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Hohmann L, Phillippe H, Marlowe K, Jeminiwa R, Hohmann N, Westrick S, Fowler A, Fox B. A state-wide education program on opioid use disorder: influential community members' knowledge, beliefs, and opportunities for coalition development. BMC Public Health 2022; 22:886. [PMID: 35508988 PMCID: PMC9066873 DOI: 10.1186/s12889-022-13248-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deep South states, particularly Alabama, experience disproportionately higher opioid prescribing rates versus national rates. Considering limited opioid use disorder (OUD) providers in this region, collaborative efforts between non-healthcare professionals is critical in mitigating overdose mortality. The Alabama Opioid Training Institute (OTI) was created in 2019 to empower community members to take action in combatting OUD in local regions. The OTI included: 1) eight full-day in-person conferences; and 2) an interactive mobile-enabled website ( https://alabamaoti.org ). This study assessed the impact of the OTI on influential community members' knowledge, abilities, concerns, readiness, and intended actions regarding OUD and opioid overdose mitigation. METHODS A one-group prospective cohort design was utilized. Alabama community leaders were purposively recruited via email, billboards, television, and social media advertisements. Outcome measures were assessed via online survey at baseline and post-conference, including: OUD knowledge (percent correct); abilities, concerns, and readiness regarding overdose management (7-point Likert-type scale, 1 = strongly disagree to 7 = strongly agree); and actions/intended actions over the past/next 6 months (8-item index from 0 to 100% of the time). Conference satisfaction was also assessed. Changes were analyzed using McNemar or Marginal Homogeneity tests for categorical variables and two-sided paired t-tests for continuous variables (alpha = 0.05). RESULTS Overall, 413 influential community members participated, most of whom were social workers (25.7%), female (86.4%), and White (65.7%). Community members' OUD knowledge increased from mean [SD] 71.00% [13.32] pre-conference to 83.75% [9.91] post-conference (p < 0.001). Compared to pre-conference, mean [SD] ability scale scores increased (3.72 [1.55] to 5.15 [1.11], p < 0.001) and concerns decreased (3.19 [1.30] to 2.64 [1.17], p < 0.001) post-conference. Readiness was unchanged post-conference. Attendees' intended OUD-mitigating actions in the next 6 months exceeded their self-reported actions in the past 6 months, and 92% recommended the OTI to others. CONCLUSIONS The Alabama OTI improved community leaders' knowledge, abilities, and concerns regarding OUD management. Similar programs combining live education and interactive web-based platforms can be replicated in other states.
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Affiliation(s)
- Lindsey Hohmann
- grid.252546.20000 0001 2297 8753Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Haley Phillippe
- grid.252546.20000 0001 2297 8753Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Karen Marlowe
- grid.252546.20000 0001 2297 8753Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Ruth Jeminiwa
- grid.265008.90000 0001 2166 5843Department of Pharmacy Practice, Thomas Jefferson University College of Pharmacy, 901 Walnut Street, Health Professions Academic Building, Philadelphia, PA 19107 USA
| | - Natalie Hohmann
- grid.252546.20000 0001 2297 8753Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Salisa Westrick
- grid.252546.20000 0001 2297 8753Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Amanda Fowler
- grid.252546.20000 0001 2297 8753Division of Post Graduate Education, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849 USA
| | - Brent Fox
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL, 36849, USA.
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López-Soto D, Griffin PM. Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis. Subst Abuse Treat Prev Policy 2021; 16:91. [PMID: 34930347 PMCID: PMC8691068 DOI: 10.1186/s13011-021-00427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. Methods We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. Results Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). Conclusions Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00427-1.
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Wares JR, Dong J, Gevertz JL, Radunskaya A, Vine K, Wiebe D, Solomon S. Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach. Harm Reduct J 2021; 18:110. [PMID: 34717657 PMCID: PMC8556858 DOI: 10.1186/s12954-021-00559-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health. Methods We developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood. Results In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered. Conclusions Mathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.
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Affiliation(s)
- Joanna R Wares
- Department of Mathematics and Computer Science, University of Richmond, 204 Jepson Hall, 221 Richmond Way, Richmond, VA, 23173, USA.
| | - Jing Dong
- Department of Mathematics and Computer Science, University of Richmond, 204 Jepson Hall, 221 Richmond Way, Richmond, VA, 23173, USA
| | - Jana L Gevertz
- Department of Mathematics and Statistics, The College of New Jersey, Ewing, NJ, 08628, USA
| | - Ami Radunskaya
- Department of Mathematics and Statistics, Pomona College, Claremont, CA, 91711, USA
| | - Kendra Vine
- Division of Substance Use Prevention and Harm Reduction, Department of Public Health, Philadelphia, PA, 19109, USA
| | - Doug Wiebe
- Penn Injury Science Center, Department of Biostatistics, Informatics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sara Solomon
- Penn Injury Science Center, Department of Biostatistics, Informatics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Childs E, Biello KB, Valente PK, Salhaney P, Biancarelli DL, Olson J, Earlywine JJ, Marshall BDL, Bazzi AR. Implementing harm reduction in non-urban communities affected by opioids and polysubstance use: A qualitative study exploring challenges and mitigating strategies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103080. [PMID: 33340947 DOI: 10.1016/j.drugpo.2020.103080] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Harm reduction services, which typically provide overdose education and prevention with distribution of naloxone and other supplies related to safer drug use, help reduce opioid-related overdose and infectious disease transmission. However, structural stigma and the ongoing criminalization of drug use have limited the expansion of harm reduction services into many non-urban communities in the United States that have been increasingly affected by the health consequences of opioid and polysubstance use. METHODS We conducted qualitative interviews with 22 professionals working with people who use drugs in cities and towns across Rhode Island and Massachusetts to understand challenges and strategies for engaging communities in accepting harm reduction perspectives and services. RESULTS Our thematic analysis identified several interrelated challenges to implementing harm reduction services in non-urban communities, including: (1) limited understandings of harm reduction practice and preferential focus on substance use treatment and primary prevention, (2) community-level stigma against people who use drugs as well as the agencies supporting them, (3) data reporting and aggregating leading to inaccurate perceptions about local patterns of substance use and related health consequences, and (4) a "prosecutorial mindset" against drug use and harm reduction. From key informants' narratives, we also identified specific strategies that communities could use to address these challenges, including: (1) identifying local champions to advocate for harm reduction strategies, (2) proactively educating communities about harm reduction approaches before they are implemented, (3) improving the visibility of harm reduction services within communities, and (4) obtaining "buy-in" from a wide range of local stakeholders including law enforcement and local government. CONCLUSION These findings carry important implications for expanding harm reduction services, including syringe service programs and safe injection sites, into non-urban communities that have a demonstrated need for evidence-based interventions to reduce drug-related overdose and infectious disease transmission.
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Affiliation(s)
- E Childs
- Abt Associates, Rockville, MD, USA
| | - K B Biello
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - P K Valente
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - P Salhaney
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - D L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - J Olson
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - J J Earlywine
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - B D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - A R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
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