Outcomes of an Interprofessional Opioid Training Program for Graduate Students in Nursing and Social Work.

Social workers and other behavioral health professionals trained to provide prevention, treatment, and recovery services for opioid use disorders (OUD) remain urgently needed in the U.S. particularly in states with widespread health professional shortage areas. To help mitigate this workforce gap, faculty in social work and nursing at a public university in Alabama developed and piloted an innovative HRSA-funded interprofessional traineeship to prepare graduate-level nursing and social work students to assess and treat opioid use disorders (OUD). The yearlong traineeship included specialized coursework on evidenced-based practice in addictions, interprofessional telemedicine and simulation training, and multi-semester field practica in outpatient treatment settings. Impact of the pilot training was evaluated using a pre-experimental one group design. Baseline and post-training surveys assessed knowledge, attitudes, and skills related to OUD and interprofessional practice and perceived program impact. Significant increases were observed for trainees' self-reported knowledge, attitudes, and skills. Moreover, at graduation students reported that the traineeship had improved their abilities to interact with underserved populations, collaborate interprofessionally, and understand ethical issues in SUD treatment as well as enhancing their professional competence, clinical problem-solving, and health workforce skills. Findings suggest that the interprofessional training program may prepare social work and nursing graduate students to effectively serve clients with OUD and help to address a critical workforce gap in medically underserved communities.

Delivery of the HIV Service and Telemedicine Through Effective Patient-Reported Outcomes (+STEP) Intervention to Increase Screening and Treatment of Mental Health and Substance Use Disorders for People Living With HIV in Alabama: Protocol for an Effectiveness-Implementation Study.

BACKGROUND: The syndemic of mental health (MH) and substance use disorders (SUDs) is common among persons living with HIV and jeopardizes HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient-reported outcomes (ePROs), completed through tablet or computer, and telemedicine are evidence- and technology-based interventions that have been used to successfully increase screening and treatment, respectively, a model that holds promise for persons living with HIV. To date, there is limited guidance on implementing ePROs and telemedicine into HIV clinical practice even though it is well known that these evidence-based tools improve diagnosis and access to care. OBJECTIVE: To address this, we aim to conduct a multicomponent intervention for persons living with HIV, including the delivery of HIV services and telemedicine through effective ePROs (+STEP), to increase screening and treatment of MH and SUD in Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Alabama. METHODS: Through this intervention, we will conduct a readiness, acceptability, and accessibility assessment and implement +STEP to improve the diagnosis and treatment of MH and SUD at RWHAP clinics in Alabama. To describe implementation strategies that address barriers to the uptake of +STEP in RWHAP clinics, we will conduct qualitative interviews in years 1 (early implementation), 2 (scale up), and 4 (maintenance) with patients and key staff to evaluate barriers, facilitators, and implementation strategies. Our Results will enable us to modify strategies to enhance +STEP penetration over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in Alabama and future sites. We will assess the impact of implementing +STEP on diagnoses, referrals, and health care use related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs and telemedicine) with historical controls. RESULTS: The first study site began implementation in April 2022. A total of 2 additional sites have initiated ePROs. Final results are expected in 2026. The results of this study will provide a foundation for future research expanding access to ePROs for improved diagnosis linked to telemedicine access to accelerate patients along the continuum of care from MH and SUD diagnosis to treatment. CONCLUSIONS: Achieving the end of the HIV epidemic in the United States necessitates programs that accelerate movement across the MH and SUD care continuum from diagnosis to treatment for persons living with HIV. Scaling these services represents a path toward improved treatment outcomes with both individual health and population-level prevention benefits of sustained HIV viral suppression in the era of undetectable=untransmittable (U=U). This study will address this evidence gap through the evaluation of the implementation of +STEP to establish the necessary systems and processes to screen, identify, and better treat substance use and MH for people living with HIV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40470.

Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach.

BACKGROUND: Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a large rural burden of disease. Mental health (MH) and substance use disorders (SUD) represent obstacles to HIV care in rural areas lacking Medicaid expansion and infrastructure. Evidence-informed technologies, such as telehealth, may enhance SUD and MH services but remain understudied in rural regions. METHODS: We conducted a readiness assessment using a mixed methods approach to explore opportunities for enhanced SUD and MH screening using electronic patient reported outcomes (ePROs) and telehealth at five Ryan White HIV/AIDS Program-funded clinics in AL. Clinic providers and staff from each site (N = 16) completed the Organizational Readiness to Implement Change (ORIC) assessment and interviews regarding existing services and readiness to change. People with HIV from each site (PLH, N = 18) completed surveys on the acceptability and accessibility of technology for healthcare. RESULTS: Surveys and interviews revealed that all clinics screen for depression annually by use of the Patient Health Questionnaire-9 (PHQ9). SUD screening is less frequent and unstandardized. Telehealth is available at all sites, with three of the five sites beginning services due to the COVID-19 pandemic; however, telehealth for MH and SUD services is not standardized across sites. Results demonstrate an overall readiness to adopt standardized screenings and expand telehealth services beyond HIV services at clinics. There were several concerns including Wi-Fi access, staff capacity, and patients' technological literacy. A sample of 18 people with HIV (PWH), ages 18 to 65 years, participated in surveys; all demonstrated adequate technology literacy. A majority had accessed telehealth and were not concerned about it being too complicated or limiting communication. There were some concerns around lack of in-person interaction and lack of a physical exam and high-quality care with telehealth. CONCLUSION: This study of PWH and the clinics that serve them reveals opportunities to expand SUD and MH services in rural regions using technology. Areas for improvement include implementing routine SUD screening, expanding telehealth while maintaining opportunities for in-person interaction, and using standardized ePROs that are completed by patients, in order to minimize stigma and bias.

Risk Reduction Strategies for Adolescent Cannabis Use Considering COVID-19 Stressors.

ABSTRACT: The past 2 years has been a challenge as society made huge adaptations to keep people safe from COVID-19 and struggled to continue life on a day-to-day basis. Working with families, young adults, and adolescents, nurses are often faced with caring for individuals who recreationally use cannabis and believe use is harmless. Adolescents as a group tend to appraise information from a different lens than adults. In an evolving world, where cannabis is legalized for medicinal and recreational use, it is important to shift the paradigm of how we approach cannabis use in adolescents. This article will focus on COVID-19's impact on cannabis use in adolescents and apply the transtheoretical model of change to promote safer choices while supporting adolescent autonomy. In addition, we will incorporate behavioral health strategies to reduce risks of cannabis use by equipping adolescents with guidelines, boundaries, and tools.

Implementing Clinical Practice Guidelines for Tobacco Cessation in a Women's Residential Substance Use Treatment Facility.

BACKGROUND: Tobacco is the leading cause of preventable death, and over 200,000 women die each year of diseases caused by tobacco. Women with substance use disorders (SUDs) are disproportionately affected. Smoking prevalence among individuals enrolled in SUD treatment is 2-4 times higher than that of the general population, yet less than half of all treatment facilities offer tobacco treatment services. However, when individuals combine treatment, they have a greater likelihood of long-term abstinence from alcohol and other substances of use. METHODS: A quality improvement project was undertaken to implement the U.S. Public Health Service guideline for tobacco cessation in a women's residential substance use treatment facility. Tobacco users were advised on their health risk and recommended to cut down or quit. They were advised that help was available using nicotine replacement therapy, behavioral counseling, or both. RESULTS: Upon admission, 67% of clients received brief advice to quit, and 30% participated in an intensive treatment aimed at reducing or eliminating cigarette use. At discharge, counseling participants (n = 21) smoked an average of nine cigarettes per day, reduced from 23, which was statistically significant. IMPLICATIONS FOR PRACTICE: Interventions reduced cigarette smoking in a population at a high risk for adverse outcomes related to use. Results suggest that more clients are interested in tobacco treatment than previously estimated. Increased administrative, clinical, and pharmacy support can sustain and further assist clients with cessation efforts.

Adolescent Girls and Alcohol Use: Increasing Concern During the COVID-19 Pandemic.

ABSTRACT: Adolescence is a time known for risky behaviors and often the initiation of alcohol use. Readily available, alcohol is often one of the drugs of choice for adolescents. Whereas in the past 30 years, the overall consumption of alcohol is down, the data in the past 10 years have shown more girls are binge drinking and meeting criteria for alcohol use disorder (AUD). The alarm of early alcohol use is the association with problems with the substances later in life. Historically, men and male adolescents consumed more alcohol than females. Recent studies indicate girls' alcohol use surpasses boys, whereas women now are developing AUD at the same rate as men. The consequences of early use can result in women's increased risk for multiple cancers, having a more severe form of AUD with less alcohol consumption as well as premature death. To further exacerbate this growing concern, the novel coronavirus (COVID-19) pandemic has created a perfect storm for increased use of alcohol to cope with the stress of living in an uncertain world. Normal daily activities have been halted with the uncertainty of school closures, zoom classroom sessions, and living in mandated social isolation. All nurses need to be screening for how families under their care have been managing stress. The time is opportune to educate and support parents in engaging their children in conversations around substance use. Parents can be supported to increase awareness of their own coping mechanisms and strengthen positive coping. Adolescents need support to strengthen interpersonal skills as well as make informed decisions concerning when and how they engage in alcohol consumption. This article will illuminate the growing need for all healthcare providers to assess and guide adolescents' coping skills during COVID with a focus on mental health, high-risk behavior, and alcohol use.

Women of Childbearing Age and Fetal Alcohol Spectrum Disorder Prevention: A Position Paper.

It is the position of the International Nurses Society on Addictions that all nurses, in all settings, should be prepared to provide care to patients with alcohol use problems, especially for women of childbearing age.

Transition Home: Safe Plan of Care for Infants With a History of Neonatal Abstinence Syndrome.

BACKGROUND AND PURPOSE: Opioid use disorder is an ever-expanding health epidemic affecting populations across the lifespan. Infants diagnosed with neonatal abstinence syndrome (NAS) often require additional resources while inpatient and after discharge to support ongoing NAS symptoms and improve outcomes. The purpose of this article is to highlight the need for a "safe plan of care" for infants with a history of NAS and provide evidence-based recommendations for providers. REVIEW OF CURRENT PRACTICE: In response to the opioid crisis, legislative efforts were passed to enhance access to care and provide valuable resources for families and clinical providers. These efforts require the development of comprehensive plans of care that include assessment of the home environment along with specialized care and services. Despite active legislation, infants and families continue to lack adequate access to resources such as therapy, specialized nutritional support, developmental specialists, and financial support. EVIDENCE-BASED RECOMMENDATIONS: An effective safe plan of care ensures that infants with a history of NAS are discharged to caregivers who are prepared, devoted, and responsive to the infants' needs. These essential components include responsive caregiving, safe and secure environments, appropriate nutrition, and health-promoting behaviors. CONCLUSION AND IMPLICATIONS: A review of current practice and evidence-based recommendations reveals essential components of a safe plan of care for infants with a history of NAS. By embracing the need for a comprehensive plan, providers can empathize with family needs and activate resources to promote healthy families and improve long-term outcomes of these infants.

Methamphetamine Use: A New Wave in the Opioid Crisis?

BACKGROUND: The ongoing drug crisis in the United States continues to be headlined with numbers of deaths related to opioid overdose. Less known to the public and health care providers is the rise in methamphetamine use, often in conjunction with opioids or adulterated with fentanyl. An old practice with a new twist is the use of methamphetamine in conjunction with an opioid such as heroin. PURPOSE: Although there are no Food and Drug Administration-approved medications to treat individuals with stimulant use disorders, a review of available studies suggests a few promising medications that may be helpful for patients in early recovery from methamphetamine. OUTCOME: Some individuals are more likely to respond to medications such as long-acting naltrexone, bupropion, and mirtazapine, who have light-to-moderate use of methamphetamine. Naloxone kits should be considered for all patients who are actively using stimulants because of a high potential of adulterated methamphetamine.

Informing Adults With HIV of Cognitive Performance Deficits Indicative of HIV-Associated Neurocognitive Disorder: A Content Analysis.

Approximately 50% of persons with HIV (PWH) meet the cognitive criteria for HIV-associated neurocognitive disorder (HAND). Informing PWH they may have HAND raises concerns given the lack of consensus-derived treatment options and overall knowledge about HAND. Thus, the current qualitative descriptive study aimed to describe PWHs' reactions to a possible diagnosis of HAND. Cognitive tests were administered to 135 PWH to determine whether they met the criteria for HAND. From 135 PWH, 109 (80.7%) participants met the cognitive criteria and were informed about their probable HAND diagnosis. Approximately 2 months later, the remaining 85 participants (24 were lost to attrition) were asked about their reactions and concerns to receiving a probable diagnosis of HAND. Their responses were thematically coded. Themes that emerged were Desire to Improve, Confirmation, Not Concerned/No Reaction, Concerned, Unexpected, Anxiety, Knowledge Seeking, and Sadness. Most themes were positive or neutral, whereas fewer negative themes were observed. Thematic/content analysis appeared to show that most PWH reacted well to their probable diagnosis and were open to ways to improve their brain health. Such openness represents a window to provide health education to patients. Implications for practice and research are provided. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 48-55.].

Shining a Light: Integrating Protocols Into Clinical Practice for Treatment of Neonatal Abstinence Syndrome.

BACKGROUND AND PURPOSE: The epidemic use of opioids is negatively influencing the health of the American people. Pregnant women and their unborn babies have not escaped the ravages of substance use. A dramatic increase in maternal opioid use has led to an increasing number of infants experiencing withdrawal symptoms known as neonatal abstinence syndrome (NAS). The purpose of this article is to highlight best practice for the management of infants with opioid withdrawal. REVIEW OF PROTOCOLS AND TREATMENTS: Review of available protocols and treatments revealed wide variation in the treatment of NAS and little use of standardized guidelines or protocols, despite current recommendations of the American Academy of Pediatrics. There is supporting evidence showing that the use of standardized protocols reduces the length of treatment and enhances outcomes in the neonatal population. EVIDENCE-BASED RECOMMENDATIONS: Evidence-based strategies to address gaps in practice include developing strong protocols to identify infants at risk and implementing standardized plans when treating NAS. Consistent assessment, initial treatment with nonpharmacologic measures, and conservative use of pharmacologic agents are important elements to an NAS treatment protocol. CONCLUSIONS AND IMPLICATIONS: In evaluating the current literature for best practice in the management of the newborn with opioid withdrawal, it is clear that evidence-based standardized protocols need to be in place for the best treatment of the mother-infant dyad, caring for both the infants with NAS as well as the mothers with opioid use disorder.

Caught in the Crossfire of the Syndemic.

The worsening opioid epidemic ignites infectious disease development and transmission as opioids abused by insufflation and/or injection establish a pathway for infection to the user and propagate vulnerability to diseases. The phenomenon of the synergistic collision of epidemics intensifying the load of disease constitutes a syndemic. Merrill Signer (1994) voiced the term "syndemic" to characterize the complex nexus of politics, economics, psychosocial/environmental factors, and health disparities resulting in the inner-city AIDS crisis of the 1990s. Today, the surge of opioid use puts individuals at risk for disease transmission and living the catastrophic clash wrought by the epidemics. By following a case study caught in the crossfire of epidemics, this article prompts to underscore recognition of the at-risk patient for HIV infection and to embolden care integration of prevention and treatment strategies nurses are qualified to execute.

Opiate Dependence or Addiction?: A Review of the Centers for Disease Control and Prevention Guidelines for Management of Chronic Pain.

In the wake of epidemic of opioid overdoses in the United States, patients who are receiving treatment for chronic pain with opioid have come under increasing scrutiny. The Centers for Disease Control and Prevention issued a guideline for managing chronic pain in 2016, which makes recommendations for opioids based on current evidence. This review will highlight key components of the guideline including differentiating addiction from dependence to assist nurses to better inform patient care in managing chronic pain.

Recovery Beyond Buprenorphine: Nurse-Led Group Therapy.

It has taken the tragedy of swelling opioid overdoses to raise addictions to national attention. This past year, a new law called the Comprehensive Addictions Recovery Act has helped to open doors for nurse practitioners and physician assistants to prescribe buprenorphine. Although this medication can assist those dependent on opioids in finding needed stability, medication-assisted treatment is only the beginning. Addiction and psychiatric nurses must play a larger role in providing various therapies that coincide with medication-assisted treatment to support ongoing recovery. One treatment option is group therapy, which is effective for individuals with substance use as well as other co-occurring disorders to develop needed skills to remain in recovery. The purpose of this review is to explore the nursing role in group therapy for substance use as well as encourage addictions and psychiatric nurse practitioners to offer recovery-focused group therapy to this population.

Echoes of the Past: Recognizing Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder in the American Veteran Population.

PURPOSE: The aim of this editorial is to explore and highlight the importance of identifying both the alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) in the veteran population. REVIEW: Determining if the patient has military experience can assist in both an accurate and complete assessment. Being aware of the patient's military service time can help better understand some of the presenting physical and mental complaints that may incorrectly be attributed to substances. Although not all veterans had trauma exposure while in the military, asking about PTSD may help identify additional issues needing attention. Having a PTSD diagnosis increases the likelihood that there is an underlying substance use disorder. Veterans with PTSD have a 65% likely comorbidity with alcohol use (Smith, Goldstein, & Grant, 2016). CONCLUSION: Recognition of PTSD as a co-occurring disorder with AUD can begin the dialogue to address treatment of both disorders to optimize recovery.

Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016.

The aim of this Policy Watch column is to provide an update on a much anticipated legislation, enacted in 2016, which enabled office-based opioid treatment (OBOT) with buprenorphine prescribing for the treatment of opioid addiction by nurse practitioners (as well as physician assistants). First, an overview of the Drug Addiction Treatment Act of 2000, which only permitted OBOT prescribing by physicians, will be described. It will be followed by a summary of the Recovery Enhancement for Addiction Treatment Act of 2015-2016. Finally, a review of the Comprehensive Addiction Recovery Act of 2016 will be provided, which includes information about important changes to OBOT regulations that enable NP prescribing of buprenorphine for the treatment of opioid addiction.

Improving Quality Outcomes in Veteran-Centric Care.

The University of Alabama at Birmingham (UAB) School of Nursing and the Birmingham Veterans Affairs Medical Center (BVAMC) created a Psychiatric-Mental Health Nurse Practitioner (PMHNP) Residency Continuity Clinic tasked with providing Veteran-centric mental health outpatient treatment informed by measurement-based care (MBC) to provide quality outcomes. Approved by the BVAMC, the UAB Institutional Review Board also approved and exempted the project as quality improvement. PMHNP residents administered the Patient Stress Questionnaire (PSQ)-an MBC tool that incorporates validated tools for assessing depression, anxiety, posttraumatic stress, alcohol use, and pain-to each Veteran from March to August 2016. Patient outcomes focused on depression and anxiety. PSQ scores were reviewed retrospectively via descriptive statistics, paired t tests, and Wilcoxon signed ranks tests. Analysis showed improvement in depression and anxiety that approached significance, and in several national Veterans Affairs mental health performance measures, reinforcing the importance of using MBC in psychiatric assessment. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 37-44.].

Update on Substance Use in Adolescence.

With alarming frequency, an individual's first substance use occurs in childhood or adolescence. However, the use of many types of substances among individuals younger than 18 has been gradually declining over the past 6 years, and our understanding of risk factors for youth substance use has improved. Risk factors identified as possibly contributing to a young individual's first encounter with cigarettes or alcohol include parents' own substance use or mental health problems. Mental disorders of children have been implicated in substance use as well. Screening and interventions are available to reduce the frequency and intensity of adolescent substance use and are suggested in the current article. Nurses are in a position to identify adolescents who are at risk for substance use disorders and link the family system to effective intervention. [Journal of Psychosocial Nursing and Mental Health Services, 54(8), 24-27.].

Transforming veterans health care through academic-practice partnerships.

The Veterans Health Affairs Office of Academic Affiliations (OAA) has invested in the creation of academic-practice partnerships to transform the care of veterans and their families. This article details how a long-standing relationship between the University of Alabama at Birmingham School of Nursing and the Birmingham Veterans Affairs Medical Center grew into such a partnership. The three programs that now exist within the Birmingham Veterans Affairs Nursing Academic Partnership (VANAP) umbrella are described, including an undergraduate VA nurse scholars program that has sustained beyond OAA funding, a VANAP graduate education program for psychiatric mental health nurse practitioners (NPs), and a Mental Health NP Residency. Key features of the programs are noted as are outcomes and lessons learned for building mutual goals and a sustainable academic-practice partnership. With the recent passage of the Veterans Choice Program, the importance of educating all nurses about veterans and veterans' health is stressed.

Reducing the Risk of Alcohol Use Disorders in Women.

Nurses and other clinicians help women to examine their lifestyles and consider changes to promote optimum health. When the question is about drinking alcohol, what is appropriate to recommend? While moderate intake may be beneficial for cardiovascular and bone health, drinking more than the recommended amount increases the risk of harmful effects. This column examines guidelines for moderate alcohol consumption for women, reviews the assessment process and demonstrates an example of a brief intervention. A program of screening, brief intervention and referral to treatment (termed SBIRT by the Substance Abuse and Mental Health Services Administration) should be part of the standard assessment for every woman. Ongoing assessment of alcohol consumption can help to better target behaviors for early intervention.