Background: The opioid epidemic in the United States (U.S.) continues to be problematic. While the number of overdoses deaths have declined in recent, this is still a problem in the U.S. One of the recommended interventions to treat opioid-use disorder (OUD) is using Medications for Opioid-use Disorder (MOUD) to treat this. The Transtheoretical Model (TTM) is a public health model that can access an individuals readiness to change health behaviors. It is important to understand how individuals with OUD can move through the stages of TTM to access MOUD treatment in rural areas, and what barriers they face when trying to access MOUD treatment in rural areas.Methods: A case study was conducted in a rural Illinois region to understand current and/or past experiences individuals with OUD have had with MOUD in rural areas. Qualitative semi-structured interviews were conducted with individuals who have had experiences with MOUD in the selected rural areas to understand how they moved through the stages of change of MOUD, and what facilitators and barriers effected their movements through TTM. Results: A total of ten interviews were conducted. Eight were men, while two were women. All participants identified being white/Caucasian. Participants resided in the case study region. All participants disclosed being on Medicaid for insurance, while two discussed having Medicare as well. Themes from the interviews were stages of change at time of interview, movements through the stages of change, relapse, and experiences with MOUD treatment. Conclusions: The main facilitators and barriers that caused movements through TTM included opioid overdose experiences, legal issues, life changing events, lacking adequate supports and resources, and positive/negative experiences with MOUD treatment. While findings of the study were consistent with literature findings, there needs to be emphasis on looking at flexibility in delivery of interventions by MOUD treatment centers. Having different interventions to accommodate individuals could help with retention rates, while addressing barriers that prevent them from accessing treatment. Having a stronger understanding of treatment center practices could help with interventions. Future research should examine the possibility of utilizing peer-recovery coaches to coincide with treatment to see if it can offset barriers/concerns in rural areas.

The United States is in the midst of an opioid crisis. Fortunately, effective treatments for opioid use disorder exist (OUD); however, they are underutilized. Medications for opioid use disorder (MOUDs) decrease death by 50 %. These MOUDs are particularly relevant in the criminal justice population given that this population has a higher OUD disease burden but is less likely than the general population to receive this life-saving treatment. Research has identified negative attitudes toward MOUDs among corrections staff as a barrier to utilizing MOUDs. This thesis examines the relationships between community correction staff familiarity with methadone, one type of MOUD, and their opinions toward methadone using extant data from the Criminal Justice Drug Abuse Treatment Studies 2 (CJ-DATS 2) series. These data were collected between 2010-2012. The study was guided by the Knowledge-Attitude Behavior (KAB) model. The data are described using descriptive statistics, and I estimate logistic regressions to examine the relationship between respondent familiarity with methadone and their attitude toward methadone while controlling for other covariates. With a sample of 167 corrections employees, I found that corrections staff who agreed or strongly agreed with the statement that they were familiar with methadone had more positive methadone attitudes. Future research should examine the relationship between familiarity/knowledge, attitudes, and behaviors in other criminal justice settings and for other MOUDs (i.e., buprenorphine and naltrexone).

Introduction: The consequences of the opioid epidemic and various prevention, mitigation, and treatment strategies have a strong hold on Appalachian communities. However, limited research has been conducted to understand the experiences of special populations impacted by opioids in this region, such as women of childbearing age living with opioid use disorder (OUD) prior to and during pregnancy. The objective of this review is to summarize existing literature on the care experience for women of childbearing age receiving treatment with medications for opioid use disorder (MOUD) in rural east Tennessee. This literature review will allow for better understanding of current treatment practices, potential gaps in care, and needed care system improvements for this patient population. Methods: A systematic PubMed search identified studies focused on MOUD and pregnancy in the rural eastern Tennessee region. Search results were screened to remove publications older than five years or from outside the region. Relevant information concerning the MOUD care experience for women of childbearing age in the area was collected from these studies. Results: Five studies were included: four surveys and a systematic review. All were published within the last five years and described experiences spanning preconception to postnatal care as well as Tennessee opioid laws that affect women of childbearing age. Two studies detailed the pre-pregnancy care experience, including information about prior pregnancies, intention of conception, contraceptive use, and perceived barriers to contraception access among women receiving MOUD. Two studies described the care experience during pregnancy and its evolution in recent years with changes in acceptance of insurance for MOUD treatment, rates of MOUD-positive prenatal drug screens, and MOUD tapering practices during pregnancy. The final included study reviewed several Tennessee opioid laws enacted over the years to combat prenatal substance use and neonatal abstinence syndrome (NAS). Notably, while total reported cases of NAS have decreased statewide in recent years, the highest rates continue to be observed in east Tennessee, with a majority of cases linked to MOUD exposure. The requirements and enforcement of NAS-related legislation in Tennessee have changed over time but their existence may deter pregnant women from seeking treatment due to fear of punitive consequences. Conclusion: The evidence compiled in this literature review points to many areas in which the care experience can be improved for women of childbearing age receiving MOUD in east Tennessee. There are concerns regarding pregnancy planning, contraceptive access, availability of evidence-based OUD treatment, cost of treatment, and fear of actual or potential negative repercussions from opioid use during pregnancy. These findings suggest multiple efforts can be undertaken by clinicians, researchers, and policymakers to enhance the experience of care for women of childbearing age living with OUD, and consequently improve the health of the population in general, in this region of Appalachia.