High-risk Individuals and Naloxone Use: Implications for THN Programs in Rural Appalachian Communities

Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others. Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of Good Samaritan Laws. Methods: The findings are based on a subsample 16 overdose victims who were identified during a one-year (2018) qualitative study on the decline of overdose fatalities in four rural counties in Western Pennsylvania. They were recruited from a larger sample of 50 current and former substance users and were interviewed a second time using a semi-structured interview guide about their overdose experiences. All interview data were analyzed using thematic analysis via NVivo. Results: Findings reveal that risk factors contribute to a severe opioid dependence that interferes with naloxone use. These factors also hinder adherence to proper naloxone protocol, designed to place overdose victims in contact with treatment providers. Implications: Recommendations are made for additional research and for pursuing measures to increase efficacy of naloxone interventions. They include developing naloxone campaigns aimed at high-risk individuals, improving their knowledge of Good Samaritan Laws, increasing adherence to THN protocols that improve the possibility of treatment, and using community harm reduction specialists for community outreach

Executive control of task switching operations.

In many everyday situations people must rapidly switch back and forth between two or more tasks in which they are engaged. Some theorists have proposed that such task switching requires special "central executive" mental operations of the kind reaching highest development in our species. This dissertation reviews all previous research on task switching and reports six behavioral experiments investigating these operations. Subjects were required to switch between two visual-manual tasks while various factors such as the amount of practice, the complexity of the two tasks, the interference between the two tasks, and the length of the response-to-stimulus interval were varied. Data from these experiments support a two-stage model of task switching in which subjects first shift task goals and then activate the relevant response-selection rules before beginning processing for the new task. In addition, evidence is found for possible switching-context effects on task-specific stages of processing including response selection and response verification operations.Ph.D.PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104816/1/9610178.pdfDescription of 9610178.pdf : Restricted to UM users only