Faculty Bibliography

OBJECTIVE:The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids. METHOD:We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach. RESULTS:We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources. CONCLUSIONS:Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.

Bisexual orientation in the context of long-term relationships comes with a unique set of challenges, especially when that relationship is mixed gender. The cultural belief that bisexual orientation is unstable or temporary paired with the presentation of a partnership that grants heterosexual privilege can be a complex place to exist for bisexual individuals. This experience was examined in semi-structured interviews of 55 bisexual people in a mixed-gender relationship. Participants were an average of 29 years of age and ranged in age from 21 to 48. Reflexive thematic analysis resulted in the identification of three major themes and two subthemes. The major themes were: (1) cultural assumptions of bisexual orientation, (2) bi-negativity/biphobia, and (3) bi-invisibility. These findings highlight the complexity of existing day-to-day as a bisexual person in a mixed-gender relationship. The implications of these findings for individuals, clinicians, and communities and directions for future research are discussed.

BACKGROUND:Despite high rates of substance use among justice-involved populations, the use of substance screening tools in justice settings varies. METHODS:Data are from the National Jail Health Care Study, which surveyed jails across the U.S. about their health care practices (n=371). Jails were asked to voluntarily submit their medical intake forms. A content analysis of intake forms (n=63) specific to questions about substance use was completed. RESULTS:Seventy-three percent (73%) of intake forms used non-standardized questions to assess current substance use, and 27% did not ask any questions about substance use. Alcohol use was most assessed (52%), followed by tobacco (30%), and marijuana (22%). Less than 11% of jails asked about use of opioids and 40% of forms asked about withdrawal history. CONCLUSIONS:The lack of adequate substance use screening in jails hinders identification of substance use disorders, potential for withdrawal symptoms, and appropriate connection to treatment resources.

BACKGROUND:The majority of patients with opioid use disorder do not receive medications for opioid use disorder (MOUD), especially in rural areas. The patient-centered access to healthcare framework posits access as a multidimensional phenomenon impacted by five healthcare system and five patient ability dimensions. Interventions to improve local MOUD treatment outcomes require an understanding of how these dimensions differ across urban and rural communities. This scoping review sought to systematically appraise the literature on MOUD access across urban and rural communities (i.e., rurality) in the US using the patient-centered access framework. METHODS:We performed a scoping review of 1) electronic databases, 2) grey literature, and 3) correspondence with content experts (March 2021). We included articles specifying the study sample by rurality and examining at least one dimension of access to MOUD. The analysis and qualitative synthesis of study results examined study characteristics and categorized key findings by access dimensions. RESULTS:The search produced 3963 unique articles, of which 147 met inclusion criteria. Among included studies, 96% (142/147) examined healthcare system dimensions of access while less than 20% (25/147) examined any of the five dimensions of patient ability. Additionally, 49% (72/147) of studies compared access dimensions by rurality. Across studies, increasing rurality was associated with fewer available MOUD services, but little was known about geographic variation in other critical dimensions of access. CONCLUSIONS:The vast majority of studies examined healthcare system dimensions of MOUD access and few studies made comparisons by rurality or prioritized the patient's perspective, limiting our understanding of how access differs by rurality in the US. As COVID-19 spurs novel changes in MOUD delivery, this inadequate multidimensional understanding of MOUD access may impede the tailoring of interventions to local needs. There is an urgent need for mixed-methods and community-engaged research prioritizing the patient's perspective of MOUD access by rurality. REGISTRATION/BACKGROUND:Open Science Framework (https://osf.io/wk6b9/).

OBJECTIVES/OBJECTIVE:There is a growing concern over the increased prevalence of fentanyl contaminated oxycodone pills, referred to as M30s. The current study is an examination of content on the Reddit social media site in order to understand the perceptions of and experiences with exposure to fentanyl contaminated M30 pills. METHODS:Data include subreddit posts collected from January 1, 2021, to July 28, 2021, from 71 drug-related subreddits using 34 fentanyl-related search terms. A random subsample of 500 posts was examined for thematic analysis. 226 (45.2%) of posts were determined to be relevant and included in the final sample. RESULTS:Over one-third (n = 85, 37.6%) of subreddit posts with mention of fentanyl were related to pressed M30 pills. Three emergent themes related to pressed M30 pills were identified: suspicion of contamination in oxycodone pills was pervasive (51.2%), composition of pills evoked anxiety (40%), and M30 mitigation and testing strategies (29.4%). CONCLUSIONS:Many persons on the online communities of Reddit who use drugs were aware of fentanyl contamination in the current pressed pill market. Reddit offered a space to network with others to discuss harm reduction strategies and anxieties surrounding the pervasiveness of fentanyl in the current drug market.

OBJECTIVE:Polysubstance use may complicate treatment outcomes for individuals who use opioids. This research aimed to examine the prevalence of polysubstance use in an opioid use disorder treatment trial population and polysubstance use's association with opioid relapse and craving. METHODS:This study is a secondary data analysis of individuals with opioid use disorder who received at least one dose of medication (n = 474) as part of a 24-week, multi-site, open label, randomized Clinical Trials Network study (CTN0051, X:BOT) comparing the effectiveness of extended-release naltrexone versus buprenorphine. Models examined pretreatment polysubstance use and polysubstance use during the initial 4 weeks of treatment on outcomes of relapse by week 24 of the treatment trial and opioid craving. RESULTS:Polysubstance use was generally not associated with treatment outcomes of opioid relapse and craving. Proportion of days of pretreatment sedative use was associated with increased likelihood of opioid relapse (OR: 1.01, 95 % CI: 1.00-1.02). Proportion of days of cocaine use during the initial 4 weeks of treatment was associated with increased likelihood of opioid relapse (OR: 1.05, 95 % CI: 1.01-1.09) but this effect was no longer significant once the potential of confounding by opioid use was considered. Sedative use during initial 4 weeks of treatment was associated with increased opioid craving (b: 0.77, 95 % CI: 0.01-1.52). The study found no other significant relationships. CONCLUSIONS:In the current study population, polysubstance use was only marginally associated with 24-week treatment outcomes.

In the United States, combined stimulant/opioid overdose mortality has risen dramatically over the last decade. These increases may particularly affect non-Hispanic Black and Hispanic populations. We used death certificate data from the US National Center for Health Statistics (2007-2019) to compare state-level trends in overdose mortality due to opioids in combination with 1) cocaine and 2) methamphetamine and other stimulants (MOS) across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian American/Pacific Islander). To avoid unstable estimates from small samples, we employed principles of small area estimation and a Bayesian hierarchical model, enabling information-sharing across groups. Black Americans experienced severe and worsening mortality due to opioids in combination with both cocaine and MOS, particularly in eastern states. Cocaine/opioid mortality increased 575% among Black people versus 184% in White people (Black, 0.60 to 4.05 per 100,000; White, 0.49 to 1.39 per 100,000). MOS/opioid mortality rose 16,200% in Black people versus 3,200% in White people (Black, 0.01 to 1.63 per 100,000; White, 0.09 to 2.97 per 100,000). Cocaine/opioid overdose mortality rose sharply among Hispanic and Asian Americans. State-group heterogeneity highlighted the importance of data disaggregation and methods to address small sample sizes. Research to understand the drivers of these trends and expanded efforts to address them are needed, particularly in minoritized groups.

BACKGROUND:The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. OBJECTIVE:This qualitative study aimed to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. METHODS:We extracted data from two major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5, 2020 to May 13, 2020 that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. RESULTS:Of the 300 subreddit posts, 100 discussed at least one type of informal coping strategy. Those strategies included: psychological and behavioral coping skills, adopting healthy habits, and using substances to manage withdrawal symptoms. Twelve subreddit posts explicitly mentioned using social distancing as an opportunity for cessation or reduction of opioid use. CONCLUSIONS:Reddit discussion forums provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance related harms.

BACKGROUND/UNASSIGNED:Rural areas have high rates of opioid and stimulant involved polysubstance use which are known to contribute to overdose. Justice-involved women are likely to have multiple substance use disorders and are particularly vulnerable in rural areas where treatment is limited. OBJECTIVES/UNASSIGNED:The research had three aims to (1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, (2) examine how women's engagement in polysubstance use changed in the 12-months following initial release from jail, and (3) determine if women's changes in substance use patterns were associated with re-incarceration during the 12-months of post-release follow-up. METHODS/UNASSIGNED:A total of 339 women with recent substance use histories were randomly recruited from three rural jails. Latent transition analysis of women's substance use from baseline (in jail) to 6 and 12-months was examined, including the effect of re-incarceration on transitions (changes in substance use patterns). RESULTS/UNASSIGNED:class (ORs: 3.14-46.56). CONCLUSION/UNASSIGNED:Justice-involved women in Appalachia reported risky polysubstance use. The first six-months post-release were a critical period for changes in substance use.

BACKGROUND/UNASSIGNED:The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.