Postpartum Access to Health Care and Opioid Use Treatment: An Evaluation of a Medicaid Population.

Background: In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy.

Methods: We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum.

Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina.

Introduction: Opioid agonist treatment (OAT) is the only treatment for opioid use disorder (OUD) proven to reduce overdose mortality, yet access to this evidence-based treatment remains poor. The purpose of this cross-sectional audit study was to assess OAT availability at residential substance use services in North Carolina.

Methods: We conducted a state-wide inventory of residential substance use service providers in North Carolina and subsequently called all providers identified, posing as uninsured persons who use heroin, seeking treatment services.

"When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies.

Background: Community-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance.

Naloxone Accessibility by Standing Order in North Carolina Community Pharmacies.

Background: According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.

Objective: The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC.

Methods: A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023.

Health Inequities Among People Who Use Drugs in a Post- America: The Case for a Syndemic Analysis.

Punitive policy responses to substance use and to abortion care constitute direct attacks on personal liberty and bodily autonomy. In this article, we leverage the concept of "syndemics" to anticipate how the already synergistic stigmas against people who use drugs and people who seek abortion services will be further compounded the decision.

A Brief Online Training to Address Pharmacists' Willingness to Dispense Buprenorphine.

Background: The recent passage of the Mainstreaming Addiction Treatment (MAT) Act could increase the number of patients seeking to fill buprenorphine prescriptions at community pharmacies; however, multiple barriers limit community pharmacists' ability and willingness to dispense buprenorphine. We assess whether a brief online buprenorphine training program (Buprenorphine Understanding in the Pharmacy Environment) improves community pharmacists' outcomes, including willingness to dispense buprenorphine.

Methods: A convenience sample of practicing community pharmacists participated in a 30-minute buprenorphine training.

Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study.

Background: Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals.

Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.

Introduction: North Carolina's 2017 STOP Act implemented several measures to address the increasing opioid overdose death rate. However, due to racial differences prescription opioid use and treatment service access, the STOP Act may exhibit differential impacts by race. This study examined the impact of the STOP Act on opioid overdose deaths by race.

Addressing buprenorphine bottlenecks in the context of MAT Act implementation: A shared responsibility.

Medications for opioid use disorder (OUD) such as buprenorphine reduce overdose mortality and other opioid related acute health events but have historically been highly regulated. The recent Mainstreaming Addiction Treatment (MAT) Act ended the requirement clinicians complete a specified training and apply for a DATA 2000 ("X") waiver on their Drug Enforcement Administration (DEA) number, to prescribe buprenorphine. With the MAT Act, any practitioner with Schedule III prescribing authority (a regular DEA number) can now prescribe buprenorphine for OUD.

Opioid Use Disorder Practice by Licensure Category in North Carolina.

Background: Nurse practitioners, physician assistants, and certified nurse midwives, collectively known as advanced practice providers (APPs), are critical members of the opioid use disorder (OUD) treatment workforce. Few studies compare the OUD treatment practice patterns of APPs relative to physicians.

Methods: In this cross-sectional study, we distributed a survey examining general substance use disorder (SUD) and OUD-specific treat-ment practices to all licensed physicians and APPs in North Carolina, resulting in a sample of 332 respondents.

Factors in rural community buprenorphine dispensing.

Background: There are pharmacy-related barriers to the dispensing of buprenorphine for the treatment of opioid use disorders. These include pharmacists' moral objections and mistrust of treatment regimens; the perception of a limit on the amount of buprenorphine able to be ordered and dispensed; stigma and concerns about diversion; and knowledge and communication gaps.

Objectives: To document pharmacy stakeholders' awareness and interpretation of regulatory policies that may impact rural community pharmacists' willingness and ability to dispense buprenorphine.

North Carolina pharmacists' willingness to sell fentanyl test strips: a survey study.

Background: Although fentanyl test strips (FTS) can accurately determine the presence of fentanyl in unregulated substances, access to FTS remains limited. This study aimed to examine North Carolina community pharmacists' attitudes and willingness to engage in various behaviors related to FTS sales and distribution.

Methods: A convenience sample of community pharmacists completed an online survey that assessed: (1) comfort initiating an FTS conversation; (2) willingness to sell FTS, distribute FTS instructions, counsel on FTS, refer patients to harm reduction organizations, and advertise FTS; (3) perceived barriers and benefits of selling FTS; and (4) interest in FTS training.

"They don't go by the law around here": law enforcement interactions after the legalization of syringe services programs in North Carolina.

Background: In 2016, the US state of North Carolina (NC) legalized syringe services programs (SSPs), providing limited immunity from misdemeanor syringe possession when law enforcement is presented documentation that syringes were obtained from an SSP. This study explores the law enforcement interactions experienced by SSP participants since the enactment of this law.

Methods: This study used a convergent, mixed-methods design consisting of structured surveys and semi-structured interviews with SSP participants in seven NC counties.

Eligible Prescriber Experiences with Substance Use Disorder Treatment and Perceptions of Pharmacy Barriers to Buprenorphine.

Objectives: The primary aim of this study was to better understand North Carolina providers' specific substance use disorder (SUD) and opioid use disorder treatment practices and buprenorphine prescribing. Furthermore, this study aimed to provide novel information regarding US South and rural providers' opioid use disorder treatment behaviors and perceptions of patient experience at community pharmacies.

Methods: An online survey consisting of closed-ended and open-ended questions was used.

Factors associated with perceived ease of access to syringes in Appalachian North Carolina.

Purpose: To examine associations between perceived ease of syringe access, syringe sources, injection behaviors, and law enforcement (LE) interactions among people who inject drugs (PWID) in rural Appalachian North Carolina (NC).

Methods: Using respondent-driven sampling, a diverse sample of 309 self-reported PWID were recruited from rural Appalachian NC. Data were collected via audio computer-assisted self-interview technology from February 2019 through March 2020.

Increasing North Carolina's Workforce Capacity for Prescribing Buprenorphine Products.

Inadequate access to opioid use disorder (OUD) treatment is a public health concern. Rates of opioid-related poisoning deaths are increasing in North Carolina and access to OUD treatment is especially sparse in rural areas. DEA-X-waivered providers that can prescribe buprenorphine as a medication for opioid use disorder (MOUD) play an essential role in treating OUD.

A content review of buprenorphine training programs for pharmacists.

Objectives: To identify and describe continuing education (CE) credit-bearing training programs for pharmacists that cover buprenorphine dispensing.

Methods: Five CE databases were searched for trainings that were in English, targeted to pharmacists, addressed use of buprenorphine for opioid use disorder treatment, not state-specific, accredited by the Accreditation Council for Pharmacy Education, and available for online registration.

Results: Twelve trainings met the inclusion criteria.

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff.

Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV.

North Carolina community pharmacists' buprenorphine dispensing practices and attitudes.

Background: Many barriers, including stocking behaviors and pharmacist attitudes, can limit access to buprenorphine in pharmacy settings.

Objectives: To assess North Carolina (NC) pharmacists' (1) buprenorphine stocking behaviors, (2) awareness and interpretation of federal and state policy regarding buprenorphine, (3) perceptions about changes in buprenorphine demand, and (4) reasons for not dispensing buprenorphine, including attitudes.

Methods: A convenience sample of currently practicing community pharmacists was recruited to participate in a 10-minute online survey.

Rural community pharmacist willingness to dispense Suboxone® - A secret shopper investigation in South-Central Appalachia.

Background: Buprenorphine access is limited for patients with opioid use disorder, especially in rural areas. Telephone audits have identified pharmacist limitations to the dispensing of buprenorphine particularly in independent pharmacies in comparison to chain pharmacies and in rural areas. The objective of this study was to assess rural community pharmacists' stated willingness to dispense buprenorphine-naloxone, and document potential bias and or stigma that the shopper experiences when asking about buprenorphine- naloxone.

Perinatal OUD Treatment Provider Understandings of Rural Patients' Experiences.

Objectives: To present perspectives of substance use treatment providers offering perinatal opioid use disorder (OUD) treatment in a largely rural, Appalachian region. To demonstrate the extent to which providers sought to understand their patients' experiences accessing treatment and how this understanding informed providers' approach to offering patient-centered care.

Methods: A qualitative study combining semi-structured interviews and participant-observation with perinatal substance use treatment providers, conducted within a comprehensive program.

Ensuring buprenorphine access in rural community pharmacies to prevent overdoses.

Background: Opioid-related drug overdoses have been rapidly increasing in the United States, especially in rural Southern and Appalachian regions. The use of buprenorphine-containing medications to treat opioid use disorder (OUD) is an evidence-based approach proven to reduce overdose death risks. Access to such treatment is uneven, with less access in parts of the United States where overdose rates are higher.