People who inject drugs, particularly opioids, are a growing population, especially in North Philadelphia. This population is at high risk for medical complications that require hospitalization. While hospitalized, this population poses unique challenges to the healthcare system, including high costs and readmission rates, as well as stress and burnout among providers and staff. These patients are at high risk of discharges against medical advice because of complicated social factors as well as inadequate recognition of pain and withdrawal. As the opioid epidemic evolves, previous strategies for managing these patients, which traditionally relied on referral to psychiatry or social work in addition to symptomatic treatment, need to be re-evaluated. Ethically, the decision-making capacity of these patients is frequently called into question, and there is a difficult-to-strike balance between respecting their autonomy and acting with beneficence to provide the best care. There are also public health concerns that come into play. Better acknowledgment of the issues that this population faces, and better management of pain and withdrawal, may improve their outcomes, as well as reduce provider stress and burnout. / Urban Bioethics

Background: Despite the many harms and limited efficacy of opioids in managing chronic noncancer pain (CNCP), they are commonly prescribed for these patients in North America. One of the harms associated with prolonged opioid use is opioid use disorder (OUD); however, the risk of addiction is uncertain. We systematically reviewed observational studies to establish the prevalence of (OUD), and to explore factors associated with OUD in patients with CNCP. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and PsycINFO from inception to December 2018 to identify studies that explored the prevalence of OUD or risk factors for OUD in patients with CNCP. Two specialists in addiction medicine reviewed each potentially eligible study, blinded to results, to ensure their outcome met DSM-5 criteria for OUD. We pooled estimates of OUD across eligible studies using random-effects models. When possible, we pooled estimates of association with OUD for all independent variables reported by more than one study. Results: Twenty-two studies reported the prevalence of OUD, and six studies reported the association of 36 factors with OUD in patients with CNCP. The pooled prevalence of OUD was 20% (95% CI: 15% to 25%); however, we found evidence for small study effects (interaction p<0.001). When restricted to larger studies (≥900 patients), the pooled prevalence of OUD was 5.8% (95% CI: 2.8% to 9.5%; moderate certainty evidence). The prevalence of OUD was not associated with level of certainty of OUD criteria, under- or overestimation of instruments compared to DSM-5 criteria, severity of OUD, or risk of bias (interaction p values ranged from 0.34 to 0.92). Moderate certainty evidence demonstrated an association between OUD and male sex (OR 1.50 [95% CI: 1.05 to 2.14]; absolute risk increase (ARI) 2.7% [95% CI: 0.3% more to 5.8% more]), current smokers (OR 1.63; [95% CI: 1.25 to 2.12]; ARI 3.3% [1.3% more to 5.7% more]), and a history of mental health disorders (OR 1.49 [95% CI: 1.17 to 1.89]; ARI 2.6% [95% CI: 0.9% more to 4.6% more]). Low certainty evidence demonstrated an association between OUD and younger age (OR for every 10-year decrement, 1.60 [95% CI: 1.11 to 2.30]; ARI, 3.2% for every 10-year decrement [95% CI: 0.6% more to 6.6% more]). Moderate certainty evidence suggested no association between OUD and a history of alcohol abuse/dependence (OR 1.32 [95% CI: 0.84 to 2.07]; ARI 1.7% [95% CI: 0.9% less to 5.5% more]), and low certainty evidence suggested no association between OUD and a history of drug abuse (OR 1.51 [95% CI: 0.75 to 3.02]; ARI 2.7% [95% CI: 1.4% less to 9.9% more]). Conclusion: Moderate certainty evidence suggests that 6% of CNCP patients prescribed opioids will develop OUD. Younger men who smoke, with a history of mental health disorders, are at higher risk. Additional research is needed to establish the association between OUD and a history of drug or alcohol abuse. / Thesis / Master of Science (MSc) / Opioids are commonly prescribed for patients with chronic pain that is not due to cancer; however, long-term opioid use inevitably leads to physical dependence and may result in addiction. Prior studies have reported extremely variable rates of opioid use disorder (OUD) following prescription for chronic noncancer pain, ranging from less than 1% to more than 50%, which has led to considerable confusion. My systematic review found moderate certainty evidence that the prevalence of OUD following prescription for chronic pain is 5.8% (95% CI: 2.8% to 9.5%). Patients who were younger, current smokers, males, and had a history of mental health disorders, had a higher risk of developing OUD. These findings will help support shared care decision-making between patients with chronic pain considering opioid therapy and their healthcare providers.

Stigmatization remains a significant barrier to the initiation and maintenance of treatment in patients with substance use disorders, with higher levels of stigma being associated with lower levels of treatment initiation and adherence. While societal stigma is frequently discussed, less discussed are the inherent biases expressed by healthcare providers. Healthcare providers often hold comparable or even higher levels of stigma against patients with substance use disorders compared to the general population, and this can have quite a significant impact on patient care. From improper treatment decisions stemming from fear and stigmatization of the medications used for opioid use disorders, to the development of mistrust and poor/worsening self-esteem secondary to poor patient-provider interactions. The effects of stigma on the substance use disorder patient cannot be understated and must be alleviated in the coming years to ensure that patients with SUDs receive the high-quality treatment that they deserve. Several interventions have been validated to help reduce stigma within healthcare providers, subsequently improving treatment outcomes. Words matter. Patient-first language is crucial; verbiage can strongly impact how not only the provider sees the patient, but how the patient views themselves (and as we know, poor self-esteem also hinders treatment outcomes). Education and normalization of SUD medications should be done at the healthcare provider level to ensure that all providers are comfortable with these medications. As higher frequency of interactions with substance use disorders has been shown to reduce levels of stigma seen within healthcare providers, it’s also crucial that trainees receive adequate exposure to this patient population. While these suggestions may take time to show effect, it’s imperative that we get the ball rolling on training future generations of healthcare providers that do not hold inherent biases and who will provide high-quality, care utilizing validated treatments. / Urban Bioethics

<p dir="ltr">Opioid use disorder (OUD) presents a challenging and nuanced condition with potential for debilitating social and physical consequences. Patients with OUD have access to treatment options, but they may encounter issues such as diversion, invasiveness, or poor adherence. With over 2.5 million adults in the US experiencing OUD as of 2021, the need for an OUD treatment that overcomes these challenges is clear. One available treatment method is Sublocade®, a PLGA-based in situ forming implant (ISFI) that releases buprenorphine. This treatment shows promise due to its physician administered extended release design, which addresses many current issues in OUD treatment. However, the practicality of this treatment remains a challenge due to its monthly injection requirement. To address this, we investigated how altering ISFI components impacts the timeframe of buprenorphine release from a PLGA-based ISFI. Our focus was on evaluating factors that lead to extended buprenorphine release while maintaining zero-order release. We varied polymer-to-solvent ratios, drug percentage, and solvent composition, assessing their effects through drug release studies. We also conducted SEM imaging and swelling/erosion studies to evaluate polymer behavior and implant microstructure, gaining further insights into drug release mechanisms. Our drug release studies revealed that higher buprenorphine content in the implant significantly reduced total drug release and linearized drug release patterns. Decreasing the polymer-to-solvent ratio similarly linearized drug release and reduced drug burst, although the overall amount of drug released over time remained similar. Introducing Triacetin (TA) as a solvent helped reduce drug burst and maintain release linearity in lower drug content implants. In higher drug content implants, TA appeared to increase drug release over time, likely due to degradation processes indicated by high swelling and increased degradation observed in SEM imaging. Erosion studies showed less implant erosion with higher drug loading, aligning with release study observations. In conclusion, solvent type and drug content significantly influence buprenorphine release in ISFI systems and should be carefully considered when designing extended release systems similar to Sublocade®.</p>

The ongoing overdose problem in the United States, particularly exacerbated by the widespread use of fentanyl, and polydrug use, represents a critical public health challenge. This thesis explores how people who use drugs (PWUD) in Orlando, Florida, are responding to the overdose problem in their community. Drawing on ethnographic research conducted at a syringe services program in Summer 2023, I argue that PWUD in Orlando actively take measures to prevent overdose and overdose deaths but are faced with many obstacles that challenge their overdose prevention efforts. I examine overdose narratives of PWUD to show how factors preventing effective overdose prevention are not just systemic but also cultural. In particular, the prevailing stigma of opioid use hinders the creation of a supportive environment for preventing overdoses and perpetuates the ostracization of PWUD in Orlando. Recognizing the profound influence of stigma towards the PWUD with whom I conducted research, I make the case for reimagining overdose prevention as a comprehensive effort in Orlando to equip PWUD, their families, first responders, and the broader community with the knowledge, skills, and tools to address overdose. Such efforts also have the potential to recalibrate cultural misconceptions and biases toward PWUD. As Florida and the nation continue to experience an overdose problem, understanding local cultural and structural challenges remains pivotal. This project demonstrates that by integrating comprehensive training and combating stigmatization of PWUD, Orlando communities can prevent overdose and save lives more effectively.

Purpose of Review: This review aims to (1) conceptualize the complexity of the opioid use disorder epidemic using a conceptual model grounded in the disease continuum and corresponding levels of prevention and (2) summarize a select set of interventions for the prevention and treatment of opioid use disorder. Recent Findings: Epidemiologic data indicate non-medical prescription and illicit opioid use have reached unprecedented levels, fueling an opioid use disorder epidemic in the USA. A problem of this magnitude is rooted in multiple supply- and demand-side drivers, the combined effect of which outweighs current prevention and treatment efforts. Multiple primary, secondary, and tertiary prevention interventions, both evidence-informed and evidence-based, are available to address each point along the disease continuum—non-use, initiation, dependence, addiction, and death. Summary: If interventions grounded in the best available evidence are disseminated and implemented across the disease continuum in a coordinated and collaborative manner, public health systems could be increasingly effective in responding to the epidemic./p>

Abstract available through Drug and Alcohol Dependence.

Dr. Robert Pack, associate dean for Academic Affairs in ETSU’s College of Public Health, joined leaders from public health schools in four other states in the Appalachian region to discuss with members of the U.S. Congress the complex and dynamic processes at work in the opioid crisis. Pack joined his colleagues in sharing findings on unique approaches to address the course of the epidemic as well as discuss how university-based public health experts are assisting affected communities by bringing traditional and novel epidemic control strategies to bear on the disease.

Bakgrund   Personer som har problem orsakade av användandet av opioider kan påträffas inom vården i direkt koppling till deras användande av substansen eller vid uppsökande av vård av andra anledningar. Som sjuksköterska finns möjligheten att identifiera ett beroende eller riskbruk och stötta personen till en förändring i livsstilen eller till egenvård (Skärsäter &amp; Wiklund, 2019). Genom att ge omvårdnad på den egna individens villkor respekteras individens värdighet och integritet vilket är avgörande för individens uppfattning av bemötandet (Svensk Sjuksköterskeförening, 2016).   Syfte   Syftet var att beskriva hur personer som använder opioider upplever mötet med hälso- och sjukvårdspersonal.   Metod   En icke-systematiskt litteraturöversikt utfördes och baserades på 17 vetenskapliga artiklar av kvalitativ design. Artiklarna eftersöktes i databaserna CINAHL och PubMed med hjälp av lämpliga sökord samt så genomfördes även en manuell sökning. Kvalitén på artiklarna granskades utefter Sophiahemmet Högskolas bedömningsunderlag och vidare användes en integrerad analys vilket resulterade i tre huvudkategorier och sex subkategorier.   Resultat  Resultatet bestod av tre huvudkategorier och sex subkategorier. Huvudkategorierna var Patienters upplevelser av vårdpersonalens kompetens, Patienters upplevelser av vårdpersonalens attityder och Patienters upplevelser av samarbetet med vårdpersonal. Subkategorierna var kunskap, kommunikation, stigmatisering, tillit, delaktighet och relationen mellan vårdpersonal och patient. Resultatet visade att majoriteten av patienter upplevt stigmatisering relaterat till deras bruk av opioider. Patienter upplevde även att de inte var delaktiga i sin vård samt förbisedda i sin behandling.   Slutsats  Resultatet från litteraturöversikten påvisade upplevd stigmatisering kring patienter som använder opioider. En stor del av stigmatiseringen kring patientgruppen grundade sig i okunskap hos hälso- och sjukvårdspersonal om “substance use disorder” (SUD). Ett starkt samband mellan vårdpersonalens kunskap om SUD och deras attityder till dessa personer uppmärksammades och det är därför viktigt att kunskapen hos vårdpersonalen ökar när det kommer till denna patientgrupp. Vidare har vårdpersonalens okunskap och stigmatiseringen kring SUD bidragit till att patienter inte tillåtits vara delaktiga i sin egen vård. / Background  People with problems caused by the use of opioids may be found in healthcare, either directly related to their use of the substance or when outreaching for other reasons. As a nurse, you have the opportunity to identify an addiction or risk use, and support the person to a change in lifestyle or to self-care (Skärsäter &amp; Wiklund, 2019). By providing care on the individual's terms, the dignity and integrity of the individual are respected, which is crucial to the individual's perception of the treatment (Svensk Sjuksköterskeförening, 2016).   Aim  The aim was to describe how people who use opioids experience the encounter with health care professionals  Method  A non-systematic literature review was performed and based on 17 scientific articles of qualitative design. The articles were searched in the CINAHL and PubMed databases using the applicable keywords. A manual search was performed. Subsequently, the quality of the articles was examined according to Sophiahemmet University's assessment data and an integrated analysis was further used, resulting in three main categories and six subcategories.   Results  The result consisted of three main categories and six subcategories. The main categories were: Patients’ experiences of Healthcare Professionals competence, Patients’ experiences of Healthcare Professionals’ attitudes and Patients’ experiences of collaboration with Healthcare Professionals. The subcategories were knowledge, communication, stigma, trust, participation and the relationship between healthcare professionals and patients. The results showed that the majority of patients experienced stigma related to their use of opioids.   Conclusions  The results of the literature review show perceived stigma around patients using opioids. Much of the stigma surrounding the patient group has been based on ignorance among health professionals about substance use disorder (SUD). A strong link between healthcare professionals' knowledge of SUD and their attitudes towards these people was recognised and it is therefore important that the knowledge of healthcare professionals increases when it comes to this patient group. Furthermore, the ignorance of healthcare professionals and the stigma surrounding SUD have contributed to patients not being allowed to participate in their own care.

The purpose of this non-experimental quantitative correlational study was to investigate the relationship between academic achievement and health in a national sample of college students using quantitative data analysis. Specifically, the researcher analyzed the relationship between three health-promoting behaviors (physical activity, strength training, and fruit and vegetable consumption), three negative health behaviors (cigarette, e-cigarette, and opioid use) and obesity with GPA. Cross-sectional data on student health collected from the American College Health Association’s National College Health Assessment II (ACHA-NCHA-II) and completed by 426,650 college students from 650 U.S. colleges during the semesters between 2015 and 2019 formed the foundation for this research. Nine research questions were addressed using a series of chi square tests. Results showed there was a significant positive relationship between health behaviors and grade average. Students who met the recommendations for fruit and vegetable consumption, moderate activity and vigorous physical activity were more likely to have GPAs than those who did not. Students who used cigarettes, opioids, or were obese were more likely to have GPAs.