Inclusion of Sex and Gender Differences in U.S. State Action Plans for Opioid Use and Opioid Use Disorder.

Background: States have developed action plans to address the "opioid crisis" over the past several years. While sex- and gender-based differences have been identified in complications of opioid use, risks of addiction to opioids, barriers to treatment of opioid use disorder, and associated stigma, it is unknown if or to what extent opioid plans consider or account for these differences. The objectives of this study were to analyze U.S. state opioid action plans and their inclusion of sex- and gender-specific concerns. Methods: A content analysis of 49 state plans was conducted in June 2020, assessing their inclusion of 14 variables covering provider education, pregnancy-related, and sex- or gender-based differences in opioid addiction and treatment. Results: Neonatal opioid withdrawal syndrome was the most common variable, noted in 57% of plans. Only 14% included pregnancy-related stigma, and 4% identified gender-specific stigma. Contraceptives and family-planning were included in 12% and 10% of plans, respectively. Two states included more than half of the variables and five plans made no mention of sex or gender differences. Conclusions: Few state plans contained sex- or gender-specific information, and those that did focused almost exclusively on childbearing, excluding other unique considerations of opioid-using-women of all ages. The results of this study could improve the care of women using opioids by informing the strategies of state agencies and impacting legislative efforts for prevention initiatives, substance use disorder treatment, and law enforcement programs.

Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors.

Background: In recent years there has been growing momentum in the USA around addressing issues of "menstrual equity" and "period poverty," including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success. Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4-6 per school). Data from the desk review and interviews were analyzed using thematic analysis. Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy. Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.