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.

Ovarian and Endometrial Endometrioid Carcinoma Following the Use of a Biologic IL-17 Inhibitor.

Evidence suggests that IL-17, a pro-inflammatory cytokine, suppresses tumor carcinogenesis; therefore, the use of IL-17 inhibitors accelerates carcinoma growth. We present a case of a perimenopausal female who was diagnosed with synchronous primary ovarian and endometrial endometrioid carcinoma following the use of secukinumab, a monoclonal antibody against IL-17. After eight months of secukinumab, she developed progressive vaginal bleeding, left upper quadrant pain, and abdominal distention. CT imaging displayed a large abdominal mass, and biopsies produced the diagnosis. It is proposed that by inhibiting IL-17, carcinogenesis was expedited. This case highlights a relationship between secukinumab and accelerated carcinogenesis. Consequently, due to the incidence of endometrial carcinoma and the morbidity rate of ovarian carcinoma, individuals taking IL-17 inhibitors may need prophylactic screening and close monitoring.

Ectopic Pregnancy Observed With Kyleena Intrauterine Device Use: A Case Report.

Kyleena (levonorgestrel 19.5 mg), a type of intrauterine device (IUD), has an efficacy rate of 99% in preventing pregnancy. Because the overall failure rate of IUDs is low, ectopic pregnancy (EP) with IUD use is uncommon. This case reports an EP observed in a female with the Kyleena IUD in place. She had no known risk factors for an EP, which makes this case noteworthy. Ultrasound and surgery confirmed a 4 cm EP in the ampulla of the left fallopian tube. Insufficient evidence exists to conclude whether the Kyleena IUD has a higher risk of EP compared to other hormonal IUDs. As the Kyleena IUD becomes a more popular option for women in search of an effective contraceptive, patients and clinicians should be aware of this potential risk. Our case emphasizes that continued research on the prevalence of EP with Kyleena use is necessary.