Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

In September of 2015, SAMHSA awarded the Partnerships for Success (PFS) grant to the State of Alaska  Department of Health and Social Services, Division of Behavioral Health (DBH). The PFS grant program is  a five‐year effort that focuses on preventing and reducing substance use and building prevention  capacity at both the state and community levels. DBH provides leadership for the project and facilitates  the conduct of project activities by community‐level coalitions. Additionally, DBH contracted with the  Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA)  to conduct a comprehensive evaluation of the PFS project.   Using a data‐informed prioritization process to narrow the substance abuse focus of the grant, the State  Epidemiological Outcomes Workgroup chose two PFS priority areas: 1) non‐medical use of prescription  opioids among 12‐25 year olds; and 2) heroin use among 18‐25 year olds. Data on the use of and  consequences related to prescription opioids and heroin in Alaska are described below.  Partnerships for Success (PFS) Priority Area: Non‐Medical Use of Prescription Opioids  Data from the National Survey on Drug Use and Health (NSDUH) indicate that young adults aged 18‐25  consistently have the highest percentage of non‐medical use of prescription pain relievers in Alaska  compared to youth aged 12‐17 and adults aged 26 and older (see Figure 1).1,2,3 While small decreases in  use were observed among all age groups from 2009 to 2014, the age‐specific pattern remained  consistent.   Figure 1. Past year non‐medical use of prescription pain relievers in Alaska from 2009 to 2014 by age  Additional data requested from NSDUH (see Table 1) indicated no significant change in non‐medical use  of prescription pain reliever estimates among 12‐25 year olds in Alaska between years 2007‐2010 and  2011‐2014 but a decreasing trend was observed for past year use and past year prescription pain  reliever dependence or abuse.4 0 5 10 15 2009-2010 2011-2012 2013-2014 Percentage 12-17 years 18-25 years 26+ years 4 Table 1. Past year non‐medical use of prescription pain reliever estimates among individuals aged 12  to 25 in Alaska from 2007 to 2014  1 Dependence/abuse is based on definitions found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV)  Estimates of past year non‐medical use of prescription pain relievers among individuals aged 12 and  older in Alaska are slightly higher than national estimates but both follow a small decreasing trend in use  from 2009 to 2014 (see Figure 2).1,2,3 Figure 2. Past year non‐medical use of prescription pain relievers among individuals aged 12 and older in  the U.S. and Alaska from 2009 to 2014  Other indicators related to non‐medical use of prescription opioids in Alaska have also decreased slightly  or stabilized in recent years. Treatment admissions for synthetic opiates (opiates or synthetics including  Methadone, Oxycodone, or Oxycontin) as a primary, secondary, or tertiary substance of abuse have  stayed relatively stable from 2013 to 2015 (1,052 to 1,011 treatment admissions), according to the  Alaska Automated Information Management System (AKAIMS).5  Age‐adjusted overdose death rates in  Alaska have decreased from 11.2 per 100,000 in 2009 to 8.5 per 100,000 in 2015. Although overdose  deaths from prescription opioids are decreasing, Alaska still has higher rates of overdose deaths from  prescription opioids than the nation overall (7.3 vs. 5.1 per 100,000 in 2012).6 Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental  Health Services (Grant #SP020783) through the State of Alaska, Division of Behavioral Health Background / Survey Methods / Prescription Opioids / Heroin / Conclusion / Reference

Medicaid Policies for Alcohol SBI Reimbursement

The purpose of this report was to review existing reimbursement policies by state Medicaid agency, including the District of Columbia (D.C.), in order to understand similarities and differences associated with financial compensation for alcohol screening and brief intervention (SBI) services. Alcohol SBI is an evidence-based practice known to help reduce atrisk alcohol consumption among patients who drink too much. 1 Although alcohol SBI was designed to be a population-based approach to address unhealthy alcohol consumption, its current utilization is limited. 2 Implementation of the practice into routine clinical care remains a challenge at the health system level even with support from federal resources (e.g., SBIRT: Screening, Brief Intervention, and Referral to Treatment). One way to encourage the uptake of alcohol SBI/SBIRT among providers is to ensure that the service is reimbursable by third-party payers. However, reimbursement opportunities vary by state and payer, and in some locations are non-existent. Information about the current status of policies will assist in the development of policies and incentives to encourage healthcare providers and systems to submit claims for alcohol SBI/SBIRT and potentially increase the routine uptake of the service in clinical careCenters for Disease Control and Prevention Cooperative Agreement Number DD00114

An Acoustic Analysis of Voicing in American English Dental Fricatives

In this study, an acoustic analysis of the dental fricatives as produced by American English speakers from the Buckeye Corpus (Pitt et al. 2006) reveals that the dental fricatives are subject to variation in voicing based on phonetic environment, much more than is usual for a pair of phonemes whose phonological distinction is based on voicing, confirmed by a comparison with the voicing of /f/ and /v/. The results of the study show that voicing (presence or absence of glottal pulses) for /θ/ and /ð/ is not predictable by phoneme in conversational speech, but it is more predictable based on voicing of surrounding sounds

Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.State of Alaska, Division of Behavioral Health Grant #SP020783Executive Summary / Introduction / Methodology / Results / Discussion / Reference

An exploration of the collegiate coach-athlete relationship and its impact on female athlete attitudes and behaviors toward disordered eating and body image

Collegiate female athletes face the challenges of conflicting feminine body ideals in society and in their sport all while striving for athletic success. Coaches are believed to play a significant role in an athlete’s development, and thus have potential to (knowing or unknowingly) reinforce, or even introduce, eating pathology as a means to achieve athletic performance and/or a body ideal. Previous research has found a link between insecure attachment and subsequent eating pathology in athletes and non-athletes alike. The coach can be viewed as an important attachment figure in an athlete’s life and development and thus serve a mediating role for how earlier attachment patterns do, or do not, transfer to an athletes identity, well-being, and functioning. The aim of the present study is to explore (1) the interpersonal dynamics that occur between a collegiate athlete and a coach, (2) the context of this attachment relationship as related to other attachment relationships, and (3) the interaction of these attachment relationships on disordered eating behaviors and negative body image beliefs. Providing a clearer picture of the interactions and relational patterns that can occur between a coach and an athlete will be useful in developing methods and interventions to help increase awareness of the coach’s impact on body image and eating, and to create tailored interventions for both coaches and athletes to access more adaptive attachment representations, coping styles, and ways of being

Effects of Estrogens on Astrocytes Exposed to Stressors

Hormone replacement therapy (HRT), used by many women to alleviate menopausal symptoms such as hot flashes and mood swings, is often a combination ofhormones such as estrogens, progesterone, and conjugated equine estrogens (CEE), extracted from the urine of pregnant mares. Previous studies have found positive correlations between estradiol and cellular protection, but recent research has concluded CEE provide less protective mechanisms as compared to endogenous hormones. This research sought to compare the effects of estrogen treatments (single and combined estrogen) on viability when astrocytes were induced with stressors (epinephrine, cortisol, and low oxygen concentration). Cultured human astrocytes were treated with 17p-estradiol and equilenin, either alone or in combination. Following estrogen treatments, astrocytes were induced with stressors, and an MTT assay was used to measure cell viability. Estradiol was expected to provide the most protection as a single hormone treatment for all three stressors. Higher concentrations of equilenin either alone or in combination with estradiol yielded significantly lower cell viability following epinephrine and cortisol stressors. There was no viability difference found in astrocytes stressed with low oxygen concentration. The analysis of this research helped to elucidate the relative protective effects of two forms of estrogens. Future research on estrogen binding using primary human astrocytes and neurons would help further understand the neurological effects of estrogens neurologically. The implications of this study suggest HRT could be detrimental to neurological cells, and these negative effects are dose dependent

Use of Chinese medicine by cancer patients: a review of surveys

Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English

Medication Assisted Treatment in the Primary Care Setting: A Prospective Review

Introduction: Project HOME Health Services (PHHS) initiated a Medication Assisted Treatment program for Opioid Use Disorder in a primary care setting that is the first of its kind in the city of Philadelphia. This study assesses the MAT program by evaluating the Quality of Life (QoL) of the participants as well as their perception of the program. Objective: The purpose of this study is to assess the QoL of the participants in the MAT program at PHHS and to evaluate the participants’ satisfaction with the program. Methods: The population includes patients enrolled in the MAT program at PHHS who consented to complete a survey. Participants completed the WHOQOL-BREF and the Mental Health Statistics Improvement Program (MHSIP) surveys. Scores for the four QoL domains were calculated. Results: Participants in the MAT program have lower QoL scores in all four domains than the general population. Most participants were satisfied with the program. The large group sizes and the identification of participants in public waiting areas are two examples of what participants liked the least. Conclusion: The QoL of individuals in this MAT program is lower than that of the generation population. While there was overall satisfied with the program, specific areas of improvement should be and have been addressed. The survey responses have allowed the staff to make necessary changes that directly impact the participants. This study will be continued to assess for other potential improvements to the MAT program, which could directly benefit its participants