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Frasure AS, Eldridge G, Hedwig TH, Mangini E. Perspectives of Opportunities and Barriers: Department of Corrections Extended-Release Naltrexone Program Evaluation. JOURNAL OF CORRECTIONAL HEALTH CARE 2025. [PMID: 40370274 DOI: 10.1089/jchc.24.11.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
People involved in the criminal justice system have higher rates of opioid use disorder (OUD) and are less likely to receive recovery services. Medications to treat OUD, such as extended-release naltrexone, have been found to reduce relapse and recidivism. We hope to provide practical lessons learned from the evaluation process of the Department of Corrections' Extended-Release Naltrexone Program and considerations for incorporating medications to treat OUD into a reentry program. The program evaluation followed participants for 1 year and conducted interviews and surveys on health, well-being, and community reintegration. The program experienced significant barriers to effective implementation; few participants received extended-release naltrexone after release, and no case management was provided after release. Despite barriers to implementation, participants reported the need for medications to support treatment of OUD. Results of this program evaluation reveal barriers and opportunities to inform longer-term strategies for similar programs, including considerations for programs pre- and postrelease, participant follow-up, and treatment options. In addition, the lack of reentry planning and coordination between the correctional system and the community introduced barriers. Opportunities exist for holistic supportive reentry starting with needs identification and coordination among correctional facilities, discharge planners, and community providers.
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Affiliation(s)
- Amber S Frasure
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Gloria Eldridge
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Travis H Hedwig
- Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Elizabeth Mangini
- Clinical Psychology Department, Fielding Graduate University, Santa Barbara California
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Parizad R, Batta A, Hatwal J, Taban-Sadeghi M, Mohan B. Emerging risk factors for heart failure in younger populations: A growing public health concern. World J Cardiol 2025; 17:104717. [PMID: 40308622 PMCID: PMC12038706 DOI: 10.4330/wjc.v17.i4.104717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 03/07/2025] [Accepted: 04/01/2025] [Indexed: 04/21/2025] Open
Abstract
Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.
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Affiliation(s)
- Razieh Parizad
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz 51656-87386, Iran
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | | | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
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Bunting AM, Oser CB, Booty M, Knudsen HK, Batty E, Staton M. Social Network Barriers to Extended-Release Naltrexone Within Rural Appalachia: Perspectives from Justice-Involved Clients and Clinicians. Subst Use Misuse 2025; 60:758-765. [PMID: 39810404 PMCID: PMC11870797 DOI: 10.1080/10826084.2024.2447430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
BACKGROUND Extended-release naltrexone (XR-NTX, Vivitrol®) is an effective, but underutilized, evidence-based treatment for people with opioid use disorder (POUD) who are incarcerated. Networks of family, friends, and clinicians serve as social influencers of health behaviors, including XR-NTX initiation, and are especially salient in Appalachia. OBJECTIVES Using a triangulation of perspectives, this study examined concordance between the social network themes that emerged from qualitative interviews with clinicians and POUD social network findings. METHODS Audio-recorded qualitative interviews were conducted with all clinicians (n = 15) providing assessments and community-based treatment linkages to justice-involved POUDs in Kentucky's Appalachian counties. Two independent coders coded the transcribed interviews. Social network data were collected from POUDs who completed prison-based treatment programs and were recently released from prison (n = 52). RESULTS Three themes related to POUDs' social network barriers of XR-NTX emerged from the clinician interviews: (1) networks with limited knowledge of XR-NTX, (2) homophily in networks, and (3) limited support networks. From the perspective of the POUD, knowledge of XR-NTX was nonexistent within their networks, aligning with the clinician theme. Homophily was prevalent in some attributes (e.g., employment), but only 31.8% of POUD networks had used drugs, providing mixed support for this theme. In concordance with clinicians, POUDs received high levels of emotional support, but lacked instrumental, financial, and treatment support from networks. CONCLUSIONS The network characteristics of Appalachian POUDs recently released from prison create challenges associated with recovery, which may be addressed through network and educational interventions.
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Affiliation(s)
- Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, US
- Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, US
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, US
| | - Marisa Booty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, US
| | - Hannah K Knudsen
- Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, US
- Department of Behavioral Science, University of Kentucky, Lexington, KY, US
| | - Evan Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, US
- Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, US
| | - Michele Staton
- Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, US
- Department of Behavioral Science, University of Kentucky, Lexington, KY, US
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Muthulingam D, Hassett TC, Madden LM, Bromberg DJ, Fraenkel L, Altice FL. Preferences in medications for patients seeking treatment for opioid use disorder: A conjoint analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209138. [PMID: 37544510 DOI: 10.1016/j.josat.2023.209138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The opioid epidemic continues to be a public health crisis that has worsened during the COVID-19 pandemic. Medications for opioid use disorder (MOUD) are the most effective way to reduce complications from opioid use disorder (OUD), but uptake is limited by both structural and individual factors. To inform strategies addressing individual factors, we evaluated patients' preferences and trade-offs in treatment decisions using conjoint analysis. METHOD We developed a conjoint analysis survey evaluating patients' preferences for FDA-approved MOUDs. We recruited patients with OUD presenting to initiate treatment. This survey included five attributes: induction, location and route of administration, impact on mortality, side effects, and withdrawal symptoms with cessation. Participants performed 12 choice sets, each with two hypothetical profiles and a "none" option. We used Hierarchical Bayes to identify relative importance of each attribute and part-worth utility scores of levels, which we compared using chi-squared analysis. We used the STROBE checklist to guide our reporting of this cross-sectional observational study. RESULTS Five-hundred and thirty participants completed the study. Location with route of administration was the most important attribute. Symptom relief during induction and withdrawal was a second priority. Mortality followed by side effects had lowest relative importance. Attribute levels with highest part-worth utilities showed patients preferred monthly pick-up from a pharmacy rather than daily supervised dosing; and oral medications more than injection/implants, despite the latter's infrequency. CONCLUSION We measured treatment preferences among patients seeking to initiate OUD treatment to inform strategies to scale MOUD treatment uptake. Patients prioritize the route of administration in treatment preference-less frequent pick up, but also injections and implants were less preferred despite their convenience. Second, patients prioritize symptom relief during the induction and withdrawal procedures of medication. These transition periods influence the sustainability of treatment. Although health professionals prioritize mortality, it did not drive decision-making for patients. To our knowledge, this is the largest study on patients' preferences for MOUD among treatment-seeking people with OUD to date. Future analysis will evaluate patient preference heterogeneity to further target program planning, counseling, and decision aid development.
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Affiliation(s)
- Dharushana Muthulingam
- Washington University School of Medicine, Division of Infectious Disease, 4523 Clayton Ave., CB 8051, St. Louis, MO, 63110, United States of America.
| | - Thomas C Hassett
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America
| | - Daniel J Bromberg
- Yale School of Public Health, New Haven, CT, United States of America
| | - Liana Fraenkel
- Yale School of Medicine, Section of Rheumatology, New Haven, CT, United States of America
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America; Yale School of Public Health, New Haven, CT, United States of America; University of Malaya, Kuala Lumpur, Malaysia
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Kerrison EMT, Hyatt JM. COVID-19 Vaccine Refusal and Medical Distrust Held by Correctional Officers. Vaccines (Basel) 2023; 11:1237. [PMID: 37515052 PMCID: PMC10384026 DOI: 10.3390/vaccines11071237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs' reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons.
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Affiliation(s)
| | - Jordan M. Hyatt
- College of Arts and Sciences, Drexel University, Philadelphia, PA 19104, USA
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Lucabeche VX, Quinn PV. Court-Mandated Treatment Outcomes for Prescribed Opioid Use Disorder: A Gender Based Study. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211044410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study provides empirical information suggesting court-mandated treatment may be a more effective treatment pathway for opioid use disorder (OUD). To examine the effects of mandated treatment for prescription opioid users, we consider the differences in discharge completion rates for court-mandated and non-mandated treatment for both males and females. We use the Treatment Episode Data Set-Discharges (TEDS-D) from 2015 to 2017 with 13,239, 14,765, and 15,433 cases, respectively, to study successful completion rates for males and females with OUD. Logistic regression analysis confirms a greater completion rate for mandated treatment episodes. Of all mandated females, 59% completed treatment in each of the 3 years as compared to the 59%, 65%, and 64% of successful completion for mandated males, respectively, from 2015 to 2017. Our results suggest court-mandated treatment pathways are more effective on treatment completion for individuals with OUD, yet treatment completion disparity between sexes increases even when females are mandated.
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Wartenweiler V, Chung G, Stewart A, Wenthur C. Pharmacy stakeholder reports on ethical and logistical considerations in anti-opioid vaccine development. BMC Med Ethics 2021; 22:30. [PMID: 33766021 PMCID: PMC7992836 DOI: 10.1186/s12910-021-00599-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As opioid use disorder (OUD) incidence and its associated deaths continue to persist at elevated rates, the development of novel treatment modalities is warranted. Recent strides in this therapeutic area include novel anti-opioid vaccine approaches. This work compares logistical and ethical considerations surrounding currently available interventions for opioid use disorder with an anti-opioid vaccine approach. METHODS The opinions of student pharmacists and practicing pharmacists assessing knowledge, perceptions, and attitudes toward current and future OUD management strategies were characterized using a staged, multi-modal research approach incorporating a focus group, pilot survey development and refinement, and final survey deployment. Survey responses were assessed using one- and two-way parametric and non-parametric analyses where appropriate, and multi-dimensional matrix profiles were compared using z-tests following an exhaustive combinatorial sum of differences calculation between items within each compared matrix. RESULTS Focus group content analysis revealed a high level of agreeableness among participants regarding anti-opioid vaccine technology and a sense of shared ownership regarding solutions to the opioid epidemic at large. Pilot survey results demonstrated subject ability to consider both pragmatic and ethical considerations related to current therapeutics and novel interventions in a single instrument, with high endurance amongst engaged subjects. Access inequality was the most concerning ethical consideration identified for anti-opioid vaccines. Support for anti-opioid vaccine implementation across various clinical scenarios was strongest for voluntary use amongst individuals in recovery, and lowest for mandatory use in at-risk individuals. CONCLUSIONS Ethical and logistical concerns surrounding anti-opioid vaccines were largely similar to those for current OUD therapeutics overall. Anti-opioid vaccines were endorsed as helpful potential additions to current OUD therapeutic approaches, particularly for voluntary use in the later stages of clinical progression.
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Affiliation(s)
- Vincent Wartenweiler
- School of Pharmacy, University of WI - Madison, 777 Highland Ave, Madison, WI, 53705, USA
| | | | - Amy Stewart
- Department of Pharmacy, UW-Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Cody Wenthur
- School of Pharmacy, University of WI - Madison, 777 Highland Ave, Madison, WI, 53705, USA.
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Matusow H, Rosenblum A, Fong C. Online Medication Assisted Treatment Education for Court Professionals: Need, Opportunities and Challenges. Subst Use Misuse 2021; 56:1439-1447. [PMID: 34154519 DOI: 10.1080/10826084.2021.1936045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although medication-assisted treatment (MAT) effectively treats opioid use disorders (OUD), MAT access is restricted in criminal justice (CJ) settings. Previous studies have documented that stigma and limited knowledge about MAT are prevalent among CJ court personnel. We describe development and pilot testing of an eLearning intervention to improve MAT knowledge and increase MAT referrals in Ohio courts. Methods: Building upon a nationwide survey conducted in 2011 of drug courts and informed by MAT opinions from judges who supervised OUD clients, we developed two eLearning MAT modules. Judges completed a brief online MAT knowledge-attitude scale (K-A) before, after, and at 3 months. Judges were asked about MAT referrals pretest and 3 months later. Results: Sixty-three judges expressed interest in the study, 25 completed the pretest and viewed the modules, 11 completed a 3 month posttest. At pretest, K-A scores were significantly (p<.05) lower for agonist medications than for extended-release naltrexone (XR-NTX; Vivitrol). K-A scores improved at posttest for agonist medications (p<.05) but declined to pretest levels three months later. Three months after the pretest, buprenorphine referrals increased from 2.6% to 9.7% (p<.05). There was no significant difference on K-A scores for agonist medication between the Ohio sample (at pretest) and the 2011 sample. Conclusion: Although there is some indication that eLearning may have strengthened knowledge gains and increased buprenorphine referrals, a more robust eLearning intervention will likely be required to increase court personnel participation and sustain eLearning knowledge gains. Recruiting and sustaining judges' participation in the study represented a significant study limitation.
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