Literature Collection

Background: 12-step groups are the most common approach to managing opioid use disorder (OUD) in the U.S. Medications for OUD (MOUD) are the most effective tool for preventing opioid misuse and relapse. Previous research has identified stigma of MOUD in 12-step groups. Objectives: We sought to identify how MOUD stigma is operationalized in 12-step groups and to identify responses to stigma. Methods: We recruited individuals with both MOUD experience and 12-step group experience from three syringe exchange programs in the U.S. using snowball sampling. We conducted individual telephone semi-structured interviews during 2018 and 2019. We coded data in Dedoose software and conducted thematic analysis using iterative categorization. Results: We recruited 30 individuals meeting our inclusion criteria. The following stigma operationalization methods were identified: prohibiting people using MOUD from speaking at meetings; encouraging shortened duration of MOUD treatment; refusing to sponsor people using MOUD; and refusing to let people using MOUD claim recovery time. Responses to stigma included the following: feeling shame; feeling anger; shopping around for different groups, leaving the group, or forming a new group; not revealing MOUD utilization or only telling a sponsor; speaking out on behalf of MOUD; and using cognitive approaches to avoid stigma internalization. Cognitive approaches included believing that anti-MOUD stigma is contrary to 12-step principles; disregarding statements as inaccurate based on one's experience of MOUD benefits; and accepting that all groups of humans have some ignorant people. Conclusion: Healthcare systems should help address MOUD stigma experienced by patients in 12-step groups, such as by offering non-12-step alternative groups and encouraging MOUD healthcare providers to prepare patients for potential stigma they may face. Some stigma response options, like shopping around for different groups, may not be feasible in rural areas or for participants newer to recovery.

Background: 12-step groups are the most common approach to managing opioid use disorder (OUD) in the U.S. Medications for OUD (MOUD) are the most effective tool for preventing opioid misuse and relapse. Previous research has identified stigma of MOUD in 12-step groups. Objectives: We sought to identify how MOUD stigma is operationalized in 12-step groups and to identify responses to stigma. Methods: We recruited individuals with both MOUD experience and 12-step group experience from three syringe exchange programs in the U.S. using snowball sampling. We conducted individual telephone semi-structured interviews during 2018 and 2019. We coded data in Dedoose software and conducted thematic analysis using iterative categorization. Results: We recruited 30 individuals meeting our inclusion criteria. The following stigma operationalization methods were identified: prohibiting people using MOUD from speaking at meetings; encouraging shortened duration of MOUD treatment; refusing to sponsor people using MOUD; and refusing to let people using MOUD claim recovery time. Responses to stigma included the following: feeling shame; feeling anger; shopping around for different groups, leaving the group, or forming a new group; not revealing MOUD utilization or only telling a sponsor; speaking out on behalf of MOUD; and using cognitive approaches to avoid stigma internalization. Cognitive approaches included believing that anti-MOUD stigma is contrary to 12-step principles; disregarding statements as inaccurate based on one's experience of MOUD benefits; and accepting that all groups of humans have some ignorant people. Conclusion: Healthcare systems should help address MOUD stigma experienced by patients in 12-step groups, such as by offering non-12-step alternative groups and encouraging MOUD healthcare providers to prepare patients for potential stigma they may face. Some stigma response options, like shopping around for different groups, may not be feasible in rural areas or for participants newer to recovery.

Approximately 10% of the U.S. population 12 years and older reported using illicit substances in 2015. This article reviews the clinical effects and treatment of persons who use cocaine, methamphetamines, 3,4-methylenedioxymethamphetamine (MDMA), synthetic cannabinoids, and synthetic cathinones ("bath salts"). Cocaine blocks the reuptake of the monoamine transporters dopamine, norepinephrine, and serotonin. Immediate clinical effects include increased energy and euphoria, as well as hypertension and arrhythmias. Acute myocardial infarction, seizures, hallucinations, hyperthermia, and movement disorders are among the possible adverse effects. Like cocaine, methamphetamine blocks reuptake of monoamine transporters, but also stimulates dopamine release and has a longer duration of action. Methamphetamine misuse is associated with severe dental problems. MDMA is a stimulant and psychedelic with a chemical structure similar to serotonin. Adverse effects include serotonin syndrome, hyponatremia, long-term memory impairment, and mood disorders. Synthetic cannabinoids can have a more intense and long-lasting effect than natural cannabis. Acute intoxication may cause severe cardiac and respiratory complications and seizures. Synthetic cathinones are marketed as cheap substitutes for other stimulants. Their effects are similar to those of other stimulants, and they are addictive. Psychosocial intervention is the main form of treatment for addiction to these substances. Promising therapies include disulfiram and substitution therapy for cocaine misuse disorders, and mirtazapine for methamphetamine use disorder.

BACKGROUND: Among individuals with opioid use disorder (OUD) and co-occurring mental illness, stimulant co-use may be associated with more severe symptoms and less treatment utilization. We sought to understand the association of stimulant use with social needs and OUD and mental illness severity and treatment. METHODS: This cross-sectional study used baseline data from a randomized controlled trial of collaborative care for primary care patients with OUD and co-occurring depression and/or posttraumatic stress disorder (PTSD). We categorized stimulant use (cocaine/methamphetamine) into daily use (20 or more days), non-daily use (1-19 days), and no use (0 days). We conducted comparisons across measures of social needs and OUD and mental illness severity and treatment through one-way analysis of variance for continuous variables and chi-square tests for categorical/binary variables. RESULTS: 123 (15.4%) participants used stimulants daily, 164 (20.6%) reported non-daily use, and 510 (64%) used no stimulants. When comparing participants by stimulant use, we found differences in education (p = 0.020), housing status (p < 0.001), legal problems (p < 0.001), recent overdose (p < 0.001), overdose risk (p < 0.001), MOUD use (p < 0.001), depression/PTSD symptoms (p < 0.001), and receipt of therapy (p = 0.004) or medication (p < 0.001) for depression/PTSD with all differences demonstrating more unmet social needs, greater OUD and mental illness severity, and lower treatment utilization for participants using stimulants. CONCLUSIONS: Among primary care patients with OUD and co-occurring depression/PTSD, individuals using stimulants experienced a higher disease burden and decreased utilization of care across multiple measures. These associations suggest that clinicians should specifically address stimulant use in the context of co-occurring OUD and mental illness.

BACKGROUND: Delivering physical and behavioral health services in a single setting is associated with improved quality of care and reduced health care costs. Few health systems implementing integrated care develop conceptual models and targeted measurement strategies a priori with an eye toward adoption, implementation, sustainment, and evaluation. This is a broad challenge in the field, which can make it difficult to disentangle why implementation is or is not successful. METHOD: This paper discusses strategic implementation and evaluation planning for a pediatric integrated care program in a large health system. Our team developed a logic model, which defines resources and community characteristics, program components, evaluation activities, short-term activities, and intermediate and anticipated long-term patient-, clinician-, and practice-related outcomes. The model was designed based on research and stakeholder input to support strategic implementation and evaluation of the program. For each aspect of the logic model, a measurement battery was selected. Initial implementation data and intermediate outcomes from a pilot in five practices in a 30-practice pediatric primary care network are presented to illustrate how the logic model and evaluation plan have been used to guide the iterative process of program development. RESULTS: A total of 4,619 office visits were completed during the two years of the pilot. Primary care clinicians were highly satisfied with the integrated primary care program and provided feedback on ways to further improve the program. Members of the primary care team and behavioral health providers rated the program as being relatively well integrated into the practices after the second year of the pilot. CONCLUSIONS: This logic model and evaluation plan provide a template for future projects integrating behavioral health services in non-specialty mental health settings, including pediatric primary care, and can be used broadly to provide structure to implementation and evaluation activities and promote replication of effective initiatives.

Sickle cell disease (SCD) remains a challenging hematologic disorder, characterized by chronic hemolysis, vaso-occlusive events, and multi-organ complications. Hypertension, a prevalent comorbidity in SCD, poses significant clinical implications, exacerbating the complexities of disease management and impacting patient outcomes. Understanding the intricate interplay between SCD and hypertension is pivotal. Mechanistic insights uncover a landscape characterized by chronic hemolysis, endothelial dysfunction, altered nitric oxide bioavailability, and increased oxidative stress, contributing to elevated blood pressure and heightened cardiovascular risks in individuals with SCD. The diagnostic challenges inherent in identifying and monitoring hypertension in SCD patients necessitate novel approaches. Current treatment paradigms encompass a spectrum of lifestyle modifications, pharmacological interventions, and multidisciplinary care models. However, the limitations and complexities inherent in managing hypertension in SCD call for innovative strategies. Tailored approaches, personalized treatments, and emerging therapeutic avenues geared explicitly toward SCD patients mark a shift toward more effective management. Advancements in technology, including wearable devices and remote monitoring systems, present opportunities to revolutionize blood pressure monitoring, enhancing patient engagement and compliance while providing more accurate and frequent measurements. Moreover, the review underscores the importance of integrated care models and multidisciplinary collaborations. Collaborative frameworks involving hematologists, cardiologists, nephrologists, and primary care physicians are integral in optimizing hypertension management and addressing the specific needs of individuals with SCD.