Literature Collection

BACKGROUND: The opioid epidemic continues to be problematic in the United States (US). Medications for opioid use disorder (MOUD) are a commonly used evidence-based approach to treating affected individuals, but little is known about its use in the rural US. We reviewed published literature and summarized access, barriers, and approaches to MOUD delivery in rural areas. METHODS: We conducted a search using databases in EBSCOhost, such as Academic Search Complete, Medline, and APA PsycArticles, using a priori aims. Articles published after 2004 were included if they were cross-sectional, analyzed secondary data, collected quantitative or qualitative primary data, were longitudinal or reported intervention results. Studies were excluded if they were conducted outside the US or did not present data. RESULTS: A total of 13 articles met all criteria. Themes from the articles included increase in rural areas with waivered physicians able to prescribe buprenorphine, barriers to physician prescribing, waivered physicians choosing not to prescribe, and inability to assess quality of MOUD practices in rural US settings. CONCLUSIONS: Additional studies of MOUD delivery in rural areas are needed to help explicate themes found in this review. Having a stronger understanding of prescribers operating practices and program roll-out in rural areas may help address some identified barriers and deliver a stronger quality treatment practice for individuals with substance-use disorder.

Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants' generally positive experiences with MOUD support the expansion of correctional MOUD programs.

PURPOSE OF REVIEW: Cocaine is a highly addictive substance with serious medical and mental health consequences. Despite these concerns, there are no Food and Drug Administration-approved medications for the treatment of cocaine use disorder (CUD). Although many medication-assisted treatments (MATs) have been investigated, no clear guidelines exist for clinicians treating patients with CUDs. RECENT FINDINGS: There are a limited number of recent data examining MATs for CUD. Multiple high-quality reviews of existing literature have been performed with psychostimulants, modafinil, bupropion, topiramate and disulfiram showing the most promise. Evidence is limited by heterogeneity of studies, small sample sizes and inconsistent results. SUMMARY: The current literature does not strongly support any individual MAT for CUD. Psychosocial interventions, namely contingency management, have the most evidence for treatment of CUD, but it is worth seriously considering MAT for patients who do not respond well to psychosocial interventions alone given limitations in access to care, relatively low risks associated with MAT and significant morbidity associated with CUD. Further research into MAT for CUD is necessary, as the combination of MAT and psychosocial interventions may be better than either alone.

OBJECTIVES: Patient mindsets influence health outcomes; yet trainings focused on care teams' understanding, recognizing, and shaping patient mindsets do not exist. This paper aims to describe and evaluate initial reception of the "Medicine Plus Mindset" training program. METHODS: Clinicians and staff at five primary care clinics (N = 186) in the San Francisco Bay Area received the Medicine Plus Mindset Training. The Medicine Plus Mindset training consists of a two-hour training program plus a one-hour follow-up session including: (a) evidence to help care teams understand patients' mindsets' influence on treatment; (b) a framework to support care teams in identifying specific patient mindsets; and (c) strategies to shape patient mindsets. RESULTS: We used a common model (Kirkpatrick) to evaluate the training based on participants' reaction, learnings, and behavior. Reaction: Participants rated the training as highly useful and enjoyable. Learnings: The training increased the perceived importance of mindsets in healthcare and improved self-reported efficacy of using mindsets in practice. Behavior: The training increased reported frequency of shaping patient mindsets. CONCLUSIONS: Development of this training and the study's results introduce a promising and feasible approach for integrating mindset into clinical practice. Practice Implications Mindset training can add a valuable dimension to clinical care and should be integrated into training and clinical practice.

This comprehensive integrated literature review provides evidence-based information on mindfulness meditation as a primary care treatment for anxiety. A variety of databases were utilized for article collection including MEDLINE Complete, CINAHL Plus with full text, Cochrane library, APA PsycInfo, APA PsycTests, Health Source: Nursing/Academic Edition, and PsycARTICLES. Research suggests anxiety can be treated effectively with a minimum of 8 weeks of meditation practice. Meditation is a cost effective and safe treatment modality that can be incorporated into the care of patients struggling with anxiety.