Opioid Treatment Programs and Risks for COVID-19 Infections, Emergency Visits, and Hospitalizations.

Background: The COVID-19 pandemic spurred relaxation of opioid treatment program (OTP) in-person daily dosing requirements. This policy change was met with widespread enthusiasm by patients and providers and did not increase illicit opioid use, overdose, or medication diversion. However, it is not known whether the policy change was effective at mitigating the COVID-19 public health emergency among people with opioid use disorder (OUD) receiving treatment at OTPs.

Influence of insurance type on healthcare utilization among rural people who use drugs.

Background: Insurance possession facilitates healthcare engagement. Though people who use drugs (PWUD) experience substantial health risks, a large proportion are un/underinsured. Medicaid/other insurance eligibility varies by state and criminal legal involvement (CLI), and a better understanding of their association is important to inform policy.

Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study.

Background: The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12).

Oregon's Emerging Psilocybin Services Workforce: A Survey of the First Legal Psilocybin Facilitators and Their Training Programs.

New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon's early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023.

Sexual identity, sexual behavior, and drug use behaviors among people who use drugs in the rural U.S.

Introduction: People who use drugs (PWUD) are at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within rural communities is not well understood. Further, while interventions designed to more explicitly affirm individuals' sexual orientation and behaviors may be more effective, descriptions of behavior variability by orientation are lacking. We sought to describe how disease transmission behaviors and overdose risk vary by sexual orientation and activity among rural PWUD.

Perceptions of Medically Complex Patients Enrolled in an Ambulatory Intensive Care Unit at a Healthcare-for-the-Homeless Clinic.

Background: There is great interest in intensive primary care interventions to address high utilization among medically and socially complex patients. How patients experience these interventions has received less attention.

Objective: To better understand patients' experience of intensive primary care, we interviewed patients receiving care from the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an ambulatory intensive care intervention at an urban federally qualified health center.

Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial.

Background: Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet fewer than 10% of PWUD in the United States access HCV treatment and access is especially limited in rural communities.

Methods: We randomized PWUD with HCV viremia and past 90-day injection drug or non-prescribed opioid use in seven rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care; EUC). Peers supported screening and pre-treatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants.

Rural houselessness among people who use drugs in the United States: Results from the National Rural Opioid Initiative.

Background: Over the last two decades, houselessness and drug-related epidemics both have expanded from urban to rural regions across the United States (US). However, our understanding of the relationship between rural houselessness, drug use, and drug-related harms has not kept pace. The current study addresses this gap by describing houselessness among a large cohort of people who use drugs (PWUD) from rural communities across 10 states.

Harm Reduction in Peer-Assisted Telemedicine for Hepatitis C: Secondary Outcomes of a Randomized Controlled Trial.

Hepatitis C (HCV) treatment for people who use drugs (PWUD) decreases injection drug use and injection equipment sharing. We examined changes in injection drug use and injection equipment sharing following HCV treatment in a randomized trial comparing peer-assisted telemedicine for HCV treatment (TeleHCV) versus peer-assisted usual care in rural PWUD. We hypothesize that TeleHCV reduces risky behaviors and peers facilitate this change.

Personal Psychedelic Experience as a Training Qualification for Facilitators: A Thematic Analysis of Qualitative Interviews with Psilocybin Experts.

Emerging legal frameworks in Oregon and Colorado license facilitators to support adults receiving psychedelic services. The current legal frameworks are silent regarding facilitators' personal experience with psychedelics. An e-Delphi process recruited 36 experts with at least 5 years' experience facilitating psilocybin experiences in ceremonial settings, indigenous practices, or clinical trials.

Peer-Assisted Telemedicine for Hepatitis C (PATHS): Process evaluation results from a State Opioid Response-funded program.

Introduction: The opioid crisis and the hepatitis C virus epidemic perpetuate and potentiate each other in a syndemic with escalating morbidity. Policy-driven funding can help resolve the syndemic through collaborative solutions that rapidly translate evidence-based interventions into real-world applications.

Methods: We report development and programmatic evaluation of Peer-Assisted Telemedicine for Hepatitis C (PATHS), which utilizes State Opioid Response (SOR) funding to scale-up a positive randomized trial of peer-assisted telemedicine HCV treatment.

Buprenorphine discontinuation in telehealth-only treatment for opioid use disorder: A longitudinal cohort analysis.

Introduction: At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes.

Methods: A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington.

Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances.

Background: The United States' (US) opioid overdose epidemic has evolved into a combined stimulant/opioid epidemic, a pattern driven in part by mitigating opioid overdose risk, variable substance availability, and personal preferences. This study aimed to investigate the association between self-reported substance preference (heroin or methamphetamine) and behavioral/health outcomes among individuals who used both heroin and methamphetamine in the rural US.

Methods: The Rural Opioid Initiative is a consortium of 8 research cohorts from 10 states and 65 rural counties that recruited individuals reporting past 30-day injection of any substance or opioid substance use by any route from 1/2018 to 3/2020.

Integrating Buprenorphine for Opioid Use Disorder into Rural, Primary Care Settings.

Background: Medications for opioid use disorder (MOUD) including buprenorphine are effective, but underutilized. Rural patients experience pronounced disparities in access. To reach rural patients, the US Department of Veterans Affairs (VA) has sought to expand buprenorphine prescribing beyond specialty settings and into primary care.

Improving access to buprenorphine for rural veterans in a learning health care system.

Objective: To describe a learning health care system research process designed to increase buprenorphine prescribing for the treatment of opioid use disorder (OUD) in rural primary care settings within U.S. Department of Veterans Affairs (VA) treatment facilities.

Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis.

Background: Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma.