Relationships Between Stigma, Risk Tolerance, and Buprenorphine Dispensing Intentions Among Community-Based Pharmacists: Results From a National Sample.

BACKGROUND: Concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists' endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, we assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions. METHODS: A sample of 207 active community-based pharmacists practicing in the United States responded to survey items measuring stigma, risk tolerance, and intentions to dispense buprenorphine. The survey included 2 vignettes in which patients presented to the pharmacy with a prescription for buprenorphine, and respondents rated their comfort with dispensing and decisions regarding dispensing in the vignette. RESULTS: Results suggest that both stigma toward patients taking buprenorphine to treat OUD and tolerance for risk in pharmacy settings are related to differences in pharmacists' intentions to and willingness to dispense buprenorphine for OUD. CONCLUSIONS: Findings support the need for interventions to reduce stigma associated with buprenorphine use among pharmacists and suggest that risk tolerance is an important determinant of pharmacists' behavior that merits further study.

Out of sight, out of mind: When and how perceived vulnerability decreases foreseeability and responsibility for causing harm in the marketplace.

Numerous social categories are often seen as vulnerable to harm. In the context of firms causing harm to individuals, we seek to better explain when and why observers absolve firms of responsibility as opposed to holding them more accountable. We propose that when someone's identity is thought to make them vulnerable to harm, identity visibility (how observable the identity is) and frequency (how common the identity is) influence the perceived foreseeability of a harmful event and firm responsibility. Across five studies (total N = 2,101), we find that when visibility and frequency are low, perceptions of foreseeability decrease, in turn decreasing firm responsibility. We illustrate how visibility and frequency, and in turn foreseeability, can vary based on the characteristics of the individual being observed (e.g., the visibility or rarity of a health condition) or context (e.g., an otherwise visible identity may be invisible in an online service context). Foreseeability and firm responsibility increased when the harmed individual's rare health condition was reframed to communicate the firm's likelihood of interacting with any individual with the same health condition. Implications for consumer welfare, policy, and inclusivity are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptions, policies, and practices related to dispensing buprenorphine for opioid use disorder: A national survey of community-based pharmacists.

BACKGROUND: Increasing buprenorphine prescribing for opioid use disorder (OUD) has been a major focus of U.S. opioid response efforts. However, concerns related to dispensing buprenorphine have been identified among pharmacists. OBJECTIVES: This study aimed to describe perceptions, policies, and practices reported by community-based pharmacists in relation to dispensing buprenorphine for OUD and to compare these responses by practice setting. METHODS: A cross-sectional online survey was administered to a random sample of 6376 pharmacists. Responses were collected anonymously from October 16, 2021, to November 7, 2021. RESULTS: A response rate of 5.1% was achieved with 325 responders, and 281 were eligible to complete the survey. Most reported practicing in a chain (50.9%) or independent pharmacy (34.7%) as a staff pharmacist (39.7%) or pharmacist-in-charge (37.0%). Most (68.1%) indicated they could usually or always fill a buprenorphine prescription promptly. The most common pharmacy policies related to buprenorphine dispensing were checking the prescription drug monitoring program (71.3%), validating the prescriber's X-waiver (44.9%), accepting only local prescribers (37.4%), and prohibiting refills more than one day early (35.8%). Policies limiting buprenorphine access to local prescribers, local patients, and established patients varied by practice setting and were most common in independent pharmacies. The strongest barriers to buprenorphine dispensing were insurance prior authorization, difficulty reaching prescribers with questions, and concerns about buprenorphine diversion. The strongest facilitators of buprenorphine dispensing were increased communication with prescribers, increased trust with prescribers, increased trust with patients, and increased education for pharmacists. CONCLUSION: Most respondents indicated they were willing and able to dispense buprenorphine products for OUD promptly. However, they also reported discomfort dispensing when factors representing potential risk of diversion are present. Mitigating this hypersensitivity to diversion risk among pharmacists should be a focus of regulatory agencies and professional organizations. Efforts to address the unique concerns of independent pharmacists will also be essential to improve access.

Don't give up? It's a little complicated: Action Crisis Moderates Consequences of goal support.

Social support for goals can be beneficial for goal pursuit, but often has unintended negative consequences for the recipient. We propose that action crisis-the state in which an individual is considering disengaging from a goal they are currently pursuing-may result in people experiencing more ambivalent reactions to goal support. Drawing on both experimental and longitudinal methods, we show that action crisis increases negative consequences of goal support, but does not reduce positive consequences of goal support. In Study 1, we experimentally manipulated goal phase (action crisis, deliberative, or implemental) and had participants imagine support or neutral interactions. In Study 2, we measured experiences of action crisis and receipt of goal support in first-year pre-health students over the course of the academic year. Action crisis predicted more negative appraisals of support, but did not impact positive appraisals of support. Similarly, action crisis predicted more negative emotions and depressive symptoms among people who received goal support, but did not impact positive emotions. These results suggest that action crisis increases the extent to which support is received as a "mixed blessing". Supplementary Information: The online version contains supplementary material available at 10.1007/s11031-022-09977-8.

Early life trauma: An exploratory study of effects on OXTR and NR3C1 gene expression and nurturing self-efficacy in mothers of infants.

BACKGROUND: In animals, adverse early experience alters oxytocinergic and glucocorticoid activity and maternal behavior in adulthood. This preliminary study explored associations among childhood trauma (loss of a parent or sexual abuse in childhood), maternal self-efficacy, and leukocyte gene expression (mRNA) of oxytocin and glucocorticoid receptors (OXTR and NR3C1) in mothers of infants. METHODS: 62 mothers (20 with early life trauma) with healthy 3-month old infants reported maternal self-efficacy, depression, infant temperament, and overall social support; the effects of early trauma on these measures were assessed. Of these, 35 mothers (14 with early trauma) underwent blood draws after 2 infant feeding times; their OXTR and NR3C1 mRNA was compared to a control group of 25 no-infant women without early trauma, and also was examined for associations with self-efficacy. RESULTS: OXTR mRNA was increased in mothers of infants versus no-infant controls (p < 0.0003), and mothers with greatest prior maternal experience had higher OXTR than those with less experience (0-2 vs. 3+ older children, p < 0.033). Mothers with early trauma and less maternal experience had lower OXTR mRNA than no-trauma mothers (p < 0.029) and lower NR3C1 mRNA than controls (p < 0.004). Mothers with depression also had lower NR3C1 than other mothers (p < 0.003) but did not differ in OXTR. Mothers with early trauma also reported their support network to be less helpful and more upsetting and unpredictable than other mothers (p < 0.035-p < 0.005). Regarding maternal behavior, in mothers with early trauma, helpful support networks increased self-reported nurturing self-efficacy when babies were not fussy but decreased it with fussy babies (p < 0.05). Support was unrelated to self-efficacy in no-trauma mothers. Similarly, among mothers with low OXTR or NR3C1 (-1SD, most having early trauma and lower maternal experience), greater support was associated with lower self-efficacy (p < 0.05), while mothers with high OXTR or NR3C1 (+1SD) tended to have higher self-efficacy with greater support. CONCLUSIONS: These preliminary findings need confirmation in a larger sample but suggest that childhood trauma influences maternal behavior and both OXTR and NR3C1 pathways in mothers of infants, and that both depression and prior maternal experience may be other important factors. Effects on maternal behavior appear to require more complex modeling.

Self-Uncertainty and the Influence of Alternative Goals on Self-Regulation.

The current research examines factors that facilitate or undermine goal pursuit. Past research indicates that attempts to reduce self-uncertainty can result in increased goal motivation. We explore a critical boundary condition of this effect-the presence of alternative goals. Though self-regulatory processes usually keep interest in alternative goals in check, uncertainty reduction may undermine these self-regulatory efforts by (a) reducing conflict monitoring and (b) increasing valuation of alternative goals. As such, reminders of alternative goals will draw effort away from focal goals for self-uncertain (but not self-certain) participants. Across four studies and eight supplemental studies, using different focal goals (e.g., academic achievement, healthy eating) and alternative goals (e.g., social/emotional goals, attractiveness, indulgence), we found that alternative goal salience does not negatively influence goal-directed behavior among participants primed with self-certainty, but that reminders of alternative goals undermine goal pursuit among participants primed with self-uncertainty.