"I think we're getting better but we're still not there": Provider-based stigma and perceived barriers to care for people who use opioids (PWUO).

Background: Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD - is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care.

First Responders' Views of Naloxone: Does Stigma Matter?

Background: Prior work has suggested that first responders have mixed feelings about harm reduction strategies used to fight the opioid epidemic, such as the use of naloxone to reverse opioid overdose. Researchers have also noted that provider-based stigma of people who use opioids (PWUO) may influence perceptions of appropriate interventions for opioid use disorder (OUD). This study examined first responders' perceptions of naloxone and the relationship between stigma of OUD and perceptions of naloxone.

"I'm Not a Good Drug Dealer": Styles of Buprenorphine Diversion in a Multisite Qualitative Study.

Background: Against the backdrop of the U.S. opioid epidemic, there has been a concerted movement to improve access to buprenorphine maintenance therapy (BMT).

Treatment trajectories and barriers in opioid agonist therapy for people who inject drugs in rural Puerto Rico.

Background: Research has shown medication for opioid use disorder (MOUD) to have positive effects, including reducing HIV and HCV transmission, but important barriers to access remain among people who inject drugs (PWID). Barriers include lack of social and familial support, bureaucracy, distance to treatment, poverty, and homelessness. However, we know little about how these barriers interact with each other to shape PWID's drug treatment access and retention.

Exploring first responders' perceptions of medication for addiction treatment: Does stigma influence attitudes?

Researchers have suggested that provider-based stigma of persons who suffer from opioid use disorder (OUD) in the criminal justice system serves as a barrier to fully implementing harm reduction strategies, such as the use of naloxone and medication for addiction treatment (MAT). While scholars have begun to explore the relationships between stigma and first responders' attitudes toward naloxone, little work has been done to assess first responders' attitudes toward other forms of harm reduction, including MAT. The goal of the current exploratory study was to help fill this gap in the literature by assessing first responders' (N = 282) attitudes toward MAT, as well as the correlates of these attitudes.

Policing pain: A qualitative study of non-criminal justice approaches to managing opioid overdose during the COVID-19 pandemic.

Opioid related drug overdose deaths are a leading cause of death and injury in the United States. While research demonstrates that where people live has a major impact on drug use and abuse, most work looks at social dynamics at the county level or under the rubric of the urban/rural divide. Only recently, scholarship has become attuned to the post-industrialized areas located on the fringes of urban cores.

Risk and enabling environments in sport: Systematic doping as harm reduction.

Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use drugs themselves. However, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments.

Misunderstandings, misperceptions, and missed opportunities: Perspectives on adherence barriers from people with CF, caregivers, and CF team members.

Objective: To identify differences in perspectives of people with cystic fibrosis (PwCF) and caregivers versus healthcare providers on adherence barriers. Mismatched perspectives may lead to miscommunication and missed opportunities to reduce barriers and improve CF outcomes.

Methods: PwCF, caregivers, and CF providers completed audio-taped, semi-structured interviews about adherence barriers.

Visualizing Age, Period, and Cohort Patterns of Substance Use in the U.S. Opioid Crisis.

Descriptions of the contemporary U.S. opioid crisis emphasize several "waves" of overdose deaths.

"They're making it so hard for people to get help:" Motivations for non-prescribed buprenorphine use in a time of treatment expansion.

Background: Buprenorphine maintenance therapy (BMT) has been widely recognized as one of the most effective treatments for opioid use disorders (OUD). In the midst of the U.S.

Clustered randomized controlled trial of a clinic-based problem-solving intervention to improve adherence in adolescents with cystic fibrosis.

Background: In Cystic Fibrosis (CF), adherence to pulmonary medications is about 50% and decreases during adolescence. Effective interventions have not been integrated into CF care. This effectiveness study tested a brief, clinic-based behavioral intervention to improve adherence.

Opioid misuse initiation: Implications for intervention.

The nonmedical use of opioids (e.g., prescription painkillers and heroin) has drastically increased over the past two decades.

The effect of maternal antidepressants on third trimester uteroplacental hemodynamics and the neonatal abstinence syndrome: a retrospective cohort study.

The objective of this study is to determine whether maternal antidepressant use during pregnancy influences uteroplacental hemodynamics, thereby affecting fetal growth and gestational age at delivery. The secondary aim was to determine the incidence of neonatal abstinence syndrome (NAS) among infants exposed to antidepressant medications. The charts of women who received obstetrical care and had a history of depression from January 2014 to December 2016 at Mount Sinai Hospital in Toronto, Canada, were reviewed.

Identifying Factors that Facilitate Treatment Adherence in Cystic Fibrosis: Qualitative Analyses of Interviews with Parents and Adolescents.

Cystic fibrosis (CF) is a progressive, genetic disease affecting multiple organ systems. Treatments are complex and take 2-4 h per day. Adherence is 50% or less for pulmonary medications, airway clearance, and enzymes.

"You Never Know What You're Getting": Opioid Users' Perceptions of Fentanyl in Southwest Pennsylvania.

Background: Urban areas in the United States have experienced a dramatic surge in fentanyl overdose deaths since 2014, a trend affecting both larger and smaller metropolitan areas. Encompassing only 1.2 million residents, Allegheny County, Pennsylvania, nevertheless saw 412 fentanyl-involved deaths in 2016, a number surpassed only by New York City and Cook County (Chicago), Illinois.

The electronic tracking of referral and attendance at cardiac rehabilitation in Counties Manukau Health: a potential model for New Zealand.

Aim: Cardiac rehabilitation (CR) programmes for patients surviving an acute coronary syndrome (ACS) event are important and recommended by clinical guidelines. Referral and attendance, however, remain suboptimal and tracking both of these aspects to inform quality improvement has been difficult. The aim of this study was to describe the use of an electronic registry to capture referral and attendance at CR in CMH and to report the characteristics of the initial cohort.

Routine proteinuria monitoring for bevacizumab in patients with gynecologic malignancies.

Background: Proteinuria leading to nephrotic syndrome is a rare adverse event arising from treatment with bevacizumab. There is limited evidence to guide the frequency and appropriate test for monitoring for proteinuria. The purpose of this study was to determine the prevalence and severity of proteinuria during bevacizumab administration to patients with gynecologic malignancies, and to evaluate risk factors associated with this toxicity; a secondary objective was to evaluate the cost of routine proteinuria monitoring to assess for opportunities of cost containment that could change clinical practice.

Thrombus-in-Transit: A Case for a Multidisciplinary Hospital-Based Pulmonary Embolism System of Care.

Background: Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death.

Case Report: In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen.

"There's nothing here": Deindustrialization as risk environment for overdose.

Background: Applying the "risk environment" approach proposed by Rhodes (2002, 2009), this study considers the diverse contextual factors contributing to drug overdose in a deindustrialized region of the United States. The Monongahela Valley of Pennsylvania, once a global center of steel production, has suffered a mass exodus of jobs, residents, and businesses since a national manufacturing crisis erupted in the early 1980s; more recently, it has seen a dramatic uptick in accidental drug poisoning deaths. Where recent local and national media attention to overdose has focused on suburban areas and middle class victims, this study concentrates instead on the deteriorating mill city of McKeesport, Pennsylvania.

Effect of food availability on the growth and thermal physiology of juvenile Dungeness crabs (Metacarcinus magister).

Juvenile Dungeness crabs spend ~1 year in the San Francisco Estuary, where they undergo considerable growth before returning to the coastal ocean. Previous studies suggest that competition, food scarcity and avoidance of conspecifics may cause some juvenile Dungeness crabs in the San Francisco Estuary to become food limited. Food limitation may force these crabs to forage in higher temperature intertidal environments in the estuary, exposing them to stressful conditions in order to sustain growth and, potentially, necessitating physiological trade-offs in energy allocation between growth and stress tolerance.

Reducing risk, producing order: The surprisingly disciplinary world of needle exchange.

Emphasizing the reduction of risk over the cessation of drug use, needle exchange in the United States is often condemned for coddling its participants. Declining the punitive measures or unwavering teleology of criminal justice and drug treatment approaches, harm-reduction measures in general are faulted by naysayers for their refusal to establish clear normative boundaries for behavior modification. This article will seek to subvert such critiques by describing the ways in which disciplinary technologies suffused one needle exchange program in New York City.

A reexamination of connectivity trends via exponential random graph modeling in two IDU risk networks.

Patterns of risk in injecting drug user (IDU) networks have been a key focus of network approaches to HIV transmission histories. New network modeling techniques allow for a reexamination of these patterns with greater statistical accuracy and the comparative weighting of model elements. This paper describes the results of a reexamination of network data from the SFHR and P90 data sets using Exponential Random Graph Modeling.