Racial and ethnic inequities in substance use treatment among women with opioid use disorder.

Background: Research describes inequities in substance use treatment, but few studies focus specifically on racial and ethnic disparities in a range of aspects of substance use treatment among women with opioid use disorder (OUD).Objective: To examine whether substance use treatment (i.e. receipt, sources, barriers) differs by race and ethnicity among women with opioid use disorder (OUD) and to identify factors associated with treatment gap (i.e. needing treatment but not receiving it).Methods: We performed cross-sectional analyses using National Survey on Drug Use and Health 2015-2019 data, restricted to non-Hispanic Black, non-Hispanic White, and Hispanic women with past-year OUD (unweighted n = 1089). We estimated the prevalence of aspects of treatment among racial and ethnic groups, and used modified Poisson regression to estimate correlates of reported treatment gap.Results: Approximately 68% of White versus 87% of Black and 81% of Hispanic women with OUD had a treatment gap (p-value 0.0034). Commonly reported barriers to treatment included prioritization, affordability, and stigma. Older age was associated with lower prevalence of treatment gap among all women [prevalence ratio (PR) = 0.83, and 95% confidence interval (CI): 0.76, 0.92], while criminal legal involvement and healthcare coverage was associated with a lower prevalence of treatment gap among Hispanic and White women only (past year arrest: Hispanic women PR = 0.38, 95% CI: 0.17, 0.86; White women PR = 0.62, 95% CI: 0.47, 0.82).Conclusions: Receipt of treatment is low among women with OUD, especially Black and Hispanic women. Intersectional intervention approaches are needed to increase access and reduce inequities.

US state laws relevant to incentives for health behavior: A qualitative analysis.

Contingency management (CM) involves provision of incentives for positive health behaviors via a well-defined protocol and is among the most effective treatments for patients with substance use disorders (SUDs). An understanding of laws affecting incentives for health behaviors and outcomes, including contexts in which incentives are already permitted, could inform efforts to disseminate CM. We conducted a systematic NexisUni legal database review of state statutes and regulations effective during 2022 to identify (a) laws that explicitly permit or prohibit delivery of incentives to patients, employees, or insurance beneficiaries for SUD-specific behaviors or outcomes, and (b) laws that explicitly permit delivery of incentives for any health behaviors or outcomes. We identified 27 laws across 17 jurisdictions that explicitly permit delivery of incentives for SUD-related behaviors or outcomes, with most occurring in the context of wellness programs. No state laws were identified that explicitly prohibit SUD-specific incentives. More broadly, we identified 57 laws across 29 jurisdictions permitting incentives for any health outcomes (both SUD- and non-SUD-related). These laws occurred in the contexts of wellness programs, K-12/early childhood education, government public health promotion, and SUD treatment provider licensing. Considering the urgent need to expand evidence-based SUD treatment in rural and underserved areas throughout the US, these findings could inform efforts to develop laws explicitly permitting provision of incentives in SUD care and enhance efforts to disseminate CM more broadly.

Systematic Identification and Categorization of Opioid Prescribing and Dispensing Policies in 16 States and Washington, DC.

OBJECTIVES: State policies can impact opioid prescribing or dispensing. Some state opioid policies have been widely examined in empirical studies, including prescription drug monitoring programs and pain clinic licensure requirements. Other relevant policies might exist that have received limited attention. Our objective was to identify and categorize a wide range of state policies that could affect opioid prescribing/dispensing. METHODS: We used stratified random sampling to select 16 states and Washington, DC, for our sample. We collected state regulations and statutes effective during 2020 from each jurisdiction, using search terms related to opioids, pain management, and prescribing/dispensing. We then conducted qualitative template analysis of the data to identify and categorize policy categories. RESULTS: We identified three dimensions of opioid prescribing/dispensing laws: the prescribing/dispensing rule, its applicability, and its disciplinary consequences. Policy categories of prescribing/dispensing rules included clinic licensure, staff credentials, evaluating the appropriateness of opioids, limiting the initiation of opioids, preventing the diversion or misuse of opioids, and enhancing patient safety. Policy categories related to applicability of the law included the pain type, substance type, practitioner, setting, payer, and prescribing situation. The disciplinary consequences dimension included specific consequences and inspection processes. DISCUSSION: Policy categories within each dimension of opioid prescribing/dispensing laws could become a foundation for creating variables to support empirical analyses of policy effects, improving operationalization of policies in empirical studies, and helping to disentangle the effects of multiple state laws enacted at similar times to address the opioid crisis. Several of the policy categories we identified have been underexplored in previous empirical studies.

Urine drug testing in the context of opioid analgesic prescribing for chronic pain: a content analysis of U.S. state laws in 2022.

BACKGROUND: In response to the opioid crisis, U.S. states have passed laws requiring urine drug testing (UDT) when opioid analgesics are prescribed for chronic pain. We sought to identify state law UDT requirements. METHODS: We searched NexisUni legal database using terms related to UDT, chronic pain, and opioids. We included laws effective during spring 2022 that required UDT when opioids were prescribed for chronic pain. We performed deductive content analysis, coding laws for mandated UDT frequency, type of clinician and type of payer to whom the law applied, and circumstances under which UDT was mandated. RESULTS: We found 32 laws across 13 states that met our inclusion criteria. UDT requirements varied substantially by state, including with regard to the type of clinician to whom the law applied, the mandated frequency of UDT (eg, at initiation/assessment, at least annually, more than once per year), and the circumstances in which UDT was mandated (eg, patient had substance use disorder; dosage/day threshold). DISCUSSION: Relatively few states have UDT mandates associated with prescribing opioids as chronic pain treatment. When developing policy indicators for empirical studies, researchers evaluating how UDT policy affects health outcomes must consider the complexity and lack of uniformity of UDT requirements. In addition, even if states mandate UDT, it is unclear whether clinicians understand the best way to use the test results.

Problem-Solving Court Staff Preferences for Educational Videos about Medications for Opioid Use Disorder.

Problem-solving courts use an interdisciplinary approach with treatment mandates, hearings, and monitoring to rehabilitate individuals arrested for drug-related crimes or lost custody of children due to drug use. Medications for opioid use disorder (MOUD) are the standard of care for treating opioid use disorder (OUD), but few problem-solving court clients with OUD are referred to MOUD. Previous studies found court staff often harbor misconceptions about MOUD and could benefit from MOUD education. Tailoring education to the intended audience is an educational best practice. We sought to identify content and style preferences for two MOUD education videos: 1) an introduction to MOUD and, 2) MOUD myths/misconceptions.We recruited 40 Florida problem-solving court staff. Using semi-structured interviews, invited document/script edits, and qualitative surveys, we collected data at each of four video development stages. We used template analysis for qualitative data.Court staff desired the following content: OUD as a chronic brain condition and MOUD as an effective response; MOUD risks and benefits; how MOUD is accessed; and the appropriate role of court staff with MOUD decisions. Style preferences were: no juvenile/cutesy animation; relatable characters/environments; simple concept illustration; individualizing the learning experience; and combinations of scientific animated videos and successful stakeholder interviews.Our findings reinforce the importance of tailoring MOUD education to the audience. Court staff's wish for education about their appropriate role with MOUD reflects their unique position making treatment referrals. Court staff's desire for stakeholder recordings of success stories mirrors the importance of opinion leaders in other dissemination studies.

Legal Limitations Associated with Microdosing Buprenorphine.

Background: Opioid overdose deaths in the U.S. continue to increase, largely due to the prevalence of fentanyl, a very powerful opioid, in the illicit drug supply. Buprenorphine treatment is effective for treating opioid use disorder, but it can be challenging for clinicians to introduce buprenorphine treatment to people who use fentanyl due to risks of precipitated withdrawal. Induction could be facilitated through a buprenorphine microdosing approach called "the Bernese method." Objective: In this commentary, we describe how federal laws inadvertently limit optimal use of the Bernese method and how federal laws could be reformed to facilitate use of the Bernese method. Results: The Bernese method requires patients to continue using the opioid of misuse (e.g., fentanyl) for seven to ten days while receiving very low doses of buprenorphine. Under federal law, the typical office-based buprenorphine prescriber can neither prescribe nor administer fentanyl short-term for buprenorphine induction purposes, essentially forcing patients to continue to temporarily obtain fentanyl via the illicit market. Conclusion: The federal government has already indicated its support for increasing buprenorphine access. We argue that the government should permit short-term dispensing of fentanyl to office-based patients undergoing buprenorphine induction.

Will the End of the X-Waiver Expand Access to Buprenorphine Treatment? Achieving the Full Potential of the 2023 Consolidated Appropriations Act.

The 2023 Consolidated Appropriations Act repealed the special waiver for prescribing buprenorphine to patients with opioid use disorder, a bipartisan goal long sought by advocates. The change has symbolic importance in recognizing that buprenorphine is a mainstream medical treatment. We argue that the maximum potential of the law can be achieved by addressing three bottlenecks. First, it is important that new training requirements for all controlled substances prescribers be grounded in scientific principles of addiction treatment and are robustly evaluated to ensure they meet quality standards. Second, even with the elimination of the waiver, there are potential constraints from state law such as state-specific requirements that practitioners require counseling or obtain a separate credential, and many states also have limiting scope of practice regulations. We recommend that these requirements are eased wherever possible to improve treatment access. Third, it is critical to build onramps to treatment in settings such as primary care, hospitals, and correctional facilities. While we anticipate that buprenorphine prescribing will primarily occur in high-volume practices, there is the potential to activate a broader workforce to serve as entry points to care. We conclude that the stage is set for significant increases in lifesaving treatment but the difficult task ahead is ensuring that the resources and training are available to build strong capacity.

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs.

BACKGROUND AND OBJECTIVES: Methadone treatment (MT) for opioid use disorder is only available in opioid treatment programs (OTPs) in the United States, with retention predictive of positive health outcomes. OTP discharge reason information is needed to develop interventions for facilitating MT retention. We sought to identify discharge reason frequencies and associations between discharge reasons and facility/county-level characteristics. METHODS: We examined annual OTP discharge reasons for all Florida OTPs from 2014 to 2017 (n = 44,774 discharges). We used multinomial logistic regression analysis to examine associations between patients' discharge reasons and (1) facility-level characteristics (e.g., size, funding type) and (2) county-level characteristics (e.g., race/ethnicity, overdose rates). RESULTS: Lost contact was the most common discharge reason (29%). Only 11% of patients were discharged for treatment completion, with the proportion one-third as low in privately versus publicly-funded OTPs (p < .001). Privately-funded OTPs had a patient share self-terminating treatment against medical advice about 3.5 times higher than publicly-funded OTPs. Inability to pay accounted for 7% of OTP discharges. Noncompliant discharges represented 6% and were more common in counties with larger proportions of Black residents (p < .01). Counties with higher drug overdose rates had significantly more discharges for noncompliance or self-terminating against medical advice (p < .01 and p < .05). DISCUSSION AND CONCLUSIONS: Statewide differences in discharge reasons exist between publicly and privately-funded OTPs, possibly reflecting differences in funding incentives and state oversight. State agencies should develop consistent approaches for collecting/reporting discharge reasons. SCIENTIFIC SIGNIFICANCE: Our study is the first to examine the relationship between OTP funding type and discharge reasons.

Laws for expanding access to medications for opioid use disorder: a legal analysis of 16 states & Washington D.C.

Background: Medications for opioid use disorder (MOUDs) are the gold standard for OUD treatment but are underused. To our knowledge, no published study has systematically identified and categorized state policy innovations for expanding MOUD utilization.Objective: We sought to identify and categorize state MOUD policy innovations.Methods: Within a stratified random sample of 16 U.S. states and Washington D.C. we searched for 2019 state statutes and regulations related to MOUD in Westlaw legal database. We then identified laws that appeared designed to increase MOUD utilization and categorized them using a template analysis approach.Results: We found 82 laws with one or more MOUD expansion policies. We identified six high-level MOUD expansion policy categories: 1) policies expanding the availability of waivered buprenorphine providers; 2) needs assessments and policies increasing public MOUD awareness; 3) criminal justice system policies; 4) Substance use disorder (SUD) treatment and sober living facility policies; 5) insurance policies; and 6) hospital policies. SUD treatment and housing facility policies, as well as insurance policies, were most common.Conclusions: Multipronged approaches are being pursued by several states to increase MOUD access. Our results can inform policymakers of MOUD expansion approaches in other jurisdictions. Policy categories can serve as the basis for policy variables for future analyses of policy effects.

Harm Reduction Policy Support among Students at Two U.S. Universities.

Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.

Stigmatization of medications for opioid use disorder in 12-step support groups and participant responses.

Background: 12-step groups are the most common approach to managing opioid use disorder (OUD) in the U.S. Medications for OUD (MOUD) are the most effective tool for preventing opioid misuse and relapse. Previous research has identified stigma of MOUD in 12-step groups. Objectives: We sought to identify how MOUD stigma is operationalized in 12-step groups and to identify responses to stigma. Methods: We recruited individuals with both MOUD experience and 12-step group experience from three syringe exchange programs in the U.S. using snowball sampling. We conducted individual telephone semi-structured interviews during 2018 and 2019. We coded data in Dedoose software and conducted thematic analysis using iterative categorization. Results: We recruited 30 individuals meeting our inclusion criteria. The following stigma operationalization methods were identified: prohibiting people using MOUD from speaking at meetings; encouraging shortened duration of MOUD treatment; refusing to sponsor people using MOUD; and refusing to let people using MOUD claim recovery time. Responses to stigma included the following: feeling shame; feeling anger; shopping around for different groups, leaving the group, or forming a new group; not revealing MOUD utilization or only telling a sponsor; speaking out on behalf of MOUD; and using cognitive approaches to avoid stigma internalization. Cognitive approaches included believing that anti-MOUD stigma is contrary to 12-step principles; disregarding statements as inaccurate based on one's experience of MOUD benefits; and accepting that all groups of humans have some ignorant people. Conclusion: Healthcare systems should help address MOUD stigma experienced by patients in 12-step groups, such as by offering non-12-step alternative groups and encouraging MOUD healthcare providers to prepare patients for potential stigma they may face. Some stigma response options, like shopping around for different groups, may not be feasible in rural areas or for participants newer to recovery.

Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder.

Background: Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. Methods: An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman's test for related samples or Cochran's Q was used to make within-group comparisons between policies and MOUDs. Results: We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Conclusion: Because respondents rarely chose "never" or "always" for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.

Common themes in early state policy responses to substance use disorder treatment during COVID-19.

Background: Limited research has examined how states have changed policies for treatment of substance use disorder (SUD) during the COVID-19 pandemic.Objectives: We aimed to identify themes in state policy responses to the pandemic in the context of SUD treatment. Identifying themes in policy responses provides a framework for subsequent evaluations of the relationship between state policies and health service utilization.Methods: Between May and June 2020, we searched all Single State Agencies for Substance Abuse Services (SSA) websites for statements of SUD treatment policy responses to the pandemic. We conducted Iterative Categorization of policies for outpatient programs, opioid treatment programs, and other treatment settings to identify themes in policy responses.Results: We collected 220 documents from SSA websites from 45 states and Washington D.C. Eight specific themes emerged from our content analysis: delivery of pharmacological and non-pharmacological services, obtaining informed consent and documentation for remote services, conducting health assessments, facility operating procedures and staffing requirements, and permissible telehealth technology and billing protocols. Policy changes often mirrored federal guidance, for instance, by expanding methadone take-home options for opioid treatment programs. The extent and nature of policy changes varied across jurisdictions, including telehealth technology requirements and staffing flexibility.Conclusion: States have made significant policy changes to SUD treatment policies during COVID-19, particularly regarding telehealth and facilitation of remote care. Understanding these changes could help policymakers prioritize guidance during the pandemic and for future health crises. Impacts of policies on disparate treatment populations, including those with limited technological access, should be considered.

Whose opinion matters about medications for opioid use disorder? A cross-sectional survey of social norms among court staff.

Background: Criminal problem-solving and dependency courts set treatment standards for opioid use disorder (OUD) but sometimes prohibit or limit utilization of medications for OUD (MOUD). Court staff beliefs about MOUD inform court treatment policies. Court staff MOUD policies may also be influenced by social norms, meaning perceptions of opinions of other individuals/entities about MOUD, including opinions of fellow staff in their court, staff in other courts, the state supreme court, other state agencies, the National Association of Drug Court Professionals (NADCP), federal agencies, and local peer support groups. To date no study has examined social norms among court staff with respect to MOUD. Methods: We distributed an online cross-sectional survey in 2019 to all criminal problem-solving and dependency court staff in Florida. Respondents were asked to identify the extent to which they cared about different entities'/individuals' opinions about MOUD and the extent to which they perceived each of those entities/individuals as encouraging MOUD. We hypothesized that court role and court type would be associated with responses. We used descriptive statistics, logistic regressions, and difference of proportions tests to analyze data. Results: 20% of the population (n = 119) completed the survey. Respondents cared most about the opinions of external treatment providers with whom they collaborate, fellow staff in their court, and the NADCP regarding MOUD. Fewer than half felt that any of these entities/individuals encourage methadone or oral buprenorphine. Additionally, fewer than 11% of respondents felt that local twelve-step peer support groups encourage the use of any form of MOUD. Conclusions: MOUD education should target all members of court teams, including collaborating treatment providers. Since court staff care relatively little about the MOUD opinions of staff in other courts, changes in opinions in one court may not affect changes in opinions in a neighboring court. The NADCP should more explicitly state its support for MOUD, and specifically oral buprenorphine and methadone treatment.

It will end in tiers: A strategy to include "dabblers" in the buprenorphine workforce after the X-waiver.

Buprenorphine is one of the gold standard medication treatments for opioid use disorder (OUD), with proven effectiveness in preventing overdose, increasing abstinence, and improving quality of life. In the United States, buprenorphine can be legally prescribed and administered in office-based settings from clinicians who are specially credentialed to provide that care under the X-waiver. We believe the X-waiver will ultimately be repealed, but there is a need for a variety of strategies to create a new treatment system after the X-waiver. Building a new tier of treatment capacity will require educational outreach, systems strategies, and enhanced payments.

Designing an "Ideal" Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder.

Treatment preferences of people with opioid use disorder (OUD) have been underexplored, especially among those with a history of utilizing medications for opioid use disorder (MOUD). Therefore, we sought to understand preferred characteristics of substance use disorder treatment centers among people recovering from OUD with a history of MOUD utilization. We recruited 30 individuals from eight states through snowball sampling initiated at three syringe exchange programs. Telephone interviews were audio-recorded and transcribed in 2018-2019. Inductive thematic analysis in Dedoose software occurred iteratively with recruitment. The following were "ideal" treatment center themes: a menu of treatment options, including MOUD and nonspiritual peer support groups; an integrated system with multiple care levels (e.g., outpatient, residential); a harm reduction approach, including for goal setting and success measures; adjunctive support services (e.g., housing); and employees with recovery experience and professional education. Many preferences directly related to core principles of person-centered care and harm reduction.

Clinical perspectives on hospitals' role in the opioid epidemic.

BACKGROUND: Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic. METHODS: We conducted individual semi-structured interviews with 23 clinicians from 6 different acute care hospitals that are part of a single healthcare system in the Midwestern United States. Our participants were hospitalists (N = 12), inpatient registered nurses (N = 9), and inpatient adult nurse practitioners (N = 2). In the interviews, we asked clinicians whether hospitals play a role in the opioid epidemic, and if so, how hospitals may contribute to the epidemic. We used a qualitative thematic analysis approach to analyze coded text for patterns and themes and examined potential differences in themes by respondent type using Dedoose software. RESULTS: The majority of clinicians believed hospitals contribute to the opioid epidemic. Multiple clinicians cited Center for Medicare and Medicaid Services' (CMS) reimbursement policy and the Joint Commission's report as drivers of inappropriate opioid prescribing in hospitals. Furthermore, numerous clinicians stated that opioids are inappropriately administered in the emergency department (ED), potentially as a mechanism to facilitate discharge and prevent re-admission. Many clinicians also described how overreliance on pre-populated pain care orders for surgical (orthopedic) patients, may be contributing to inappropriate opioid use in the hospital. Finally, clinicians suggested the following initiatives for hospitals to help address the crisis: 1) educating patients about negative consequences of using opioids long-term and setting realistic pain expectations; 2) educating medical staff about appropriate opioid prescribing practices, particularly for patients with complex chronic conditions (chronic pain; opioid use disorder (OUD)); and 3) strengthening the hospital leadership efforts to decrease inappropriate opioid use. CONCLUSIONS: Our findings can inform efforts at decreasing inappropriate opioid use in hospitals.

Beliefs about medications for opioid use disorder among Florida criminal problem-solving court & dependency court staff.

BACKGROUND: Criminal problem-solving and dependency (child/dependent) court staff refer clients with opioid use disorder (OUD) to treatment and set treatment policies. Negative beliefs regarding the safety and efficacy of medications for opioid use disorder (MOUD) have previously been reported in court staff. MOUD is superior to other OUD interventions, is severely underutilized, and is highly effective even in the absence of behavioral treatment. OBJECTIVE: We examined Florida court staff MOUD beliefs, exploring associations with court type and staff role. We also explored beliefs about the relationship of MOUD to child reunification, counseling, polysubstance use, and titration requirements. METHODS: We modified a previously developed cross-sectional survey. We fielded the online survey among all Florida criminal problem-solving and dependency court staff. Likert scale questions were asked about beliefs regarding methadone, buprenorphine, and extended-release naltrexone. We analyzed responses using descriptive statistics and logistic regression. RESULTS: 154 individuals (26% of the population) responded. Only 1/3 believed MOUD was more effective for OUD than nonpharmacological treatment. 31% believed methadone treatment makes it difficult for parents to regain child custody. Criminal problem-solving court staff were more likely to report certain positive beliefs about naltrexone. Fewer than 10% felt any MOUD should be permitted without counseling. Over 60% felt prescribers should have tapering plans for each MOUD patient. Beliefs were generally more positive for naltrexone than buprenorphine, and more positive for buprenorphine than methadone. CONCLUSIONS: Court staff need education about MOUD efficacy. Policymakers should prohibit courts from banning MOUD and from preventing child reunification for parents utilizing MOUD.

College students' perceived knowledge of and perceived helpfulness of treatments for opioid use disorder at two American universities.

Background The U.S. is experiencing an opioid overdose health crisis, largely driven by opioid use disorder (OUD). College students have relatively high rates of substance use disorders. Objectives To identify perceived knowledge of and perceived helpfulness of various OUD treatments, including medications for OUD (MOUD), among college students. Methods A convenience sample of students enrolled at two public universities during Fall 2018/Spring 2019 were recruited for an online cross-sectional survey. Questions examined reported knowledge of and perceived helpfulness of MOUD (i.e. methadone, buprenorphine, naltrexone) and non-MOUD treatments for OUD (e.g. peer support groups, individual counseling, group counseling, outpatient treatment). Logistic regression examined associations between knowledge, perceived helpfulness, and demographic variables. Results We received 1,439 responses and kept 1,280 (39% male; 61% female). Respondents were significantly more likely to report knowledge about non-MOUD treatments than MOUD treatments (48.7% of respondents reported being very knowledgeable about individual counseling, 4.4% about methadone, 3.8% about naltrexone, and 3.4% about buprenorphine). Among those reporting at least some MOUD knowledge, few perceived MOUD as helpful/very helpful (methadone 14%, naltrexone 14%, and buprenorphine 11%). Among those reporting at least some counseling knowledge, 71% felt counseling was helpful/very helpful. Perceived treatment knowledge was significantly and positively associated with perceived treatment helpfulness. Conclusions Students had more positive attitudes toward non-MOUD treatments than toward MOUD despite greater efficacy of the latter for OUD. Colleges could provide information about MOUD during orientation, in course work, through student extracurricular organizations, or through college health clinics.

College Student Preferences for Substance Use Disorder Educational Videos: A Qualitative Study.

BACKGROUND: College student preferences regarding substance use disorder (SUD) education and treatment-related education have been understudied, despite this population's relatively high risk of developing SUDs and low help-seeking rates. We sought to identify students' preferences regarding content, style, and format of educational online videos about SUDs and SUD treatment. METHOD: We held six, two-hour long focus groups with college student participants from Indiana University from 2017 to 2018 during which participants were shown drafts of scripts, mock-up images, and animation and then asked open-ended questions about their preferences and suggested changes. Focus groups were audio recorded and transcribed. Researchers then undertook thematic analysis of focus groups: independently coding transcripts for data related to the research questions, conducting consensus coding, and then analyzing coded data for themes. RESULTS: 39 students participated in focus groups, approximately half of whom were undergraduate students and the other half were graduate students. They preferred animated video characters that were relatable to college students but abstract enough to represent a range of students, such as stick figures with backpacks. They preferred conversational narration with subtle humor and references to realistic reasons for college students using drugs or alcohol. Participants encouraged inclusion of information about SUD impacts on school, work, and relationships, in addition to physical health. Participants opposed any content or style that could be interpreted as fear-mongering. They requested more information regarding medication-assisted treatment efficacy and less information about side effects. CONCLUSION: College students have unique cultural needs, necessitating tailored educational interventions about SUD and SUD treatments.