Establishing Peer Recovery Support Services to Address the Central Appalachian Opioid Epidemic: The West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS) Pilot Program

Introduction: Central Appalachia has been disproportionately affected by the opioid epidemic and overdose fatalities. We developed West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS), a program based on peer recovery support, to engage individuals using opioids and link them with a range of services. Methods: Community partners providing services to individuals with opioid use disorder (OUD) were identified and collaborations were formalized using a standardized memorandum of understanding. The program was structured to offer ongoing peer recovery support specialist (PRSS) services, not just a one-time referral. A website and cards describing the WV PEERS program were developed and disseminated via community partners and community education sessions. Results: Overall, 1456 encounters with individuals with OUD (mean= 2 encounters per individual) occurred in a variety of community settings over 8 months. The majority of referrals were from harm reduction programs. Overall, 63.9% (n=931) of individuals served by WV PEERS accessed services for substance use disorders and/or mental health problems. Over half (52.3%; n = 487) of individuals entered substance use and/or mental health treatment, and nearly a third (30.4%; n = 283) remained in treatment over six months. Implications: Using the WV PEERS model, PRSSs effectively engaged and linked individuals with OUD to mental health and substance use treatment in rural central Appalachia. Future research is needed to determine whether these services reduce the risk of overdose mortality

Open doors and closed frontiers: the limits of American empire

This article argues that the contemporary American empire displays two structural limits. The first refers to geographical limits. As opposed to most of its imperial predecessors, the logic of contemporary US power militates against direct, territorial domination as a means of sustaining global hegemony. The second limitation, tightly linked to this first one, is that of power defined in a conventional sense as the capacity to secure outcomes. Consequently, since 1945 the USA has generally projected its global power through open doors (capitalist markets) and closed frontiers (sovereign territorial states). The article explores the peculiar limits to US empire with reference to two of its principal western precursors — the Roman and British empires — and concludes that the recent invasion and occupation of Iraq highlights the perils of an American strategy that seeks to conquer territories militarily and politically control their populations

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery