bernhofer EI. Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder. J Am Assoc Nurse Pract 2024:01741002-990000000-00216. [PMID: 38656884 DOI: 10.1097/jxx.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
ABSTRACT People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.
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Affiliation(s)
| | - Esther I Bernhofer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Garcia V, McCann L, Lauber E, Vaccaro C, Swauger M, Heckert DA. Opioid Overdoses and Take-Home Naloxone Interventions: Ethnographic Evidence for Individual-Level Barriers to Treatment of Opioid Use Disorders in Rural Appalachia. Subst Use Misuse 2024; 59:1313-1322. [PMID: 38635977 DOI: 10.1080/10826084.2024.2340986] [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: 04/20/2024]
Abstract
Introduction: Research indicates that take-home naloxone (THN) is saving lives across rural Appalachia, but whether it also results in treatment for opioid use disorders (OUDs) remains unclear. This study involves a detailed qualitative analysis of interviews with 16 individuals who had overdosed on opioids 61 times to understand why a THN intervention does not routinely lead to OUD treatment. Methods: This study builds upon a one-year (2018) qualitative study on community responses to opioid overdose fatalities in four adjacent rural counties in Western Pennsylvania. Using a semi-structured interview guide, 16 individuals who had experienced one or more overdoses were interviewed. Using NVivo, the transcribed audio-recorded interviews were coded, and a thematic analysis of the coded text was conducted. Findings: Findings reveal that of the 29 overdoses that included a THN intervention, only eight resulted in treatment. The analysis derives five individual-level barriers to treatment: (1) opioid dependence, (2) denial/readiness, (3) opioid withdrawal fears, (4) incarceration concerns, and (5) stigma and shame. These barriers impeded treatment, even though all the interviewees knew of treatment programs, how to access them, and in some cases had undergone treatment previously. Discussion and Conclusion: findings indicate that there is evidence that the five barriers make entering treatment after a THN intervention challenging and seemingly insurmountable at times. Recommendations based on the findings include increasing efforts to reduce stigma of OUDs in the community, including self-stigma resulting from misusing opioids, increasing informational efforts about Good Samaritan Laws, and increasing familiarity with medication-assisted treatments for OUDS.
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Affiliation(s)
- Victor Garcia
- Research Scientist, Prevention Research Center, Berkeley, California, USA
| | - Lisa McCann
- Department of Sociology, Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Erick Lauber
- Department of Communications Media, Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Christian Vaccaro
- Department of Sociology Associate Director Mid Atlantic Research and, Training Institute Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Melissa Swauger
- Nonprofit Management, Empowerment and Diversity Studies (new address), Slippery Rock University of Pennsylvania Slippery Rock, Pennsylvania, USA
| | - Daniel Alex Heckert
- Department of Sociology Director Mid Atlantic Research and Training Center, Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
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Sibley AL, Klein E, Cooper HLF, Livingston MD, Baker R, Walters SM, Gicquelais RE, Ruderman SA, Friedmann PD, Jenkins WD, Go VF, Miller WC, Westergaard RP, Crane HM. The relationship between felt stigma and non-fatal overdose among rural people who use drugs. Harm Reduct J 2024; 21:77. [PMID: 38582851 PMCID: PMC10998326 DOI: 10.1186/s12954-024-00988-x] [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: 06/13/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Emma Klein
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave, Suite 510, Portland, OR, 97201, USA
| | - Suzan M Walters
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, 180 Madison, New York, NY, 10016, USA
| | - Rachel E Gicquelais
- School of Nursing, University of Wisconsin-Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Stephanie A Ruderman
- Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main St, Springfield, MA, 01199, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - William C Miller
- Department of Epidemiology, UNC Gillings School of Global Public Health, CB#8050, 3rd Floor Carolina Square, Chapel Hill, NC, 27516, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Mail Stop 359931, Seattle, WA, 98104, USA
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Nataraj N, Rikard SM, Zhang K, Jiang X, Guy GP, Rice K, Mattson CL, Gladden RM, Mustaquim DM, Illg ZN, Seth P, Noonan RK, Losby JL. Public Health Interventions and Overdose-Related Outcomes Among Persons With Opioid Use Disorder. JAMA Netw Open 2024; 7:e244617. [PMID: 38568691 PMCID: PMC10993074 DOI: 10.1001/jamanetworkopen.2024.4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/05/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Given the high number of opioid overdose deaths in the US and the complex epidemiology of opioid use disorder (OUD), systems models can serve as a tool to identify opportunities for public health interventions. Objective To estimate the projected 3-year association between public health interventions and opioid overdose-related outcomes among persons with OUD. Design, Setting, and Participants This decision analytical model used a simulation model of the estimated US population aged 12 years and older with OUD that was developed and analyzed between January 2019 and December 2023. The model was parameterized and calibrated using 2019 to 2020 data and used to estimate the relative change in outcomes associated with simulated public health interventions implemented between 2021 and 2023. Main Outcomes and Measures Projected OUD and medications for OUD (MOUD) prevalence in 2023 and number of nonfatal and fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. Results In a baseline scenario assuming parameters calibrated using 2019 to 2020 data remained constant, the model projected more than 16 million persons with OUD not receiving MOUD treatment and nearly 1.7 million persons receiving MOUD treatment in 2023. Additionally, the model projected over 5 million nonfatal and over 145 000 fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. When simulating combinations of interventions that involved reducing overdose rates by 50%, the model projected decreases of up to 35.2% in nonfatal and 36.6% in fatal opioid-involved overdoses among persons with OUD. Interventions specific to persons with OUD not currently receiving MOUD treatment demonstrated the greatest reduction in numbers of nonfatal and fatal overdoses. Combinations of interventions that increased MOUD initiation and decreased OUD recurrence were projected to reduce OUD prevalence by up to 23.4%, increase MOUD prevalence by up to 137.1%, and reduce nonfatal and fatal opioid-involved overdoses among persons with OUD by 6.7% and 3.5%, respectively. Conclusions and Relevance In this decision analytical model study of persons with OUD, findings suggested that expansion of evidence-based interventions that directly reduce the risk of overdose fatality among persons with OUD, such as through harm reduction efforts, could engender the highest reductions in fatal overdoses in the short-term. Interventions aimed at increasing MOUD initiation and retention of persons in treatment projected considerable improvement in MOUD and OUD prevalence but could require a longer time horizon for substantial reductions in opioid-involved overdoses.
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Affiliation(s)
- Nisha Nataraj
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S. Michaela Rikard
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kun Zhang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ketra Rice
- Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine L. Mattson
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R. Matthew Gladden
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Desiree M. Mustaquim
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zachary N. Illg
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Puja Seth
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rita K. Noonan
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan L. Losby
- Division of Overdose Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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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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14
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Pfalzgraf AR, Friend R, Jones KD. Do FIQR Severity Categories and Symptoms, Differentiate Between Continuous, Intermittent and Non-Opioid Users in the Treatment of Fibromyalgia? Pain Manag Nurs 2024; 25:181-188. [PMID: 37993311 PMCID: PMC11016416 DOI: 10.1016/j.pmn.2023.10.005] [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: 03/27/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Many fibromyalgia patients utilize opioids to treat symptoms. It is important to better understand nuances regarding this treatment option and any stigma associated with this treatment modality. AIM This study: (1) assessed the prevalence of opioid use among continuous, intermittent, and non-opioid users in fibromyalgia patients; (2) determined whether the Revised Fibromyalgia Impact Questionnaire (FIQR) was useful in distinguishing opioid use and symptom burden; and (3) assessed whether fibromyalgia patients encountered stigma and/or invalidation. DESIGN A cross-sectional, observational study of 1,105 participants' responses to validated fibromyalgia and invalidation scales and demographic questions. METHODS The study employed online survey methodology. RESULTS A total of 45% of patients reported utilizing opioids (27% continuous, 18% intermittent, 55% non-users). FIQR disease categories (mild to most severe) strongly distinguished between opioid and non-opioid users with 59% of users falling in the most severe category and 68% of non-users falling in mild disease category (p < .0001). Interestingly, intermittent users were similar to non-users on FIQR severity (65.9 versus 65.7; p <0.60, 0-100) while continuous users reported greater severity than the former (73.9, p < .0001). Continuous users particularly reported more problems with daily activities (p < .0001), being overwhelmed (p < .0001), and being unable to accomplish goals (p < .0001). Stigma related to being 'drug seeking' and being 'judged'. Invalidation was infrequent. CONCLUSIONS Opioid use is common in fibromyalgia and increases monotonically with FIQR severity. Multidisciplinary approaches which help patients perform daily activities, decrease feelings of overwhelm, accomplish goals, and reduce stigma may be beneficial.
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Affiliation(s)
- Andrea R Pfalzgraf
- From the National University of Natural Medicine, Helfgott Research Institute, Portland, OR.
| | - Ronald Friend
- Department of Psychology, College of Arts and Sciences, Stony Brook University, Stony Brook, NY (emeritus); Fibromyalgia Research Unit, Oregon Health & Science University, Portland, OR
| | - Kimberly Dupree Jones
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Oregon Health & Science University, Division of Neurology, Portland, OR
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15
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Kriegel LS, Hampilos K, Weybright E, Weeks DL, Jett J, Hill L, Roll J, McDonell M. Addressing the Spectrum of Opioid Misuse Prevention, Treatment, and Recovery in Rural Washington State Communities: Provider Identified Barriers and Needs. Community Ment Health J 2024; 60:600-607. [PMID: 38200378 DOI: 10.1007/s10597-023-01215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
The opioid overdose epidemic has significantly impacted rural communities. Rural settings present unique challenges to addressing opioid misuse. The purpose of the current study was to understand the similarities and differences between rural and urban-based providers serving rural communities. Washington state-based opioid-related service providers who serve rural communities (N = 75) completed an online survey between July and September 2020. Chi-square tests of association were used to examine significant differences in proportions between rural providers and rural-serving urban providers across opioid prevention, treatment, and recovery training topics. Rural providers reported receiving significantly less opioid treatment and recovery training on the criminal legal system, workplace-based education on treatment and recovery, and co-occurring disorder treatment; and significantly higher prior opioid prevention training on the prevention programs for youth and accessing prevention funding. Differences between rural and rural-serving urban providers demonstrate ways in which rural-urban partnerships can be strengthened to enhance public health.
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Affiliation(s)
- Liat S Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Katherine Hampilos
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Weybright
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Douglas L Weeks
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Julianne Jett
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Laura Hill
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - John Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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16
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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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17
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Hershow RB, Love Pieczykolan L, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. Were Needles Everywhere?: Differing Views on Syringe Waste and Disposal Associated With Needs-Based Syringe Services Programs Among Community Partners and Persons Who Inject Drugs. Subst Use Misuse 2024; 59:1174-1181. [PMID: 38509704 PMCID: PMC11103866 DOI: 10.1080/10826084.2024.2330895] [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: 03/22/2024]
Abstract
BACKGROUND Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs. METHODS Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs. RESULTS Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs. CONCLUSIONS Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.
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Affiliation(s)
- Rebecca B. Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Love Pieczykolan
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne Wilson
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shannon McBee
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shawn Balleydier
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Kathryn G. Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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De Meyer F, Bencherif N, De Ruysscher C, Lippens L, Vanderplasschen W. Self-change from problems with alcohol and drugs: A scoping review of the literature since 2010. Drug Alcohol Rev 2024. [PMID: 38501257 DOI: 10.1111/dar.13834] [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: 10/04/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
ISSUES Self-change from alcohol and drug use problems is increasingly acknowledged in research. Despite the growing number of published studies, the most recent broad review of this dispersed field dates back to 2010. The present review narratively synthesises key findings from empirical studies and critically identifies research gaps and directions for further research. APPROACH Following the PRISMA guidelines for scoping reviews, a systematic search was conducted in multiple scientific databases, resulting in the identification of 56 relevant articles with explicit empirical results on self-change. KEY FINDINGS The scoping review presents findings related to: (i) methods and definitions used; (ii) the prevalence of self-change; (iii) indicators of self-change; (iv) the process of self-change; and (v) population views on self-change. CONCLUSION The review highlights the significant growth in research on self-change considering key themes as well as the need for a relational and time-bound approach to self-change in research and practice.
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Affiliation(s)
- Florian De Meyer
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Nellie Bencherif
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | | | - Lou Lippens
- Department of Special Needs Education, Ghent University, Ghent, Belgium
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19
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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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20
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MacLean RR, Spinola S, Pittman B, Meyerovich J, Szollosy SK, Wolkowicz NR, Minnix S, Sofuoglu M. The relationship of pain intensity and opioid craving with delayed methadone dose: A preliminary study of individuals with opioid use disorder. Br J Clin Pharmacol 2024. [PMID: 38439592 DOI: 10.1111/bcp.16027] [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: 10/02/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS Despite a strong theoretical link between opioid craving and pain, little is known about the temporal relationship between pain and craving and the acute experience of pain in the context of methadone treatment. Using a cross-over design, the current study evaluated the time course of pain and craving and objective experience of pain as a function of the last methadone dose. METHODS Participants (n = 20) presented for the study in the morning and either received methadone dose as scheduled or delayed dose until the afternoon. During the 4-h study visit, participants completed a series of tasks, including repeated assessment of pain and craving at 0, +40, +70, +130, +160 and +240 min and a cold pressor test (CPT) at +15 and +220 min. RESULTS Separate mixed model results demonstrated no effect of dosing condition on craving; however, there was a significant dosing condition by time interaction (F(5,209) = 3.38, P = .006) such that pain increased over time in the delayed methadone condition but decreased in time in the scheduled methadone condition. A mixed model predicting self-reported pain revealed a three-way interaction between dosing condition, craving and time (F(5,197) = 2.39, P = .039) explained by a positive association between craving and pain at each time point (except 240 min) in delayed condition (P-range = .004-.0001). A separate mixed model on CPT data indicated a significant condition by time interaction such that pain threshold decreased in the delayed, but not scheduled, condition (F(1,57) = 4.01, P = .050). CONCLUSIONS These preliminary findings highlight the potential for increased risks after even a short delay in receiving a methadone dose.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Suzanne Spinola
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian Pittman
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Noah R Wolkowicz
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stacy Minnix
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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21
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Kenefick HW, Wing A. BeHERE's effective virtual training to build capacity to support people who use drugs in non-substance use disorder settings. Harm Reduct J 2024; 21:38. [PMID: 38351012 PMCID: PMC10863279 DOI: 10.1186/s12954-024-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Human service settings not specifically focused on supporting people who use drugs (PWUD), especially those with a substance use disorder (SUD), such as probation and parole services, homeless shelters, and work re-entry and job training programs, offer a unique opportunity to assist this population and prevent overdose deaths. During the COVID-19 pandemic (pandemic), building capacity in such settings for overdose prevention, harm reduction, and to address barriers to treatment, recovery, and support services required that training vendors use a virtual format. Post-pandemic, virtual training remains a cost-effective and convenient alternative to in-person training. The Behavioral Health and Racial Equity (BeHERE) Training Initiative of Health Resources in Action, which offers eight training modules on prevention, recovery, and harm reduction, delivered 224 online trainings between April 2020 and June 2022. METHODS A mixed methods evaluation based upon the Kirkpatrick Training Evaluation Model was employed, which utilized post-training (n = 1272) and follow-up surveys (n = 62), and key informant interviews (n = 35). RESULTS The findings showed BeHERE's trainings were relevant, engaging, and satisfying to trainees; increased their knowledge, skills, and confidence; and influenced workplace performance. Some participants also indicated that the training influenced the effectiveness of their work with clients and other staff. CONCLUSIONS The evaluation identified aspects of training that make a virtual format effective at improving the capacity of non-SUD settings to address substance use and support PWUD. Findings offer insights for those interested in delivery of virtual training, as well as training to influence the practice of human service providers across different settings to support PWUD.
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Affiliation(s)
| | - Alexis Wing
- Health Resources in Action, 2 Boylston Street, Suite 400, Boston, MA, 02116, USA
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22
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López-Castro T, Jakubowski A, Masyukova M, Peterson M, Pierz A, Kodali S, Arnsten JH, Starrels JL, Nahvi S. Loss, liberation, and agency: Patient experiences of methadone treatment at opioid treatment programs during the COVID-19 pandemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209235. [PMID: 38061636 PMCID: PMC10932891 DOI: 10.1016/j.josat.2023.209235] [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: 03/10/2023] [Revised: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Despite its safety and effectiveness, methadone treatment for opioid use disorder (OUD) remains highly stigmatized, and stringent opioid treatment program (OTP) attendance requirements create barriers to retention for many patients. The COVID-19 pandemic prompted a shift in federal regulations governing methadone, including a blanket exemption permitting increased take-home doses of methadone. We studied the impact of these changes upon established patients' experiences of OTP care. METHOD We conducted semi-structured qualitative interviews with 18 OTP patients who met our criteria of having established OTP care (i.e., enrolled at the OTP for at least 12 weeks) and were administered methadone three to six days weekly prior to the March 2020 blanket exemption. Interviews centered on how COVID-19 had affected their experiences of receiving treatment at an OTP. RESULTS We identified three interconnected themes relevant to transformation of OTP care by the COVID-19 pandemic. Participants described mourning therapeutic OTP relationships and structure (1. loss), yet feeling more satisfaction with fewer in-person OTP visits (2. liberation), and appreciating more opportunities to self-direct their OUD care (3. agency). DISCUSSION Structural changes made to OTP care early in the COVID-19 pandemic resulted in loss of community and structure. Increasing the availability of take-home methadone also improved patient experience and sense of agency. Our findings join a diverse body of converging evidence in support of policy changes allowing for more flexible dosing and individualized OTP care.
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Affiliation(s)
- Teresa López-Castro
- Department of Psychology, Colin Powell School of Civic and Global Leadership, The City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Andrea Jakubowski
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Mariya Masyukova
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Project Renwal, Inc. 200 Varick Street, 9th Floor New York, NY 10014
| | - Meghan Peterson
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Department of Social Medicine, University of North Carolina - Chapel Hill School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, United States
| | - Amanda Pierz
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; The City University of New York Graduate School of Public Health and Health Policy, 55 W. 125(th) Street, New York, NY 10027, United States
| | - Sruthi Kodali
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
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Hsu M, Jung OS, Kwan LT, Jegede O, Martin B, Malhotra A, Suzuki J. Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209216. [PMID: 37981243 DOI: 10.1016/j.josat.2023.209216] [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: 03/07/2023] [Revised: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Achieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness. METHODS We interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data. RESULTS Fifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status. CONCLUSION Systems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.
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Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
| | - Olivia S Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Li Ting Kwan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bianca Martin
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Aniket Malhotra
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Joji Suzuki
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
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24
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Franz B, Dhanani LY, Hall OT, Brook DL, Fenstemaker C, Simon JE, Miller WC. Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals. Addict Sci Clin Pract 2024; 19:7. [PMID: 38243307 PMCID: PMC10797921 DOI: 10.1186/s13722-024-00436-y] [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: 06/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. METHODS In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine's efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. RESULTS On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = - 0.34; 95% CI - 0.46, - 0.21); intentions to increase time spent with this patient population (b = - 0.36; 95% CI - 5.86, - 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33-0.94). CONCLUSIONS Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA.
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Cheyenne Fenstemaker
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Public Health , University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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25
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Watson DP, Ray B, Phalen P, Duhart Clarke SE, Taylor L, Swartz J, Gastala N. Fentanyl Exposure and Detection Strategies Utilized by Clinical Trial Participants Seeking Linkage to Opioid Use Disorder Treatment at a Syringe Service Program. J Med Toxicol 2024; 20:13-21. [PMID: 38048033 PMCID: PMC10774457 DOI: 10.1007/s13181-023-00979-7] [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: 08/11/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
INTRODUCTION The USA continues to face a fentanyl-driven overdose epidemic. Prior research has demonstrated users of illicit opioids are concerned about fentanyl exposure and overdose, but the strategies they report using to detect fentanyl's presence lack empirical support. This study compares self-report and biologically detected fentanyl use and investigates overdose risk and risk reduction behaviors among a sample of high-risk people who use opioids. METHODS Structured enrollment interviews conducted as part of a larger clinical trial assessed self-reported fentanyl exposure as well as strategies used to determine believed fentanyl exposure and prevent overdose among 240 participants enrolled at a Chicago, IL syringe service program. Urinalysis measured actual fentanyl exposure. RESULTS Most participants identified as African American (66.7%) and had considerable overdose experience (76.7% lifetime and 48% in the past year). Most also tested positive for fentanyl (93.75%) despite reporting no past year use of fentanyl or fentanyl-adulterated drugs (64.17%). The most utilized approaches reported for identifying fentanyl exposure were stronger effects of the drug (60.7%), sight or taste (46.9%), and being told by someone using the same drugs (34.2%). Few participants (14%) reported using fentanyl test strips. No significant associations were identified between self-report and urinalysis measures or urinalysis results and risk reduction strategies. CONCLUSION This study adds to prior fentanyl exposure risk research. The disconnect between participants' fentanyl detection methods and reported overdose experiences supports the need for more research to identify and understand factors driving access and use of overdose prevention resources and strategies.
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Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL, 60610, USA.
| | - Bradley Ray
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Chapel Hill, NC, 27709, USA
| | - Peter Phalen
- Department of Psychiatry, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA
| | - Sarah E Duhart Clarke
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Chapel Hill, NC, 27709, USA
| | - Lisa Taylor
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL, 60610, USA
| | - James Swartz
- Jane Addams College of Social Work, The University of Illinois at Chicago, 1040 W Harrison Street, Chicago, IL, 60607, USA
| | - Nicole Gastala
- Department of Family Medicine, Mile Square Health Centers, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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26
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Franz B, Dhanani LY, Hall OT, Brook DL, Simon JE, Miller WC. Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US. Harm Reduct J 2023; 20:180. [PMID: 38129903 PMCID: PMC10740221 DOI: 10.1186/s12954-023-00918-3] [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: 06/15/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). METHODS We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one's training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. RESULTS Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. CONCLUSION Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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27
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Qayyum SN, Ansari RS, Ullah I, Siblini D. The FDA approves the second OTC naloxone - a step toward opioid crisis mitigation. Int J Surg 2023; 109:4349-4350. [PMID: 37678319 PMCID: PMC10720828 DOI: 10.1097/js9.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Sardar N Qayyum
- Department of Internal Medicine, Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa
| | | | - Irfan Ullah
- Department of Internal Medicine, Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa
| | - Dima Siblini
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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29
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Salomon A, Bartlett M, Chenery M, Jauncey M, Roxburgh A. Outrage and algorithms: Shifting drug-related stigma in a digital world. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104224. [PMID: 37857181 DOI: 10.1016/j.drugpo.2023.104224] [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: 03/09/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Illicit drug dependence is one of the most stigmatised health conditions worldwide and the harmful impacts of stigma for people who use drugs are well documented. The use of stigmatising language about drugs in traditional media is also well documented. The increasing use of digital media platforms has revolutionised the way we communicate, and extended the reach of our messages. However, there are issues specific to the ways in which these platforms operate that have the potential to increase drug-related stigma. This paper outlines the importance of language, narrative, and imagery in reducing this stigma. It discusses the challenges digital media platforms present to achieving this goal, including the use of engagement strategies that trigger fear and increase stigma, the potential for amplifying stigmatising messages by using algorithms, and the potential for dissemination of misinformation. Key strategies to frame conversations about drug use are presented including 1) appeal to values of fairness and equity rather than scaring people; 2) avoid correcting misinformation as it strengthens unhelpful stigmatising frames of drug use; and 3) create a new narrative, focusing on the diversity of experiences of people who use drugs. Internationally we are at a critical juncture with respect to drug policy reform, and efforts to reduce drug-related stigma are central to building support for these reforms. The extensive reach of digital media platforms represents an important opportunity to communicate about illicit drug use. The challenge is to do so in a way that minimises stigma. If we are to achieve change, a narrative that puts values, people, health care and equity at the centre of the conversation is critical.
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Affiliation(s)
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | | | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia; Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Amanda Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
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30
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Krendl AC, Perry BL. Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions. Psychol Sci Public Interest 2023; 24:90-126. [PMID: 37883667 DOI: 10.1177/15291006231198193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - Brea L Perry
- Department of Sociology, Indiana University Bloomington
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Picco L, Xia T, Bell JS, Pearce C, Buchbinder R, Lubman DI, Nielsen S. Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis. Drug Alcohol Rev 2023; 42:1639-1646. [PMID: 37798947 PMCID: PMC10947011 DOI: 10.1111/dar.13754] [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: 05/24/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Prescription drug monitoring programs (PDMP) are increasingly used to identify people prescribed high-dose opioids. However, little is known about whether PDMPs impact opioid agonist treatment (OAT) uptake, the gold standard for opioid use disorder. This study examined the impact of PDMP implementation on OAT initiation among people prescribed opioids, in Victoria, Australia. METHODS De-identified electronic records from all 464 Victorian general practices included in the POLAR database were used. OAT initiation was defined as a new OAT prescription between 1 April 2017 and 31 December 2020, with no OAT prescriptions in the year prior. Interrupted time series analyses were used to compare outcomes before (April 2017 to March 2019) and after (April 2019 to December 2020) PDMP implementation. Binary logistic regression was used to examine differences in patients' characteristics associated with OAT initiation prior to and after PDMP implementation. RESULTS In total, 1610 people initiated OAT, 946 before and 664 after PDMP implementation. No significant immediate (step) or longer-term (slope) changes in the rates of OAT initiation were identified following PDMP implementation, after adjusting for seasonality. A high opioid dose (>100 mg oral morphine equivalent) in the 6-months prior to OAT initiation was the only significant characteristic associated with reduced odds of OAT initiation post-PDMP implementation (odds ratio 0.29; 0.23-0.37). DISCUSSION AND CONCLUSIONS PDMP implementation did not have a significant impact on OAT initiation among people prescribed opioids. Findings suggest additional clinical initiatives that support OAT initiation are required to ensure PDMPs meet their intended target of reducing opioid-related harms.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Turning Point, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Chavanne D, Ahluwalia JS, Goodyear K. The effects of race and class on community-level stigmatization of opioid use and policy preferences. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104147. [PMID: 37639913 DOI: 10.1016/j.drugpo.2023.104147] [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: 03/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND With opioid use and overdose rates continuing to plague minority communities in the U.S., we explored whether a geographic community's racial composition and social class affect how opioid use in the community is stigmatized and what policy preferences arise in response. METHODS We use case vignettes in a randomized, between-subjects study (N = 1478) with a nation-wide survey. The vignettes describe a community where opioids are harmfully used, varying whether the community was (1) wealthy or poor, (2) predominantly Black or White and (3) facing prevalent use of painkillers or heroin. We tested how these variables affect public stigmatization of opioid use (measured with ratings of responsibility, dangerousness, sympathy, concern, anger, and disappointment) preferred levels of social distance from communities with opioid use (measured with responses to questions about living, working, and interacting in the community), and policy preferences for responding to opioid use (measured with levels of support for providing a safe-consumption site in the community, treating drug use in the community punitively, treating drug use in the community as an illness, and funding drug treatment in the community through income redistribution). RESULTS Compared to wealthy communities with opioid use, poor communities with opioid use were less stigmatized in terms of responsibility, sympathy, concern, anger, and disappointment; they were also met with less support for punitiveness, more support for treating drug use as an illness, and preferences for greater social distance. Compared to White communities with opioid use, Black communities with opioid use were less stigmatized in terms of responsibility, and they were met with stronger preferences to not live and work there and with reduced support for using income redistribution to provide drug treatment for people in the community. Poor-Black communities with opioid use were also perceived to be more dangerous than both poor-White and wealthy-Black communities with opioid use. CONCLUSION These results point to class- and race-based territorial stigma affecting how communities with opioid use are judged and whether policies for providing communities with treatment are supported.
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Affiliation(s)
- David Chavanne
- Department of Economics, Connecticut College, New London, CT, USA.
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA; Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J 2023; 20:131. [PMID: 37700329 PMCID: PMC10498612 DOI: 10.1186/s12954-023-00867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America. METHODS This narrative review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as "xylazine", "opioid", and "harm reduction". RESULTS Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets. DISCUSSION Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures. CONCLUSION Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA, 23298, USA.
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Tay Wee Teck J, Butner JL, Baldacchino A. Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review. J Telemed Telecare 2023:1357633X231195607. [PMID: 37661829 DOI: 10.1177/1357633x231195607] [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: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
- Forward Leeds and Humankind Charity, Durham, UK
| | - Jenna L Butner
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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Barreveld AM, Mendelson A, Deiling B, Armstrong CA, Viscusi ER, Kohan LR. Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist. Anesth Analg 2023; 137:488-507. [PMID: 37590794 DOI: 10.1213/ane.0000000000006280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Opioid use disorder (OUD) is a rising public health crisis, impacting millions of individuals and families worldwide. Anesthesiologists can play a key role in improving morbidity and mortality around the time of surgery by informing perioperative teams and guiding evidence-based care and access to life-saving treatment for patients with active OUD or in recovery. This article serves as an educational resource for the anesthesiologist caring for patients with OUD and is the second in a series of articles published in Anesthesia & Analgesia on the anesthetic and analgesic management of patients with substance use disorders. The article is divided into 4 sections: (1) background to OUD, treatment principles, and the anesthesiologist; (2) perioperative considerations for patients prescribed medications for OUD (MOUD); (3) perioperative considerations for patients with active, untreated OUD; and (4) nonopioid and nonpharmacologic principles of multimodal perioperative pain management for patients with untreated, active OUD, or in recovery. The article concludes with a stepwise approach for the anesthesiologist to support OUD treatment and recovery. The anesthesiologist is an important leader of the perioperative team to promote these suggested best practices and help save lives.
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Affiliation(s)
- Antje M Barreveld
- From the Department of Anesthesiology, Tufts University School of Medicine, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Andrew Mendelson
- Department of Anesthesiology, University of Virginia School of Medicine, University of Virginia Hospital, Charlottesville, Virginia
| | - Brittany Deiling
- Department of Anesthesiology, University of Virginia School of Medicine, University of Virginia Hospital, Charlottesville, Virginia
| | - Catharina A Armstrong
- Department of Medicine, Tufts University School of Medicine, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Eugene R Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lynn R Kohan
- Department of Anesthesiology, University of Virginia School of Medicine, University of Virginia Hospital, Charlottesville, Virginia
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Zhu DT, Tamang S, Humphreys K. Promises and perils of the FDA's over-the-counter naloxone reclassification. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100518. [PMID: 37497396 PMCID: PMC10366474 DOI: 10.1016/j.lana.2023.100518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 07/28/2023]
Affiliation(s)
- David T. Zhu
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Suzanne Tamang
- Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Menlo Park, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Farrell A, O'Brien B, Janeczko P, Cassimatis N, Monoky D. Heroin Inhalation Leukoencephalopathy: An Overlooked Entity in the Opioid Epidemic. Cureus 2023; 15:e40535. [PMID: 37461780 PMCID: PMC10350332 DOI: 10.7759/cureus.40535] [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] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Heroin inhalation leukoencephalopathy (HIL) is a rare complication of vaporized heroin inhalation leading to white matter degeneration resulting in a range of neurologic disturbances including softened speech, cerebellar ataxia, behavioral changes, cerebellar gait abnormalities, and even respiratory failure resulting in death in the most severe cases. Magnetic resonance imaging (MRI) most commonly demonstrates bilateral hyperintensities affecting the basal ganglia, periventricular white matter, and cerebellum. In this case report, we present a relatively mild case of HIL in a young female patient to describe the characteristic challenges associated with the condition's presentation, diagnosis, and treatment. While healthcare workers everywhere are addressing a complex and ever-changing opioid epidemic, we strive to raise awareness about HIL as only one of a variety of complications resulting from opioid use disorder.
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Affiliation(s)
- Aidan Farrell
- Radiology, Hackensack Meridian School of Medicine, Nutley, USA
| | | | | | | | - David Monoky
- Radiology, Hackensack University Medical Center, Hackensack, USA
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Miller NM, Campbell C, Shorter GW. Barriers and facilitators of naloxone and safe injection facility interventions to reduce opioid drug-related deaths: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104049. [PMID: 37247475 DOI: 10.1016/j.drugpo.2023.104049] [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: 10/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Opioid drug-related deaths continue to be a significant public health concern in the Republic of Ireland (ROI) and Northern Ireland (NI). While both regions have implemented naloxone to reduce drug related deaths, there remains a gap in the implementation of a supervised injection facility (SIF). This study aimed to identify barriers and facilitators to implementing naloxone and a SIF to reduce opioid drug-related deaths in ROI and NI. METHODS Semi-structured interviews (n=23) were conducted in ROI and NI with experts by experience (n=8), staff from low threshold services (n=9), and individuals involved in policy making (n= 6). Data were analyzed using coding reliability Thematic Analysis and were informed by the Risk Environmental Framework. RESULTS The findings illustrated that stigma within the media, health centers, and the community was a significant barrier to naloxone distribution and SIF implementation. Policing and community intimidation were reported to hinder naloxone carriage in both the ROI and NI, while threats of paramilitary violence towards people who use drugs were unique to NI. Municipal government delays and policy maker apathy were reported to hinder SIF implementation in the ROI. Participants suggested peer-to-peer naloxone delivery and amending legislation to facilitate non-prescription naloxone would increase naloxone uptake. Participants recommended using webinars, Town Halls, and a Citizens' Assembly as tools to advocate for SIF implementation. CONCLUSION Local and regional stigma reduction campaigns are needed in conjunction with policy changes to advance naloxone and a SIF. Tailoring stigma campaigns to incorporate the lived experience of people who use drugs, their family members, and the general community can aid in educating the public and change negative perceptions. This study highlights the need for ongoing efforts to reduce stigma and increase accessibility to evidence-based interventions to address opioid drug-related deaths in the ROI, NI, and internationally.
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Affiliation(s)
| | | | - Gillian W Shorter
- Drug and Alcohol Research Network & Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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Hutchinson M, Lavigne É, Patterson Z. Opioid use in the era of COVID-19: a multifaceted study of the opioid epidemic in Canada. Front Pharmacol 2023; 14:1122441. [PMID: 37305538 PMCID: PMC10247957 DOI: 10.3389/fphar.2023.1122441] [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: 12/12/2022] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: The COVID-19 pandemic has had wide economic, social, and health impacts, and has disproportionately affected individuals who were already vulnerable. Individuals who use opioids have dealt with evolving public health measures and disruptions while also dealing with the ongoing opioid epidemic. Opioid-related mortalities in Canada increased throughout the COVID-19 pandemic, but it is unclear to what extent public health measures and the progression of the pandemic contributed to opioid-related harms. Methods: To address this gap, we used emergency room (ER) visits recorded in the National Ambulatory Care Reporting System (NACRS) between 1 April 2017, and 31 December 2021, to investigate trends of opioid-related harms throughout the pandemic. This study also included semi-structured interviews with service providers in the field of opioid use treatment, to help contextualize the trends seen in ER visits and offer perspectives on how opioid use and services have changed throughout the COVID-19 pandemic. Results: Overall, the number of hospitalizations related to an opioid use disorder (OUD) decreased with progressing waves of the pandemic and with increasing severity of public health measures in Ontario. The rate of hospitalizations related to opioid poisonings (e.g., central nervous system and respiratory system depression caused by opioids) significantly increased with the progressing waves of the pandemic, as well as with increasing severity of public health measures in Ontario. Discussion: The increase in opioid-related poisonings is reflected in the existing literature whereas the decrease in OUDs is not. Moreover, the increase in opioid-related poisonings aligns with the observations of service providers, whereas the decrease in OUD contradicts the trends that service providers described. This discrepancy could be explained by factors identified by service providers, including the pressures on ERs during the pandemic, hesitancy to seek treatment, and drug toxicity.
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Affiliation(s)
- Molly Hutchinson
- Faculty of Public Affairs, Carleton University, Ottawa, ON, Canada
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Harvey LH, Sliwinski SK, Flike K, Boudreau J, Gifford AL, Branch-Elliman W, Hyde J. The integration of harm reduction services in the Veterans Health Administration (VHA): a qualitative analysis of barriers and facilitators. J Addict Dis 2023:1-9. [PMID: 37154222 PMCID: PMC10630529 DOI: 10.1080/10550887.2023.2210021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Substance use is common among U.S. military veterans and veterans are at high risk for negative consequences associated with substance use, such as injection-related infections and overdose. Although harm reduction services (HRS) are highly evidence-based, implementation in traditional healthcare settings has been limited. This formative, qualitative study sought to identify barriers and facilitators to the integration of HRS and identify appropriate implementation strategies to support the optimized integration of a comprehensive bundle of HRS in the Veterans Health Administration (VHA). METHODS Semi-structured interviews explored how harm reduction is currently understood by VHA providers and elicited input on perceived facilitators and barriers to implementation. Data were analyzed using a directed content analysis and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation framework was used to organize findings. Results were then mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR - ERIC) tool. RESULTS 15 interviews with VHA providers were conducted across 5 sites. Respondents reported that current HRS are fragmented and dependent on the knowledge, time, and comfort level of individual providers. Stigma around substance use at the patient, provider, and institutional levels was noted to be a key barrier to HRS adoption. Based on identified barriers and facilitators, strategies that may be effective for increasing adoption of HRS include engagement of champions, communication and educational strategies, and adaptation of existing infrastructure. CONCLUSIONS Many of the barriers identified in this formative study may be addressed using evidence-based implementation strategies. Additional research is needed to identify implementation strategies that are effective for addressing stigma, which is perceived to be a persistent challenge to the provision of integrated harm reduction services.
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Affiliation(s)
- Leah H Harvey
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Samantha K Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Kimberlee Flike
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Jacqueline Boudreau
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Allen L Gifford
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Westyn Branch-Elliman
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Veterans Affairs Boston Healthcare System, Department of Medicine, Boston, MA, USA
| | - Justeen Hyde
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
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Sohn M, Delcher C, Talbert JC, Cheng Y, Xu Y, Jadhav ED, Freeman PR. The Impact of Naloxone Coprescribing Mandates on Opioid-Involved Overdose Deaths. Am J Prev Med 2023; 64:483-491. [PMID: 36496279 DOI: 10.1016/j.amepre.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Since 2017, a total of 10 states have mandated naloxone coprescribing intended to prevent fatal opioid overdoses. This study aims to assess the association between naloxone coprescribing/offering mandates and opioid-involved overdose deaths on the basis of the opioid type. METHODS Data on overdose deaths from 1999 to 2020 came from the National Center for Health Statistics CDC WONDER Online Database. This study examined deaths stratified by illicit/synthetic opioids and prescription/treatment opioids. Difference-in-difference negative binomial regression models estimated average marginal effects and 95% CIs. Covariates included opioid dispensing rate, Good Samaritan law, pharmacy-based naloxone access law, mandatory use of prescription drug monitoring program, and recreational cannabis dispensaries. Data collection and analysis were conducted in 2022. RESULTS Ten states implemented naloxone coprescribing/offering mandates during the period. Coprescribing/offering mandates significantly reduced the number of prescription/treatment overdose deaths by 8.61 per state per quarter (95% CI= -15.13, -2.09), a 16% reduction from the counterfactual estimates. Coprescribing/offering mandates did not significantly impact illicit/synthetic overdose deaths (average marginal effect=0.32; 95% CI= -18.27, 18.91). CONCLUSIONS Coprescribing/offering mandates prevent overdose deaths for its target population, individuals using prescription/treatment opioids. These mandates do not appear to impact populations using illicit/synthetic opioids; thus, expanded efforts are needed to reach these individuals.
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Affiliation(s)
- Minji Sohn
- College of Pharmacy, Ferris State University, Big Rapids, Michigan.
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Jeffery C Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Yue Cheng
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Yong Xu
- Marketing Department, College of Business, Ferris State University, Big Rapids, Michigan
| | - Emmanuel D Jadhav
- College of Health Professions, Ferris State University, Big Rapids, Michigan
| | - Patricia R Freeman
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Al-Ghafri Q, Radcliffe P, Gilchrist G. Barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in the Muslim communities: A systematic narrative review of studies on the experiences of people who receive services and service providers. Drug Alcohol Depend 2023; 244:109790. [PMID: 36805826 DOI: 10.1016/j.drugalcdep.2023.109790] [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: 08/05/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of drug use in Muslim communities is difficult to estimate due to religious, social, and cultural prohibition toward drug use. With Islam affecting all aspects of life in the Muslim world, people who use drugs do it clandestinely to avoid stigma and exclusion from the community, leading to a low number of them seeking treatment for their drug use. This review explored the barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in Muslim communities. METHODS This review was in accordance with PRISMA. Seven databases were systematically searched for qualitative, quantitative, and mixed methods studies conducted in countries where at least 70% of the population were Muslim or where data were presented separately for Muslim communities in other countries. Eligible articles were reviewed, and key qualitative themes were abstracted and compared across studies and settings. RESULTS Twenty-four studies were included from Iran, Bangladesh, Afghanistan, Tajikistan, Kazakhstan, Kyrgyzstan, Egypt, Lebanon, and UAE. Two themes were identified: a psychosocial theme included denial of the problem severity, lack of trust in the treatment system, fear of breach in confidentiality and privacy, the need for community support, religion and women who use drugs. Additionally, an organizational theme included affordability, treatment Service characteristics, lack of Awareness, service providers' Attitudes, drug use registration and fear of legal consequences of drug use. Stigma was also identified as an over-arching theme. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies with where 12 of the studies met all 5 the quality criteria. No studies were excluded for having lower quality scores. CONCLUSION This review reflected how diverse the Muslim world is in drug use. It is important to use mosques to raise awareness on people who use drugs and reduce stigma. Providing holistic services for people who use drugs specially women will improve their access to treatment and harm reduction services in the Muslim world.
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Affiliation(s)
- Qutba Al-Ghafri
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
| | - Polly Radcliffe
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
| | - Gail Gilchrist
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, National, National Addiction Centre, 4 Windsor Walk, Denmark Hill Campus, London SE5 8BB, UK.
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Goldfarb SS, Graves K, Geletko K, Hansen MD, Kinsell H, Harman J. Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder. J Emerg Med 2023; 64:481-487. [PMID: 36997432 DOI: 10.1016/j.jemermed.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition. OBJECTIVES The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder. METHODS The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model. RESULTS There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01). CONCLUSIONS The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.
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Affiliation(s)
- Samantha Sittig Goldfarb
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Katelyn Graves
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Karen Geletko
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Megan Deichen Hansen
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Heidi Kinsell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Jeff Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Nielsen S, Larney S. Commentary on Glanz et al.: Longer buprenorphine treatment duration is associated with lower rates of opioid overdose, but can we address barriers to staying in treatment? Addiction 2023; 118:108-109. [PMID: 36045583 PMCID: PMC10086851 DOI: 10.1111/add.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Sarah Larney
- Centre de Recherche du CHUM and Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Canada
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman DI, Nielsen S. Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs. Drug Alcohol Rev 2023; 42:193-202. [PMID: 36169553 PMCID: PMC10947049 DOI: 10.1111/dar.13551] [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: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Amelia Berg
- Association of Participating Services UsersSelf Help Addiction Resource CentreMelbourneAustralia
| | | | - Michael Savic
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Poulsen MN, Asdell PB, Berrettini W, McBryan K, Rahm AK. Application of the COM-B model to patient barriers and facilitators of retention in medication treatment for opioid use disorder in rural Northeastern United States: A qualitative study. SSM. MENTAL HEALTH 2022; 2:100151. [PMID: 36776723 PMCID: PMC9912293 DOI: 10.1016/j.ssmmh.2022.100151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Medications for opioid use disorder (MOUD) reduce illicit opioid use and overdose mortality, but effectiveness remains limited by poor treatment retention. Understanding multilevel barriers and facilitators to retention from the patient perspective can guide intervention strategies to improve retention. Methods We conducted semi-structured telephone interviews to elicit perspectives of individuals with opioid use disorder (OUD) currently (n = 19) and formerly (n = 16) receiving treatment from a multi-clinic outpatient MOUD program in Pennsylvania in July 2020 to January 2021. The Capability, Opportunity, Motivation, Behavior model provided a theoretical framework for analysis. Results Based on interview themes, physical, rather than psychological, capability was more salient to MOUD engagement, and pertained to individual-level factors such as side effects, withdrawal, and the degree to which MOUD addressed participants' need for pain management. Co-existing mental health conditions also challenged participants' physical ability to attend appointments. The opportunity domain contained both physical and social aspects. Physical opportunity for MOUD engagement centered on community-level factors related to MOUD access (e.g., distance, transportation) and clinical-level factors including program policies. Themes related to social opportunity included interpersonal influences-such as therapeutic and social support-and stigma associated with OUD and MOUD. Motivation emerged as the dominant domain for patients. Reflective motivation factors included individual-level factors such as participants' recognition of their addiction and "readiness" to quit illicit opioid use, attitudes toward MOUD, future treatment expectations, motivation to engage in MOUD, and perceived consequences of disengagement. Automatic motivation factors included the degree to which MOUD created a sense of normalcy for participants and the use of illicit drugs to numb emotions. Conclusions Factors at the individual, interpersonal, clinical, community, and societal levels influenced patients' capability, opportunity, and motivation to engage in MOUD. Understanding such factors can inform implementation strategies to improve retention.
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Affiliation(s)
- Melissa N. Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA,Corresponding author. 100 North Academy Avenue Geisinger, Danville, PA, 17822, USA. (M.N. Poulsen)
| | - Patrick B. Asdell
- Department of Population Health Sciences, Geisinger, Danville, PA, 17822, USA
| | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kortney McBryan
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, 17822, USA
| | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, 17822, USA
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Lynch T, Rodriguez W, Eddie D. Education and careers were our way out. J Subst Abuse Treat 2022; 142:108869. [PMID: 36088738 DOI: 10.1016/j.jsat.2022.108869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/17/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
Stigma thrives in vacuums of awareness where stereotypes are allowed to persist. When those of us with lived experience of addiction and addiction recovery stay in the shadows, we miss an opportunity to challenge a harmful narrative-that people with addiction are fundamentally different from other people and don't get better. Here, we three addiction treatment professionals share our lived experience of overcoming substance use disorder, highlighting how education and careers have formed the cornerstones of our recoveries. We also link our experiences to the emerging recovery capital literature, which speaks to the importance of employment in the SUD recovery process, while highlighting how systemic racism and the crimes against humanity committed in the name of the war on drugs remain barriers to many pursuing education and new careers.
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Affiliation(s)
- Toby Lynch
- Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | | | - David Eddie
- Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA; Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, USA.
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