Virtual Peer Support in Women's Health for Pregnant People and Mothers With Substance Use Disorder.

OBJECTIVE: To evaluate the effectiveness of a virtual peer support group associated with a women's health unit for mothers and pregnant people with substance use disorder. DESIGN: The project was guided by the Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health. Pre-/postintervention surveys were used to evaluate outcomes. SETTING: Women's health unit in a 325-bed hospital with 900 births a year in the U.S. Midwest and a virtual online meeting format. PARTICIPANTS: Thirteen people with substance use disorder. INTERVENTION/MEASUREMENTS: Participants were recruited by nurses on the womens health unit and from existing online peer support meetings. Participants attended a 12-week session of facilitated substance use disorder peer support meetings through an online virtual format. Surveys included the Depression, Anxiety, and Stress Scale; the Alcoholics Anonymous Intention Scale; and pre-/postintervention surveys developed by the authors. Descriptive statistics and narrative description of qualitative data were used. RESULTS: The Depression, Anxiety, and Stress Scale scores were reduced, on average, by 25%, indicating that participants showed improvement in these conditions. Responses to open-ended questions showed that participants found the meetings helpful for developing coping mechanisms. The virtual space was seen as a comfortable, safe space where participants were able to develop community. CONCLUSION: Substance use disorder treatment continues to challenge health care providers across the United States. Peer support meetings have been effective in the treatment of people with substance use disorder. Nursing has the holistic historical precedence of creating effectual education and support programs. This program evaluation exemplifies that women's health units are an appropriate location where nurses can integrate this established evidence-based treatment modality.

Attitudes toward syringe exchange programs in a rural Appalachian community.

OBJECTIVES: To evaluate community attitudes concerning syringe exchange programs (SEPs) in a rural community as part of an effort to implement evidence-based harm reduction strategies and improve health outcomes related to opioid use disorder. METHODS: Dissemination of a 24-item survey to individuals living in a rural community followed by comparative analysis of survey results based on support for SEPs. RESULTS: Three hundred and sixty-one individuals responded. Overall, 49.3% of respondents indicated support for syringe exchange. Individuals who support syringe exchange as a harm reduction service are more likely to: agree that opioid use disorder is a real illness (p < 0.0001); agree that anyone can become addicted to pain medications (p = 0.01); agree that medication assisted treatment is effective (p < 0.0001); agree that individuals with OUD have the same right to a job (p < 0.0001); be willing to administer naloxone to a stranger (p < 0.0001); support HIV and HCV screening (p < 0.0001), condom distribution (p < 0.0001), and medication for opioid use disorder (p < 0.0001). They are less likely to believe that harm reduction services encourage drug use (p < 0.0001). CONCLUSIONS: Positive correlations exist between support for SEPs, awareness of OUD as a chronic illness, less stigmatizing attitudes toward individuals with OUD, and support for other harm reduction strategies. Efforts to increase awareness of OUD as a chronic illness may lead to greater acceptance of harm reduction strategies in rural areas, easing evolution of evidence-based healthy policy.

"If You Could Wave a Magic Wand": Treatment Barriers in the Rural Midwest.

INTRODUCTION: The multigenerational health considerations and negative economic impacts related to the opioid epidemic are many. Increasing numbers of opioid-related fatalities are bolstered by barriers related to access to evidence-based treatment. Ohio is ranked second in the country for number of opioid-related deaths, and for many their treatment needs remain unmet due to impaired access to effective treatment, in rural, medically underserved areas of the state. PURPOSE: The goal of this study was to assess opioid use disorder treatment barriers in order to increase access to evidence-based treatment, wrap around services, and harm reduction efforts to support the reintegration of persons with substance use disorder back into society and subsequently reduce opioid fatalities in a rural, medically underserved region of Ohio. METHODS: As part of a larger mixed-methods study design where a community health survey was randomly distributed to residents in a rural county in Ohio, this study used qualitative methods to triangulate findings. To supplement the data received from the surveys, 20persons with a diagnosed opioid use disorder (OUD) took part in focus group sessions guided by trained researchers. The sessions were transcribed, and the data was analyzed using Braun and Clarke's thematic analysis method. RESULTS: Three major themes emerged from the data: epigenetics and exposure, management of disease including re-integration into society, and disease process. The participant data created insight regarding the need to recognize OUD as a chronic condition that must be addressed with integrated components of medical, behavioral, and mental health morbidities throughout the lifespan and across generations. CONCLUSIONS: Findings from this study support the need for targeted interventions for integrated care and improved wrap around services such as transportation, sober living, and employment.

Stress Reduction Through Mindfulness Meditation in Student Registered Nurse Anesthetists.

Student registered nurse anesthetists (SRNAs) experience high levels of stress related to the level of difficulty and time commitment associated with an integrated Doctor of Nursing Practice anesthesia program. Although some degree of stress is necessary for motivation, unmanaged stress can contribute to illness, dissatisfaction, and substance use. A search of the literature showed that mindfulness meditation training reduces stress and improves academic performance in graduate student populations. An evidence-based practice project was developed and implemented to provide SRNAs with a novel stress management mechanism. A guided mindfulness meditation application for smart phones (Headspace, Headspace) was chosen as the intervention modality. Research shows that this application is an effective and convenient delivery system for mindfulness meditation training, decreasing stress during a 10-day trial. SRNAs attended a mindfulness presentation and completed an introductory guided mindfulness meditation module using the Headspace application on their personal smart phone. Preintervention and postintervention surveys (N=33) using the Depression Anxiety Stress Scales 21-item questionnaire were analyzed using the Wilcoxon signed rank test. Results showed significant reductions (P<.01) in depression (Z=-3.36), anxiety (Z=-3.07), and stress (Z=-3.46) scores, representing reductions of 32%, 32%, and 47%.

The Impact of the Disease Model of Substance Use Disorder on Evidence Based Practice Adoption and Stigmatizing Attitudes: A Comparative Analysis.

BACKGROUND: Evidence-based practices are shown to improve health outcomes in persons with substance use disorder (SUD), but practice adoption is often limited by stigma. Stigma towards these patients leads to poor communication, missed diagnoses, and treatment avoidance. AIMS: The purpose of this study was to survey a rural community to conceptualize knowledge and attitudes towards SUD and opioid use disorder. DESIGN: The study design was cross-sectional survey using a convenience sample in a rural community in southwestern Ohio. METHODS: A 25-item electronic survey was created to assess knowledge and attitudes of the community towards SUD, evidenced-based practices, and stigma. Questions were grouped into five subcategories to meaningfully address high-priority areas. Descriptive statistics included frequencies and percentages. A comparative analysis was performed using Chi-square and phi to evaluate response rates from the first question, A substance use disorder is a real illness like diabetes and heart disease, to the other survey questions. RESULTS: A total of 173 people responded to the survey. The response to "A substance use disorder is a real illness like diabetes and heart disease" resulted in two groups of similar size, with 83 (48.5%) of the respondents agreeing with the statement. There was a significant difference (p < .001) in 15 questions between the two groups. CONCLUSIONS: People who believe SUD is a real illness were more likely to support evidence-based treatment practices, show less stigma towards those suffering from SUD, and support harm reduction services.

Community Attitudes Toward Opioid Use Disorder and Medication for Opioid Use Disorder in a Rural Appalachian County.

PURPOSE: To evaluate community attitudes concerning opioid use disorder (OUD) and medication for opioid use disorder (MOUD) in a rural community, and to plan educational initiatives to reduce stigma surrounding OUD and treatment. METHODS: Dissemination of a 24-question survey to people living in a rural community followed by comparative analysis of survey results between 2 groups classified by recognition of OUD as a real illness. FINDINGS: Three hundred sixty-one individuals responded. Overall, 69% agreed that OUD is a real illness. Respondents recognizing OUD as a real illness were less likely to agree that individuals with OUD are dangerous (P = .014), more likely to agree that MOUD is effective (P < .001), that individuals with OUD should have the same right to a job (P < .001), and that naloxone should be administered for every overdose every time (P = .002). CONCLUSIONS: Significant stigma exists toward individuals with OUD in rural communities, and recognizing OUD as a real illness is associated with less stigmatizing attitudes and better understanding of MOUD. Further study should focus on how to effectively convince communities that OUD is a real illness.

Educational Program to Increase Substance Use Disorder Knowledge and Decrease Stigma in First-Year Nursing Students.

PURPOSE: The opioid epidemic in the United States is changing the population nurses serve. Stigma and bias among healthcare providers towards patients with substance use disorder occurs across disciplines and negatively impacts the care provided to this population. We sought to assess the knowledge and perceptions of first-year nursing students at a large college of nursing towards those with opioid use disorder and to provide an educational intervention with the goals of decreasing bias, increasing substance use disorder knowledge, and increasing the understanding of multi-pronged treatment strategies. DESIGN: The program consisted of an interactive two-hour presentation based on the disease model of addiction. METHODS: First year nursing students from a large urban college were administered a pre- and post-presentation survey designed to evaluate their perceptions towards those with opioid use disorder. RESULTS: Thematic analysis indicated stigma and bias was present in some first-year nursing students towards those with opioid use disorder. Results from a summary t-test showed a significant increase in the mean scores from pre- to post-test (t = -2.224, df 429, p = .027). CONCLUSIONS: Our project results indicate that knowledge and bias towards those with substance use disorder can be changed with education, which may improve the delivery of healthcare to this vulnerable population. CLINICAL IMPLICATIONS: Since bias and stigma negatively impact care provided by clinicians, presentations such as this one can not only provide education on evidence based practices, but may change the attitudes of future providers, improving the quality of healthcare delivered to this vulnerable population.

Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Naïve Patients.

The purpose of this research study was to identify factors associated with prolonged postoperative opioid use in opioid-naïve patients in 2 domains: specific patient characteristics and exposure through postoperative opioid prescriptions. A retrospective analysis was conducted of electronic medical records of opioid-naïve adult orthopedic surgical patients at a large academic medical center from January 1, 2012, through December 31, 2017. In this cohort, 4% continued to refill opioid prescriptions more than 90 days after their surgical procedure. Prolonged use was associated with an initial prescription that had an oral morphine milligram equivalent above 675. Receipt of opioid prescription refills was a significant predictor for receiving additional opioid prescriptions over time. Multivariate logistic regression indicated that the independent predictors of prolonged postoperative opioid use were alcohol abuse, black race, Medicaid insurance, and the following comorbidities: diabetes, mood disorder, hypertension, and chronic kidney disease. To decrease the rate of prolonged postoperative opioid use, clinical changes can be investigated, including collaborative perioperative pain management strategies using nonopioid pain control methods; perioperative patient screening; education of patients and clinicians; and close postoperative follow-up, especially in the most vulnerable populations.