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Blanford C, Rowell-Cunsolo T. How Social Workers Can Be Deployed to Assist with the Ongoing Opioid Crisis. HEALTH & SOCIAL WORK 2024; 49:185-191. [PMID: 38878168 DOI: 10.1093/hsw/hlae019] [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: 08/18/2023] [Revised: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 07/21/2024]
Abstract
The opioid epidemic has claimed more than 1 million lives in the United States over the past two decades. The persistent increase in deaths indicates that current strategies intended to decrease the negative consequences of opioid use are inadequate. Harm reduction strategies are designed to promote safer substance usage and reduce overdose mortality rates, yet the implementation of harm reduction programs is inhibited by community- and provider-level stigma against people who use opioids, coupled with limited understanding and insufficient education about harm reduction approaches. Despite ongoing research, engagement in opioid treatment programs remains a challenge, and the opioid crisis continues to disproportionately harm marginalized populations. This article describes how social workers are prepared to play a larger role in opioid use treatment because they are trained with the skill set and values necessary to facilitate access to harm reduction programs, promote engagement in substance use treatment, and create and advocate for interventions to address problematic substance use, especially in high-need communities.
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Affiliation(s)
- Courtney Blanford
- Courtney Blanford, MSW, is a doctoral student, School of Social Work, University of Wisconsin-Madison, 1350 University Avenue, Madison, WI 53706, USA
| | - Tawandra Rowell-Cunsolo
- Tawandra Rowell-Cunsolo, PhD, is assistant professor, School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
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Ward MK, Guille C, Jafry A, Gwanzura T, Pryce K, Lewis P, Brady KT. Digital health interventions to support women with opioid use disorder: A scoping review. Drug Alcohol Depend 2024; 261:111352. [PMID: 38861765 DOI: 10.1016/j.drugalcdep.2024.111352] [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: 10/27/2023] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Digital health interventions have the potential to address barriers to care for women. To design effective digital health interventions that meet the needs of this population, a full assessment of the existing literature is required. METHODS This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. A total of four databases were searched: Medline (OVID), Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. Search terms were informed by a preliminary search and included synonyms for opioid use disorder, digital health, and women. Abstract screening and full text review was completed after reviewer calibration. Data extraction was carried out through data charting. RESULTS After removal of duplicates, 901 abstracts were screened; the full text of 26 manuscripts were reviewed. After full text review, 17 studies published between 2018 and 2023 were included in the scoping review. Types of digital health interventions and study designs varied widely, with a majority focused on the peripartum period (n=12). Of 11 studies focused on OUD treatment, only three reported outcomes related to MOUD utilization. Two studies described community engagement to inform the development or modification of interventions. CONCLUSION A variety of digital health interventions are currently being used to address OUD among women. Areas for future work include examining efficacy for MOUD utilization, incorporating community engagement into intervention development, providing support for OUD treatment and recovery in the late postpartum period and beyond, and the development of mobile health applications.
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Affiliation(s)
- Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, USA
| | - Ayesha Jafry
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Kayla Pryce
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-405, Miami, FL 33199, USA
| | - Patrice Lewis
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, USA
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Metcalfe RK, Dobischok S, Bansback N, MacDonald S, Byres D, Lajeunesse J, Harrison S, Koch B, Topping B, Brock T, Foreman J, Schechter M, Oviedo-Joekes E. Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task. Addiction 2024. [PMID: 39054406 DOI: 10.1111/add.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIMS Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. DESIGN Cross-sectional preference elicitation survey. SETTING Metro Vancouver, British Columbia, Canada. PARTICIPANTS 124 current and former iOAT clients. MEASUREMENTS Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. FINDINGS Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. CONCLUSIONS Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.
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Affiliation(s)
- Rebecca Kathleen Metcalfe
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
| | - Sophia Dobischok
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- Department of Education and Counselling Psychology, McGill University, Montreal, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | | | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Bryce Koch
- Doctor Peter Center, Vancouver, BC, Canada
| | - Blue Topping
- Downtown Community Health Centre, Vancouver, Canada
| | - Terry Brock
- Lookout Housing and Health Society, Surrey, Canada
| | - Julie Foreman
- Hope to Health Research and Innovation Centre, Vancouver, Canada
| | - Martin Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Titus-Glover D, Shaya FT, Welsh C, Roane L. The Lived Experiences of Pregnant and Parenting Women in Recovery Toward Medication Treatment for Opioid Use Disorder. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:367-377. [PMID: 38254261 DOI: 10.1177/29767342231221055] [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: 01/24/2024]
Abstract
BACKGROUND Maternal misuse of prescription opioids and illicit drugs such as, heroin and non-pharmaceutical fentanyl analogs has increased in the last 2 decades and one in 5 women reported misuse of opioids. Medications for opioid use disorder (MOUD) are recommended for treating pregnant women with opioid use disorder (OUD). MOUD is effective in reducing cravings and negative outcomes, yet treatment is underutilized and varies in integration and intensity of resources across health systems. Exploring perceptions of MOUD delivery among pregnant/parenting women promises to uncover and address the underlying challenges to treatment, a perspective that may be different for providers and stakeholders. Therefore, our main purpose is to elicit patients' experiences and perceptions of MOUD, associated access to treatment, and availability of supportive resources during pregnancy/postpartum to inform OUD treatment. METHODS Through a qualitative research approach we gathered data from individual interviews/focus group discussions for this pilot study. Pregnant and postpartum parenting women (n = 17) responded to questions related to perceptions of MOUD, access to treatment, and availability of social and psychosocial resources. Data were collected, transcribed, and coded (by consensus) and emerging themes were analyzed using grounded theory methodology. RESULTS Emerging themes revealed positive uptake and perceptions of MOUD, continuing gaps in knowledge, negative impact of stigmatization, and limited access to programs and resources. Supportive relationships from family, peers, healthcare providers and child welfare staff, and co-located services were perceived as positive motivators to recovery. CONCLUSIONS Through the unique lenses of women with lived experience, this study revealed several themes that can be transformative for women. Overall perceptions of MOUD were positive and likely to facilitate uptake and promote positive recovery outcomes. Bridging knowledge gaps will reduce anxieties, fears about neonatal opioid withdrawal syndrome and adverse maternal outcomes. Additionally, a deeper understanding of stigmatization and relationships can inform an integrated patient-centered approach to OUD treatment.
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Affiliation(s)
| | - Fadia T Shaya
- Department of Practice, Sciences and Health Outcomes Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Christopher Welsh
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
| | - Lynnee Roane
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Mumba MN, Mugoya GT, Allen RS, Glenn AL, Richman J, Ghera A, Butler A, Rogers B, Granger TA, Davis LL. The methods and baseline characteristics of a multi-site randomized controlled trial evaluating mindfulness-based relapse prevention in conjunction with peer support to improve adherence to medications for opioid use disorders. Front Psychiatry 2024; 15:1330672. [PMID: 38974917 PMCID: PMC11224476 DOI: 10.3389/fpsyt.2024.1330672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/09/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Medications for opioid use disorders (MOUD) remain the gold standard for treating OUD, but treatment initiation and adherence remain challenging. Exclusive utilization of pharmacotherapy as a treatment modality for OUD is sub-optimal, and a combination of psychotherapies and pharmacotherapies is recommended. General trends indicate the benefits of peer mentoring and MBRP separately. Therefore, we hypothesize that the combined effect of MBRP and Peer mentoring will produce synergistic improvements in MOUD adherence compared to an enhanced twelve-step facilitation (TSF). Methods This paper describes the methods and baseline characteristics of a multi-site randomized controlled trial evaluating the effectiveness of a combination of MBRP and peer support (MiMP) compared to an enhanced TSF in improving adherence to MOUD. Both MiMP and TSF are 12-week manualized protocols that utilize licensed therapists. The interventions are delivered in weekly group sessions that last about 75-90 minutes per session. The primary outcome is MOUD adherence. Secondary and exploratory outcomes include relapse, cravings, depression, anxiety, stress, quality of life, and pain catastrophizing. Results The participants' ages ranged from 21 years to 77 years, with a mean age of 44.5 (SD ± 11.5 years). There was an almost equal distribution of gender and place of residence. Overall, 51.9% (n=54) of participants identified as female and 48.1% (n=50) were male. Similarly, 51.9% (n=54) of participants resided in urban areas, while 48.1% (n=50) resided in rural areas. Participants identified as either black or white, with over three-quarters identifying as white (77.9%, n= 81) and 22.1% (n= 23) as black. Most participants randomized to the 12-step facilitation group were white (93.1%). Relationships and employment status were well distributed between categories. Over half of the participants reported some college or higher education. Over 90% of the participants made less than $75,000 per year. Some participants indicated that they had both public and private health insurance. Discussion and conclusion This study is innovative in several ways including combining MBRP and peer support, addressing comorbid mental health issues among individuals with OUD, utilizing manualized protocols, and evaluating of both physiological and self-reported measures in assessing cortisol reactivity as a predictor of relapse and treatment outcomes.
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Affiliation(s)
- Mercy Ngosa Mumba
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, United States
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States
| | - George Tongi Mugoya
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, Tuscaloosa, AL, United States
| | - Rebecca S. Allen
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Andrea L. Glenn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Joshua Richman
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
- Birmingham VA Health Care System, Birmingham, AL, United States
| | - Anchal Ghera
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States
- Birmingham VA Health Care System, Birmingham, AL, United States
| | - Austin Butler
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, United States
| | - Blossom Rogers
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, United States
| | - Teresa Ann Granger
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, Tuscaloosa, AL, United States
| | - Lori L. Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, United States
- Birmingham VA Health Care System, Birmingham, AL, United States
- Department of Psychiatry, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
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Bello JK, Dell NA, Laxton AM, Conte M, Chen L. Prevalence and predictors of medication for opioid use disorder among reproductive-aged women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100239. [PMID: 38711835 PMCID: PMC11070671 DOI: 10.1016/j.dadr.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Background Women of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12-49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode. Methods This cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015-2021 Treatment Episode Data Set-Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States. Results In the sample of females aged 12-49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD. Conclusions We identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Aaron M. Laxton
- School of Social Work, Saint Louis University, St. Louis, MO, USA
- Assisted Recovery Centers of America, St. Louis, MO, USA
| | - Mary Conte
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Lynn Chen
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Binder A, Mick I. Shaping and shifting schemas on supervised injectable opioid treatment: findings from a cross-sectional qualitative study in two German treatment facilities. Addict Sci Clin Pract 2024; 19:45. [PMID: 38802962 PMCID: PMC11129426 DOI: 10.1186/s13722-024-00475-5] [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: 09/29/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Supervised injectable opioid treatment (SIOT) is a promising alternative for people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral opioid substitution treatment. Yet, SIOT utilization remains limited in Germany. We propose that this is due to beliefs, or schemas, on SIOT among people living with OUD. Drawing from medical sociology and social psychology, this study explores the emergence and evolution of such schemas on SIOT. METHODS We conducted semi-structured interviews with 34 individuals currently in or eligible for SIOT in two German outpatient treatment facilities and paralleled an inductive qualitative content analysis with the exploration of individual cases. RESULTS The analysis revealed that peer-to-peer interaction and individuals' practical experiences in therapy are crucial in constructing and changing idiosyncratic and shared schemas of SIOT. When facing ambiguous information, cognitive strategies like subtyping served to mitigate uncertainty. CONCLUSION This research has important practical implications for integrating experiential knowledge into clinical care and improve information sharing among people living with OUD. A nuanced understanding of the complex network of informal advice-seeking and -giving among people living with OUD is indispensable to adequately expand treatment modalities of proven effectiveness.
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Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (outpatient clinic for addiction medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (outpatient clinic for addiction medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Annette Binder
- Universitätsklinikum Tuebingen, Sektion Suchtmedizin und Suchtforschung (addiction medicine and addiction research department, Medical University Hospital Tuebingen, University of Tuebingen), Calwerstraße 14, 72076, Tuebingen, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
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Goss T, Esguerra J, Newman C, Patrick J, Templeton K. Inclusion of Sex and Gender Differences in U.S. State Action Plans for Opioid Use and Opioid Use Disorder. J Womens Health (Larchmt) 2024; 33:275-282. [PMID: 38064491 DOI: 10.1089/jwh.2023.0232] [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] [Indexed: 03/13/2024] Open
Abstract
Background: States have developed action plans to address the "opioid crisis" over the past several years. While sex- and gender-based differences have been identified in complications of opioid use, risks of addiction to opioids, barriers to treatment of opioid use disorder, and associated stigma, it is unknown if or to what extent opioid plans consider or account for these differences. The objectives of this study were to analyze U.S. state opioid action plans and their inclusion of sex- and gender-specific concerns. Methods: A content analysis of 49 state plans was conducted in June 2020, assessing their inclusion of 14 variables covering provider education, pregnancy-related, and sex- or gender-based differences in opioid addiction and treatment. Results: Neonatal opioid withdrawal syndrome was the most common variable, noted in 57% of plans. Only 14% included pregnancy-related stigma, and 4% identified gender-specific stigma. Contraceptives and family-planning were included in 12% and 10% of plans, respectively. Two states included more than half of the variables and five plans made no mention of sex or gender differences. Conclusions: Few state plans contained sex- or gender-specific information, and those that did focused almost exclusively on childbearing, excluding other unique considerations of opioid-using-women of all ages. The results of this study could improve the care of women using opioids by informing the strategies of state agencies and impacting legislative efforts for prevention initiatives, substance use disorder treatment, and law enforcement programs.
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Affiliation(s)
- Taylor Goss
- Pennsylvania State University College of Medicine, State College, Pennsylvania, USA
| | - Jody Esguerra
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Connie Newman
- Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Jessica Patrick
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Skogseth EM, Brant K, Harrison E, Apsley HB, Crowley M, Schwartz RP, Jones AA. Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:11782218231222339. [PMID: 38433748 PMCID: PMC10906498 DOI: 10.1177/11782218231222339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Introduction The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.
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Affiliation(s)
- Emma M Skogseth
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Brant
- Department of Agricultural Economics, Society, and Education, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
| | - Eric Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Max Crowley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
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10
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Bremer W, Plaisance K, Walker D, Bonn M, Love JS, Perrone J, Sarker A. Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature. Front Public Health 2023; 11:1141093. [PMID: 37151596 PMCID: PMC10158842 DOI: 10.3389/fpubh.2023.1141093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers. Methods In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described. Results On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%). Conclusion The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.
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Affiliation(s)
- Whitney Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, School of Medicine, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Karma Plaisance
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Drew Walker
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Jennifer S. Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
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Fox HC, Milivojevic V, Sinha R. Therapeutics for Substance-Using Women: The Need to Elucidate Sex-Specific Targets for Better-Tailored Treatments. Handb Exp Pharmacol 2023; 282:127-161. [PMID: 37592081 DOI: 10.1007/164_2023_687] [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] [Indexed: 08/19/2023]
Abstract
In the last decade, alcohol consumption in the US has risen by 84% in women compared with 35% in men. Furthermore, research has shown that sex- and gender-related differences may disadvantage women in terms of developing a range of psychological, cognitive, and medical problems considerably earlier in their drinking history than men, and despite consuming a similar quantity of substances. While this "telescoping" process has been acknowledged in the literature, a concomitant understanding of the underlying biobehavioral mechanisms, and an increase in the development of specific treatments tailored to women, has not occurred. In the current chapter we focus on understanding why the need for personalized, sex-specific medications is imperative, and highlight some of the potential sex-specific gonadal and stress-related adaptations underpinning the accelerated progress from controlled to compulsive drug and alcohol seeking in women. We additionally discuss the efficacy of these mechanisms as novel targets for medications development, using exogenous progesterone and guanfacine as examples. Finally, we assess some of the challenges faced and progress made in terms of developing innovative medications in women. We suggest that agents such as exogenous progesterone and adrenergic medications, such as guanfacine, may provide some efficacy in terms of attenuating stress-induced craving for several substances, as well as improving the ability to emotionally regulate in the face of stress, preferentially in women. However, to fully leverage the potential of these therapeutics in substance-using women, greater focus needs to the placed on reducing barriers to treatment and research by encouraging women into clinical trials.
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Affiliation(s)
- Helen C Fox
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
| | - Verica Milivojevic
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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