Considerations for Opioid Use Disorder Treatment From Policy Makers' Experiences With COVID-19 Policy Flexibilities.

OBJECTIVE: This qualitative study aimed to examine how states implemented COVID-19 public health emergency-related federal policy flexibilities for opioid use disorder treatment from the perspective of state-level behavioral health policy makers. Recommendations are given for applying lessons learned to improve the long-term impact of these flexibilities on opioid use disorder treatment. METHODS: Eleven semistructured interviews were conducted with 13 stakeholders from six state governments, and transcripts were qualitatively coded. Data were analyzed by grouping findings according to state-, institution-, and provider-level barriers and facilitators and were then compared to identify overarching themes. RESULTS: Policy makers expressed positive opinions about the opioid use disorder treatment flexibilities and described benefits regarding treatment access, continuity of care, and quality of care. No interviewees reported evidence of increased adverse events associated with the relaxed medication protocols. Challenges to state-level implementation included gaps in the federal flexibilities, competing state policies, facility and provider liability concerns, and persistent systemic stigma. CONCLUSIONS: As the federal government considers permanent adoption of COVID-19-related flexibilities regarding opioid use disorder treatment policies, the lessons learned from this study are crucial to consider in order to avoid continuing challenges with policy implementation and to effectively remove opioid use disorder treatment barriers.

The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study.

BACKGROUND: In March 2020, Veterans Health Administration (VHA) enacted policies to expand treatment for Veterans with opioid use disorder (OUD) during COVID-19. In this study, we evaluate whether COVID-19 and subsequent OUD treatment policies impacted receipt of therapy/counseling and medication for OUD (MOUD). METHODS: Using VHA's nationwide electronic health record data, we compared outcomes between a comparison cohort derived using data from prior to COVID-19 (October 2017-December 2019) and a pandemic-exposed cohort (January 2019-March 2021). Primary outcomes included receipt of therapy/counseling or any MOUD (any/none); secondary outcomes included the number of therapy/counseling sessions attended, and the average percentage of days covered (PDC) by, and months prescribed, each MOUD in a year. RESULTS: Veterans were less likely to receive therapy/counseling over time, especially post-pandemic onset, and despite substantial increases in teletherapy. The likelihood of receiving buprenorphine, methadone, and naltrexone was reduced post-pandemic onset. PDC on MOUD generally decreased over time, especially methadone PDC post-pandemic onset, whereas buprenorphine PDC was less impacted during COVID-19. The number of months prescribed methadone and buprenorphine represented relative improvements compared to prior years. We observed important disparities across Veteran demographics. CONCLUSION: Receipt of treatment was negatively impacted during the pandemic. However, there was some evidence that coverage on methadone and buprenorphine may have improved among some veterans who received them. These medication effects are consistent with expected COVID-19 treatment disruptions, while improvements regarding access to therapy/counseling via telehealth, as well as coverage on MOUD during the pandemic, are consistent with the aims of MOUD policy exemptions.

Nonverbal behavior and the vertical dimension of social relations: a meta-analysis.

The vertical dimension of interpersonal relations (relating to dominance, power, and status) was examined in association with nonverbal behaviors that included facial behavior, gaze, interpersonal distance, body movement, touch, vocal behaviors, posed encoding skill, and others. Results were separately summarized for people's beliefs (perceptions) about the relation of verticality to nonverbal behavior and for actual relations between verticality and nonverbal behavior. Beliefs/perceptions were stronger and much more prevalent than were actual verticality effects. Perceived and actual relations were positively correlated across behaviors. Heterogeneity was great, suggesting that verticality is not a psychologically uniform construct in regard to nonverbal behavior. Finally, comparison of the verticality effects to those that have been documented for gender in relation to nonverbal behavior revealed only a limited degree of parallelism.

Smiling and relative status in news photographs.

To test the hypothesis that lower social status is associated with more smiling, the authors used newspaper photographs and their associated news stories as the basis for scoring the smiling and relative social status of the 2 individuals in each photograph. Independent raters judged smiling and 5 dimensions of relative status for 496 individuals in 248 newspaper photographs. There was no relation between status and smiling, although status and smiling were both related to other variables such as gender, age, and story valence. These findings add to a growing body of evidence that there is no generalized relation between smiling and status.

On boredom and experimentation in humans.

This article discusses the ethical and methodological issues associated with boredom experienced by human participants during psychological experiments. Ways are suggested in which informed consent, briefing, and debriefing can be used to prevent or remedy boredom induced during experiments. We address methodological and ethical concerns, and we discuss the advantages of the proposed approach for experimenters' practice and training of undergraduate students. Future directions for much needed research on these topics are also emphasized.