Northeast Tennessee has been disproportionately burdened by a high prevalence of opioid prescribing, prescription drug abuse, addiction, overdose, and Neonatal Abstinence Syndrome. The East Tennessee State University Prescription Drug Abuse and Misuse Working Group (PDAMWG) formed upon recognizing an urgent need for a collaborative, multi-faceted response to reduce prescription drug abuse. Composed of over 100 members from various agencies, organizations, and institutions, members of this highly interprofessional, university-sponsored working group include academic scholars, healthcare providers, pharmacists, elected officials, students, community members, and more. This collaboration has successfully generated multiple funded research projects and numerous evidence- and community-based initiatives targeting prescription drug abuse. This seminar will focus on substance abuse prevention, specifically the prevention of prescription drug abuse. In addition to providing a data supported summary of the epidemic in the region, this seminar will outline the historical development of the PDAMWG and describe past and present research and community-based initiatives. An emphasis will be on the continuous commitment of the PDAMWG to the development, dissemination, and implementation of evidence-based practices to reduce prescription drug abuse and improve population health in the region. This seminar will also document research as well as community-based outcomes of PDAMWG efforts. Consequently, participants will recognize the effectiveness of strong, cross-sector partnerships for population health improvement. Relatedly, participants will develop a concrete understanding of a collaborative approach that bridges academic research and community-based practice. Perhaps most importantly, participants will discover its potential for replication in other communities to support the achievement of maximum, evidence-based outcomes for various health concerns. Lastly, participants will be introduced to the underlying model of the PDAMWG, which visually depicts evidence-based strategies along the disease continuum. As a result, participants will appreciate the complexity of public health problems and the subsequent importance of a multi-pronged, evidence-based response to addressing them

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Background: University scholars and community members formed the Prescription Drug Abuse and Misuse Working Group in response to the prescription drug abuse/misuse epidemic plaguing the Appalachian region. Their collaboration has yielded no fewer than four funded and six volunteer service projects in the community. A concern voiced by key community stakeholders has been the non-medical use of prescription drugs (NMUPD) among the workforce. The team discovered that the relationship between NMUPD and workplace characteristics is understudied. This study aimed to show the overall and industry-specific prevalence of NMUPD, and to examine workplace characteristics associated with NMUPD. Methods: Data from the 2011-2012 National Survey on Drug Use and Health (NSDUH) were used. Multiple logistic regression assessed workplace characteristics on past-year NMUPD among employed adults 18 years and older, controlling for demographic variables. Results: The overall prevalence of NMUPD was 9.23% (95% CI: 8.98-9.48). The industries with the highest prevalence were: arts, entertainment, recreation, accommodation, and food services (14.48%; 95% CI: 13.70-15.27), construction (10.82%; 95% CI: 9.77-11.87), and retail trade (10.04%; 95% CI: 9.34-10.74). NMUPD was significantly associated with industry type (p Conclusions: Results suggest alcohol or drug use workplace policies and employee assistance or other counseling programs may protect against NMUPD. Workplace prevention efforts for NMUPD could benefit from incorporating these approaches.

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The Drug Treatment and Training Project of the State of Oregon Mental Health Division, Alcohol and Drug section in Portland, Oregon is engaged in the treatment of young people between the ages of 15 and 27 who have indicated that they have a problem with drugs, and have asked help in overcoming this problem. As part of the treatment program, the clients are given the Minnesota Multiphasic Personality Inventory (MMPI) and a questionnaire developed by the drug project. The thesis analyses the Drug Treatment’s MMPI results and compares them to other studies.

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Background: Despite substantial global progress against the HIV/AIDS epidemic, the Eastern Europe and Central Asian region has experienced a 43% increase in HIV incidence. The HIV epidemic in Kazakhstan has outpaced that of the region, with the incidence of new infections growing by 73% since 2010. Key populations of people who inject drugs (PWID), female sex workers (FSW) and their sexual partners account for the majority of new infections, where drug policies continue to undermine HIV prevention and control efforts. Kazakhstan has made insufficient progress towards 95-95-95 HIV epidemic control targets, with 78% of people living with HIV (PLWH) knowing their HIV status, of which 57% receive ART, and 48% of those receiving ART achieve viral suppression. Laws, policies and their enforcement can shape social and structural determinants of health, and it is fundamental to understand how punitive legal environments shape the HIV epidemic in Kazakhstan. This dissertation seeks to identify patterns of police violence victimization among FSW who use drugs and examine how police violence is associated with the HIV risk environment. Given the insufficient progress towards 95-95-95 HIV epidemic control targets, this dissertation also seeks to identify how patterns of injection and sexual HIV transmission risk behaviors vary among men and women who inject drugs and examine how criminal-legal involvement is associated with patterns of HIV transmission risk behaviors. Methods: Data on police violence victimization among FSW who use drugs were drawn from Project Nova, a cluster-randomized control trial that evaluated the efficacy of a combination HIV risk reduction and microfinance intervention. A community-based sample of 255 FSW who use drugs were recruited and enrolled between February 2015 and May 2017 in Almaty, Kazakhstan. Latent class analysis (LCA) was used to characterize women into distinct subgroups (i.e., classes) of police violence victimization. Next, multinomial logistic regression was used to examine how police violence victimization subgroups are associated with the physical, social, economic and policy HIV risk environment. Data on injection and sexual HIV transmission risk behaviors were drawn from Bridge, an implementation science study that evaluated the effectiveness of HIV service integration into needle/syringe programs on retention in care and viral suppression for PWID living with HIV in Kazakhstan. A random sample of 450 men and 166 women who inject drugs were recruited and enrolled in Almaty, Shymkent, and Temirtau/ Karaganda between February 2017 and June 2019. Similarly, LCA was used to characterize distinct subgroups of HIV transmission risk behaviors among men and women who inject drugs. Multinomial logistic regression was then used to identify associations between criminal-legal involvement and patterns of HIV transmission risk. Results: Three subgroups of police violence victimization among FSW who use drugs emerged. Just over half were characterized as experiencing low violence victimization (“Low Violence;” 51%); over one-third were characterized as experiencing all forms of police violence victimization (Poly-Victimization; 34%), and 15% were characterized as experiencing primarily discrimination and extortion from the police. Relative to Low Violence, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR= 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (aOR= 2.73 (1.15, 6.50)), injection drug use (IDU) (aOR= 2.00 (1.12, 3.58)), greater number of unsafe injection behaviors (aOR= 1.21 (1.08, 1.35)), homelessness (aOR= 1.92 (1.06, 3.48)), greater drug use stigma (aOR= 1.22 (1.07, 1.39)) and sex work stigma (aOR= 1.23 (1.06, 1.43)), greater number of sex work clients (aOR= 2.40 (1.33, 4.31)), working for a boss/pimp (aOR= 2.74 (1.16, 6.50)), client violence (aOR= 2.99 (1.65, 5.42)), economic incentives for condomless sex (aOR= 2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (aOR= 3.47 (1.42, 8.50)), recent arrest (aOR= 2.99 (1.36, 6.55)) and detention (aOR= 2.93 (1.62, 5.30)), and negative police perceptions (aOR= 8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. Distinct patterns of HIV transmission risk behaviors emerged among men and women, in which men were characterized as having Low Sexual Risk (41.8%), Injection & Sexual Risk (36.4%), and High Injection Risk (21.8%) behaviors. Class membership in the Injection & Sexual Risk and High Injection Risk class was associated with greater criminal-legal involvement, compared to the Low Sexual Risk class. This is demonstrated by higher odds of multiple detentions ((aORInjection & Sexual Risk = 1.28 (1.10, 1.49); aORHigh Injection Risk = 1.25 (1.06, 1.46)) and drug court participation (aORHigh Injection Risk = 5.29 (1.03, 27.20) in the past six months, committing crimes while under the influence of alcohol or drugs (aORInjection & Sexual Risk = 2.79 (1.53, 5.11); aORHigh Injection Risk = 2.76 (1.34, 5.65), and perceived police discrimination (aORHigh Injection Risk = 1.79 (1.01, 3.19). Women who inject drugs were characterized as having Low Injection & Sexual Risk (60.7%), Sex Work Behaviors (8.4%), High Injection Risk (30.7%) behaviors. Class membership in the Sex Work Behaviors and High Injection Risk class was associated with greater odds of being detained (aORSex Work Behaviors= 4.59 (1.27, 16.53) and experiencing verbal police harassment (aORSex Work Behaviors= 3.31 (1.20, 9.15); aORHigh Injection Risk = 2.91 (1.32, 6.40), compared to the Low Injection & Sexual Risk class. Conclusion: Results from this dissertation show that police violence against FSW who use drugs is pervasive in Kazakhstan. Patterns of police violence victimization among FSW who use drugs vary, with multiple forms of police violence victimization being associated with greater HIV susceptibility. This dissertation also demonstrates that men and women who inject drugs and are living with HIV have a high prevalence of injection and sexual HIV transmission risk behaviors, despite low viral suppression, and that patterns of HIV transmission risk behaviors vary by gender. Moreover, criminal-legal involvement is associated with injection and sexual HIV transmission risk, particularly among men who inject drugs. Collectively, these results support drug policy reforms and suggest that decriminalization of drug use and possession may promote enabling environments that support harm reduction, and subsequently reduce HIV transmission through injection and sexual networks of PWID in Kazakhstan.

The presentation will look beyond red flags to inform Rx legitimacy judgments and subsequent prescribing and dispensing decisions. The presenter will describe the outcomes of two research projects that examined prescribers’ and pharmacists’ perceptions of Rx legitimacy and Rx drug abuse communication behaviors. Attendees will gain insight into the process of evaluating Rx legitimacy and learn how subjectivity inherent in these judgments influences prescribing and dispensing behaviors and patient care. The presenter also will identify evidence­based, practice-friendly interventions to engage community pharmacists in community-based prevention of Rx drug abuse and its consequences.

Thesis (Ed. D.)--University of Hawaii at Manoa, 1995. / Includes bibliographical references (leaves 161-167). / Microfiche. / x, 167 leaves, bound ill. 29 cm

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