Systematic Review of Opioid Use Disorder Treatment Training for Medical Students and Residents.

BACKGROUND: Opioid use and overdose represent a major public health crisis in the United States. Training in opioid use disorder treatment is a complex and multi-faceted endeavor with topics that range from harm reduction and overdose reversal to medication-assisted treatment. METHODS: We conducted a systematic review of literature on medical school opioid training to assess the current state of medical student and resident training to treat opioid use disorder. RESULTS: Seven total studies were identified that evaluated medical student or resident trainings. All the studies showed some positive change in knowledge, confidence, attitudes, and/or practice behavior of the participants. DISCUSSION: Six of the seven studies were conducted among medical residents, and only two included medical students. The reviewed studies effectively addressed specific aspects of effective opioid use disorder treatment. More studies are needed that include medical students, and on effective, all-inclusive training strategies for opioid use disorder curricula.

A Systematic Review of the Effectiveness of Interventions Designed to Teach U.S. Medical Students to Address Interpersonal Violence across the Life Course.

PURPOSE: Interpersonal violence (IV) is a leading cause of morbidity, disability, adverse mental health conditions, and mortality. Without additional training, physicians are likely to limit their attention to the presenting trauma without recognizing or addressing potential long-term effects. METHODS: A systematic review of the literature was conducted using PRISMA guidelines to identify original studies that focused on how medical students are taught to address IV across the life course. RESULTS: Twenty-nine (29) articles were identified that sought to teach medical students how to respond to IV at different stages of the patient's life course. CONCLUSIONS: Research findings suggest that teaching medical students about IV can have a positive impact on their knowledge, attitudes, and skills. Despite the near universal support by medical and professional associations to address it, the evidence base for how to address IV effectively in the medical curriculum is still lacking.

Alcohol misuse among older adult public housing residents.

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n = 187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.

Integrated recovery management model for ex-offenders with co-occurring mental health and substance use disorders and high rates of HIV risk behaviors.

This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.

Preliminary outcomes of a model program for increasing treatment access for African American women who use crack cocaine and are at risk for contracting HIV.

In the United States, the threat of HIV/AIDS to African American women's health has become the focus of much concern. This paper describes a federally funded community-based program that provides services to African American women at risk for HIV/AIDS in Nashville, Tennessee. The program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important for the continued development of culturally relevant interventions aimed at reducing the disproportionate rates of HIV/AIDS within the African American community by ensuring treatment access to all populations.

Improving access to substance abuse treatment services for consumers with AIDS: a formative evaluation.

This paper presents the findings of a formative evaluation used to guide the implementation of programming funded by an HIV/Treatment Capacity Expansion grant received from Substance Abuse and Mental Health Administration. Data were gathered from programmatic records regarding access to treatment, individual interviews with persons with HIV referred to treatment that did not attend, and interviews with persons with HIV currently receiving substance abuse treatment. Findings connected to record review indicate that the program is functioning in accordance with current model standards, while interviews indicated several barriers to access. Suggestions are offered to improve the implementation of substance abuse treatment to persons living with HIV/AIDS.

Perceptions of sexual risks and injection for HIV among African American women who use crack cocaine in Nashville, Tennessee.

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville,Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV.