Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment.

INTRODUCTION: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. METHODS: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. RESULTS: EMS providers' perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. CONCLUSION: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.

Community Pharmacist Utilization of Legislation That Allows Impact on the Opioid Crisis in the State of Minnesota: A Mixed-Methods Approach.

BACKGROUND: As opioid overdose deaths climb, legislation supporting pharmacists in developing their role to address the crisis has expanded. Although Minnesota pharmacists are encouraged to utilize opiate antagonist, syringe access and authorized collector legislation, the use patterns of these tools are unknown. METHODS: A mixed-methods approach was used to survey 8405 Minnesota-licensed pharmacists on their practices related to the opioid crisis. An analysis of community pharmacist utilization of opioid-related legislation was conducted. RESULTS: The majority (88.64%) of respondents indicated that they had not dispensed naloxone in the past month using a protocol; 59.69% reported that they had not dispensed naloxone by any method in the past month. Over sixty percent (60.61%) of respondents agreed they are comfortable with dispensing syringes and would dispense noninsulin syringes in their pharmacy under the statewide Syringe Access Initiative; 25.86% reported that they are not comfortable dispensing syringes. The majority (78.64%) of respondents reported that they do not participate in collecting unwanted pharmaceuticals. CONCLUSION: While pharmacists have the potential to play a key role in efforts focused on addressing the opioid crisis through harm reduction strategies, this role and the use of supporting legislation is currently underutilized in the state of Minnesota.

The effects of enriched environment on the behavioral and corticosterone response to methamphetamine in adolescent and adult mice.

Methamphetamine alters behavior and the stress response system. Relatively little research has examined the effects of methamphetamine in adolescents and compared these effects to those in adults. Housing in enriched environments has been explored as one way to protect against the effects of methamphetamine, but the findings are conflicting and no study has examined how enriched environment may alter the behavioral and corticosterone responses to methamphetamine in adolescent and adult rodents. We examined the long-term effects of methamphetamine exposure on anxiety, social behavior, behavioral despair, and corticosterone levels in adolescent and adult mice housed in enriched or isolated environments. Enriched environment did not alter the behavioral or corticosterone response to methamphetamine. Methamphetamine exposure decreased anxiety and increased behavioral despair in adult mice, but methamphetamine did not alter behavior in adolescent mice. There was no effect of methamphetamine on social behavior or corticosterone levels. Our findings demonstrate that the specific environmental enrichment paradigm used in this study was not sufficient to mitigate the behavioral effects of methamphetamine and that adolescent mice are relatively resistant to the effects of methamphetamine compared to adult mice.