Correlates of Staff Acceptability of a Novel Telemedicine-Delivered Medications for Opioid Use Disorder Program in a Rural Detention Center.

Opioid overdose death is significantly increased immediately following incarceration. Evidence-based medications are underutilized in rural jails and detention centers. We have reported our efforts to address this gap through telemedicine-based medications for opioid use disorder treatment (tele-MOUD) for incarcerated patients. Staff acceptance and perceptions are critically important factors in the assurance of program validation. We assessed tele-MOUD acceptability and perceptions of effectiveness and stigma in one detention center. Overall, we found that jail staff's general acceptability of the program was rather low, as was perceived effectiveness of MOUD, while stigmatizing beliefs were present. Furthermore, tele-MOUD acceptability was positively correlated with perceptions of MOUD effectiveness and negatively correlated with stigmatizing notions of MOUD (p's < 0.001). Findings suggest the need for educational interventions. Future research investigating the potential moderating effects of training on staff acceptability of jail-based tele-MOUD will support the implementation and sustainability of these life-saving programs.

"I think we're getting better but we're still not there": Provider-based stigma and perceived barriers to care for people who use opioids (PWUO).

BACKGROUND: Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD - is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. METHODS: This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. RESULTS: Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. CONCLUSIONS: Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma - blameworthiness - in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma.

Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties.

Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.

Firearm Ownership, Defensive Gun Usage, and Support for Gun Control: Does Knowledge Matter?

Recent incidents of gun violence have raised questions about public access to "military-style" firearms and the need for more-restrictive forms of gun control. Proponents of more-restrictive forms of gun regulation argue that such measures will help combat the disproportionately high rates of gun crime in the United States. Opponents believe that such measures infringe upon constitutional rights and hinder law-abiding citizens' abilities to adequately defend themselves. This project explores the characteristics of gun owners living in Pennsylvania and public perceptions of three different categories of gun control. Results indicate that most gun owners have received some form of training and take appropriate safety precautions with their firearms. Further, 1 in 4 gun owners reported using their firearm in self-defense at some point in their life. Regarding gun control, most participants favored strategies intended to keep guns away from dangerous and "at risk" people, such as required background checks for all types of gun purchases, mental health screenings, and mandatory gun education. However, most participants opposed complete firearm bans. Among those who are the least supportive of such polices are those who are the most knowledgeable about gun crime, gun legislation, and gun functioning. Policy implications are discussed within. Supplementary Information: The online version contains supplementary material available at 10.1007/s12103-021-09644-7.

Emotional Exhaustion and Turnover Intentions among Counselors in Rural Substance Use Disorder Treatment Programs.

Counselor turnover is a serious problem for substance use disorder (SUD) treatment programs, especially in rural areas. This study examined the relationship between workload, workplace environment, and emotional exhaustion on turnover intentions among SUD treatment counselors in rural Pennsylvania. An online, anonymous survey was administered to rural SUD treatment counselors in Pennsylvania between October and December 2020. Completed surveys from 206 counselors were used for analysis. Variables included multi-dimensional measures of emotional exhaustion, intention to quit, workload, and workplace environment. Results showed age, perceptions of distributive justice, and management communication to be inversely related to emotional exhaustion and intention to quit. A subsequent analysis showed that the direct effects of these variables on intention to quit were reduced with the inclusion of emotional exhaustion in modeling, suggesting a potential mediation effect. Findings indicated that higher levels of emotional exhaustion were directly related to a greater intention to quit. A statistically significant indirect relationship was also found for distributive justice on intention to quit through emotional exhaustion, indicating a significant mediating effect. While counseling is a stressful occupation with high potential for burnout, these results show that organizations can adopt practices that help lower emotional exhaustion and turnover intentions for their counselors which could improve retention in the SUD treatment field. This is especially important for rural areas, where there is a high demand for SUD services and not enough treatment workers to meet that demand.

Rural SUD counselors experience high levels of burnout and turnover.Emotional exhaustion ("burnout") is the strongest predictor of intent to quit.Management communication and distributive justice can improve counselor retention.

First Responders' Views of Naloxone: Does Stigma Matter?

BACKGROUND: Prior work has suggested that first responders have mixed feelings about harm reduction strategies used to fight the opioid epidemic, such as the use of naloxone to reverse opioid overdose. Researchers have also noted that provider-based stigma of people who use opioids (PWUO) may influence perceptions of appropriate interventions for opioid use disorder (OUD). This study examined first responders' perceptions of naloxone and the relationship between stigma of OUD and perceptions of naloxone. METHODS: A web-based survey assessing perceptions of PWUO and naloxone was administered to 282 police officers and students enrolled in EMT and paramedic training courses located in the Northeastern United States. Bivariate and multivariable analyses assessed the relationship between variants of stigma (e.g., perceived dangerousness, blame, social distance, and fatalism) and self-reported perceptions of naloxone. RESULTS: Participants, in the aggregate, held slightly negative attitudes toward the use of naloxone. Findings from multivariable modeling suggest that stigma of OUD, living in a rural area, and prior experience administering naloxone, were significantly and inversely related to support for the use of naloxone. Support for the disease model of addiction and associating drug use with low socioeconomic status were positively related to support for the use of naloxone. CONCLUSION: Efforts to alleviate perceptions of PWUO as dangerous, blameworthy, or incapable of recovery may increase first responders' support for naloxone. To this end, first responder training programs should include instruction on the disease model of addiction, and more broadly, attempt to foster familiarity between PWUO and the professionals who serve them.

Examining Factors Related to Departmental Adoption of Crisis Intervention Team (CIT) Models: A Survey of Police Chiefs.

In an effort to improve police responses for handling incidents involving people with mental illness (PWMI), many police departments have adopted the Crisis Intervention Team (CIT) model. However, to date, there has been very little published research that has focused on examining factors related to the adoption of CIT models through the lens of police chiefs. To help fill this gap in the literature, the current study used data collected from a sample of 204 police chiefs in the Commonwealth of Pennsylvania to examine variables related to departmental adoption of the CIT model. Findings show that several factors (e.g., chief training, chief educational attainment, and departmental resources) were associated with departmental adoption of the CIT model. Policy implications and suggestions for future studies based on these findings are discussed within.

The Influence of Media Violence on Intimate Partner Violence Perpetration: An Examination of Inmates' Domestic Violence Convictions and Self-Reported Perpetration.

Research suggests that the representation of violence against women in the media has resulted in an increased acceptance of attitudes favoring domestic violence. While prior work has investigated the relationship between violent media exposure and violent crime, there has been little effort to empirically examine the relationship between specific forms of violent media exposure and the perpetration of intimate partner violence. Using data collected from a sample of 148 inmates, the current study seeks to help fill these gaps in the literature by examining the relationship between exposure to various forms of pleasurable violent media and the perpetration of intimate partner violence (i.e., conviction and self-reported). At the bivariate level, results indicate a significant positive relationship between exposure to pleasurable television violence and self-reported intimate partner abuse. However, this relationship is reduced to insignificant levels in multivariable modeling. Endorsement of domestic violence beliefs and victimization experience were found to be the strongest predictors of intimate partner violence perpetration. Potential policy implications based on findings are discussed within.

Exploring first responders' perceptions of medication for addiction treatment: Does stigma influence attitudes?

Researchers have suggested that provider-based stigma of persons who suffer from opioid use disorder (OUD) in the criminal justice system serves as a barrier to fully implementing harm reduction strategies, such as the use of naloxone and medication for addiction treatment (MAT). While scholars have begun to explore the relationships between stigma and first responders' attitudes toward naloxone, little work has been done to assess first responders' attitudes toward other forms of harm reduction, including MAT. The goal of the current exploratory study was to help fill this gap in the literature by assessing first responders' (N = 282) attitudes toward MAT, as well as the correlates of these attitudes. The study specifically focused on examining the relationship between provider-based stigma and attitudes toward MAT. Results show that, in the aggregate, first responders held slightly negative attitudes toward the use of MAT. Moreover, the study found that certain dimensions of stigma (i.e., dangerousness and fatalism) to exhibit a negative relationship with attitudes toward MAT, while support for the disease model of addiction was associated with positive perceptions. Policy implications based on these findings are discussed within.

Revisiting the Empirical Status of Social Learning Theory on Substance Use: A Systematic Review and Meta-Analysis.

Background: Despite ample empirical research testing components of Akers' Social Learning Theory (SLT) on substance use, no research to date has attempted to synthesize the empirical evidence. Objectives: The purpose of this article is to synthesize prior research that has examined the utility of SLT for predicting specific types of substance use, both legal and illegal. Methods: Using a systematic review and meta-analysis, the current study estimated the effect size results from 83 primary studies published between 1974 and 2018 that had empirically tested concepts of Akers' SLT regarding substance use. In addition, moderator analyses examined variations in effect sizes across measurement constructs and among specific types of substance use. Results: Results indicated medium-sized weighted mean effect size estimates for SLT in relation to substance use. Regarding conceptualization of SLT, measures of Differential Association produced the strongest effect size estimates. Moderator analyses also revealed that mean effect size estimates were largest for soft drugs, for studies conducted in the context of the United States, and for adult samples. Conclusions: The authors conclude that SLT constructs may be better suited for explaining soft drug use than hard drug use. Given the relatively sparse primary research that has controlled for temporal ordering, collected data from multiple differential associates, or considered opportunity effects, caution in the interpretation of synthesis results is warranted.