Effects of Childhood Trauma on Mentalization Capacities and Dissociative Experiences.

This study examined the relationship between childhood trauma, dissociation, and mentalization. Childhood trauma has been understood to affect both dissociation and mentalization, but it is unclear how these processes interact amidst the presence of childhood trauma. Specifically, the study sought to determine whether hypermentalization or hypomentalization would mediate the relationship between childhood trauma and dissociation. Mentalization describes the ability to understand the mental states of both the self and others, and suboptimal mentalization occurs when an individual experiences hypermentalizing, understood as a high level of certainty about mental states, or hypomentalizing, understood as a high level of uncertainty about mental states. 100 participants completed self-report measures assessing their experiences of childhood trauma using the Early Trauma Inventory Short Form Revised, dissociation using the Dissociative Experiences Scale II, and mentalization capacities using the Reflective Functioning Questionnaire. A series of mediation analyses were conducted, and it was found that neither hypermentalization or hypomentalization mediated the relationship between childhood trauma and dissociation. However, additional analyses revealed that dissociation mediated the relationship between childhood trauma and hypermentalization. The implications of the findings are explored and discussed within the context of the current literature, and the relationship between dissociation and mentalization is considered.

Barriers to and recommendations for take-home naloxone distribution: perspectives from opioid treatment programs in New Mexico.

BACKGROUND: Naloxone is a safe and effective medication to help reverse opioid overdose. Providing take-home naloxone to patients in opioid treatment settings is a critical step to reducing opioid overdose deaths. In New Mexico, a US state with one of the highest rates of opioid overdose deaths, legislation was passed in 2017 (House Bill 370) to support take-home naloxone, and followed by naloxone training of Opioid Treatment Program staff to increase distribution. METHODS: Naloxone training was offered to all New Mexico Opioid Treatment Programs along with a baseline survey to assess current practices and barriers to take-home naloxone distribution. Focus groups were conducted approximately 1 year post-training with staff at a subset of the trained Opioid Treatment Programs to assess the impact of the legislation and training provided. RESULTS: Baseline survey results show most Opioid Treatment Program staff were unfamiliar with House Bill 370, reported conflicting understandings of their agency's current take-home naloxone practices, and reported a number of barriers at the patient, agency, and policy level. Follow-up focus groups revealed support for House Bill 370 but persistent barriers to its implementation at the patient, agency, and policy level including patient receptivity, cost of naloxone, staff time, and prohibitive pharmacy board regulations. CONCLUSIONS: In spite of targeted legislation and training, provision of take-home naloxone at remained low. This is alarming given the need for this lifesaving medication among the Opioid Treatment Program patient population, and high opioid death rate in New Mexico. Locally, important next steps include clarifying regulatory guidelines and supporting policy/billing changes to offset costs to Opioid Treatment Programs. Globally, additional research is needed to identify the prevalence of take-home naloxone distribution in similar settings, common barriers, and best practices that can be shared to increase access to this vital lifesaving medication in this critical context.

"You've got to care to carry this stuff" Community implications from take-home naloxone use: A qualitative study.

BACKGROUND: In New Mexico, drug overdose rates have been among the highest in the nation for the past two decades, with 332 overdose deaths involving opioids in 2017. While interventions aimed at enhancing distribution and uptake of take-home naloxone (THN) have identified people who use opioids as viable candidates, there exists a gap in applying these findings to underserved, ethnic minority women. METHODS: We conducted qualitative interviews with participants recruited from a parent study which recruited 395 women diagnosed with OUD who participated in a two year study (April 2016-May 2018) during which they received opioid overdose education and two free THN kits for their use. RESULTS: Findings characterize the social dynamics of persistent opioid exposure, accidental overdose, and take home naloxone use to reverse overdose, and we identified three overarching themes: 1) Crisis management and community responsibility; 2) Complex social networks as informal channels for family to family and peer to peer naloxone distribution and education; and 3) Participant preferences and strategies for THN distribution and education. CONCLUSIONS: Participants in the ASAP program demonstrated an unquestionable willingness to distribute naloxone when they had access to it, and the ability to replace it. Further research is warranted to apply these findings in interventional contexts to refine strategies toward prioritizing distribution of THN, enhance training tools and optimize community locations for engagement.

Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program.

Importance: The US opioid crisis was deemed a public health emergency in 2017. More than 130 individuals in the US die daily as a result of unintentional opioid overdose deaths. Objective: To measure use of take-home naloxone for overdose reversals performed by study participants with opioid use disorder receiving treatment at an opioid treatment program. Design, Setting, and Participants: In a year-long cohort study, between April 4, 2016, and May 16, 2017, 395 study participants enrolled at the University of New Mexico Addiction and Substance Abuse Opioid Treatment Program, an outpatient clinic treating substance use disorders. Inclusion criteria included all patients enrolled at University of New Mexico Addiction and Substance Abuse Opioid Treatment Program during the study enrollment period; positive history of opioid use disorder treated with methadone, buprenorphine, or naltrexone; and age 18 years or older. Exclusion criteria included allergy to naloxone and age younger than 18 years. The study closed 1 year after enrollment, on May 17, 2018. Data analysis was performed from May 2018 to July 2019. Exposure: Two doses of take-home naloxone combined with opioid overdose education were provided to study participants. Main Outcomes and Measures: The primary outcome was to measure the association of take-home naloxone with overdose reversals performed by patients with opioid use disorder enrolled in an opioid treatment program. Results: We enrolled 395 study participants (270 female [68.4%]; mean [SD] age, 35.4 [12.6] years; 260 [65.8%] with Hispanic white race/ethnicity) in the 1-year prospective trial. Sixty-eight female participants (25.2% of all female participants) were pregnant at the time of enrollment. Seventy-three of the 395 study participants (18.0%) performed 114 overdose reversals in the community. All community reversals were heroin related. Most study participants (86.8%) stated that the person on whom they performed an overdose reversal was a friend, relative, acquaintance, or significant other. In the year before enrollment, only 18 study participants (4.5%) had been prescribed naloxone. Conclusions and Relevance: Take-home naloxone as part of overdose education and naloxone distribution provided to patients in an opioid treatment program may be associated with a strategic targeted harm reduction response for reversing opioid overdose-related deaths. Policy makers may consider regulations to mandate overdose education and naloxone distribution in opioid treatment programs.