Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids.

Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members' overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.

Stigma Communication Surrounding Nonmedical Opioid Use Among Affected Family Members.

A growing body of research demonstrates the role of language in stigma toward nonmedical opioid use (NMOU). Terms like "substance abuser" perpetuate stereotypes and evoke punitive judgments. This study examines how affected family members (AFMs) communicate stigma when discussing their loved one's NMOU. Semi-structured interviews were conducted with 34 adults with a close family member with a history of NMOU. An iterative approach was used to analyze instances when stigmatizing terms or messages were used. AFMs described people engaged in NMOU as underweight, "dirty," or "nodding off," and often labeled these individuals "addicts" or opioid "abusers." Responsibility for the NMOU was attributed to both internal (e.g. choice) and external (e.g. brain disease) factors. People engaged in NMOU were linked to physical danger, resource threats, and threats to the family members' reputation and relationships. While most stigma messages related to the person engaged in NMOU, stigmatizing messages directed toward AFMs also emerged; family members labeled "enablers" were judged, blamed, and described as a threat to the person engaged in NMOU. Although AFMs expressed care and desire to support their loved ones, they often conveyed stigma in their language choices. This language among AFMs may reflect internalized stigma. Increased efforts are needed to help AFMs cope with the challenges of a loved one's NMOU and identify effective ways to support their loved one. One way AFMs can support their loved one is by using more inclusive, person-first language.

Attitudes toward medications for opioid use disorder among peer recovery specialists.

Background: Peer recovery specialists (PRSs) are substance use service providers with lived experience in recovery. Although a large body of research demonstrates the efficacy of medications for opioid use disorder (MOUD), emerging research suggests PRSs' attitudes toward MOUD are ambivalent or mixed. Few studies have quantitatively assessed factors influencing PRSs' attitudes.Objectives: This study identifies personal and professional characteristics associated with attitudes toward MOUD among PRSs.Methods: PRSs working at publicly funded agencies in Michigan completed a self-administered web-based survey (N = 266, 60.5% women). Surveys assessed socio-demographics, treatment and recovery history, attitudes toward clients, and attitudes toward MOUD. Multiple linear regression was used to identify factors associated with attitudes toward MOUD.Results: A minority of PRSs (21.4%) reported a history of treatment with MOUD, while nearly two-thirds reported current 12-step involvement (62.5%). Compared to PRSs without a history of MOUD treatment, PRSs who had positive (b = 4.71, p < .001) and mixed (b = 3.36, p = .010) experiences with MOUD had more positive attitudes; PRSs with negative experiences with MOUD had less positive attitudes (b = -3.16, p = .003). Current 12-step involvement (b = -1.63, p = .007) and more stigmatizing attitudes toward clients (b = -.294, p < .001) were associated with less positive attitudes toward MOUD. Black PRSs had less positive attitudes than White PRSs (b = -2.50, p = .001), and women had more positive attitudes than men (b = 1.19, p = .038).Conclusion: PRSs' attitudes toward MOUD varied based on the nature of their lived experience. Findings highlight considerations for training and supervising PRSs who serve individuals with opioid use disorder.

Public Perceptions of Opioid Use for Chronic Non-Cancer Pain.

Background: Chronic non-cancer pain affects 20% of Americans. This is significantly impacted by the ongoing opioid crisis and reduced opioid dispensing. Public perceptions additionally shape pain management strategies. Purpose: This study explores public attitudes toward prescription opioids for chronic non-cancer pain. We aim to understand how public attitudes are influenced by the evolving opioid crisis and shifting opioid use patterns. Methods: In Michigan, 823 adults participated in a Qualtrics survey on attitudes toward nonmedical and medical prescription opioid use. Multivariable logistic regression was performed to identify factors associated with beliefs that doctors prescribe opioids for too long (Model 1) and chronic pain patients should transition to alternative treatments (Model 2). Results: About half (49.4%) of respondents believed doctors keep patients on prescription opioids for too long, while two-thirds (65.7%) agreed chronic pain patients should be tapered off medications. Knowing someone who misused opioids and perceptions of substance use (e.g. perceived risk of prescription opioid misuse, stigma toward chronic pain patients, perceived prevalence of prescription opioid misuse, and awareness of fentanyl) were associated with greater odds of believing doctors keep patients on opioids too long. Demographics (age and education), substance use histories and perceptions (e.g. perceived risk and stigma) were associated with greater odds of believing patients should be tapered off their medication. Conclusions: These findings inform strategies to correct public misperceptions, emphasizing the importance of personal experience, perceived risks, and stigmatization of chronic pain patients. This insight can guide effective pain management for those with chronic non-cancer pain.

Binge Drinking and Cannabis Use among Transgender and Gender-Diverse Young Adults in Michigan.

Substance use rates are higher among transgender and gender-diverse people than cisgender people. Rates of substance use are also higher among young adults compared with other age groups. However, little research examines substance use among transgender and gender-diverse young adults. This study examines factors associated with binge drinking and cannabis use among transgender and gender-diverse young adults in Michigan. Participants (N = 78; ages 18-25) completed an online survey that included demographics and substance use and related characteristics. Race, stimulant misuse, and sedative misuse were associated with more frequent binge drinking. Older age and past-year pain reliever misuse were associated with less frequent cannabis use. Past-year stimulant use and using cannabis alone were associated with more frequent cannabis use. These findings suggest that additional marginalized identities may increase the risk for maladaptive substance use. Future research should examine substance use behaviors and correlates to inform interventions among this population.

Attitudes toward Medication for Opioid Use Disorder among Substance Use Treatment Providers.

Background: Provider attitudes can be a powerful reinforcer of stigma toward medication for opioid use disorder (MOUD). This study examines attitudes toward MOUD among substance use treatment providers and identifies personal and professional characteristics associated with more positive attitudes. Methods: Treatment providers (N = 570) working at publicly-funded substance use programs in Michigan self-administered a web-based survey (November 2020 through July 2021), reporting their socio-demographics, professional experience, and attitudes toward MOUD. Linear regression was used to identify factors associated with general attitudes toward MOUD and three logistic regression models were calculated to identify factors associated with perceptions of each medication. Results: Half of providers considered methadone an effective treatment (53.0%); 62.9% considered buprenorphine effective, and 70.3% considered naltrexone effective. Receipt of training (B = 1.433, p = .009) and serving pregnant women or women with children (B = 1.662, p < .001) were associated with more positive attitudes toward MOUD. Providers with advanced degrees were more likely to consider methadone (OR = 2.264, p = .006), buprenorphine (OR = 2.192, p = .009), and naltrexone (OR = 2.310, p = .011) effective. Rural providers were more likely to consider naltrexone effective (OR = 2.708, p = .003). Providers working with criminal legal populations were more likely to consider buprenorphine (OR = 2.948, p = .041) and naltrexone (OR = 4.108, p = .010) effective, but not methadone. Conclusion: Treatment providers' attitudes remain poorly aligned with the evidence base. Increased efforts are needed to address attitudes toward MOUD among the specialized treatment workforce.

Predictors of Safe Prescription Opioid Storage and Participation in Drug Take-Back Events: Results from a Statewide Survey.

Improper storage and disposal of prescribed opioids can lead to diversion or accidental poisonings. Studies of emergency department and cancer patients suggest prescription opioids are rarely stored securely or disposed of when unneeded. Safe storage and disposal practices reduce risks for others living in or visiting a household. The purpose of this study is thus to examine prescription opioid storage and participation in drug take-back events among Michigan adults. Participants (N = 702) were recruited through social media advertisements to complete an online survey in July and August 2018. Logistic regression was used to examine correlates of safe storage and disposal. 8.4% (n = 59) of participants reported always keeping opioids locked; 29.8% (n = 209) reported attending a drug take-back event. Black participants and those who believed that illegal drug use was a serious problem had greater odds of locking opioids; participants with higher levels of education or who knew someone who used heroin or misused prescription opioids had lesser odds of locking opioids. Age and race were associated with take-back event participation. Findings identify factors associated with safe prescription opioid storage/disposal and indicate safe storage/disposal seldom occurs. Education and provision of safe storage equipment should be designed for diverse ages, races/ethnicities, and levels of education. Drug take-back events not hosted by law enforcement may have broader appeal, as may those led by Black or other people of color. Wider use of drug donation boxes may facilitate increased disposal among those who do not wish to or cannot attend take-back events.

Overestimation of Prescription Pain Reliever Misuse and Heroin Use among Adults.

BACKGROUND: Estimates from the National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019) suggest 3.6% of persons aged 12 and older misused prescription pain relievers in the past year and 0.3% used heroin. However, research suggests that most individuals drastically overestimate rates of substance use and misuse. Those who overestimate substance misuse are often more likely to misuse substances themselves (Kilmer et al., 2015; McCabe, 2008). Purpose: To compare perceived versus actual rates of prescription pain reliever misuse and heroin use among a statewide sample of adults and identify correlates of these differences. Methods: Participants (N = 689) recruited through social media estimated rates of prescription pain reliever misuse and heroin use. Participants also indicated whether they engaged in pain reliever misuse or heroin use, and whether they knew anyone who misused prescription pain medications or heroin. Results: Almost all participants (98.11%) overestimated the prevalence of prescription pain reliever misuse (mean estimate = 41.25%) and heroin use (99.71%, mean estimate =25.46%). Women and African Americans were more likely to overestimate prescription pain reliever misuse and heroin use. Knowing someone who misused prescription pain relievers was significantly associated with overestimating prescription pain reliever misuse. Personal use was not associated with overestimating prevalence of either substance. Conclusions: Adults consistently overestimate rates of prescription pain reliever misuse and heroin use. Overestimation may increase normative perceptions of substance use and ultimately lead to increased substance use. Social-norms based education and interventions may be particularly important among groups that are more likely to overestimate use.

Correlates of Expressed Emotion Among Family Members of Individuals Who Sought Treatment for Opioid Use.

Expressed emotion has been robustly associated with negative mental health outcomes. Understanding correlates of expressed emotion by family members of individuals with opioid use disorder is important, as this group faces high levels of stress and can play an important role in their loved ones' treatment. Thus, immediate family members of individuals who sought treatment for opioid problems (N = 195) completed a web-based survey that included measures of expressed emotion, self-stigma, social support, and demographic characteristics. Multiple linear regression analyses were conducted to examine correlates of two types of expressed emotion-criticism and emotional overinvolvement. Results indicated that higher self-stigma and lower social support were significantly associated with higher emotional overinvolvement. Higher self-stigma and having experienced debt related to a family member's opioid use were associated with higher criticism. Thus, self-stigma and financial burden may exacerbate likelihood of expressed emotion, whereas social support may buffer against expressed emotion.

Public Perceptions of Risks Associated with Mixing Opioid Pain-Relievers with Alcohol and Benzodiazepines.

Objectives: Use of alcohol or benzodiazepines with opioid pain-relievers increases risk of overdose and overdose death. A substantial proportion of adults receives an opioid prescription each year, and a number of these adults also use benzodiazepines or alcohol. As public opinion continues to shape public policy, it is imperative to understand correlates of recognizing risk of mixing substances in order to inform public outreach and prevention efforts. Methods: Characteristics associated with perceived risk were explored using an online survey of a community sample of adults (N = 639) in Michigan. Two logistic regression models examined potential correlates of perceived risk of 1) mixing opioid pain-relievers with alcohol and 2) mixing opioid pain-relievers with benzodiazepines. Results: In the multivariate results, participants reporting at least one heavy drinking episode in the past month (AOR = 0.46, p = .001) and individuals with advanced degrees (AOR = 0.49, p = .014) had lower odds of believing that mixing alcohol and opioid pain-relievers poses a great risk, while women (AOR = 1.66, p = .042) had higher odds. Participants reporting lifetime (AOR = 0.58, p = .046) or past-year (AOR = 0.28, p = .001) non-medical opioid use had lower odds of reporting that mixing benzodiazepines and opioid pain-relievers poses a great risk, whereas older participants (AOR = 1.02, p = .037) had higher odds. Conclusions: Certain groups were more likely to underestimate risks of mixing opioid pain-relievers with alcohol or benzodiazepines. Results underscore the importance of targeted public awareness campaigns, prevention programing, and communication between physicians and patients about the risks of mixing substances, particularly among high-risk groups.

Correlates of substance use in pregnant women under community supervision after conviction for a criminal offence: The role of psychological distress.

BACKGROUND: Being pregnant while under community supervision after conviction for a criminal offence can be a highly stressful experience, and pregnant women under community supervision are at an elevated risk for substance use. AIMS/HYPOTHESES: To test for relationships between psychological distress and use of tobacco, alcohol, or marijuana during the month prior to a research assessment among pregnant women under community supervision, controlling for demographic characteristics. METHODS: Data from the National Survey on Drug Use and Health were aggregated for the years 2008-2016, inclusive. Logistic regression analyses were conducted to examine correlates of past-month use of each substance. RESULTS: Of all 505,796 people in the survey, 6,974 were pregnant women of whom 280 reported being under community supervision for a criminal offence; relevant data were available for 271 of these cases. The pregnant women under community supervision reported higher rates of past-month substance use of each kind and of psychological distress than pregnant women not under community supervision. Past-month serious psychological distress, but not remitted psychological distress, corresponded strongly with past-month alcohol use even when controlling for demographic characteristics and other substance use. CONCLUSIONS: Our findings add to the very sparse literature about a group of women likely to be exceptionally vulnerable during pregnancy and underscore the importance of screening for symptoms of substance use and of psychological distress amongst them. Among women under community supervision, alcohol use was less likely in the second or third trimester than the first, but as those using alcohol were more likely to report past month psychological distress, it may be important to provide additional resources and treatment services for these women.

Applying Social Cognitive Theory to Explore Relational Aggression across Early Adolescence: A Within- and Between-Person Analysis.

In the past two decades, there has been a significant amount of research on children's relational aggression, which has been found to be associated with psychosocial problems. Longitudinal studies have examined changes in relational aggression during early adolescence in relation to individual characteristics; however, most studies compare individual differences between people with regard to rates of relational aggression. A shortcoming to the current literature is the lack of studies that use a multilevel approach to examine individual differences (between-person) as well as the extent to which individuals deviate from their own typical levels (within-person) over time. In this study, within- and between-person psychological and peer-related predictors of rates of relational aggression over time were examined. Participants included 1,655 students in 5th-8th grade (mean age: 13.01) from four public middle schools in the Midwest, which consisted 828 females and 827 males. In terms of race and ethnicity, 819 (49.5%) were African Americans, followed by 571 (34.5%) Whites, and 265 (16%) Others. Longitudinal data were collected over four waves across two years of middle school. The findings indicated that contrary to the hypothesis that relational aggression would increase over time, there was no significant growth across time. Age, gender, and race were not associated with relational aggression over time; however, consistent with the Social Cognitive Theory, changes in within-person impulsivity, anger, and peer delinquency were all positively related to increases in relational aggression. At the between-person level of analysis, depressive symptoms and peer delinquency were related to relational aggression. Findings suggest that school-based programs that address anger management, impulsivity, empathy, and victimization could help prevent relational aggression.

Technology-based interventions and trainings to reduce the escalation and impact of alcohol problems.

There has been a rapid increase in the development of technological innovations to reduce the escalation and impact of alcohol problems among adolescents and adults. Technology-based interventions offer the possibility of reaching individuals who otherwise might not seek treatment, (e.g., those in remote areas, those not perceiving a need for treatment, or others who may resist treatment). This article describes four case examples of technology-based interventions for risky drinking: 1) a freely available and interactive website that provides individualized feedback and information on risky drinking patterns; 2) a brief intervention for adolescents that provides individualized feedback to teens regarding their alcohol use; 3) a computer-delivered screening and brief intervention for alcohol use among pregnant women, and 4) a simulation program for training social workers in screening and brief intervention. These case examples highlight how technology may have a role in addressing the Alcohol Misuse Grand Challenge.

Perceived Treatment Needs Among Women With Co-occurring Substance Use Disorders and PTSD.

OBJECTIVE: Perception of need is a key factor that influences decisions to seek help and complete treatment for substance use and mental health problems. In the current study, we examine patterns of perceived treatment needs among women with co-occurring substance use disorders and posttraumatic stress disorder (PTSD) and explore how these patterns are associated with demographics, psychosocial variables, and treatment-related factors. METHODS: Secondary data analysis of the Women and Trauma Study from the National Institute on Drug Abuse's Clinical Trial Network was conducted. The sample included 353 women with co-occurring substance use disorders and PTSD (full or subthreshold) receiving outpatient substance abuse treatment. Latent class analysis was used to examine patterns of perceived treatment need and multinomial logistic regression was used to identify characteristics associated with these patterns. RESULTS: The sample included women between the ages of 18 and 65 (mean = 39.2, SD = 9.3) and was 46% White, 34% African American, and 21% other races/ethnicities. A three-class model representing unique perceptions of treatment needs demonstrated the best fit (Bayesian information criterion = 2101.43; entropy = 0.76; average posterior probabilities ≤ 0.82). Class one reported elevated needs in multiple areas (38%), class two reported low needs (23%), and class three reported substance use and psychological needs (40%). Living with a substance abuser, depression symptoms, recent substance use, and treatment coercion were significantly associated with membership in class 2 (OR = .28, .84, .22, and 2.32, respectively). Other race, being married, depression symptoms, recent substance use, and criminal justice involvement were associated with membership in class 3 (OR = 2.32, 2.32, .94, .42, and 1.69, respectively). Number of treatment sessions attended was not significantly associated with class membership. CONCLUSIONS: Results provide insight into how women with co-occurring PTSD and substance use disorders view their treatment needs. While some women reported high levels of self-identified need in other areas (e.g., physical health, employment/financial support, and family or social relationships), others did not identify as having any problems (including substance use or psychological problems). Level of severity and temporal aspects of problems may be significant factors that influence women's perceived need for treatment. This clinical trial is registered at www.clinicaltrials.gov as trial #NCT00078156.

Support for Safe Consumption Sites Among Peer Recovery Coaches.

Safe consumption sites (SCSs), legally sanctioned facilities where people can use drugs under medical supervision, are an effective strategy to reduce overdose fatalities. Peer recovery coaches (PRCs), substance use service providers with lived experience in recovery, are a key provider group affecting SCS implementation. This study assesses support for SCSs among PRCs and identifies personal and professional characteristics associated with support for these sites. PRCs (N = 260) in Michigan were recruited to complete a web-based survey (July-September 2021), reporting their demographics, lived experience, abstinence orientation, attitudes toward clients, training experiences, and support for legalizing SCSs. Logistic regression was used to identify factors associated with support for SCSs. Half of PRCs (49.0%) expressed support for legalizing SCSs in Michigan. Compared to women, men had greater odds of supporting SCSs (OR = 2.113, p = .014). PRCs who identified as Black (OR = 0.361, p = .014) and other people of color (OR = 0.338, p = .014) had lower odds of supporting SCSs compared to PRCs who identified as white. More stigmatizing attitudes toward clients (OR = 0.921, p = .022) and preference for abstinence-only treatment (OR = 0.452, p = .013) were associated with lower odds of supporting SCSs. Increasing support for SCSs among PRCs is important given their influence on the success of SCS initiatives. Professional training which addresses deeply rooted values and beliefs may help increase support for SCSs. However, policy changes may be necessary to address structural racism affecting SCS acceptability among PRCs of color.

Demographic, substance use, and mental well-being correlates of high-intensity drinking among college students and non-college young adults: implications for intervention.

OBJECTIVE: To assess demographic, substance use, and mental wellbeing factors associated with high-intensity drinking (HID; 10+ drinks on one occasion) among college- and non-college young adults, to inform prevention and intervention efforts. PARTICIPANTS: A total of 1,430 young adults (819 in college and 611 not attending college) in a Midwestern state who reported trying alcohol at least once. METHODS: Participants were recruited via social media between November 2019 and February 2020 to complete a web-based survey assessing demographics, substance use, and mental well-being. Logistic regression was conducted to assess relationships between these measures and HID among (1) college students and (2) non-college young adults. RESULTS: About 14.0% of participants reported past-month HID. Among both college- and non-college young adults, men, those who perceived slight or no risk of harm from binge drinking, and those who used alcohol and marijuana simultaneously in the past year had greater odds of reporting past-month HID. Among students, past-year prescription drug misuse was also associated with HID. CONCLUSIONS: High intensity-drinking is concerning given potential adverse consequences. Campus programming should address norms that may promote such drinking and other high-risk substance use associated with HID.

Does Coping Mediate the Relationship Between Adverse Childhood Experiences and Health Outcomes in Young Adults?

Adverse childhood experiences (ACEs) affect 22-75% of American young adults. ACEs are associated with adverse health outcomes that begin in young adulthood. Yet, scant research has examined if coping can mediate the relationship between ACEs and adverse outcomes. The current study determined if coping mediates the relationship between ACEs and body mass index (BMI), substance use, and mental health outcomes in young adults. A community sample of 100 White and 100 Black young adults 18-34 years of age participated in a cross-sectional study conducted via Zoom conferencing. Participants provided demographic data, height/weight, and completed measures of ACEs, coping, substance use, and mental health outcomes. Coping was measured using an established three-factor model consisting of adaptive, support, and disengaged coping. Structural equation modeling (SEM) examined the relationships of ACEs to outcomes as mediated by coping. Participants were predominantly female (n = 117; 58.5%) and mid-young adult (M = 25.5 years; SD = 4.1). SEM results indicated good model fit: (CMIN/df = 1.52, CFI = 0.94, RMSEA = 0.05 [90% CI = 0.03-0.07], SRMR = 0.06). Only disengaged coping mediated the ACE and substance use (ß = 0.36, p = .008), smoking (ß = 0.13, p = .004), and mental health (ß=-0.26, p = .008) relationships. Disengaged coping styles may be a critical mechanism in developing adverse mental health and substance use outcomes among ACE-exposed individuals. Future ACE and health outcomes research should examine the role of coping. Interventions focusing on adaptive coping may improve the health of individuals exposed to ACEs.

Ambivalence and contingencies: A qualitative examination of peer recovery coaches' attitudes toward medications for opioid use disorder.

INTRODUCTION: Peer recovery coaches (PRCs) are an important provider group affecting medications for opioid use disorder (MOUD) uptake and retention. However, some PRCs may have experiences and beliefs that do not align with the use of MOUD. This study examines PRCs' perceptions of MOUD and how PRCs' attitudes affect their interactions with clients. The article also explores factors influencing PRCs' attitudes. METHODS: The study team conducted semi-structured interviews by phone with PRCs in Michigan (N = 34, July through September 2021). The study asked participants about their opinion of MOUD, how they help clients to make decisions about MOUD, and whether they have encountered negative attitudes toward MOUD in their work. Data analysis was guided by Tracy's (2020) iterative phronetic approach. RESULTS: Nearly all PRCs acknowledged the social stigma surrounding MOUD. PRCs described the stigma toward MOUD as affecting treatment access, utilization, and recovery support. While most PRCs expressed support for many recovery pathways, support for MOUD was contingent on the type of medication and the conditions under which it is used. PRCs often described MOUD as acceptable only in the short-term when paired with psychosocial interventions, after nonpharmacological treatment attempts had failed. PRCs with concerns about MOUD reported sometimes avoiding discussions about MOUD with clients, spreading misinformation about MOUD, and encouraging clients to discontinue treatment. However, many PRCs expressed a desire to support clients' self-determination despite their own biases. CONCLUSIONS: Findings highlight a need for education and stigma reduction among PRCs and point to specific areas for intervention. PRCs described deeply engrained beliefs about MOUD rooted in their own treatment histories and recovery practices. Provision of high-quality training and supervision to shift attitudes among PRCs will be key to increasing the use of MOUD.

Experiences of healthcare and substance use treatment provider-based stigma among patients receiving methadone.

Background: Medications for Opioid Use Disorder (MOUD) are efficacious, however only one-third of individuals with an opioid use disorder (OUD) enter into treatment. Low rates of MOUD utilization are partially due to stigma. This study examines provider-based stigma toward MOUD and identifies factors associated with experiencing stigma related to MOUD from substance use treatment and healthcare providers among people receiving methadone. Methods: Clients receiving MOUD at an opioid treatment program (N = 247) were recruited to complete a cross-sectional computer-based survey assessing socio-demographics, substance use, depression and anxiety symptoms, self-stigma, and recovery supports/barriers. Logistic regression was used to examine factors associated with hearing negative comments about MOUD from substance use treatment and healthcare providers. Results: 27.9% and 56.7% of respondents reported they sometimes/often hear negative comments about MOUD from substance use treatment and healthcare providers, respectively. Logistic regression results indicate that individuals who experience more negative consequences resulting from their OUD (OR=1.09, p=.019) had greater odds of hearing negative comments from substance use treatment providers. Age (OR=0.966, p=.017) and treatment stigma (OR=1.42, p=.030) were associated with greater odds of hearing negative comments from healthcare providers. Conclusions: Stigma can be a deterrent to seeking substance use treatment, healthcare, and recovery support. Understanding factors associated with experiencing stigma from substance use treatment providers and healthcare providers is important as these individuals may act as advocates for those with OUD. This study highlights individual factors associated with hearing negative comments about methadone and other MOUD and point to areas for targeted education.

Driving After Cannabis Use Among Young Adults in Michigan.

Introduction: Driving after cannabis use is associated with a number of risks. Examination of driving after cannabis use among young adults is particularly important, as young adults have the highest rates of cannabis use and among the highest rates of traffic crashes. The current study examines rates and correlates of driving after cannabis use among young adults (aged 18-25) who reported past month cannabis use. Methods: Participants were from Michigan and recruited through paid Facebook and Instagram advertisements between February and March 2018 (n=461). Results: Nearly a third (31.9%) of the sample reported driving after cannabis use in the past month. Young adults who were employed (aOR=1.872, p=0.045), had medical cannabis cards (aOR=2.877, p<0.001), endorsed coping reasons for use (aOR=2.992, p=0.007), and endorsed social/recreational reasons for use (aOR=1.861, p=0.034) had greater odds of driving after cannabis use. Students had lower odds of driving after use (aOR=0.573, p=0.011). Conclusions: Employment and having a medical cannabis card may be important risk markers for identifying individuals more likely to drive after use of cannabis. Prevention efforts could provide psychoeducation at dispensaries to individuals with medical cannabis cards about the risks of driving after use. Coping motives for cannabis use may also be useful in identifying young adults at the greatest risk of driving after use of cannabis.