Literature Collection

Syringe services programs (SSPs) complement substance use disorder treatment in providing services that improve the health of people who use drugs (PWUD). Buprenorphine treatment is an effective underutilized opioid use disorder treatment. Regulations allow buprenorphine prescribing from office-based settings, potentially including SSPs although few studies have examined this approach. Our objective was to assess the attitudes among PWUD toward the potential introduction of buprenorphine treatment in an SSP. Methods: In this qualitative study, we recruited 34 participants who were enrolled at a New York City-based SSP to participate in one of seven focus group sessions. The focus group facilitators prompted participants to share their thoughts in five domains: attitudes toward (1) medical clinics; (2) harm reduction in general; (3) SSP-based buprenorphine treatment; (4) potential challenges of SSP-based treatment; and (5) logistical considerations of an SSP-based buprenorphine treatment program. Four researchers analyzed focus group transcripts using thematic analysis. Results: Of the 34 participants, most were white (68%), over the age of 40 years old (56%), and had previously tried buprenorphine (89%). Common themes were: 1) The SSP is a supportive community for people who use drugs; 2) Participants felt less stigmatized at the SSP than in general medical settings; 3) Offering buprenorphine treatment could change the SSP's culture; and 4) SSP participants receiving buprenorphine may be tempted to divert their medication. Participants offered suggestions for a slow intentional introduction of buprenorphine treatment at the SSP including structured appointments, training medical providers in harm reduction, and program eligibility criteria. Conclusion: Overall, participants expressed enthusiasm for onsite buprenorphine treatment at SSPs. Research on SSP-based buprenorphine treatment should investigate standard buprenorphine treatment outcomes but also any effects on the program itself and medication diversion. Implementation should consider cultural and environmental aspects of the SSP and consult program staff and participants.

BACKGROUND: Intentional or accidental drug-overdose is a leading cause of mortality in U.S. women of child-bearing age. Opioid use during pregnancy is not only associated with maternal overdose, but with low birth weight at term and neonatal abstinence syndrome (NAS). Buprenorphine was approved as a medication for opioid use disorder (MOUD) in the United States in 2002 and is for many women, a preferred treatment option versus methadone. Buprenorphine is relatively safe during pregnancy and is associated with lower rates of NAS than methadone. Given the importance of MOUD during pregnancy, relatively little information exists regarding patients' questions and concerns about buprenorphine treatment, including the psychological challenges they face. AIMS: The purpose of the study was to describe the perinatal concerns of women with opioid use disorder who posted to an online suboxone forum. METHODS: Qualitative descriptive design to analyze some 170 posts from mothers with OUD to an online Suboxone(®) support forum over the period 2016-2021. RESULTS: The analysis of the interview data revealed 4 important themes: (a) Stigma resulting in self-deprecation, low self-esteem, and low self-efficacy; (b) stigma from family members and loved ones; (c) stigma from the medical profession; and (d) stigma from the community at-large (social stigma). CONCLUSIONS: There is compelling evidence to emphasize the importance of open communication and support between medical personnel and patients to ensure optimal outcomes for mother and baby.

PURPOSE: International university students (ISs) experience elevated rates of psychological distress due to the unique challenges of living and studying in a new country. Nonetheless, their utilisation of mental health services tends to be low. This study aimed to explore ISs' experiences of help-seeking via the Scottish primary healthcare services. METHODS: A qualitative design using semi-structured interviews and interpretative phenomenological analysis (IPA) was employed. The sample included nine female ISs from a range of cultural backgrounds, who sought mental health support from the Scottish primary healthcare services within the previous year. RESULTS: Participants' help-seeking experiences, contextualised within the challenging, liminal reality of living and studying in Scotland as an IS, were hindered by challenges with navigating two healthcare systems simultaneously and culturally-mediated attitudes towards mental health. Positive and negative experiences of patient-GP interactions had a considerable impact on participants' subsequent help-seeking endeavours. CONCLUSIONS: Transnational and relational lenses are key for understanding ISs' help-seeking. Beyond individual factors, help-seeking trajectories hinge on perceived quality of patient-doctor relationships and the accessibility of both local and home-country systems. These findings highlight the need for universities to implement targeted mental wellbeing interventions for ISs, and primary care to improve the quality patient-GP interactions.