Medication for opioid use disorder in rural America: A review of the literature.

In rural America, opioid use disorder (OUD) continues to adversely impacted familial, public, and economic systems, creating extraordinary societal and financial burden. This comparative analysis of state-level public health policy and practices in rural opioid use abatement promotes the development and implementation of contextualized evidence-based comprehensive policy initiatives. Policy analysis across select highly affected states (Indiana, Kansas, Kentucky, and West Virginia) and exemplar OUD policy response states (Colorado, Massachusetts, Ohio, and Vermont) was performed using a systematic review of literature, legislation, plans, and policies. Findings included close alignment between states’ OUD policies and public health best practice standards; minimized differences between exemplar and highly affected states policy responses; and resource driven gaps in opioid epidemic legislation, regulation, guidelines, strategic plans, and initiatives. Furthermore, it is advocated that public and private stakeholders committed to health equity must seek reductions in opioid related disease and mortality through increased resource allocation.

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Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211050121 ◽

2021 ◽

pp. 107839032110501

Author(s):

Karen Werder ◽

Alexa Curtis ◽

Stephanie Reynolds ◽

Jason Satterfield

Keyword(s):

Health Care ◽

Treatment Outcomes ◽

Health Care Professionals ◽

Treatment Method ◽

Opioid Use Disorder ◽

Narrative Review ◽

Intentional Stance ◽

Review Of The Literature ◽

Opioid Use ◽

Education Practice

BACKGROUND: Despite an increase in access to medications for opioid use disorder, less than 20% of individuals with opioid use disorder (OUD) receive treatment. Stigmatizing language has been identified as a potential trigger for explicit and implicit biases that may adversely affect treatment enrollment and quality of care for persons with OUD. AIMS: To conduct a narrative review of the literature on stigmatizing language and OUD, examine how treatment outcomes are affected, and present strategies to reduce bias and promote OUD treatment. METHOD: A narrative review of the literature between 2010 and 2019 was conducted using CINAHL, PubMed, and PsycINFO. Key search terms were opioid use disorder (or substance use disorder), stigma, and language. Fifty-two articles were screened for inclusion, and 17 articles were included in this review. RESULTS: The articles reviewed provide consensus that stigmatizing language toward persons with OUD fosters explicit and implicit bias and impedes engagement in treatment. Four themes emerged: (1) stigma and language, (2) stigma and language used by health care professionals, (3) stigma and language used by the general public, and (4) stigma and language used by people with OUD. CONCLUSIONS: Stigmatizing language is dehumanizing and plays a pivotal role in bias and discrimination that may contribute to unsatisfactory treatment outcomes among persons with OUD. Health care professionals, nursing in particular, must assume an intentional stance against stigma perpetuated toward persons with OUD through advocacy in education, practice, policy, and the media.

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Opioid use disorder and rural America

The Opioid Epidemic and Infectious Diseases ◽

10.1016/b978-0-323-68328-9.00003-5 ◽

2021 ◽

pp. 25-38

Author(s):

Wajiha Z. Akhtar ◽

Judith Feinberg

Keyword(s):

Opioid Use Disorder ◽

Rural America ◽

Opioid Use

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Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder

General Psychiatry ◽

10.1136/gpsych-2020-100412 ◽

2021 ◽

Vol 34 (4) ◽

pp. e100412

Author(s):

Colleen B Mistler ◽

Roman Shrestha ◽

John Gunstad ◽

Victoria Sanborn ◽

Michael M Copenhaver

Keyword(s):

Cognitive Dysfunction ◽

Applied Research ◽

Opioid Use Disorder ◽

Cognitive Profiles ◽

Review Of The Literature ◽

Opioid Use ◽

Cognitive Demands ◽

Behavioural Interventions ◽

Comprehensive Collection ◽

Behavioural Therapies

Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions.A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes.Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients’ ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.

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