The COVID-19 pandemic adversely affected the lives of most Americans. People with Substance Use Disorder (SUD) were particularly vulnerable to the negative effects brought on by the pandemic. This study explored the increase in deaths due to opioid overdose during the pandemic exacerbated by factors such as increased stress, decrease in treatment options due to social distancing requirements and facility closures, social isolation, and an increase in spare time. Access to treatment for opioid use disorder (OUD) was interrupted by the measures meant to mitigate the spread of COVID-19. Through a systematic review of current literature, it was demonstrated that existing patients were able to maintain access to care, while few new patients were able to initiate treatment. Telehealth proved to be a vital means of assuring PWUD were able to access life-saving treatment amid a pandemic. Further research is needed to determine whether SUD treatment measures during the COVID-19 pandemic warrants changing the policies long term.

Background: Approximately 70% of US adults currently receiving opioid agonist treatment (OAT) for opioid use disorder are of reproductive age. Among women receiving OAT at risk of having an unintended pregnancy, typically less than half report any current contraceptive use compared to 90% in the general population. In addition, the rate of unintended pregnancy among women receiving OAT is disproportionately higher than the general population (~80% vs. 45%, respectively). Lack of knowledge about family planning may be contributing to decreased rates of contraceptive use and increased rates of unintended pregnancy among women receiving OAT. Method: Participants were a convenience sample of women and men receiving OAT or a comparison group receiving primary care (PC) services. Family planning knowledge was assessed with the recently validated Contraceptive Knowledge Assessment (CKA), a self-administered 25-question multiple-choice survey. A two-way ANOVA, with fixed factors (i.e. patient sample and sex), compared the total number of correct responses for all questions and five more specific content areas (p<.05). Results: Overall, 332 participants completed this survey. The mean percent of total correct responses was significantly lower in the OAT sample (n=167) compared to the PC sample (n=165), 47% vs. 53% correct, respectively (p<.001) or approximately 1.5 questions less. The mean percent of correct responses in four of the five content areas was also lower among the OAT sample compared to the PC sample (ps<.01). The mean percent of total correct responses was significantly higher among women (n=169) than men (n=163), 56% vs. 44% correct, respectively (p<.0001) or approximately 3 questions more. The percent of correct responses in four of the five content areas was also higher among women than men (ps<.01). Conclusion: Given the substantial discrepancy in rates of contraceptive use and unintended pregnancy between individuals receiving OAT and the general population, it is somewhat unexpected that individuals receiving OAT did not have lower levels of family planning knowledge, although patients in both samples only answered approximately 50% of the questions correctly. Results from the present study suggest deficits in family planning knowledge, while statistically significant, may be less clinically so. Overall, lack of family planning knowledge is likely only playing a small role in population differences in contraceptive use and unintended pregnancy and interventions aimed at decreasing these differences will need to address other barriers to accessing family planning services and utilizing contraception in this population.

Background: One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists’ nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. Methods: We conducted a telephone census of community pharmacies in the Appalachian counties of North Carolina, Tennessee, and Virginia from April–June 2018. Behaviors studied included having ever sold syringes without a prescription, quantity of individuals to whom nonprescription syringes were dispensed in the past 30 days, having ever denied a request for nonprescription syringes, and past 30-day denial of nonprescription syringe requests. Behavioral intention and perceptions of legality were elicited. Results: A response rate of 52.3 % was achieved (N = 391). North Carolina pharmacists reported increased past 30-day dispensing, less denial of nonprescription syringe requests, and decreased justification for syringe dispensing (proof of medical need) as compared to Tennessee and Virginia pharmacists. Behavioral intention to dispense did not vary by state but did vary by political affiliation. Perceptions of syringe dispensing legality in NC were significantly different from those in TN and VA. Conclusions: Significant differences in pharmacists’ perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.

Purpose: The study examined the associations of multiple psychiatric and chronic conditions with the self-reported history of major depressive disorder (MDD) among patients with opioid use disorder (OUD) and tested whether the associations differed by gender. Methods: We conducted a secondary data analysis of baseline data from a clinical trial including 1,646 participants with OUD, of which 465 had MDD. A variable cluster analysis was used to classify chronic medical and psychiatric conditions. Multivariable logistic regression analyses were used to estimate their associations with MDD in subjects with OUD. Results: Nine variables were divided into three clusters: cluster 1 included heart condition, hypertension, and liver problems; cluster 2 included gastrointestinal (GI) problems and head injury, and cluster 3 included anxiety disorder, bipolar disorder, and schizophrenia. The overall prevalence of MDD in participants with OUD was 28.3% (22.8% for males and 39.5% for females). Gender, anxiety disorder, schizophrenia, liver problems, heart condition, GI problems, and head injury were significantly associated with MDD. Gender-stratified analyses showed that bipolar disorder, liver problems and individuals with one chronic condition were associated with MDD only in males, whereas heart condition, hypertension, and GI problems were associated with MDD only in females. In addition, anxiety disorder, head injury, individuals with one or more than two psychiatric conditions, and individuals with more than two chronic conditions were associated with MDD regardless of gender. Conclusions: Treatment plans in patients with OUD should not only address MDD but also co-morbid psychiatric and chronic medical conditions that occur with MDD.

This study examined the associations of polysubstance use, mood disorders, and chronic conditions with the history of anxiety disorder among patients with opioid use disorder (OUD). We performed a secondary analysis of the baseline data from a clinical trial including 1,645 individuals with OUD, of which 513 had anxiety disorder. Substance use disorders (SUDs) included alcohol, amphetamines, cannabis, cocaine, and sedative use disorders. Mood disorders included major depressive disorder (MDD) and bipolar disorder (BD). Chronic conditions were allergies, gastrointestinal problem(s), skin problem(s), and hypertension. Sedative use disorder, MDD, BD, skin problems, and hypertension were significantly associated with anxiety disorder (p < 0.05). Additionally, more than two SUDs, two mood disorders, and more than two chronic conditions were significantly associated with anxiety disorder (p < 0.05). These findings highlight the comorbid mental health and physical health problems in individuals with OUD, as well as the need for integrated multidisciplinary treatment plans.

Substance use is a serious and growing problem in the U.S. The impact of substance use disorders is vast and can affect more than the person with the disorder. Drug overdose deaths and related hospitalizations are positively associated with a rise in foster care case nationwide. When a child is removed from a home, social workers see first if there are biological family members who could provide a suitable home for the child as to make the transition less disruptive for the child. The average age of a kin caregiver was 59 years old in 2018, so this likely means grandparents are stepping in the caregiver role. Appalachia specifically has been hit hard by the opioid epidemic, and its rates of both overdose deaths and foster care cases have greatly increased. However, no research has analyzed the association between rates of grandparents as primary caregivers of children and county-level drug overdose mortality rates in Appalachia specifically and then compared that to the same association for non-Appalachian areas. Thus, this study decided to examine the association between those variables with a national dataset made from county-level data from multiple sources, mainly the CDC National Center for Health Statistics and the U.S. Census Bureau American Communities Survey (ACS). A cross-sectional analysis of 5-year estimates for drug overdose mortality on a county-level associated with the ACS data on grandparents acting as primary caregivers of grandchildren under the age of 18 was performed. There were three hypotheses: 1) counties with higher rates of drug overdose mortality will have higher rates of grandparents acting as primary caregivers of children under 18 years old, 2) the rate of grandparents serving as primary guardians of children under 18 years old will be higher in Appalachian counties than in non-Appalachian counties, 3) the correlation between grandparents serving as primary caregivers of children under 18 years old and drug overdose mortality will be stronger in Appalachian counties as opposed to non. For each hypothesis, a bivariate analysis was run independently, and by using multivariate modeling, the association between grandparents as primary caregivers and overdose mortality was evaluated. Running these analyses determined some statistically significant results: as overdose rates increase, rates of grandparent guardians increase; the rate of grandparent caregivers is higher in Appalachian counties than non-Appalachian counties; and there is a stronger correlation between overdose mortality rate increases and grandparents as caregivers increases in Appalachian counties as opposed to non-Appalachian counties. This is useful as there is a lack of research discussing this specific relationship, especially in rural areas such as in Appalachia. Furthermore, these results could help inform policies and programs to support grandparent guardians and help lessen the impacts of parental substance use for children.

The United States is in the midst of an opioid crisis, with more than 130 people dying each day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2018a). Given the recent spike in overdose deaths associated with highly potent synthetic opioids (i.e., fentanyl), there are few signs of the crisis abating (CDC, 2018a). Compared to other age groups, the prevalence of both heroin and prescription opioid use is particularly elevated among young adults (Sharma, Bruner, Barnett, & Fishman, 2016). While there is a large body of evidence demonstrating the effectiveness of substance use treatment in general, only 40-60% of individuals remain abstinent in the year following treatment (McLellan, Lewis, O’Brien, & Klebler, 2000). Less attention has been given to the process of treatment, making it challenging to determine what works and what needs improvement. This information is necessary in developing a comprehensive understanding of the treatment process, which in turn, will inform treatment decisions and improve client outcomes. The current study adds to existing literature by assessing during-treatment change on four proximal outcomes measuring substance-related cognitions (i.e., abstinence self-efficacy and commitment to sobriety) and self-concept (i.e., internalized shame and self-compassion). It was hypothesized that participants would demonstrate significant changes in the favorable direction on all four proximal outcomes. A sample comprised of primarily young adults with opioid use disorders attending short-term residential substance use treatment were enrolled in a naturalistic longitudinal study and assessed at intake, mid-treatment, and discharge. Individual growth curve models were used to examine change over time at both the aggregate and individual levels on the four proximal outcomes. Several potential moderating influences (e.g., demographic information, substance use history, mental health symptoms) were explored to better understand initial status and responses to treatment. Results revealed significant changes in the expected direction on all four proximal outcomes. In addition, several variables emerged as significant predictors of initial status and rates of change. These results provide further evidence that residential substance use treatment is not only a viable option in reducing substance use, but also impacts other important outcomes relevant to clients’ functioning and overall well-being.

No description available.

Background Opioid use has become a huge public health crisis and opioids are now one of the leading causes of deaths related to drugs worldwide. Identifying differences in predictors and treatment outcomes for people with opioid use disorder (OUD) that were introduced by prescription versus other means is important. It is also vital to understand what the goals are and needs that patients want to achieve out of OUD treatment. Methods We used systematic review methodology to first examine any adverse outcomes that may be associated with prescribing opioids for acute low back pain. We also conducted a systematic review and meta-analysis examining what are the differences in patients with OUD that were initially introduced to opioids by prescription in comparison to those introduced by recreational means. We then conducted an observational study using data obtained from the GENetics of Opioid Addiction (GENOA) research collaborative. We examined treatment outcome differences between individuals introduced to opioids through a licit prescription and those introduced through illicit means. We conducted a mixed-methods study asking what the desired goals of patients with OUD from the Pharmacogenetics of Opioid Substitution Treatment (POST) project are. Using data from POST, we also examined the treatment outcome differences between those that were receiving methadone treatment in comparison to those that were on buprenorphine. Results The systematic review examining adverse outcomes of prescribing opioids for acute low back pain found that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI 1.06,2.33). The second systematic review found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while in treatment. Our results from GENOA also showed that those introduced to opioids by prescription were more likely to have chronic pain, an older age of onset of opioid use, less likely to have hepatitis C and use cannabis. When we asked patients what goals they desired out of treatment, we found that the most frequently reported patient important outcomes were to stop treatment (39%) and avoid all drugs (25%). When comparing OUD patients by treatment we discovered that those receiving buprenorphine were less likely to consume illicit opioids and amphetamines but more likely to have used alcohol in comparison to those on methadone. Conclusion With this knowledge, we can recognize unique risk factors for each patient and provide more tailored treatment that can incorporate this into clinical practice to address specific concerns in various cohorts of OUD patients. Additionally, the variation in the selection of outcomes demand the need for further research to establish a set of outcomes that considers patients’ goals and preferences for OUD treatment. / Thesis / Candidate in Philosophy

There is an established bidirectional relation between substance use and traumatic brain injuries (TBIs). Despite the high rate of prescribing opioids for pain management following a TBI and the epidemic of opioid use disorder (OUD) in the United States, scarce research has specifically analyzed the association between TBI and OUD. In a series of three interrelated manuscripts, the present study will first examine the prevalence and features of TBIs among persons seeking treatment for OUD. Next, the present study will evaluate the association between TBI and indicators of risky health behaviors and OUD severity, including the risk of overdose and polysubstance use. The predictive ability of symptoms of posttraumatic stress disorder, anxiety, impulsivity, depression, and chronic pain on odds of having had a TBI will also be calculated. Last, a systematic review will be conducted to provide comprehensive guidelines for effective methods of tailoring OUD treatment to mitigate the effects of TBI on treatment outcomes. Altogether, the findings will aid in the understanding of the development of TBI for persons with OUD, provide insight into common clinical complexities for patients with OUD and TBI, and offer guidance on how best to tailor interventions to increase substance use treatment efficacy for persons with TBI.