Background: People in the United States who use opioids frequently use emergency department (ED) services. Some hospitals have begun placing peer recovery support specialists (PRSS) in EDs to support and advocate for patients and provide linkages to services, in an effort to reduce future presentations for opioid-related and other health problems related to substance use. However, evidence supporting the impact of PRSS services on reducing future ED presentations is limited, and even less is known about ED-based PRSS services delivered via telehealth.
Methods: Using records from a large Indiana-based hospital system, we conducted an interrupted time series (ITS) analysis of ED patients presenting for unintentional opioid overdose or other opioid-related issues. Over a five-year period, 2,542 unique ED visits were included across 12 hospitals. The primary outcome assessed was the impact of PRSS telehealth service implementation (comparing pre- and post-periods) on 30-day all-cause ED revisits. Analyses were also stratified by appropriate demographics.
Results: There was no significant change in 30-day ED revisits between pre- and post-implementation of the PRSS telehealth program. Results of sex-stratified ITS indicated a significant change for females only, with decreasing log-odds of ED revisits post-program implementation (post-implementation slope OR = 0.911, p = 0.031; slope change OR = 0.874, p = 0.017).
Conclusions: Although there was no detectable difference in overall ED revisits following program implementation, outcomes of stratified analyses suggested that the program may have been more impactful for females vs. males. Future research should examine the underlying mechanism of the observed sex differences to target behavioral change more effectively for all participants of telehealth PRSS services in ED settings.
Background: A new transitional housing program was established in Sudbury, Ontario, Canada, in response to the escalating prevalence of substance use and homelessness, and the specific challenges faced in Northern Ontario. There is a scarcity of research investigating the implementation of housing programs with clinical, social, and functional support for people with substance use in Northern settings in the era of Fentanyl and its analogs and a contaminated dangerous drug supply. To bridge this knowledge gap, we evaluated a unique harm reduction-focused transitional housing program. Our study objectives encompassed exploring patients' viewpoints on considerations when implementing a transitional housing program for people with substance use and mental disorders.
Methods: This is a qualitative interview study of 12 clients from a transitional housing program that offers comprehensive health and social assistance through addiction medicine, psychiatric consultation, primary care, and harm reduction services to clients in a transitional housing program in an Urban setting in Northern Canada. This study was a pilot project, to gather their perspectives on the care provided by the team. Maslow's Hierarchy of Needs was used to contextualize the data.
Results: Participants emphasized the importance of the program's housing first approach, its positive impact on accessing health and social services, and the increase in sense of belonging, self-esteem, and confidence because of being in the program. Participants also indicated that the program had a positive overall impact, leading to reduced substance use, improved mental and emotional well-being, and enhanced socio-economic conditions. However, several considerations were highlighted as important for ensuring the effectiveness of the program, such as better aligning client and program expectations, facilitating access to community supports with food, support with medication regimen, providing empathetic engagement, and individualizing approaches to care.
Conclusion: A new transitional housing program in a Northern Urban setting in the era of an increasingly contaminated drug supply led to perceived positive outcomes for clients. Important considerations include focusing (or enhancing supports) on physiological needs and empathetic, individualized approaches to care.
Background: Smoking is a major preventable cause of death, associated with cancers and chronic diseases. Nurse-initiated smoking cessation programs have proven effective, providing counseling, education, and mental health support. These interventions increase quit rates by tackling nicotine addiction, emphasizing the important role of nurses and the need for targeted training. Systematic reviews and meta-analyses are essential for gaining a deeper understanding of the effectiveness of various cessation strategies.
Methods: A literature search was conducted using eight electronic databases (CINAHL, EMbase, MEDLINE, Cochrane, RISS, KMbase, KISS, and NDSL). The literature search was conducted from March, 27, 2024, to August 1, 2024. All included studies were randomized controlled trials (RCTs). Quality assessment was conducted using the Risk of Bias (ROB) tool. RevMan 5.4 was used for qualitative analysis, with effect sizes measured as odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Thirteen studies, all published after 2005, were included in the evidence assessment of nurse-initiated smoking cessation programs. The interventions examined comprised 11 intensive or personalized counseling programs and 3 telephone-based approaches. The OR for self-reported quit success 7-day smoking cessation rate at 6-month follow-up was 1.43 (95% CI [1.08, 1.90]), indicating a significant difference in quit effectiveness (Z = 2.27, p =.01), with moderate heterogeneity observed across studies (I2 = 67.0%, p =.001). A meta-analysis of 7-day point abstinence rate at 12-month follow-up revealed a pooled OR of 1.18 (95% CI [0.96, 1.44]), showing no significant difference in quit effectiveness (Z = 1.58, p =.11) and moderate heterogeneity among the studies (I2 = 55.0%, p =.02).
Conclusions: A comprehensive approach by trained nursing professionals is essential in addressing the complexities of smoking cessation. Further clinical trials are needed to assess intervention methods and follow-up strategies. Future research should emphasize long-term outcomes and ongoing support to sustain behavior change, contributing to more effective, tailored cessation programs and improved public health outcomes.
Background: Methamphetamine use is a pressing public health concern among people who inject drugs (PWID) worldwide. This study aimed to estimate the prevalence of methamphetamine use and its correlates in a nationwide survey among PWID in Iran in 2020.
Methods: We recruited 2,684 PWID in 11 major cities from July 2019 to March 2020 using respondent-driven sampling (RDS). Participants were eligible if they were ≥ 18 years old, self-reported drug injection in the last 12 months, resided in the city of the study, and provided a valid RDS coupon. Behavioral data was collected using a standard questionnaire via face-to-face interviews. 2,259 PWID (84.2%) with valid responses to the primary outcome (i.e., methamphetamine use (either injecting or non-injection use) in the last three months) were included in the analysis. We used RDS-Gile's SS weighted analysis for descriptive statistics and a survey package (svy) using linearized variance estimations and stratification by cities for bivariable and multivariable logistic regression analyses.
Results: The last 3-month prevalence of methamphetamine use among PWID was 47.0% (95% CI: 44.9, 49.1). The following factors were significantly associated with methamphetamine use in the last three months: history of homelessness in the last 12 months (aOR = 1.57; 1.77, 2.10), drug use onset before the age 18 (aOR = 1.40; 1.05, 1.87), injecting drug for more than ten years (aOR = 1.47; 1.11, 1.95), using non-injection (aOR = 7.18; 4.93, 10.47) and injecting illicit opioids (aOR = 2.98; 2.03, 4.36) in the last three months, as well as having multiple sex partners in the last 12 months (aOR = 1.60; 1.50, 2.73) and region (north: aOR = 5.42; 2.92 10.03; south: aOR = 2.95; 2.04, 4.27; east: aOR = 24.43; 15.62, 38.22).
Conclusions: The frequency of methamphetamine use among PWID is considerable in Iran. Our findings underscore the importance of implementing tailored comprehensive harm reduction services for this sub-population of PWID. They also emphasize the urgent need for evidence-based interventions to address the harms associated with the increasing co-use of opioids and methamphetamine among PWID.
Opioid use disorder (OUD) is highly prevalent among jail and prison populations in the United States, including in Wisconsin. Medications for opioid use disorder (MOUD), including long-acting injectable naltrexone, are crucial in the treatment of OUD. These medications are especially important for individuals transitioning out of jail or prison and back into the community. Unfortunately, few individuals who were formerly incarcerated continue MOUD after reentry due to a variety of barriers. Wisconsin community pharmacists are highly accessible and uniquely positioned to provide care for this population, specifically by administering injectable naltrexone. However, community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated has not been previously explored. As a first step, this legislative and regulatory review aimed to identify Wisconsin statutes and administrative codes that may impact these services for this population. Two legal databases were searched to identify relevant Wisconsin statute and administrative code subsections. Overall, 24 statute subsections (from 7 chapters) and 31 administrative code subsections (from 12 chapters) were identified that (1) highlighted a need or potential role of community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated or (2) served as a potential barrier or facilitator to the availability, access, or use of these services. Future work should focus on helping community pharmacists leverage available resources and overcome existing legal barriers to providing or supporting MOUD services. Importantly, work should be done to ensure that individuals who were formerly incarcerated can be linked to these services upon reentry.
Background: Public authorities use a variety of control policies, with varying degrees of severity, to reduce the prevalence of health-damaging habits. Since these policies can only succeed if people understand and approve of them, this study mapped Colombians' positions on policies to control tobacco and marijuana consumption.
Method: A sample of 147 adults was presented with 32 vignettes illustrating a control policy. Each vignette contained four items of information: the behavior targeted (smoking tobacco or using marijuana), the nature of preventive measures (e.g., information campaigns), the degree of regulatory measures (e.g., prohibition of use by minors) and the severity of penalties (e.g., imprisonment).
Results: Through cluster analysis, three qualitatively different positions were found in relation to control policies for each substance: Generally unfavorable, irrespective of policy (22% and 17%), Depends on regulation (18% and 22%), and Always favorable, irrespective of policy (23% and 25%). A substantial minority of participants (37% and 36%) expressed no opinion at all.
Conclusion: While qualitatively different positions on the acceptability of national policies to control tobacco and marijuana consumption were indeed observed among Colombian participants, the most frequent response seemed to be indifference (or indeterminacy), with other positions reflecting little more than systematic opposition or blind acquiescence. It would therefore be useful to make citizens aware that their opinions count, that their relative indifference to these issues is in itself a problem, and that it is by taking their perspectives into account that one can truly define and make effective public health policies that are understood and accepted by as many people as possible.
Background: Underutilization of medications for opioid use disorder (MOUD) remains a persistent obstacle to addressing the opioid epidemic. This study explores MOUD agency experiences with patient census growth as well as multi-level barriers and facilitators to expanding MOUD from the perspectives of agency staff.
Methods: Semi-structured qualitative interviews were conducted with 66 employees representing 30 MOUD agencies in eight Kentucky counties in the United States from December 2022 to June 2023 as part of the HEALing (Helping to End Addiction Long-term®) Communities Study in Kentucky (HCS-KY). Interviews were conducted prior to the development of partnerships to implement strategies focused on expanding MOUD census and increasing MOUD retention. Facility administrators/directors, prescribers, and clinicians were prioritized for recruitment, but agencies could identify other staff to participate. Interviews were recorded and transcribed. A consensus-based approach to coding and thematic analysis was used.
Results: Although some agencies had a fairly static number of patients, most described recent experiences with modest growth in MOUD census and the ability to provide same day/next day MOUD. Multi-level factors, including organizational, patient, and community factors, were perceived to impact MOUD census. Organizational characteristics impacting growth included the physical space of the clinic and staffing. Organizational policies in some agencies constrained treatment retention, while other agencies implemented innovations to better meet patients' needs. Patients often encountered numerous obstacles to treatment initiation and retention, including limited access to transportation, technology, stable housing, and childcare. These patient-level barriers often reflected community characteristics, while community stigma also impeded MOUD growth.
Conclusions: Although some degree of growth in MOUD has occurred, multiple barriers are impeding further increases in treatment initiation and retention. Overcoming some barriers would likely require policy changes related to financing and regulation, while other barriers would require community-level efforts to decrease stigma and greater community investment in infrastructure, such as transportation and housing.
Trial registration: ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .
Background: Rumination is an essential trans-diagnostic process associated with substance use disorders (SUDs) in psychopathology. In China, methamphetamine and heroin have become major illegal drugs, but the role of rumination in their use remains unclear. The objective of this study was to investigate the relationship between rumination subtypes and drug craving in patients with methamphetamine use disorder (MAUD) and 81 patients with heroin use disorder (HUD).
Methods: A total of 489 participants, including 408 patients with MAUD and 81 patients with HUD, were recruited from a rehabilitation center. Participants were screened for inclusion criteria, and the Obsessive Compulsive Drug Use Scale (OCDUS) was used to assess drug craving. Rumination was assessed using the Ruminative Responses Scale (RRS), categorized into three dimensions: symptom rumination, brooding, and reflective pondering. Correlational and multiple regression analyses were conducted to examine associations between rumination and craving.
Results: Compared to patients with MAUD, patients with HUD had significantly higher RRS and OCDUS total score (42.51 vs 39.71 and 25.99 vs 20.95, both p < 0.01). In patients with MAUD, the OCDUS total score was positively correlated with the total score (r = 0.298, p < 0.01) and all subscale scores of the RRS (for reflective pondering, r = 0.180; for brooding, r = 0.230; for symptom rumination, r = 0.325; all p < 0.01). However, in patients with HUD, only symptom rumination was positively associated with the OCDUS total score (r = 0.247, p < 0.05). Multiple regression showed symptom rumination was independently associated with OCDUS total score in both groups (for patients with MAUD, β = 0.324, p < 0.001; for patients with HUD, β = 0.252, p < 0.05).
Conclusions: Our findings suggest that rumination shows different effects on craving in male patients with MAUD and HUD. Moreover, symptom rumination may have a significant influence on the connection between rumination and craving in individuals with MAUD and HUD.
Background: The Drug User Liberation Front led an evaluation of a non-medicalized model of safer supply known as a "Compassion Club." This club sourced, rigorously tested, packaged, and accurately labeled certain illicit substances and then provided them to club members at cost in order to investigate the effects and feasibility of a non-medical model of safer supply. Operating for 14 months, the club provided low-cost, quality-controlled illicit substances to individuals at risk of fatal overdose in Vancouver, Canada's Downtown Eastside neighbourhood. This study was undertaken to explore perceived impacts of the Compassion Club among its participants, as well as their perceptions regarding how the Club could be improved.
Methods: At the one-year time point of club operations 43 participants from the club's membership completed an interviewer-administered survey which is utilized in this cross sectional analysis. Descriptive statistics were employed to assess the perceived influence of club membership on various factors, including drug use patterns, harm reduction practices, financial outcomes, housing stability, and overall well-being.
Results: Applicable responses reported benefits from membership in the Compassion Club, including reduced drug use (64.3%), decreased reliance on illicit markets (86.7%), lowered risk of overdose (90.0%), and increased likelihood of using sterile equipment (84.6%). Mental health (74.2%), physical health (63.3%), and overall well-being (70.0%) were also noted improvements. Suggestions for club improvement included extended operating hours, broader substance selection, and improved accessibility.
Conclusion: The reported reductions in drug use and improved adherence to harm reduction practices described herein underscore the perceived benefits of this unique program. Compassion Clubs represent a distinct strategy to mitigate overdose risk and enhance the well-being of drug users. These insights advance ongoing dialogues on overdose prevention strategies, urging further research to refine non-medicalized approaches within the evolving landscape of interventions.
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