Anger and associated risk and protective factors among rural American adolescents: Implications for violence prevention.

Background: Adolescent violence in the United States is a prevalent public health problem and is understudied in rural settings. Anger is a significant risk factor for adolescent violence. To better craft adolescent violence interventions, it is important to examine anger and identify its most significant associated factors.

Pharmacy Naloxone Standing Order and Community Opioid Fatality Rates Over Time.

Importance: Despite the proliferation of pharmacy standing-order naloxone dispensing across many US states before the change to over-the-counter status, few policy analyses have evaluated the implementation of pharmacy naloxone standing orders in addressing opioid overdose fatality among communities.

Objective: To determine whether the implementation of pharmacy standing-order naloxone was associated with lower opioid fatality rates compared with communities without pharmacies with standing-order naloxone.

Design, Setting, And Participants: This retrospective multisite study was conducted with an interrupted time series analysis across 351 municipalities in Massachusetts over 24 quarters (from January 1, 2013, through December 31, 2018).

Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State.

Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis.

Opioid Prescribing Patterns After Imposition of Setting-Specific Limits on Prescription Duration.

Importance: Despite their widespread adoption across the US, policies imposing one-size-fits-all limits on the duration of prescriptions for opioids have shown modest and mixed implications for prescribing.

Objective: To assess whether a prescription duration limit policy tailored to different clinical settings was associated with shorter opioid prescription lengths.

Design, Setting, And Participants: This cross-sectional study examined changes in opioid prescribing patterns for opioid-naive Medicaid enrollees aged 12 to 64 years before and after implementation of a statewide prescription duration limit policy in West Virginia in June 2018.

Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA.

Background: Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.

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.

Drug treatment perspectives and experiences among family and friends of people who use illicit opioids: A mixed methods study.

Introduction: Increasing evidence-based treatment for opioid use disorder (OUD) is key to reducing opioid-related morbidity and mortality. Family and close friends of people with OUD can play an important role in motivating and facilitating their loved ones' treatment. We examined evolving knowledge about OUD and its treatment among family and close friends of people who use illicit opioids and their experiences navigating the treatment system.

"You didn't have a choice, but to be on your train. The train was moving": West Virginia pharmacists' perspectives on opioid dispensing during the evolution of the opioid crisis.

Background: West Virginia (WV) has been at the forefront of the opioid crisis in the United States, with the highest rate of opioid overdose mortality involving prescription opioids in the country. To curb the crisis, the state government implemented a restrictive opioid prescribing law in March 2018, Senate Bill 273 (SB273), to decrease opioid prescribing. However, sweeping changes in opioid policy can have downstream effects on stakeholders such as pharmacists.

Mixed methods research: A primer for the vascular surgeon.

Mixed methods research is an approach that intentionally integrates both quantitative and qualitative research methods to answer a research question. The hallmark of mixed methods research is a focus on designing studies that integrate both quantitative and qualitative data, yielding greater results than either method could yield on its own. There are a number of fundamental concepts that are essential to conducting mixed methods research.

Pain Management During West Virginia's Opioid Crisis.

Purpose: Opioid use disorder has caused significant morbidity and mortality resulting in opioid prescribing limiting laws, such as State Bill 273 in West Virginia. The purpose of this study is to explore the impacts of a restrictive opioid prescription law on physicians in medical practice in West Virginia.

Methods: A qualitative study with open-ended semistructured interviews with a purposive sample of physicians in West Virginia.

Pharmacy naloxone codispensing: A mixed methods study of practices and perspectives under a statewide standing order program.

Background: In a previous statewide naloxone purchase trial conducted in Massachusetts, we documented high levels of naloxone accessibility, upon patient request, under the state's naloxone standing order (NSO) program. Equally important for reducing overdose mortality rates is expanding naloxone access via codispensing alongside opioid prescription and syringe purchases at pharmacies.

Objective: To understand naloxone codispensing from the perspective of pharmacists under the Massachusetts NSO program.

Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California.

Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti-HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, which has among the highest prevalence of injection drug use (IDU) in the United States. We surveyed 494 peer-recruited PWID (≥18 years of age) in 2016 about their experiences with HCV testing and treatment, and conducted HCV and HIV antibody testing for all participants.

"The DEA would come in and destroy you": a qualitative study of fear and unintended consequences among opioid prescribers in WV.

Background: West Virginia has one of the highest rates of opioid overdose related deaths and is known as the epicenter of the opioid crisis in the United States. In an effort to reduce opioid-related harms, SB 273 was signed in 2018, and aimed to restrict opioid prescribing in West Virginia. SB 273 was enacted during a time when physician arrests and convictions had been increasing for years and were becoming more prevalent and more publicized.

Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial.

Background: West Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV's naloxone standing order (NSO) program.

Methods: A stratified random sample of 200 chain and independent retail pharmacies across WV were included.

Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts.

Background: Naloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown.

Pharmacists' experiences with a statewide naloxone standing order program in Massachusetts: a mixed methods study.

Objectives: In a prior statewide naloxone purchase trial conducted in Massachusetts, we documented a high rate of naloxone dispensing under the state's standing order program. The purpose of this study was to understand the factors that facilitate naloxone access under the Massachusetts naloxone standing order (NSO) program and identify any remaining barriers amenable to intervention.

Design: Mixed methods design involving a pharmacist survey and 3 pharmacist focus groups.

Mobile phone and internet use among people who inject drugs: Implications for mobile health interventions.

Mobile health (mHealth) interventions have the potential to improve substance use treatment engagement and outcomes, and to reduce risk behaviors among people who inject drugs (PWID). However, there are few studies assessing mobile technology use among PWID and none have investigated continuity of mobile phone use. : We surveyed 494 PWID.

A community-based study of abscess self-treatment and barriers to medical care among people who inject drugs in the United States.

Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess characteristics, treatment utilization, and barriers to medical treatment among N = 494 community-recruited PWID. We used descriptive statistics to determine the frequencies of self-treatment and medical treatment for their most recent past-3-month abscess as well as barriers to seeking medical treatment.

Consider the Source: Associations between Syringe Sources and Risky Injection Behaviors in California's Central Valley.

Background: Sterile syringe access is critical to prevent serious viral and bacterial infections among people who inject drugs (PWID) but many areas across the United States lack sufficient access. Although California law allows nonprescription pharmacy syringe sales and syringe services programs (SSPs), access gaps remain in the largely rural Central Valley.

Objective: The purpose of this study was to examine syringe access and related injection behaviors among PWID in Fresno, California.

Barriers to Integrated Medication-Assisted Treatment for Rural Patients With Co-occurring Disorders: The Gap in Managing Addiction.

Objective: Guidelines for treatment of opioid use disorder stipulate for mental health assessment and the option for treatment alongside medication for opioid use disorder (MOUD). Yet efforts to expand MOUD treatment capacity have focused on expanding the workforce of buprenorphine providers. This article aims to describe the processes facilitating and impeding integrated care for rural patients with co-occurring opioid use disorder and mental health conditions.

Assessing the impact of a restrictive opioid prescribing law in West Virginia.

Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days' supply, and first-time opioid prescriptions to 7 days' supply for surgeons and 3 days' for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts.

System-level factors shaping the implementation of "hub and spoke" systems to expand MOUD in rural areas.

Hub and spoke systems (HSS) are increasingly promoted as a systems-level intervention to expand access to medication for opioid use disorders (MOUD), particularly in rural areas with limited treatment options. The HSS model consists of sub-systems in which "hubs" deliver specialized expertise to a regional network of office-based opioid treatment (OBOT) providers in "spokes," who together create a continuum of acute and chronic care. Yet, little is known about system-level factors (e.