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.

Abstract available in the American Journal of Pharmaceutical Education.

Indiana University-Purdue University Indianapolis (IUPUI) / Heavy alcohol consumption and opioid overdose rates continue to increase in the United States (U.S.). Social workers provide approximately 70% of the behavioral healthcare in the U.S. Medication-assisted treatment (MAT) combines FDA-approved medications with psychosocial interventions to provide a comprehensive approach to recovery for alcohol use disorder (AUD) and opioid use disorder (OUD). However, stigmatized attitudes toward individuals with AUD, OUD, and MAT limit MAT’s use. Guided by critical social theory, this study explores factors that predict master’s-level social workers’ (MSWs) attitudes toward AUD and OUD and, by extension, factors that predict their acceptance of MAT. A repeated measures analysis of variance (ANOVA) identified MSWs from Indiana, Kentucky, and Ohio (N = 140) having more favorable statistically significant (p < 0.001) attitudes toward individuals with AUD than those with OUD. Multiple regression models used age, gender identity, political ideology, years working in addiction (tenure), social work licensure, and 12-step facilitation beliefs to predict AUD and OUD attitudes, with AUD and OUD attitudes included in the regression models for MAT acceptance. Increased years working in addiction (tenure) was a statistically significant predictor in elevating attitudes toward individuals with AUD (p < 0.05) and OUD (p < 0.01). A more liberal political ideology (p < 0.001), increased years working in addiction (tenure) (p < 0.05), and more favorable attitudes toward individuals with AUD and OUD (p < 0.001) were statistically significant predictors in MAT acceptance. These results warrant increasing MSWs’ education on addiction and research on factors that impact their acceptance of MAT. Increasing MSWs’ education on addiction may lower stigmatized attitudes toward individuals with AUD and OUD and increase MAT acceptance. MSWs’ increased acceptance of MAT could improve patient health outcomes.

Supervised Injection Facilities (SIFs) for the medical supervision of illicit drug use exist in Europe, Canada, and Australia to reduce infectious disease transmission, overdose deaths, and other harms of drug use. They have been shown to reduce rates of needle sharing by 69% and local overdose mortality by 35% without increasing rates of drug use or related crime. In light of increasing rates of illicit opioid use and overdose death in Massachusetts, the Massachusetts Medical Society recently endorsed opening a SIF in Boston. This thesis proposes a study of the Boston SIF with the hypothesis that higher SIF utilization will be associated with decreased incidence of fatal overdose, HIV seroconversion, and HCV seroconversion during the study period. I propose evaluating this hypothesis prospectively by following clients of the SIF at 6 month intervals and comparing the rates of overdose death and HIV or HCV seroconversion among frequent and infrequent clients of the SIF. Based on data reported from previous SIFs and projections of the population of people who inject drugs (PWID) in Boston, a study with this design should detect a significant difference in these three primary endpoints between people using the SIF frequently and those using it infrequently within five years. A positive finding would confirm the efficacy of SIFs in harm reduction and secondary prevention for Opioid Use Disorder (OUD), potentially leading to broader adoption in other hotspots of opioid use in the United States.

Opioid use disorder (OUD) is a chronic relapsing condition associated with significant patient morbidity and mortality. Patients suffering from OUD have an increased risk of death from suicide, HIV, infectious disease, and trauma, among other causes. Patients suffering from OUD often manage various comorbid psychiatric illnesses and homelessness. From 1999 to 2017, an estimated 400,000 people died from prescription opioid related overdoses. In 2014, there were 28,647 opioid related overdose deaths in the United States. The current standard of care for treatment of OUD is an opioid receptor agonist methadone or buprenorphine combined with a psychosocial intervention, like cognitive behavioral therapy (CBT), contingency management (CM), or motivational interviewing (MI). MI has proven to be effective in treating OUD when combined with methadone and buprenorphine. Other studies have found increased rates of opioid abstinence when study subjects were provided recovery housing contingent on urine that was free of opioids and other substances (CM). Among patients with a history of incarceration and co-morbid OUD, stable housing in some form -- private residence or living with a friend or family -- has been found to be effective in reducing opioid use when compared to homelessness as a control, suggesting homelessness confers a higher risk of opioid use. This prospective observational study aims to evaluate the effect of stable housing on opioid use disorder treatment and recovery. Study subjects will be Boston area residents who are prescribed methadone. Investigators will follow study subjects over six months while they attend weekly motivational interviewing sessions as part of their treatment regime and attend methadone clinics as usual. Once per week, study subjects will submit urine samples to study affiliated Medical Assistants (MA). Urine samples will be sent to LabCorp for toxicology analysis. At the conclusion of the study, investigators will examine which patients had longer time to relapse based on their housing status. We hypothesize that subjects with stable housing will have longer abstinence, as measured by urine toxicology, than subjects without stable housing. Positive findings could be used to help influence policy makers and federal and state legislation to promote stable housing for patients recovering from OUD.

Bakgrund: Opioider har använts under lång tid i historien för analgetisk verkan. Opioidanvändning orsakar kroniska förändringar i hjärnans receptorer och ökad tolerans. Långt gången användning kan leda till opioidbrukssyndrom. Vid svår smärta är opioider det enda medicinska alternativet och idag används patientens smärtskattning för att få reda på patientens smärtintensitet. Sjuksköterskans bemötande och attityder är viktigt vid patientnära kontakt för att lägga grunden för god omvårdnad. Syfte: Att belysa sjuksköterskans attityd till att ge smärtbehandling till patienter med opioidbrukssyndrom. Metod: Studien genomfördes som en litteraturstudie med induktiv ansats och nio artiklarna analyserades med hjälp av innehållsanalys. Resultat: Databearbetningen resulterade i fem kategorier och sju underkategorier. Sjuksköterskor hade svårt att veta ifall smärta hos patienter med opioidbrukssyndrom grundade sig i beroende eller smärta av andra orsaker. Samtidigt hade sjuksköterskorna en vilja att lindra smärtan och en uppfattning att ingen skulle behöva lida trots opioidbrukssyndrom. Patientgruppen sågs som krävande och sjuksköterskor upplevde en oro att stå ensam inför beslut i smärtbehandling och vilket beslut som var korrekt. Konklusion: Sjuksköterskors attityder mot patienter med opioidbrukssyndrom var ofta negativa och patientens smärta blev inte betrodd. Sjuksköterskorna uttryckte en utmaning i att veta ifall patienters smärtskattning var reell, samtidigt som patienterna förtjänar smärtlindring. / Background: Opioids have been used throughout history for their analgesic effect. Opioid use causes chronic changes in the brain's receptors and tolerance, prolonged use can lead to opioid use disorder. In case of severe pain, opioids are the only option and today a patient's pain assessment is used to determine a patient's pain intensity. The nurses’ approach and attitudes are important in near patient contact to establish the foundation of good nursing care. Purpose: The purpose of the study was to highlight nurses’ attitudes towards pain treatment of patients with opioid use disorder. Method: The study was carried out as a literature study with an inductive approach and nine articles were analyzed with the help of content analysis. Results: The analysis resulted in five categories and seven subcategories. Nurses had a hard time knowing if a patient with opioid use disorder's pain is caused by addiction or other sources of pain. At the same time, the nurses had a wish to treat the pain and wanted no one to suffer, even though patients had opioid use disorder.  The patient group was regarded as demanding, and nurses experienced concern standing alone taking a decision on their own regarding pain treatment and which decisions were correct. Conclusion: Nurses' attitudes towards patients with opioid use disorder were often negative and they did not believe their patient’s pain. Nurses expressed a challenge in knowing whether the patient’s pain assessment was truthful or not, at the same time they believed patients deserve pain treatment.

In the US, rural Native American communities (RNACs) experience excess morbidity in mental health disorders and mortality from opioid use disorder (OUD). This study used mixed methods to evaluate and analyze the primary data from 76 healthcare providers (HPs) from 24 states across the US (physicians = 7%), to identify HP knowledge and training regarding available prevention, treatment, and recovery (PTR) programs in treating OUD, assessment and management skills, and networking and collaboration capacity among the RNACs they serve. The HP completed the Opioid Survey for Health Care Providers online. A majority of HPs reported a need for knowledge and training regarding OUD treatments (92%). Less than half of the HPs provide intensive outpatient treatment; 40% contracted out for medication assisted treatment/medications for opioid use disorder (MAT/MOUD) services. Recovery support was low at 33% for adults and 38% for youth. HPs reported use of Narcan to be effective in reversing overdose (87%). Qualitative responses supported survey findings and described barriers, including lack of resources, inadequate staffing, insufficient funding, lack of training and OUD knowledge, stigma, and lack of tribal involvement and support. The study findings indicate HPs' need for information and training about OUD and networking and collaboration of healthcare settings to meet the needs of the RNAC they serve. Efforts are needed to improve on recovery programs with an emphasis on the youth. Culturally adapted MAT/MOUD approaches are needed to sustain long-term recovery care.

No description available.

The primary purpose of this study is to determine the occurrence of drug therapy adjustment in people with substance use disorder receiving medication-assisted treatment when admitted to an acute care facility for a comorbid condition. The secondary purpose is to understand the correlation between the presence of adjustment of therapy for substance use disorder and influence on recovery from comorbid conditions. A literature review exploring drug therapy for addicted individuals during hospitalization was performed using various databases, search terms included *substance use disorder or *substance abuse or *illicit drug use or *drug abuse or *MAT or *maintenance therapy, combined with *inpatient or *hospital or *acute care or *admission. The data was conformed into tables that synthesized the relationship between drug therapy adjustment for individuals with substance use disorder during an acute care admission. Initial review of the articles revealed 78 articles relative to the topic, 16 of those articles met inclusion criteria and were selected for a detailed analysis. Studies suggest the need for provider education and guidelines for treating individuals receiving MAT in an acute care facility. While individuals with substance use disorder often use acute care services, their medication-assisted treatment is rarely acknowledged or adjusted. Many studies focus on individuals with substance use disorder, yet, addressing medication-assisted therapy is still inconsistent, and lacks official guidelines.

No description available.