Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings - A Narrative Review.

In this narrative review, we outline the literature describing the history, training, certification, and role of peer recovery support specialists working with people with substance use disorders at different stages of active use and recovery. We explore the impact of peer recovery support specialists serving people in various settings, including the community, hospitals and emergency departments, jails and prisons, and treatment and recovery agencies; and describes considerations for future expansion of peer recovery support services, including supervision needs, compassion fatigue and burnout, and scope of practice. Finally, we make recommendations to support the broad implementation of peer recovery support services as a sustainable, cohesive, and replicable component of harm reduction and addiction services. We also make recommendations for research to continue to evaluate peer recovery support specialist interventions across settings and outcomes.

Reduction in Oregon's Medication Dosing Visits After the SARS-CoV-2 Relaxation of Restrictions on Take-home Medication.

To slow the spread of SARS-CoV-2 in opioid treatment programs (OTPs), SAMHSA notified State Opioid Treatment Authorities that stable patients could receive up to 27 days of take-homes, less stable patients could receive up to 13 days with fewer take-homes for other patients. An analysis assessed how the relaxed standards affected the number of patient dosing visits and the amount of take-home medications dispensed in Oregon's 20 public, nonprofit, and for-profit OTPs. OTPs reported the number of patients receiving take homes pre and post federal policy change at 3 time points: pre SARS-CoV-2 (February or first half of March), post 1 SARS-CoV-2 (March, April, or May), and post 2 SARS-CoV-2 (April, May, or June). The patients receiving each quantity of take-homes were counted and means calculated for visits and take-homes per patient per month. A negative binomial mixed-effects regression model assessed change in mean dosing visits per patient. During the pre SARS-CoV-2 period, OTPs served 7792 patients monthly with 120,513 medication visits and dispensed 44,883 take-home doses. Mean patient visits per month were 15.5 with 5.8 take-homes per patient per month. Following the policy change, medication visits declined 33% and take-home medication increased 97% with 10.4 mean visits per patient and 11.3 mean take-homes per patient. The negative binomial mixed-effects regression model estimated a 54% reduction in mean visits per patient. The policy change had the intended effect. More research is needed to assess unintended consequences associated with increased access to take-home medication.

Providing support to patients in emotional encounters: a new perspective on missed empathic opportunities.

OBJECTIVE: Studies have repeatedly found that providers miss 70-90% of opportunities to express empathy. Our study sought to characterize provider responses to patients' emotions, with the overall goal of better understanding reasons for lack of empathic response. METHODS: We analyzed 47 visits between patients and their providers. We defined empathic opportunities as instances where patients expressed a strong negative emotion. We then developed thematic categories to describe provider response. RESULTS: We found a total of 29 empathic opportunities within 21 visits. Provider responses were categorized as ignore, dismiss, elicit information, problem-solve, or empathize. An empathic statement occurred at some point in the response sequence in 13/29 opportunities (45%). When problem-solving was the initial response, empathic statements rarely occurred in subsequent dialogue. Among the 16 instances with no empathic statements, providers engaged in problem-solving in 8 (50%). CONCLUSION: Similar to other studies, we found providers missed most opportunities to respond empathically to patient emotion. Yet contrary to common understanding, providers often addressed the problem underlying the emotion, especially when the problem involved logistical or biomedical issues, as opposed to grief. PRACTICE IMPLICATIONS: With enhanced awareness, providers may better recognize situations where they can offer empathy in addition to problem-solving.