Thesis (Ph.D.)--Boston University.

Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-02

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Intro: Opioids and their role in medicine, their use and abuse, have become a topic of intense scrutiny and interest over the last several years. Since 1999, the number of opioid overdose deaths has quadrupled, while the amount of prescription opioids sold in the U.S has increased by the same factor. Federal lawmakers, law enforcement, pharmaceutical companies, and investigative journalists have all become involved in what is often called “the opioid epidemic”, a stage where the issues of pain management, drug abuse, regulation, and autonomy are in seeming opposition. Physicians are uniquely positioned on this stage, both as healers and healthcare providers, professionals tasked with managing pain, preventing and treating addiction and overdose, and advocating for the needs of the population they serve. Paradoxically, issues related to pain management, addiction, and abuse are widely underrepresented in the educational curricula of most physicians’ formal training. This study aims to assess the attitudes and knowledge related to opioids in family medicine residents in a rural Appalachian residency program; as well as measure how these attitudes and knowledge change in the cohort after a limited course of education in issues surrounding opioid use, prescription, and abuse. It is our hope that this intervention will edify the residents, and they will feel more prepared to confront issues surrounding opioids as they move forward in their careers. Methods: Residents were given a ten-item questionnaire that assessed their knowledge of current Tennessee and Virginia state laws with regards to the prescription of opioids: The questionnaire also included an open-ended question where residents were asked to express how they felt about prescribing opioids: opinions they had formed, things they learned, things that they wished were different. Responses were uniquely identified by a paired code that abstracted the identity of the respondent from subsequent analysis. After anonymous collection of the completed questionnaire and open-ended response, a 30 minute didactic session was administered by the authors outlining common issues with opioid prescriptions, an overview of current TN and VA state law regarding opioid prescription, clinic policy, and discussion with residents of current thinking regarding best practices. The questionnaire was then administered again, responses were anonymously gathered and paired with their pre-didactic identification number. The responses were then analyzed to assess the impact of the didactic on understanding of current opioid prescribing law, and the open ended responses were examined for common themes in residents’ perception of prescribing opioids while in residency. - Conclusions: In general, short and focused didactic education regarding current state laws regarding opioid prescription appears to benefit residents understanding of how to prescribe opioids appropriately. Residents generally find the processes surrounding opioid prescription challenging, medically and emotionally, and are interested in more education about the topic.

Objective: Students from 5 public schools in east Tennessee in grades 6 through 10 were assessed for their risk of eating disorder. Method: The Eating Attitudes Test (EAT40), a self-administered questionnaire, was given anonymously to 1,302 male and female adolescents. Results: The results showed that 19.8% of females and 3.7% of males scored above 29, indicating high risk for development of an eating disorder. There was also a trend toward increased prevalence of risk in areas that are more rural. Conclusions: These findings suggest that the risk for eating disorders may be greater in rural areas than has previously been believed. This has implications for understanding the etiology of these diseases as well as demonstrating the need for more research in these often underserved areas.

Scale 1 inch = 160 British Statue Miles. Published in A Modern and Authentic System of Universal Geography by George Alexander Cooke. London, 1807. Drawn by Aaron Arrowsmith and engraved by J. Lodge. It shows the eastern United States and southern Canada from Nova Scotia to a portion of Florida and west to the Mississippi. Rivers and several towns in Pennsylvania are named. / https://dc.etsu.edu/rare-maps/1101/thumbnail.jpg

The Appalachian region faces widescale drug use and opioid addiction that exceeds the national average, and the crisis needs more attention in order to properly address the issue. Many previous studies have documented the problems Appalachian residents face regarding widespread opioid addiction and other diseases of despair. However, this study focuses on two causes behind the opioid crisis: a lack of access to medical care and over prescription of opioids. Additionally, the problem is affected by social and economic factors that perpetuate the problem of opioid addiction within Appalachia. For this study, previous research and studies on opioid abuse in Appalachia will be compiled into a literature review to make connections and determine previous identified factors contributing to the opioid crisis in the Appalachian region. Additionally, health professionals in Appalachia were be interviewed to provide professional perspective on the opioid addiction crisis in the Appalachian region. An infographic highlighting recovery rates and positive outcomes concerning the opioid addiction crisis was also developed to provide an accurate, positive outlook on the situation to the public. Several factors were identified as major contributors to the opioid crisis in Appalachia. These include mental health issues, PTSD from a variety of sources, association with drug users and normalization of drug use, and chronic pain relief. The principal problem identified revolved around the relationship between an easy access to opioids and a lack of access to medical care. The Appalachian region needs appropriate medical resources that would improve quality of life in the region and reduce opioid addiction.

Podium presentation on Appalachian Highlands Center for Nursing Advancement.

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