Dissertations / Theses on the topic 'Opioid use disorder (OUP)'
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1
Wu, Katherine C. "A Care and Justice Ethics Approach to Opioid Use Disorder in Pregnancy." NEOMED College of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ne2gs1620579941339304.
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Hayel-Moghadam, Kamran, and Meredith K. Ginley. "The Interplay between Depression and Bipolar Disorders and OUD/SUD." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etsu-works/8880.
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Mort, Sophia C. "Utilizing Health Professional Students’ Knowledge, Attitudes, and Beliefs to Inform the Development of a Contact-Based Educational Approach to Address the Opioid Epidemic." Ohio University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1597412295795281.
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Pack, Robert P. "Opioid Use Disorder." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1335.
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Creviston, Megan. "Adverse Childhood Experiences among Individuals with Opioid Use Disorder." Wright State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=wright1610112137970568.
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Drayton, Antwana L. "Opioid Use Disorder: The Ugly Return and Treatment Effectiveness of Heroin Use." UNF Digital Commons, 2018. https://digitalcommons.unf.edu/etd/814.
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Relationships among demographic, socioeconomic and person factors and Opioid Use Disorder diagnosis, treatment, and recidivism were explored. Data from a sample of 4,860 adults with substance use difficulties were analyzed. A program evaluation was conducted on Gateway Community Services to explore the use of Medication Assisted Treatments (MATs) and Psychosocial (PS) treatments to address Opioid Use Disorder. Using archival data, a chi-square analysis and independent sample t-test was performed. The results expressed that a relationship among race, type of substance use diagnosis, and treatment type and recidivism rate was found. While White/Non-Hispanics adults were more likely to use heroin than any other racial/ethnic backgrounds, gender differences were also found. Finally, frequency and duration of a combined treatment (PS + MAT) were negatively related to recidivism with no determination of previous prescription opioid use to be examined at this time.
Keywords: medication assisted treatment, recidivism, psychosocial, opioid
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Ochalek, Taylor Anne. "Examining sucrose subjective response among individuals with opioid use disorder." ScholarWorks @ UVM, 2020. https://scholarworks.uvm.edu/graddis/1185.
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Aims: Opioid use disorder (OUD) is associated with significant morbidity and mortality, and opioid agonist treatment (OAT) with methadone or buprenorphine represents the most efficacious treatment. However, data suggest that chronic administration of opioids may be associated with significant weight gain, possibly by altering an organism’s perception of and preference for sweet foods. The primary aim of this laboratory study was to rigorously examine sucrose subjective response among adults receiving OAT and a comparison sample without OUD. As secondary outcomes, we also sought to compare the groups on additional baseline characteristics that may influence subjective sucrose response and weight gain during treatment.
Methods: Participants were 40 adults receiving treatment for OUD (OUD+) and a comparison sample of 40 adults without OUD (OUD-). All participants completed an initial screening visit that included questionnaires on eating behaviors, diet and nutrition, recent substance use, and measurement of body mass index. Eligible participants completed two, same-day outpatient laboratory sessions during which they sampled six experimenter-administered concentrations of sucrose solution (0, 0.1, 0.25, 0.5, 0.75, and 1.0M in distilled water) each three times under double-blind counterbalanced conditions. Following each exposure, participants rated the pleasantness and intensity of each sample using 100-point visual analog scales.
Results: OUD+ participants rated sucrose solutions as less pleasant than OUD- participants (p<0.001). However, this effect was limited to the three lowest sucrose concentrations (0, 0.1, 0.25M), and at higher concentrations there were no group differences. There were no between-group differences on ratings of intensity (p=0.35). Given these baseline group differences in placebo (0M) responding, sucrose response was also examined in terms of change from baseline. In this analysis, there was a significant group effect, with a higher magnitude of change in pleasantness ratings and a lower magnitude of change in intensity ratings from 0M in OUD+ vs. OUD- participants (p’s<0.05). With regard to baseline characteristics that may influence sucrose response and eating behavior more generally, the OUD+ group had a higher prevalence of obesity, food insecurity, unhealthy eating behaviors, high sugar consumption, and nutrition knowledge deficits compared to the OUD- group (p’s<0.05).
Conclusion: Data from preclinical and clinical research have suggested that opioid agonist medications may enhance subjective response to sweet flavors. In the present study, OUD+ participants exhibited a higher magnitude of change in pleasantness ratings from placebo compared to OUD- participants. However, this effect was largely driven by pronounced group differences in perceived pleasantness of essentially unsweet solutions. On the outcome of sucrose intensity, findings were more mixed with no consistent differences between OUD+ and OUD- participants. In contrast, group differences were far more pronounced in participants’ daily eating behaviors and nutrition knowledge, with OUD+ participants presenting with a consistently more severe profile. These data highlight the significant risk factors experienced by OUD+ individuals that extend beyond drug-related risks and may inform future scientific and clinical efforts to improve health outcomes in this vulnerable population.
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Toler, Kimberly. "Trauma-Informed Care for Persons With Opioid Use Disorder in Ohio." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7202.
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Prevention, social work, and community awareness programs have not led to the successful reduction of opioid overdose deaths nationwide, and particularly in Ohio. This study explored social work perspectives about trauma-informed care (TIC) for persons with opioid use disorder in Ohio. The research questions for this study examined how social workers in Ohio implemented TIC when providing outpatient treatment to opioid users and what challenges they faced when providing TIC. Using an action research methodology, data were collected through individual semistructured interviews with 5 social work professionals, selected through purposive sampling based on experience in the field of substance use in Ohio and the use of TIC. Contemporary trauma theory and TIC were chosen to frame the research project. Three themes emerged through thematic analysis of the data: appreciation for trauma-informed opioid use disorder treatment, organizational and professional challenges to the use of trauma-informed opioid use disorder treatment, and environmental barriers to successful trauma-informed outpatient opioid use disorder programming. The study aligned with the social work core values of competence and principles of harm reduction. The findings from the study might bring about social change by igniting dialogue among treatment providers about how TIC interventions could support integrated treatment and holistic approaches to combatting opioid addiction in Ohio.
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Salwan, Aaron J., Nicholas E. Hagemeier, Kelly N. Foster, Jesse Arnold, Billy Brooks, Arsham Alamian, and Robert P. Pack. "Pharmacist and Physician Engagement in Tertiary Prevention of Opioid Use Disorder." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7742.
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Bogdanowicz, Karolina. "Risk of mortality in secondary mental health treatment for opioid use disorder." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/risk-of-mortality-in-secondary-mental-health-treatment-for-opioid-use-disorder(37f04662-37c8-4a28-8247-bd3b0b55e3e8).html.
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This thesis utilizes anonymized patient health records from one of the largest mental health service providers in Europe and explores mortality risk factors, at both patient-level and service-level, in individuals with opioid use disorder (OUD) enrolled in secondary drug and alcohol treatment. The thesis explores associations between psychological wellbeing, comorbid diagnosis of personality disorder (PD), serious mental illness (SMI) and alcohol use disorder (AUD), in relation to mortality in opioid dependence. Specific risk situations in time and context are also explored, with investigations of clustering of deaths in the period immediately after transfer of patients and their care and after end of opioid substitution treatment (OST) in a cohort of opioid dependent individuals in specialist addiction treatment. The thesis also investigates if routine brief risk assessments given to OUD patients can predict all-cause or cause specific mortality and determine if these risks may be modified by admission to services.
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Hagemeier, Nicholas E. "The Role of Community Pharmacy in Addressing and Preventing Opioid Use Disorder." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5433.
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Ripley, Dana Marie. "Counseling interventions with buprenorphine for treatment of opioid use disorders." Diss., Virginia Tech, 2019. http://hdl.handle.net/10919/88809.
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Opioid abuse and opioid related deaths continue to affect families and communities across the United States. Medication-assisted treatment shows advantages over other types of interventions for opioid use disorder (OUD) (Bart, 2012). While buprenorphine, an approved medication for the treatment of OUD, has a wide research base to support its efficacy, there is little research or guidance on behavioral interventions to use in conjunction with the medication. Investigating clients' experiences in treatment can provide helpful and necessary information for improving treatment efforts. The following qualitative study used a phenomenological approach to explore the client experience of group therapy with buprenorphine for OUD. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for self-disclosure. This research highlights the importance of the therapeutic alliance, the 11 therapeutic factors of groups, and the necessity of building authentic relationships in treatment.Doctor of Philosophy
As opioid overdoses continue to rise in the United States, it is essential that we improve addiction treatment. Medication-assisted treatment (MAT) combines the use of medications and counseling to treat the whole person. This type of approach shows advantages over counseling only interventions for opioid use disorder (OUD) (Bart, 2012). While MAT shows promise over counseling only approaches, there is little research or guidance on how to implement counseling with the medication. Investigating clients’ experiences in treatment can provide helpful and necessary information for improving counseling in MAT. The following qualitative study used in-depth interviews with participants who are currently in a MAT program to better understand their experiences in treatment. Results showed the importance of supportive, genuine relationships in recovery, as well as the need for accountability and a safe space for sharing. This research helps further knowledge of treatment for OUD to better serve those affected by addiction, as well as adding to the gaps in group therapy and addiction’s literature.
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Chamberlain, Jude M. "Development of an MMPI-2 Scale to Aid in Assessing Opioid Use Disorder." Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1398255420.
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Priest, Kelsey Caroline. "Hospital-Based Services for Opioid Use Disorder: a Study of Supply-Side Attributes." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/4829.
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The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals.
Opioid use disorder (OUD)-related hospitalizations are increasing, and incurring significant costs; care delivered in this setting is likely sub-optimal. This study examined hospital-based services for OUD using a conceptual framework based on an interdisciplinary review of policy, organizational behavior, systems science, economics, and health services delivery scholarship. The study's primary research question was: How do supply-side attributes influence hospital OAT delivery, health outcomes, and health services utilization for persons hospitalized with OUD? Supply-side attributes refer to the contextual elements inside and outside of a hospital that may be associated with hospital OAT delivery performance, such as social structures (e.g., hospital standards of care, societal values) and resources and technologies (e.g., hospital staffing, federal treatment policies).
A mixed methods study described, explored, and identified how patients with OUD are cared for in the hospital and the barriers and facilitators to delivering OAT during hospitalization. The sequential mixed methods approach (i.e., qualitative followed by quantitative analyses) included analysis of 17 key informant interviews with addiction medicine physicians from 16 non-federal U.S. hospitals, 25 hospital guidance documents from 10 non-federal U.S. hospitals, and administrative data from 12,407 OUD-related hospital admissions from the Veterans Health Administration (VHA) health system.
The findings from the study's three aims and 16 research sub-questions were integrated to reach seven conclusions: 1) OAT is underused in the hospital; 2) OAT delivery varies within and across hospitals; 3) OAT is used ineffectively; 4) non-OAT modalities are inappropriately used during and after hospitalization; 5) supply-side attributes inside and outside the hospital facilitate and impede hospital OAT delivery; 6) demand-side attributes facilitate and impede hospital OAT delivery; and 7) the hospital is an important service delivery mechanism in the OUD care continuum.
The study's findings could be extrapolated to improve policy and practice by implementing education and health service delivery interventions through regulatory and allocative policy mechanisms focused on physicians, medical trainees, and hospital and health system administrators. Understanding how OAT delivery may be improved within the acute care delivery system is an important element to support efforts to curb the ongoing drug poisoning crisis.
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Mullins, Jonathan David. "A Comparative Study of Recovery Ecosystems for Opioid Use Disorder in Portugal and Appalachia." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/honors/620.
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A comparison of the structure and effectiveness of recovery ecosystems for opioid use disorder in Portugal and Appalachia, with a focus on identifying areas for improvement within the Appalachian region.
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Serratore, Catherine. "Trends and Patterns in Use of Medications for Opioid Use Disorder in a Commercially Insured Population in the U.S." UKnowledge, 2019. https://uknowledge.uky.edu/pharmacy_etds/108.
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Opioid use disorder (OUD) and opioid overdose are pervasive public health problems in the U.S. Medications for opioid use disorder (MOUD) have been shown effective to reduce OUD morbidity and mortality. Two distinct approaches to MOUD are currently used: agonist therapy (methadone or buprenorphine) or antagonist therapy (naltrexone). Limited information is available about the patterns of use, adherence to therapy, and characteristics of those who use agonist vs. antagonist therapy. The objective of this study is to assess recent trends in MOUD, adherence in use of MOUD, and the characteristics of those who use agonist vs. antagonist therapy in a nationally representative population of commercially insured patients in the U.S.
This retrospective descriptive study utilized data from Truven Marketscan Commercial Claims and Encounters database from years 2011 to 2016. All individuals aged 18 years and older who have a diagnosis of OUD and utilize MOUD at any point during the study period were included. Demographic characteristics of interest included age, gender, geographic region, and type of insurance coverage. Clinical characteristics of interest included diagnosis of OUD and type of MOUD used, including extended – release naltrexone for injection, oral naltrexone, buprenorphine in combination with naloxone, and buprenorphine alone. Descriptive analyses were employed to understand utilization patterns and trends over time and proportion of days covered was used to measure adherence. Frequency and percentage are presented for categorical variables. Adherence of MOUD will be estimated by measuring proportion of days covered. As this study uses de-identified commercial health claims data, it has been determined as not human subjects research by the University of Kentucky’s Office of Research Integrity.
Agonist therapy with buprenorphine or buprenorphine/naloxone was the most common treatment, representing 75.7% of those receiving treatment. Between 2011 and 2016, the percentage of individuals receiving treatment with partial agonist therapy decreased 16.5% to 9.2%, respectively. Meanwhile, the percentage of individuals receiving treatment with antagonist treatment increased from 0.1% in 2011 to 0.3% in 2016. In the analysis of proportion of days covered, all MOUD reported a decrease at both 180 and 365 days. In the commercial population, younger female patients were more likely to be treated with injectable naltrexone. Specifically, in the North Central geographic region, commercial adult patients were more likely to be treated with buprenorphine monotherapy.
Overall, this study found a decrease in use of agonist therapy from 2011 through 2016, with an increase in use of antagonist therapy in the same time period. However, the increase in use of antagonist therapy does not fully account for the decrease in use of agonist therapy, suggesting that since 2011 many patients with OUD still remain untreated. All MOUD types were analyzed and saw a decrease in proportion of days covered, as a measure of adherence, from 2011 to 2016 putting patients at an increased risk for relapse, further complications, emergency visits, and hospitalizations. More information is needed about characteristics of patients who not only seek out treatment for OUD, but also maintain their treatment overtime.
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Ochalek, Taylor A. "A novel mhealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder." ScholarWorks @ UVM, 2018. https://scholarworks.uvm.edu/graddis/845.
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Aims: Untreated opioid use disorder (OUD) is associated with overdose, premature death and infectious disease, including human immunodeficiency virus (HIV) and Hepatitis C (HCV). While prior studies have shown that educational interventions are associated with improvements in HIV and HCV knowledge and reductions in risk behaviors, those examined to date have typically been time- and resource-intensive. We recently developed an HIV+HCV Education intervention which aims to improve HIV and HCV knowledge in a single visit using an automated iPad platform. In this project, we examined its ability, using a within-subject evaluation, to improve knowledge of HIV and HCV transmission and risks among adults with OUD.
Methods: Participants were 25 adults with OUD who were enrolled in a 12-week randomized trial evaluating the efficacy of an Interim Buprenorphine Treatment (IBT) for reducing illicit opioid use while awaiting entry into community-based opioid treatment. Participants completed a baseline HIV+HCV knowledge assessment (Pre-Test) followed by corrective feedback, both administered via iPad. They then completed an interactive HIV flipbook and animated HCV video, also on iPad, followed by a second administration of the knowledge assessment (Post-Test). Finally, to evaluate whether any changes in knowledge persisted over time, the HIV+HCV assessment was administered again at 4 and 12 weeks following study intake.
Results: At baseline (Pre-Test), participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. After completing the educational intervention, participants answered 86% of items correctly on both the HIV and HCV assessments (p’s<.001). These improvements in knowledge also persisted throughout the three-month study, with scores at Week 4 and 12 timepoints significantly greater than baseline (p’s<.001).
Conclusion: An HIV+Hepatitis Education intervention delivered via a portable, automated iPad platform may produce significant and persistent improvements in HIV and HCV knowledge among adults with OUD. These data provide additional support for the use of mobile educational interventions for enhancing HIV and HCV knowledge in individuals at elevated risk for infectious disease.
Support: This trial was supported by NIDA R34 DA3730385 (Sigmon) with additional support by NIDA T32 DA007242 (Higgins).
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Jordan, Justin Richard. "Come as You Are: The Acceptability of Harm Reduction Approaches for Opioid Use Disorder among Professional Counselors." Diss., Virginia Tech, 2021. http://hdl.handle.net/10919/102979.
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Over the last two decades, the Opioid Epidemic has caused immense harm to communities nationwide. Over 400,000 fatal opioid overdoses occurred in the United States between 1999 and 2017 (CDC, 2019). Professional counselors are among the front-line treatment providers addressing substance use, including Opioid Use Disorders. Professional counselors have a unique professional identity that is built upon humanistic values, a commitment to social justice, and client empowerment. These values align closely with contemporary approaches to substance use treatment, including harm reduction strategies. Harm reduction is an approach to substance use treatment that involves mitigating risks and improving the quality of life of individuals, regardless of their willingness or ability to stop using substances. There are several harm reduction strategies that reduce the risk of fatal opioid overdose or secondary harms of opioid use specifically, including medication-assisted treatment and the distribution of naloxone for overdose reversal. This study examined the acceptability of harm reduction strategies for Opioid Use Disorder among addiction treatment professionals, with a focus on professional counselors. In addition to measuring the level of acceptance of harm reduction for Opioid Use Disorder among professional counselors, counselors were also compared to other professionals who treat substance use. Predictors of acceptability of harm reduction for Opioid Use Disorder were examined based on overlapping components of professional counseling identity and harm reduction philosophy among professional counselors as well.
The results of this study provided a baseline for the level of harm reduction acceptance among counselors who treat substance use. Counselors did not have higher levels of harm reduction acceptance for OUD compared to social workers with advanced degrees or bachelor's level substance use treatment providers. Social justice attitudes and empathy were statistically significant predictors of acceptance among counselors. This research indicates that these two factors are key components of counselor identity that explain harm reduction acceptance. The findings of this study highlight a need for more research about harm reduction acceptance for OUD among counselors, including further examination of provider factors that influence acceptance and examination of a broader array of professionals. This research contributed to the understanding of how professional counselors perceive novel approaches for addressing Opioid Epidemic.Doctor of Philosophy
The Opioid Epidemic is a public health crisis that has led to hundreds of thousands of overdose deaths over the last two decades. Counselors are among the treatment professionals addressing substance use in the United States, including responding to the Opioid Epidemic. Harm reduction is a unique approach to substance use treatment that focuses on keeping people who use substances alive and healthy, regardless of their ability or intent to stop using substances. The current study sought to explore the perceptions of harm reduction strategies for people who use opioids among counselors, including comparing their attitudes to other professionals and exploring the impact of their professional identity. Counselors were not found to be more accepting of harm reduction than other professionals who treat substance use and social justice and empathy were key aspects of counselor professional identity that predicted accepting attitudes towards harm reduction. More research is needed to understand how counselor identity affects harm reduction perceptions.
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Mathis, Stephanie M., Nicholas Hagemeier, Angela Hagaman, John Dreyzehner, and Robert P. Pack. "A Dissemination and Implementation Science Approach to the Epidemic of Opioid Use Disorder in the United States." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2780.
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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>
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Melbostad, Heidi S. "Comparing Family Planning Knowledge Among Females and Males Receiving Opioid Agonist Treatment or Seeking Primary Care Services." ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/1137.
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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.
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Loveday, William A. "Prescription opioid analgesic drug misuse: What can we learn from doctor-shopping behaviour." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/108061/1/William_Loveday_Thesis.pdf.
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This thesis examined the phenomenon of 'doctor shopping' for prescription opioid drugs in Queensland to identify whether aspects of this behaviour could be used better identify drug misuse and to assist doctors in better treatment of patients. Findings suggest that doctor shopping is a complex and uncommon behaviour in patients receiving prescription opioid drugs and not necessarily associated with aberrant drug use. It appears that long-term high dose use of prescription opioids is a greater indicator of concern and potential risk of harm. These outcomes have relevance to the implementation of real-time reporting of prescription opioid drugs in Australia.
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Spivack, Stephanie. "The Care of Hospitalized Intravenous Drug Users in 2019." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/553776.
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Urban BioethicsM.A.
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.
Temple University--Theses
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Apelt, Sabine M. [Verfasser], and Michael [Akademischer Betreuer] Soyka. "Safety and effectiveness of Buprenorphine-Naloxone sublingual tablet in the treatment of opioid use disorder / Sabine M. Apelt ; Betreuer: Michael Soyka." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2019. http://d-nb.info/1183572239/34.
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Brooks, Billy. "Rural Opioid and Other Drug Use Disorder Diagnosis: Assessing Measurement Invariance and Latent Classification of DSM-IV Abuse and Dependence Criteria." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etd/2569.
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The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and that diagnosis of these disorders across rural and urban populations may not be generalizable due to these same effects. This study applies measurement invariance analysis and factor analysis techniques: item response theory (IRT), multiple indicators, multiple causes (MIMIC), and latent class analysis (LCA), to the DSM-IV abuse and dependency diagnosis instrument. The sample used for the study was a population of adult past-year illicit drug users living in a rural or urban area drawn from the 2011-2012 National Survey on Drug Use and Health data files (N = 3,369| analyses 1 and 2; N = 12,140| analysis 3). Results of the IRT and MIMIC analyses indicated no significant variance in DSM item function across rural and urban sub-groups; however, several socio-demographic variables including age, race, income, and gender were associated with bias in the instrument. Latent class structures differed across the sub-groups in quality and number, with the rural sample fitting a 3-class structure and the urban fitting 6-class model. Overall the rural class structure exhibited less diversity and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants). This result suggests underlying elements affecting SUD patterns in the two populations. These findings inform the development of surveillance instruments, clinical services, and public health programming tailored to specific communities.
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Ancona, Rachel M. "Modeling Opioid Use Disorder in an Emergency Department Population Using Electronic Medical Records: Machine Learning for Propensity Score Weighting and Data Mining." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1593268439567828.
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Melton, Tyler C., Nicholas E. Hagemeier, Kelly N. Foster, Jesse Arnold, Billy Brooks, Arsham Alamian, and Robert P. Pack. "Primary Care Physician and Community Pharmacist Opioid-Related Communication and Screening Behaviors." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7743.
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Allen, Grundi. "The reduction of relapse potential after the incorporation of vocational services in a substance abuse residential program for women." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1573570966154273.
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Larson, Olivia Grace. "Changes in Self-Concept and Substance-Related Cognitions During Short-Term Residential Substance Use Treatment." Diss., NSUWorks, 2019. https://nsuworks.nova.edu/cps_stuetd/124.
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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.
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Al, Battashi Hamed Mubarak. "The Impact of Resilience, Spirituality, and Self-Regulation on the Quality of Life of Adults with Opioid Use Disorder in the Gulf State of Oman." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1625854190511036.
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MacVicar, Sonya. "IBriS study : intervention supporting breastfeeding in substance dependency." Thesis, Robert Gordon University, 2016. http://hdl.handle.net/10059/2119.
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Introduction: Breastfeeding offers the substance exposed mother and child potential short and long-term health benefits, with breast milk shown to alleviate the severity of Neonatal Abstinence Syndrome. Substance dependent women, however, have limited success establishing breastfeeding with physical, psychological and institutional factors cited as barriers. This study aimed to develop and test the feasibility of an evidence informed and theory based intervention to support continued breastfeeding for this group. Methods: The research was a two-phase feasibility study. Phase 1 informed intervention development using a mixed methodology approach which included (a) a comprehensive systematic literature review of breastfeeding support for women from disadvantaged groups (b) expert advisory group recommendations and (c) ‘think aloud’ verbal protocols with opioid dependent women. Phase 2 underpinned the evidence with the theoretical constructs of behaviour change, prior to testing the acceptability and implementation fidelity of the intervention in a feasibility study with an embedded small-scale randomised controlled trial. Results: Phase 1 identified the barriers to breastfeeding continuation as low maternal self-efficacy; neonatal feeding difficulties associated with withdrawal and unsupportive healthcare practices. Evidence and theory synthesis resulted in an integrated breastfeeding support model founded on practical, informational, psychological, person-centred and environmental components. Phase 2 demonstrated that the intervention was feasible to implement and acceptable to participants. The randomised controlled trial reported higher rates of continued breastfeeding and a greater level of maternal confidence in breastfeeding ability in the intervention group compared to the control group. Breastfed infants were less likely to require pharmacological management and had corresponding shorter durations of hospitalisation than formula fed infants. Conclusion: The research provided an original contribution to the development of a complex healthcare intervention which is meaningful to both existing research and clinical practice. The findings highlighted the potential of the intervention to support breastfeeding for the substance exposed mother and baby, which has wide ranging implications for the improved health and social equalities of this group.
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Beechey, Riley Tegan Anne. "Pharmacist Utilization of Opioid Misuse and Abuse Interventions: Acceptability Among Pharmacists and Patients in Detox." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1499974262218499.
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Kobelt, Paula Anne. "Nasal Spray Can Save Lives: Engaging Emergency Department Nurses in the Provision of Naloxone Nasal Spray to High Risk Patients." Otterbein University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1493059037547445.
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Pettyjohn, Samuel. "The impact of structural level state laws on syringe service program access and risk environment of people who inject drugs (PWID)." Digital Commons @ East Tennessee State University, 2005. https://dc.etsu.edu/etd/3756.
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Background: Understanding concentrated areas with high rates of opioid use disorder (OUD) allows for improved placement of Narcan access points through syringe services programs (SSPs). People Who Inject Drugs (PWID) have lower risk of contracting infectious diseases the closer they are to SSPs. Tennessee law prohibits SSPs within 2000ft of a school or park, impacting the placement of SSPs in non-urban areas. Testing factors related to SSP siting placement within a system dynamic model can better determine the relationship between PWID risk environment and SSP access and utility.
Methods: We identified areas of greatest need for harm reduction interventions within a non-urban Tennessee county with Emergency Medical Services (EMS) Narcan administrations data (Aim 1). We then created a Google map to determine a theoretical ideal location for an SSP. We then applied the current legal restrictions to SSP placement to find the next-closest legal location (Aim 2). We then developed a theoretical system dynamic model of SSP access and utility and Risk Environment (Aim 3).
Results: We determined “EMS Zone 1” has a higher rate of EMS Narcan administrations than most EMS zones in the county and a higher rate compared to the whole county (Aim 1). We located a theoretical SSP location with shorter walk, drive, and public transportation times compared to the existing location. The closest legal SPP location still had an improvement in travel times but lacked other utility factors (Aim 2). Our theoretical model indicates that laws limiting SSP placement increase the distance PWID travel to SSPs. The distance of support services to SSP sites has a negative relationship with risk environment and to accessibility and utility of SSPs (Aim 3).
Conclusion: County-level geographic data is too crude to determine true “hot spots” of OUD. This new method using EMS data can provide entities a process for determining the best location for SSPs. Identifying measures of utility/accessibility for PWID can identify improved locations for SSPs but legal restrictions may lower utility/accessibility of SSPs especially for non-urban PWID. Current “Policy” or “Structural” level factors as described by the Social Ecological Model negatively impact PWID risk environment. Structural” or “Policy” and “Community” level interventions among state, city, and county governments have the highest potential to positively impact PWID risk environment.
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Pettyjohn, Samuel. "The Impact of State-Level Laws on Syringe Service Program Access and Risk Environment of People Who Inject Drugs (PWID)." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etd/3756.
Full textAbstract:
Background: Understanding concentrated areas with high rates of opioid use disorder (OUD) allows for improved placement of Narcan access points through syringe services programs (SSPs). People Who Inject Drugs (PWID) have lower risk of contracting infectious diseases the closer they are to SSPs. Tennessee law prohibits SSPs within 2000ft of a school or park, impacting the placement of SSPs in non-urban areas. Testing factors related to SSP siting placement within a system dynamic model can better determine the relationship between PWID risk environment and SSP access and utility.
Methods: We identified areas of greatest need for harm reduction interventions within a non-urban Tennessee county with Emergency Medical Services (EMS) Narcan administrations data (Aim 1). We then created a Google map to determine a theoretical ideal location for an SSP. We then applied the current legal restrictions to SSP placement to find the next-closest legal location (Aim 2). We then developed a theoretical system dynamic model of SSP access and utility and Risk Environment (Aim 3).
Results: We determined “EMS Zone 1” has a higher rate of EMS Narcan administrations than most EMS zones in the county and a higher rate compared to the whole county (Aim 1). We located a theoretical SSP location with shorter walk, drive, and public transportation times compared to the existing location. The closest legal SPP location still had an improvement in travel times but lacked other utility factors (Aim 2). Our theoretical model indicates that laws limiting SSP placement increase the distance PWID travel to SSPs. The distance of support services to SSP sites has a negative relationship with risk environment and to accessibility and utility of SSPs (Aim 3).
Conclusion: County-level geographic data is too crude to determine true “hot spots” of OUD. This new method using EMS data can provide entities a process for determining the best location for SSPs. Identifying measures of utility/accessibility for PWID can identify improved locations for SSPs but legal restrictions may lower utility/accessibility of SSPs especially for non-urban PWID. Current “Policy” or “Structural” level factors as described by the Social Ecological Model negatively impact PWID risk environment. Structural” or “Policy” and “Community” level interventions among state, city, and county governments have the highest potential to positively impact PWID risk environment.
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Shahrokh, Bahram Edward Kaikhosrow. "The Experience of Relapse After Long-term Sobriety and Subsequent Return to Sobriety." Antioch University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1560629709925552.
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Bertin, Célian. "Évaluation pharmacoépidémiologique des Troubles de l’usage du sulfate de morphine." Thesis, Université Clermont Auvergne (2017-2020), 2020. http://theses.bu.uca.fr/nondiff/2020CLFAC016_BERTIN.pdf.
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La prescription d’antalgiques opioïdes a fortement augmenté ces dix dernières années dans la plupart des pays industrialisés. Cette inflation s’est logiquement accompagnée d’un accroissement des complications iatrogènes de ces molécules, aux premiers rangs desquels les problématiques de dépendance, de trouble de l’usage, d’intoxications involontaires et parfois de décès. La France paraît, à l’heure actuelle, globalement préservée de ce qui est désormais qualifié de « crise des opioïdes », grâce à sa réglementation stricte sur la prescription et la délivrance de ces molécules, dont la plupart sont classées comme stupéfiants. Toutefois, le dernier rapport (2019) « État des lieux de la consommation des antalgiques opioïdes et leurs usages problématiques » de l’Agence Nationale de Sécurité du Médicament et des produits de santé, pointe l’existence de signaux d’alerte sur un opioïde spécifique : « le sulfate de morphine est l’antalgique opioïde fort le plus consommé en ville et ayant le taux de notifications le plus important ; en particulier la spécialité Skénan® qui représente 81 % des notifications ». Ces alertes ciblaient particulièrement deux populations de patients, auxquels les deux premières parties de ce travail de recherche vont se consacrer.La première partie de ce travail s’est attachée à évaluer l’usage de sulfate de morphine hors Autorisation de Mise sur le Marché dans un contexte de trouble de l’usage d’opioïdes comme médicament de substitution alternatif aux traitements conventionnels (buprénorphine ou méthadone), ou en remplacement de l’héroïne. La prévalence de cet usage alternatif restait méconnue, tout comme les caractéristiques sociodémographiques et sanitaires de ces patients et les complications auxquels cet usage pouvait les exposer. L’évaluation de ces risques revêt une importance particulière, la galénique à libération prolongée du Skénan® étant décrite par les études antérieures comme fréquemment altérée pour être injectée par voie intraveineuse, majorant les risques de surdose et de complications infectieuses, mais aussi thrombotiques. L’utilisation d’approches pharmacoépidémiologiques sur bases de données exhaustives de remboursements de l’Assurance Maladie a permis de montrer que l’usage régulier de morphine, à la manière d’un médicament de substitution, ne concernait qu’une minorité de patients (1,0 %), rapporté à l’ensemble de ceux concernés par un trouble de l’usage d’opioïde. Toutefois, ces usagers encourraient un risque de surdose dans l’année suivant l’instauration de la morphine 3,8 et 2 fois supérieur aux témoins qui débutaient, respectivement, de la buprénorphine ou de la méthadone. Les risques de décès, de mésusage, et d’infections bactériennes étaient aussi augmentés, tandis que leur situation sociale et sanitaire générale paraissait plus précaire, avec des comorbidités accrues par rapport aux témoins. La deuxième partie de ce manuscrit s’est consacrée aux patients souffrant de douleurs chroniques, recevant des prescriptions régulières et persistantes de sulfate de morphine oral dans ce contexte. Les données de pharmacovigilance indiquent qu’un certain nombre d’entre eux ont développé un trouble de l’usage d’opioïdes secondaire iatrogène au sulfate de morphine, pouvant s’accompagner d’intoxications involontaires. En l’absence de données françaises concernant la prévalence des surdoses et troubles de l’usage de morphine chez les patients douloureux chroniques avec et sans dépendance aux opioïdes, nous avons conduit une étude pharmacoépidémiologique dont nous avons comparé les résultats avec ceux de témoins dépendants non-douloureux. En France, en 2015, 16 665 patients douloureux chroniques bénéficiant de délivrances régulières de sulfate de morphine ont été identifiés, parmi lesquels 905, soit 5,4 %, présentaient un trouble de l’usage d’opioïdes comorbide à leurs douleurs. (...)Opioid analgesic prescriptions have increased significantly over the past decade in most industrialized countries. This inflation has logically been accompanied by an increase in complications related to the iatrogenicity of these drugs, primarily problems of dependence, use disorders, unintentional intoxication and, in some cases, death. Today, France appears to have been spared from what is now called the ‘opioid crisis’, due to its strict regulations on the prescription and dispensing of these drugs, which are mostly classified as narcotics. However, the latest report (2019): ‘Use and Abuse of Opioid Analgesics’ from the National Agency for the Safety of Medicines and Health Products: ’Morphine sulfate is the most consumed strong opioid analgesic supplied by high street pharmacies, and has the highest rate of notifications, in particular concerning the product Skénan® which represents 81% of notifications.’ These alerts particularly targeted two patient populations, to which the first two parts of this research work will be focused.The first part of this work focused on evaluating the use of morphine sulfate outside the scope of the Marketing Authorization in the context of opioid use disorders as an alternative to conventional treatments (buprenorphine or methadone), or as a replacement for heroin. The prevalence of this alternative use remained unknown, as did the sociodemographic and health characteristics of these patients and the complications to which this use could expose them. The assessment of these risks is of particular importance, as the sustained-release galenic form of Skénan® has been described by previous studies as frequently altered to be injected intravenously, increasing the risks of overdoses and infectious as well as thrombotic complications. The use of pharmacoepidemiological approaches based on exhaustive French health insurance reimbursement databases has shown that regular use of morphine, as a substitution therapy, concerned only a minority of patients (1.0%) out of all those affected by opioid use disorders. However, these users would be at 3.8- and 2.0-times greater risk of overdose within one year after starting morphine than controls who started buprenorphine or methadone, respectively. The risks of death, misuse, and bacterial infections were also increased, while their overall social and health status appeared more vulnerable, with increased comorbidities compared to controls.The second part of this manuscript was focused on patients suffering from chronic pain, receiving regular and persistent oral morphine sulfate prescriptions in this context. Pharmacovigilance data indicate that a number of them have developed opioid use disorders secondary to morphine sulfate iatrogenicity, which may be accompanied by unintentional intoxication. In the absence of French data concerning the prevalence of overdoses and morphine use disorders in chronic pain patients with and without opioid dependence, we conducted a pharmacoepidemiological study comparing the results with those of non-pain dependent controls. In the absence of French data concerning the prevalence of overdoses and morphine use disorders in chronic pain patients with and without opioid dependence, we conducted a pharmacoepidemiological study comparing the results with those of non-pain dependent controls. In France, in 2015, 16,665 chronic pain patients benefiting from regular morphine sulfate dispensing were identified, of whom 905, i.e. 5.4%, presented an opioid use disorder comorbid to their pain. Among the latter, the prevalence of overdose hospitalizations was 6.0-times higher than that of pain non-dependent patients and twice that of pain dependent controls. The social and health characteristics of these pain-dependent patients were at the interface between those of the painful non-dependent, less vulnerable, and the painless non-dependent, more deprived. (...)
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Olsen, Andrew Edward. "A proposed study of supervised injection on Boston's "Recovery Road"." Thesis, 2018. https://hdl.handle.net/2144/33025.
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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.
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Gureghian, Alexander S. "Stable housing with methadone maintenance therapy and motivational interviewing as a treatment for opioid use disorder." Thesis, 2020. https://hdl.handle.net/2144/42146.
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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.
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Leung, Brandon. "Describing connections to substance use disorder treatment from a medical monitoring program servicing the homeless." Thesis, 2020. https://hdl.handle.net/2144/41287.
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INTRODUCTION: Drug overdose death is now the leading cause of mortality among homeless adults in Boston, with opioids implicated in a majority of those deaths. Harm reduction interventions help minimize the risks associated with substance use, and are critical in supporting individuals with substance use disorder. Medical monitoring programs are an effective harm reduction strategy that work to prevent fatal drug overdoses and keep people safe while still actively using.
METHODS: Visit data from the Supportive Place for Observation and Treatment (SPOT) was compiled and analyzed. The two measures of interest were the count of referrals to substance use disorder treatment and the count of visits prior to the first referral to treatment. Chi-square tests of independence, odds ratios, and binary logistic regression models were used to describe the association between factors of interest and referrals to substance use disorder treatment.
RESULTS: Gender and age did not show any significant association to a connection to treatment. Overdose history (Adjusted Odds Ratio 6.59), reported stimulant use (AOR 2.59), and documented health or harm reduction education (AOR 5.14) were all associated with increased odds of being referred to substance use disorder treatment. Heavy sedation (AOR 0.55) was associated with decreased odds of a treatment referral.When examining factors associated with rapid connection to treatment, male gender (OR 1.87) was associated with increased odds, while overdose history (AOR 0.42) was associated with decreased odds.
DISCUSSION: The two most impactful factors associated with increased odds of connecting to substance use disorder treatment were reported overdose history and documented education. Both of these factors suggests that a strength of SPOT is its ability to form and maintain meaningful connections with participants. One way that SPOT could improve referral outcomes would be to increase its ability to engage participants, such as through the recruitment of more harm reduction specialists or peer recovery coaches.
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Park, Han na. "Ocular comorbidities in neonatal abstinence syndrome." Thesis, 2016. https://hdl.handle.net/2144/19422.
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Chronic opioid exposure in utero places the infant at risk of Neonatal Abstinence Syndrome (NAS), a clinical diagnosis of neurological, autonomic, and/or gastrointestinal withdrawal symptoms from opioid abstinence at birth. The prevalence of NAS is rising concurrently with the recent epidemic of opioid misuse among the general population in the United States, including pregnant women. Opioid misusing women typically receive methadone or buprenorphine as a treatment throughout pregnancy. However, the opioid misuse during pregnancy is associated with higher obstetric complications and a higher incidence of NAS in infants, at times requiring pharmacological intervention. The exact consequences to the human development from opioid exposure in utero remain unclear.
Animal studies suggest that the fetal impacts of opioid exposure may differ from the consequences for an adult who uses opioids. Furthermore, there may be neurodevelopmental alterations in myelin physiology, dendritic length in the brain, and neurotransmitter systems when a child is exposed to opioids in utero. Clinical studies highlight associations between perinatal opioid exposure and gene mutation variants, cranial abnormalities on imaging, and a high prevalence of ocular and visual comorbidities. Ocular and visual comorbidities are of particular interest, because they may be treatable when detected early.
The current literature about NAS infants and ocular and visual comorbidities is limited by the retrospective and small case-control study designs employed by the majority of the research groups. The proposed study design is a prospective study comparing groups of opioid exposed and non-opioid exposed infants born at Boston Medical Center in Boston, Massachusetts. The ocular and visual comorbidities detected in each group will be quantified, while analyzing the relationship and the relative risk attributable to the infant’s and mother’s demographics. The social context of opioid misuse may complicate the interpretation of the data; however, the design anticipates sufficient recruitment and generalizability as it is conducted at a safety net hospital. Ultimately, the goal of this proposal is to reduce the risk to the fetus with perinatal opioid exposure and build the knowledge base about ocular comorbidities in NAS infants so that optimal and comprehensive care can be provided in the future.
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Jackson, Joanna Rachel. "Examining the Variability in and Impact of State-Level Regulations of Opioid Treatment Programs." Diss., 2019. http://hdl.handle.net/1805/21088.
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Indiana University-Purdue University Indianapolis (IUPUI)The United States is experiencing a severe opioid use epidemic with more than 2 million people currently suffering from opioid use disorder (OUD), of which, over 1 million need treatment. Opioid treatment programs (OTPs) are evidence-based modality providing comprehensive care to individuals experiencing OUD. OTPs provide counseling, medical assessments, and medication-assisted treatment, which decrease the use of illicit opioids, reduce associated deaths, criminality, and improve the psychosocial wellbeing of its patients. However, OTPs have been extensively regulated at the federal, state, and local levels with little consistency and varying degrees of enforcement across the country, particularly at the state level, creating a “regulatory fog”. This complex regulatory environment has made it challenging to study new or changing regulations and their impact on health outcomes. In order to better understand the variation of OTP regulation, this dissertation: (1) employs public health law research methods to map the entire landscape of state-level regulation of OTPs and associated state characteristics in effect on January 1, 2017; (2) examine how state-level regulations affect the delivery of care from the perspective of OTP administrators through key-information interviews; and (3) examines associations between regulatory burden and related health outcomes of individuals experiencing OUD, by state.
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Grant, Stephen Nicholas. "Investigation of Some Small Molecule-Protein and Protein-Protein Interactions in Nicotine Addiction, Opioid Use Disorder, and COVID-19." Thesis, 2022. https://thesis.library.caltech.edu/14302/1/Thesis%20Stephen%20Grant%20Final_v2.pdf.
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Nicotine addiction, opioid use disorder, and COVID-19 have made lasting impacts on every aspect of society. These are complicated conditions, and studies in these fields will likely continue for decades, if not centuries. Here, we make contributions to each of these issues using electrophysiology and microscopy. The first chapter goes into the motivation behind this thesis and the major experiments I used in my graduate career. In the second chapter, we introduce a new amino acid into the mouse muscle nicotinic acetylcholine receptor in an attempt to understand the dynamics of receptor activation. In the third chapter, we continue the Lester lab’s work on the neuroscientific effects of menthol and how it plays a role in nicotine addiction. We found the binding site for menthol on the α4β2 nicotinic acetylcholine receptor, which continues our hypothesis that the neuroscientific effects of menthol are detrimental to cigarette smokers. Fortunately, partly because of our studies, mentholated nicotine products are being phased out of the United States. The fourth and fifth chapters investigate μ-opioid receptor trafficking, both the trafficking from the endoplasmic reticulum and endocytosis from the plasma membrane. Both of these events play a role in inducing opioid use disorder and increasing the danger of using opioids. We hope that these studies will help other researchers understand opioid use disorder and fight the opioid epidemic. Finally, we studied the effects of SARS-COV-2 proteins on epithelial sodium channels. These channels are important for regulating lung fluid levels where their improper function may cause pulmonary edema. Pulmonary edema has been observed in COVID-19 patients. Altogether, we believe that we have made meaningful impacts on these important health concerns in this thesis. We look forward to how the scientific communities continue to build on our results.
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Bagley, Sarah Mary. "Agreement between self-report and urine drug test results in a sample patients treated with buprenorphine for opioid use disorder." Thesis, 2017. https://hdl.handle.net/2144/27116.
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BACKGROUND: Urine drug testing (UDT) is recommended to monitor primary care patients treated for opioid use disorder with buprenorphine. Whether UDT data contributes clinically useful information beyond patient self-report of drug use has received minimal attention. It is unclear whether differences between patient self-report and UDT results varies with time in treatment.
OBJECTIVES: To estimate concordance between self-report and UDT results and evaluate if discordant results are associated with time in treatment.
METHODS: Retrospective review of electronic medical records of patients enrolled in the Office Based Opioid Treatment program at Boston Medical Center between January 2011–April 2013. Typically, patients submit a urine sample for UDT at the beginning of a clinical visit and are subsequently asked about recent cocaine and opioid use which is documented in the electronic medical record. We compared UDT results to patient self-report of cocaine and opioid use.
RESULTS: Of 1,755 UDT from 130 patients, 4% (78/1755) were positive for cocaine and 10% (157/1563) for opioids other than buprenorphine. At visits with a cocaine positive UDT, 76% of patients (59/78) did not disclose cocaine use. At visits with an opioid positive UDT, 57% of patients (89/157) did not disclose opioid use. The odds of having a positive UDT for either cocaine or opioids with no disclosure of use decreased over a year of treatment.
CONCLUSION: In a sample of primary care patients with opioid use disorder treated with buprenorphine, fewer than 10% of UDTs were positive for cocaine or opioids, and in these instances patient self-reported use of cocaine or opioids less than half the time. As duration of treatment increased, patients were more likely to disclose use. Urine drug testing contributes new and useful information for clinical consideration of the optimal care of patients with drug use disorders; how best to collect and utilize this information merits further study.
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Epstein, Rachel Lee. "Screening for hepatitis C virus among adolescents and emerging adults in federally qualified health centers in the United States, 2012–2017." Thesis, 2019. https://hdl.handle.net/2144/38154.
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INTRODUCTION: Despite rising hepatitis C virus (HCV) incidence in the United States in recent years among young adults, little data describe HCV testing in youth. My objective was to characterize the HCV care cascade in adolescents and emerging adults in a large US sample and to describe the association between diagnosed substance use disorders (SUDs) and HCV testing.
METHODS: In this retrospective cohort study, I describe HCV care cascade outcomes for youth 13–21 years old seen at least once from 1/2012–9/2017 at an OCHIN-participating federally qualified health center. Using electronic health record data, I analyzed odds of HCV testing by number of concurrent diagnosed SUDs associated with HCV risk (those associated with injection or intranasal use: opioids, amphetamines, and cocaine).
RESULTS: Among 269,124 youth who met inclusion criteria, (54.7% female, 62.5% non-white, mean age [SD] at testing 18.5 [2.2] years), 6812 (2.5%) were tested for HCV antibody, 122/6812 (1.8%) of those tested were anti-HCV positive, and of anti-HCV positive youth, 75.4% had additional diagnostic testing. Only 1 had documented HCV treatment. Each additional HCV risk-associated SUD was associated with higher odds of HCV testing, particularly in younger (OR 9.12, 95% CI 6.78, 12.4 in 13–15 year-olds, and OR 8.37, 95% CI 7.48, 9.36 in 16–18 year-olds) compared with older youth (OR 3.9, 95% CI 3.59, 4.24 in 19–21 year-olds).
CONCLUSION: This study highlights important gaps in recommended HCV testing during the current opioid crisis. As the first step in the care cascade, addressing missed testing opportunities is critical for reducing hepatitis C burden.2020-09-28T00:00:00Z
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Santos, Monika Maria Lucia Freitas dos. "Defeating the dragon: Heroin dependence recovery." Thesis, 2006. http://hdl.handle.net/10500/2369.
Full textAbstract:
Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed.Psychology
(M.A.(Psychology))
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(10724028), Jason David Ummel. "NONINVASIVE MEASUREMENT OF HEARTRATE, RESPIRATORY RATE, AND BLOOD OXYGENATION THROUGH WEARABLE DEVICES." Thesis, 2021.
Find full textAbstract:
The last two decades have shown a boom in the field of wearable sensing technology. Particularly in the consumer industry, growing trends towards personalized health have pushed new devices to report many vital signs, with a demand for high accuracy and reliability. The most common technique used to gather these vitals is photoplethysmography or PPG. PPG devices are ideal for wearable applications as they are simple, power-efficient, and can be implemented on almost any area of the body. Traditionally PPGs were utilized for capturing just heart rate, however, recent advancements in hardware and digital processing have led to other metrics including respiratory rate (RR) and peripheral oxygen saturation (SpO2), to be reported as well. Our research investigates the potential for wearable devices to be used for outpatient apnea monitoring, and particularly the ability to detect opioid misuse resulting in respiratory depression. Ultimately, the long-term goal of this work is to develop a wearable device that can be used in the rehabilitation process to ensure both accountability and safety of the wearer. This document details contributions towards this goal through the design, development, and evaluation of a device called “Kick Ring”. Primarily, we investigate the ability of Kick Ring to record heartrate (HR), RR, and SpO2. Moreover, we show that the device can calculate RR in real time and can provide an immediate indication of abnormal events such as respiratory depression. Finally, we explore a novel method for reporting apnea events through the use of several PPG characteristics. Kick Ring reliably gathers respiratory metrics and offers a combination of features that does not exist in the current wearables space. These advancements will help to move the field forward, and eventually aid in early detection of life-threatening events.