Thesis (Ph. D.)--University of Chicago, Committee on Neurobiology, June 2000. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph.D.)--Texas Christian University, 2006. / Title from dissertation title page (viewed Sept. 11, 2006). Includes abstract. Includes bibliographical references.

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Thesis advisor: Richard McGowan / Vermont had 13.9 overdose deaths per 100,000 people in 2014, almost 2.5 times less than New Hampshire in the same year (Rudd 2016). Much of this has been attributed to the framework Vermont has in place for treatment of Opioid Use Disorder (OUD), specifically the “Hub and Spoke” model of treatment. This model has been highly praised due to the continuity of care waivered spoke physicians are able to provide, and the overall success the program has had in reducing overdoses and addiction as a whole, typically through the “gold standard” of Medication Assisted Treatment (MAT). “The Doorway” as the hub and spoke system is called in New Hampshire, is realistically a referral framework that links people seeking treatment with OUD to a provider, which is very different from the structure in Vermont. Vermont is predicted to spend about $85 million of Medicaid money on treatment for people with OUD in 2019 (Table 1). Meanwhile, New Hampshire, a state with over double the population, is projected to spend $52 million in 2019 (Table 2). This is likely due to differences in Medicaid payment structure and MAT-waivered physician availability; Vermont has a larger rate of MAT providers per 10000 population of 2.71 compared to 2.05 in New Hampshire. New Hampshire Medicaid reimburses behavioral health providers poorly, providing an indexed reimbursement rate of 0.83 in comparison to 1.11 in Vermont (Kaiser Family Foundation 2019). To initiate change and create a treatment utilization rate equivalent to Vermont, it is estimated New Hampshire would have to spend $133 million to $150 million in 2019, which is not possible given the taxation structure in place. / Thesis (BA) — Boston College, 2019. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Economics.

Background and Objectives: Opioid addiction is a major contributor to the global burden of disease and carries a significant risk of morbidity and mortality. Individuals with opioid addiction are subject to numerous adverse consequences including infectious diseases, medical complications, psychiatric disorders, and social disintegration. Women especially experience a heightened vulnerability to the adverse medical and social consequences of opioid addiction as a result of biological sex characteristics and socially-defined gender roles, which increases their risk for poor treatment outcomes. The general objective of this thesis if to investigate sex and gender differences in the management and treatment of opioid addiction with a focus on hormonal influences, genetic variation, and sociobehavioral characteristics including substance use behavior, health status, and social functioning. Methods: Using various methodologies, we compared the biological and social characteristics of men and women with opioid addiction in the context of methadone treatment. We assessed sex and gender differences in methadone treatment outcomes using a systematic review of the literature and a meta-analysis, which was developed based on published protocol. Next, we used data from the multi-centre GENOA cross-sectional study including 250 patients with opioid addiction recruited from Ontario methadone clinics to measure testosterone levels among men and women compared to non-opioid using controls; total serum testosterone was assayed using ELISA and RIA techniques. Following this study, we conducted a systematic review and meta-analysis to test the effect of opioid use on testosterone levels, performing subgroup analyses by sex and type of opioid used. Using the previous GENOA sample, we then completed genotype analysis on variants of BDNF and DRD2 genes to test the genetic effect on continued opioid use, measured through urine drug screening. Finally, we recruited an additional 503 participants meeting criteria for opioid use disorder who were receiving treatment with methadone, from which we obtained information on drug use patterns and addiction severity using the Maudsley Addiction Profile (MAP) tool to evaluate sex and gender differences. Results: In our initial systematic review, we found 20 studies collectively showing that women were less likely than men to report alcohol use, employment, or legal involvement, but were more likely to misuse amphetamines. Using the GENOA dataset of methadone patients, we found a significant reduction in testosterone level among men but not women, which was associated with methadone dose. We also determined that testosterone did not fluctuate significantly between menstrual cycle phases. In line with these findings, our systematic review showed a significant suppression in mean testosterone level among men that use opioids compared to controls, but not in women. Our results also showed that methadone did not affect testosterone differently than other opioids. Among GENOA participants, BDNF rs6265 and DRD2 rs1799978 genetic variants were not significantly associated with continued opioid use while in methadone maintenance treatment. Our final study identified sex and gender differences in substance use, health status, and social functioning. Women were younger, had children, were current smokers, had higher rates of benzodiazepine use, more frequent physical and psychological health problems, family history of psychiatric disorders, more partner conflict, and began regular use of opioids through a physician prescription. In comparison, men were more likely to be employed and to report cannabis and amphetamine use. Conclusions: This thesis has demonstrated that men and women are differentially affected by opioid addiction and experience sex- and gender-specific challenges throughout the course of methadone treatment that are likely to impact treatment outcomes. The identification of clinically-relevant sex and gender differences is important to our understanding of the addiction profile, and can therefore be used to promote strategies for effective treatment and management of opioid addiction among men and women incorporating both biological and social perspectives. / Thesis / Doctor of Philosophy (PhD)

Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / There is a paucity of data relating to the psychology of heroin addiction. It was the purpose of this investigation to generate some meaningful data which might have utility for the adequate understanding, prevention, and treatment of this ·serious social-psycholog ical problem. Heroin addicts were contrasted with non-addict controls with respect to three important psychological dimensions: self-esteem, future time perspective, and locus of control. Three major hypotheses were based on the assumption that heroin addict subjects had low self-esteem, a foreshortened future time perspective, and an external locus of control. Three minor or secondary hypotheses were also developed which assumed a positive interrelationship between self-esteem, future time perspective and locus of control. / 2031-01-01

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Yes / We linked UK cancer registry data with the corresponding electronic primary care medical records of 6080 patients who died of cancer over a 7-year period in a large United Kingdom city. We extracted all prescriptions for analgesics issued to each patient in the linked cohort during the 12 months before death and analysed the extent and duration of strong opioid treatment with clinical and patient characteristics. Strong opioids were prescribed for 48% of patients in the last year of life. Median interval between first prescription of a strong opioid and death was 9 weeks (interquartile range 3-23). Strong opioid prescribing was not influenced by cancer type, duration of illness, or gender but was adversely influenced by older age. Compared with patients who died in a hospice, those who died in a hospital were 60% less likely to receive a strong opioid in primary care before admission (relative risk ratio 0.4, CI 0.3-0.5, P < 0.01). The study provides the first detailed analysis of the relatively late onset and short duration of strong opioid treatment in patients with cancer before death in a representative UK cohort. This pattern of prescribing does not match epidemiological data which point to earlier onset of pain. Although persistent undertreatment of cancer pain is well documented, this study suggests that strategies for earlier pain assessment and initiation of strong opioid treatment in community-based patients with cancer could help to improve pain outcomes. / National Institute for Health Research (NIHR) (RP-PG-0610-10114)

published_or_final_version / Physiology / Doctoral / Doctor of Philosophy