Medications for opioid use disorder in state prisons: Perspectives of formerly incarcerated persons.

Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants' generally positive experiences with MOUD support the expansion of correctional MOUD programs.

Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms.

OBJECTIVE: The COVID-19 pandemic led to unprecedented temporary federal and state regulatory flexibilities that rapidly transformed medication for opioid use disorder (MOUD) treatment delivery. This study aimed to understand changes in treatment providers' care during COVID-19, provider experiences with the adaptations, and perceptions of which changes should be sustained long-term. METHODS: We conducted in-depth, semi-structured interviews with 20 New Jersey MOUD providers, purposively sampled to reflect diversity in provider setting, specialty, and other characteristics. Using a rapid analysis approach, we summarized content within interview domains and analyzed domains across participants for recurring concepts and themes. RESULTS: MOUD treatment practice changes taking place during the COVID-19 pandemic included a rapid shift from in-person care to telehealth, reduction in frequency of toxicology testing and psychosocial/counseling services, and modifications to prescription durations and take-home methadone supplies. Modifications to practice were positively received and reinforced a sense of autonomy for providers as well as enhancing the ability to provide patient-centered care. All respondents expressed support for making temporary regulatory flexibilities permanent, but differed in their implementation of the flexibilities and the extent to which they planned to modify their own practices long-term. CONCLUSION: Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic.

Measuring Youth Empowerment: An Item Response Theory Analysis of the Sociopolitical Control Scale for Youth.

Sociopolitical control (SPC) has been identified as a key element of the intrapersonal component of psychological empowerment. The Sociopolitical Control Scale (SPCS) is a widely used measure and has been modified for use among youth (SPCS-Y). In light of the emerging interest in SPC among youth within community-based research, this study applied item response theory (IRT) to examine the psychometric properties of the SPCS-Y and to explore a brief version. Data were collected between 2006 and 2013 from a convenience sample of high school students (N = 1,808), located in a midsized, economically disadvantaged urban community in the northeastern United States. Findings indicate that the two subscales, leadership competence, and policy control, were unidimensional and items functioned well. Most items functioned particularly well at low and moderate levels of the construct, but a few were able to capture higher levels of the construct. Based on our IRT analyses of the performance of items on the subscales, we selected items to create a brief version of the SPCS-Y (BSPCS-Y) and performed structural equation modeling for further examination. Results provide empirical evidence to support the reliability and validity of the SPCS-Y and suggest a brief version based on high-performing items is possible.

Emergency department-based peer support for opioid use disorder: Emergent functions and forms.

Emergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.

Measuring Sense of Community Responsibility in Community-Based Prevention Coalitions: An Item Response Theory Analysis.

Research on sense of community (SOC) has traditionally been approached from a resource perspective. Recently, however, research on the experience of SOC has evolved to include a related but distinct construct of sense of community responsibility (SOC-R), or feelings of accountability for the well-being of a community. This study applied item response theory to examine the psychometric properties of a SOC-R scale used in an evaluation of community-based substance abuse prevention coalitions. Data were collected in 2017 from coalition members (analytic sample = 309) in the northeastern United States. Findings indicate that the scale was reliable, unidimensional, and functioned well, particularly at low and moderate levels of the construct. The addition of two items intended to capture higher levels of the construct improved the scale's functioning at higher levels of SOC-R. The adapted SOC-R scale was also shown to have moderately strong relationships with conceptually relevant variables, including SOC, coalition participation, number of roles performed in the coalition, and engagement in community action activities. These findings provide empirical evidence to support the reliability and validity of the SOC-R scale, and have critical implications for our conceptualization of the SOC construct, its measurement, and for the evaluation of community-based prevention interventions.