Development of an eHealth Harm Reduction Resource to Address Opioid Use Among Youth in Rural Northern California

Problem: Opioid use and misuse is a leading cause of injury and death among adolescents and young adults in the United States, with a three-fold increase in opioid overdoses since 2000 (Carney et al., 2018; Hudgins et al., 2019). Opioid misuse correlates with misuse of other substances, which exponentially increases health risks over time. The most effective treatment for opioid use disorder (OUD) among adolescence is through effective prevention interventions that either prevent the development of the OUD or enable timely diagnosis and treatment in order to prevent poor health outcomes. Context: The use of eHealth technology, which has been successfully used in the management of other chronic diseases, including hypertension and diabetes mellitus, is one proposed intervention to prevent OUD among youth and to connect them with treatment resources (Nuamah et al., 2020). This technology could be particularly useful among youth due to their familiarity with and affinity towards using technology in their everyday lives. Granite Wellness Centers (GWC), a drug and alcohol treatment organization in rural Northern California, received grant funding from The California Youth Opioid Response (YOR California), to design and develop an eHealth resource to address OUD among youth ages 12 years to 24 years in rural Northern California communities (California Institute for Behavioral Health Solutions, 2015). This project sought to design and develop an eHealth resource and to conduct a pilot program. Interventions: A youth focus group and online survey were conducted to gather stakeholder data and input regarding the design for the eHealth drug resource. The stakeholder data informed the design and development of the GWConnect mobile app, to include culturally-informed harm reduction tools, such as unbiased, evidence-based drug information; news alerts; ask-a-provider feature; and local treatment resources. An 80-day pilot program was conducted to assess effectiveness of the app. Outcome Measures: A pre/post pilot survey was administered to assess change in youth knowledge of drugs, knowledge of local drug treatment resources, and the likelihood that youth would use the app to access information on drugs and local treatment resources. The surveys also assessed whether youth found the app to be effective in delivering the aforementioned content and their level of satisfaction with the app. Results: Through data analysis, results indicated a 26.47% increase in knowledge about drugs and a 20.32% increase in likelihood youth would use a mobile app to access information on drugs. Interestingly, even though the greatest increase was observed in knowledge of drug treatment resources and how to access them (45.83%), there was only a slight increase in the likelihood youth would use a mobile app to access information on treatment resources (14.09%). Overall, the pilot program participants were satisfied with GWConnect and found it to be effective. Conclusions: Increased knowledge can empower youth to make informed decisions preventing substance use disorder and/or reducing harm related to risky behaviors Increased knowledge of treatment resources can improve timeliness of treatment initiation and reduce harm associated with untreated substance use disorder. The overarching aim of GWConnect is to reduce the incidence of OUD and overdoses among rural youth in Northern California; therefore, future longitudinal research is needed to assess its effectiveness over a period of time. Keywords: Opioid use disorder/OUD, prevention, treatment, youth, adolescents, mobile application, mobile app, app, eHealth resource, and eHealth technology

Overdose alert and response technologies : state-of-the-art review

Funding: Technology Enabled Care program of the Scottish Government.Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective: Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods: We conducted a “state-of-the-art review.” A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results: Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%). Conclusions: There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them.Publisher PDFPeer reviewe

Innovations in Opioid Law and Policy Interventions Workshop: Summary of Proceedings

In 2017, Indiana University, in cooperation with Indiana Governor Eric Holcomb and community partners, launched the Grand Challenge: Responding to the Addictions Crisis initiative, a university-wide effort to advance interdisciplinary research and interventions in response to the substance abuse crisis affecting Indiana and the nation. The “Legal and Policy Best Practices in Response to the Substance Abuse Crisis” project is one of sixteen funded under Phase 1 of the Grand Challenge. In July 2018, and as part of this project, the research team convened a group of national experts to discuss legal and policy innovations to respond to the opioid use disorder (OUD) crisis. This report summarizes the proceedings of this workshop and updates some of the recommendations made by the team in their March 2018 Preliminary Report. During the workshop, experts answered targeted questions relating to the challenges in implementing law and policy recommendations to respond to the addiction crisis, as well as identified gaps in the current research. Participants provided examples of innovative interventions to respond to this crisis across four primary topic categories: (1) Criminalization; (2) Public Health; (3) Treatment; and (4) Effectuating Change

Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

Purpose of Review To describe models of integrated and co-located care for opioid use disorder (OUD), hepatitis C (HCV), and HIV. Recent Findings The design and scale-up of multidisciplinary care models that engage, retain, and treat individuals with HIV, HCV, and OUD are critical to preventing continued spread of HIV and HCV. We identified 17 models within primary care (N = 3), HIV specialty care (N = 5), opioid treatment programs (N = 6), transitional clinics (N = 2), and community-based harm reduction programs (N = 1), as well as two emerging models. Summary Key components of such models are the provision of (1) medication-assisted treatment for OUD, (2) HIV and HCV treatment, (3) HIV pre-exposure prophylaxis, and (4) behavioral health services. Research is needed to understand differences in effectiveness between co-located and fully integrated care, combat the deleterious racial and ethnic legacies of the “War on Drugs,” and inform the delivery of psychiatric care. Increased access to harm reduction services is crucial

COVID-19 pandemic impact on harm reduction services : an environmental scan

The COVID-19 pandemic has profoundly worsened the overdose crisis in the U.S. and magnified disparities in access to health care, social services and other basic needs experienced by people who use drugs (PWUD) and people with substance use disorders (PWSUD). Overdose rates are rising steadily, with death rates estimated to be 22.8% higher in July 2020 compared to July 2019. For decades, harm reduction organizations have provided essential, nonjudgmental services that promote safer drug use, prevent overdose death, link people to treatment and recovery supports and support holistic health.To better understand the impact of the pandemic on harm reduction organizations and PWUD, the National Council for Behavioral Health, with support from the Centers for Disease Control and Prevention (CDC), conducted an environmental scan consisting of a literature review and 21 key informant interviews with staff from harm reduction organizations in the U.S. Information collected through the literature and from key informants demonstrate that the pandemic has resulted in: 1) increased health and social harms to PWUD, 2) significant disruptions to harm reduction services and operations and 3) innovative adaptations by harm reduction organizations to continue to serve the needs of participants.The COVID-19 pandemic has resulted in increased health and social harms among PWUD. Rates of substance use and their associated harms, such as skin and soft tissue infections due to reduced access to safer use supplies or fear of seeking medical care in emergency departments (EDs), have increased and worsened. Meanwhile, mental health and peer supports are limited, as public health guidance to isolate from others to reduce COVID-19 transmission contradicts harm reduction\u2019s messaging to never use alone.There has been significant disruption to harm reduction services due to the pandemic and, in some cases, they have been suspended or terminated. Staff and volunteer hours have been reduced to limit in-person interactions in accordance with public health guidance; however, reduced staff capacity in tandem with the increased need for services has resulted in high rates of staff burnout. Disruptions in the supply chain have led some organizations to struggle to provide participants safer use supplies, while others are unable to provide HIV and hepatitis C testing due to risks of COVID-19 transmission. Further, social distancing protocols have prevented staff and participants from engaging in social activities that are integral to the harm reduction community.The National Council for Behavioral Health developed this environmental scan with support from the Centers for Disease Control and Prevention (CDC). The project team would like to thank all of the key informants who generously devoted their time, expertise and resources to inform this report at an incredibly challenging time during the COVID-19 pandemic.This publication was made possible by grant number 6 NU38OT000318-02-02 from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $750,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.Harm-Reduction-Environ-Scan.pdf?daf=375ateTbd562021grant number 6 NU38OT000318-02-02 from the Centers for Disease Control and Prevention1074

Feasibility and Acceptability of Mindfulness-Based Relapse Prevention and Adjunct Mobile Technology in Rural Communities

While problematic substance use transcends geographic regions, rural communities appear to be especially impacted. More prevalent problematic substance use and associated problems in these areas are exacerbated by lack of consistent access to evidence-based practices. Mindfulness-Based Relapse Prevention (MBRP) combines standard cognitive-behavioral relapse prevention with formal and informal mindfulness training, and may be a novel and effective treatment approach for substance use disorders (SUD) in these isolated areas. The current study explored feasibility and acceptability, and potential differences in variance accounted for by group randomization on substance use and secondary outcomes, between MBRP and treatment as usual (TAU) in a rural treatment setting, as well as the impact of a specially designed mobile application on treatment engagement and enactment. No differences were observed in variance of substance use or secondary outcome by groups; however, participants in TAU vs. MBRP were more likely to drop out of treatment against medical advice. The mobile application did not appear to impact treatment engagement or enactment. Implications and limitations are discussed

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Risk Reduction Regarding Stigmatized and Marginalized Communities

While there are several perspectives on marginalization, there are multiple marginalized individuals, social groups, and communities globally. This process of marginalization produces individuals, groups and communities which are refused complete privileges, rights, and power within the broader political and social framework. Social, cultural, biological, and economic factors can thus be used as yardsticks to marginalize individuals and communities. Marginalization can be based on gender, race and ethnicity, social class, and sexuality, among others. Clearly, marginalized communities face poorer health outcomes and these outcomes are sometimes linked to risky behaviors more prevalent in such demographics. Marginalization is associated with reduced health outcomes and can limit the agency of marginalized communities. However, even within sites of marginalization, affected communities make significant attempts to mitigate health risks and retain agency. For example, marginalized men who have sex with men in China face severe discrimination which affects their health outcomes. Even within such contexts, these men still encourage peers to receive sexually transmitted infection testing. I explore how marginalized communities reduce health risks likely produced by marginalization and retain agency through doing so. I explore sexually transmitted infection testing and related issues in Chinese men who have sex with men, the United States legal cannabis industry, and medication for those with opioid use disorder. In doing so, I will provide understanding on risk reduction of health behaviors in marginalized communities, building a knowledge base to aid overall health outcomes. In the first chapter, I detailed a range of cannabis-centric studies. First, I detailed cannabis usage preferences among United States cannabis users. I put forth that frequent cannabis use may increase risk of health harms and highlighted the need to minimize problematic use. I also explored sociodemographic indicators and their association with likelihood for cannabis-related emergency department admissions in New York City. Results suggested that cannabis use may further burden marginalized groups. I investigated large cannabis firms’ motivations for participating in the cannabis space. I put forth that policymakers be aware that non-profits and for-profits both seek to expand cannabis access and consider the groups as a unified whole. In the second chapter I explored concerns regarding sexually transmitted infection testing in the Chinese men who have sex with men environment. I first detailed factors associated with sexually transmitted infection testing. Results detailed the role of altruism in a sexually transmitted infection testing intervention. Expressions of altruism may promote contributions toward public health initiatives in marginalized communities. In the same vein, I detailed the association between men who have sex with men community-centric behaviors and contributions toward others’ sexually transmitted infection testing. I proposed that community-oriented behaviors may be related with a reduction in testing service costs. Then, I evaluated whether men who have sex with men selected a sexually transmitted infection test appropriate for their sexual behavior. I suggested that disclosing sexual identity to treatment providers can improve men who have sex with men sexually transmitted infection prevalence estimates. I also detailed the correlates of antisocial behavior on the world\u27s largest gay dating app among Chinese men who have sex with men. I suggested that age, condom use, and number of social ties may be associated with antisocial behavior, with implications for the design of online sexual health interventions. Finally, I assessed if same-sex sexual behavior disclosure of Chinese men who have sex with men was related to number of HIV self-testing kits requested, and number of test results successfully uploaded by alters in a network-based HIV self-testing intervention. Findings had implications for the development of network-based interventions for key populations. In the final chapter I detailed that various forms of social network support may influence medication for opioid use disorder treatment outcomes. Failure to implement successful social network support programs within medication for opioid use disorder treatment settings may represent an important missed opportunity to engage patients at risk of treatment failure. While the topics here are broad, they all share similar thematic arcs. Low sexually transmitted infection testing uptake, opioid use disorder and cannabis use are issues often disproportionately faced by marginalized communities. Establishing marginalization as the causal factor behind these concerns is often complex, but there is significant work indicating that problematic patterns of drug use and poor sexual health outcomes are engendered by marginalization. Marginalization is associated with conditions inimical to health and well-being, creating a host of health risks. Such marginalization limits the agency of affected communities. However, even within these sites of marginalization, men who have sex with men seek testing and opioid use disorder patients seek medication, mitigating health risks borne from marginalization. I advance that marginalized communities are not completely helpless considering reduced health outcomes, indicating how agency is reclaimed. Finally, I indicated other cases where fostering agency in marginalized communities needs to be carefully considered

Overdose Alert and Response Technologies: State-of-the-art Review

Background:Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses.Objective:Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated.Methods:We conducted a “state-of-the-art review.” A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject.Results:Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%).Conclusions:There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them