Beyond Fentanyl Test Strips: The Need To Decriminalize All Drug Checking Equipment In Tennessee, Jeremy C. Kourvelas Mph

SMART Policy Briefs

KEY POINTS

• In 2022, Tennessee decriminalized fentanyl test strips (FTS) through Public Chapter 764. Thousands have since been distributed by the state and nonprofit coalitions as a key harm reduction strategy. As of the end of 2023, 44 other states and D.C. had also decriminalized FTS.

• Research indicates that people who use drugs are five times as likely to change their behaviors (including reducing drug use overall) in response to a test result that is positive for fentanyl. People who use methamphetamine are especially likely to change their behaviors.

• However, the law only applies to “narcotic testing equipment used to …

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Deconstructing Drugs: Addressing The Stigma, Harm Reduction, And Policy Solutions, Charlotte Theriault

Themis: Research Journal of Justice Studies and Forensic Science

Black and homeless people who struggle with substance use disorder (SUD), especially opioid use disorder (OUD), have experienced unique obstacles due to inequalities relating to their social determinants of health (SDOH). Historical context and peer-reviewed research were used to evaluate racial bias and expand upon the factors that contributed to the opioid crisis, the effects of COVID-19 on drug overdoses, and the presence of fentanyl in illicit drug supplies. Various studies combat the stigma surrounding substance use disorder (SUD) by acknowledging the disease as a chronic health condition. Research showed that the most effective way to combat these inequalities and …

Dance/Movement Therapy: A Novel Approach For Latino Males With Incarceration Histories In Sud Treatment, Aletia Egipciaco

Expressive Therapies Capstone Theses

This paper investigates how open clients would be to participating and engaging in Dance/Movement Therapy (DMT) sessions at a residential SUD facility. The questions asked were (1) What level of engagement would clients have and (2) How would they engage in DMT group sessions at a residential substance use disorder facility? A program lasting 8 weeks, aimed at facilitating DMT group sessions, was conducted at a residential SUD facility twice a week. The objective was to assess participant engagement levels and observe their involvement in the DMT sessions. Residents of the facility were invited voluntarily to attend the DMT groups. …

States’ Covid-19 Restrictions Were Associated With Increases In Drug Overdose Deaths In 2020, Douglas A. Wolf, Shannon M. Monnat, Jennifer Karas Montez, Emily E. Wiemers, Elyse Grossman

Center for Policy Research

Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies …

Trends In Substance Use And Mental Health Among Adolescents In Georgia, 2002-2022, Saumya S. Palipudi, Bangaru Talli Palipudi, Murty Komanduri

Georgia Public Health Association Annual Meeting and Conference

Background: While substance use and absence of mental health disorders among youth in the United States (US) have declined over the past two decades, post COVID-19 pandemic, these conditions have increased significantly with notable disparities, and witnessed a crisis in public health. In 2022, 24.7% or 6.1 million adolescents aged 12 to 17 in the US had either Major Depressive Episodes (MDE) or Substance Use Disorder (SUD) and 3.7 percent had both in the prior year². Increased stress, lack of peer connections, parental abuse, and poor mental health conditions were attributed to this increase in substance use^{3-7 …}

The Long And Winding Road: What Comes Next After Detox, Michelle Pryce, Karen Lasater

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Detoxification centers are specialized facilities treating patients with substance use disorder (SUD). The detoxification process is a medically managed treatment where substances are slowly weaned from the body. This process lasts approximately 5-7 days. Most patients meet the criteria for SUD upon admission, but do not seek specialized post-discharge treatment, which has been found to increase long-term sobriety.

LOCAL PROBLEM: The site was a 16-bed adult detoxification center located in South Carolina. The operations manager identified there was no standardized discharge educational planning process to support long-term sobriety. This project’s aim was to increase the percentage of …

Fos Expression In Lateral Hypothalamus/Perifornical Area Is Correlated With Psychosocial Stress-Induced Cocaine-Seeking Behavior In A Sex-Specific Manner, Milena Sudarikov, Nicole M. Hinds, Ireneusz D. Wojtas, Desta M. Pulley, Daniel F. Manvich

Rowan-Virtua Research Day

Cocaine Use Disorder persists as a significant public health concern in the United States. Recent epidemiological data indicate that rates of cocaine-involved overdose deaths are rising, and treatment of Cocaine Use Disorder is challenging due to a lack of FDA-approved medications to help patients achieve abstinence and avoid relapse. Stress can precipitate cocaine craving and trigger relapse episodes, however the underlying neural circuitry by which stressors drive cocaine seeking is not completely understood. Our laboratory has recently identified the potential involvement of the rostrolateral aspect of the periaqueductal gray (rlPAG) in psychosocial stress-induced cocaine-seeking behavior using a rodent model of …

Evaluating The Prevalence Of Postpartum Substance Use In South Jersey, Hebba Ahmad, Joanna Petrides

Rowan-Virtua Research Day

The goal of this study was to evaluate the prevalence of substance use among women who experience postpartum depression. Looking at South Jersey women in particular, we aimed to compare the rates of women who began to engage in substance use after undergoing labor within the past one year who are covered by private health insurance versus those with Medicaid coverage. A retrospective chart review was performed, and although the small sample size limited our attempts at data analysis, it revealed that there is work to be done in this field. There needs to be methods in reducing the stigma …

Spot The Signs - Comunicación Es Lo Más Importante, Daniel Rios, Victoria Wong Murray, Alexus Weatherspoon, Amy Palen, Kenneth W. Stagliano, Stephen M. Scheinthal

Rowan-Virtua Research Day

Opiate overdose is an unfortunately common risk factor for suicide; suicide attempts accounted for an estimated 30% of fatal opioid overdoses during the pandemic. As a result, the Rowan School of Osteopathic Medicine Department of Psychiatry developed an Integrated Mental Health Awareness and Suicide Prevention program targeted at members of the community and frontline workers to increase awareness and provide brief interventions, which demonstrated an improvement of 89% in our English-speaking attendees.

Spanish is the most common non-English language in New Jersey, with an estimated 1.3 million speakers. Hispanic patients also frequently experience culturally bound stigmas, so it is vital …

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Back From Baclofen: A Case Report Of Baclofen Overdose, Alexis M. Dunn, Andrew M. Vasta, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 45-year-old female who presented with intentional Baclofen overdose. The patient was lethargic and then quickly unresponsive and hypotensive, intubated by EMS in the field. By the time the patient was admitted to the Intensive Care Unit (ICU), the patient was clinically brain dead. After several days of supportive care, patient slowly, and miraculously, regained full neurologic functioning and was admitted to the Psychiatric Unit.

Over The Counter Overdose: A Case Of Tylenol Toxicity, Swet M. Patel, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 51-year-old man presenting to the Emergency Department (ED) with suicidal ideations (SI) endorsing an intentional overdose of acetaminophen. Just as important is the clinical presentation; it is equally important to obtain a detailed history of patient's presentation leading to the ED visit when evaluating a suicide attempt. Tylenol (acetaminophen) is a common over the counter (OTC) medication available to the public. Management of Tylenol overdose follows a standard outline of things to observe and intervene on. In this case, we discuss how Tylenol overdose is managed in a clinical setting through a patient who …

Opioid Prescription Rates Before And After Alto Program And Various Factors Affecting Emergency Department Opioid Prescription Rates, Neel B. Patel, James F. Baird

Rowan-Virtua Research Day

Opioid prescription rates vary between patient population, diagnosis, location, and emergency department characteristics. High prescription rates offer an avenue for potential opioid addiction and overdoses. Alternatives to opioids (ALTO) is a new program already implemented in certain emergency departments to help change opioid prescription rates by introducing new protocols for first line treatments for pain management. With current trends still showing that South Jersey opioids prescription rates are the highest in the state of New Jersey, ALTO was introduced at Inspira Health Network located in South Jersey. This study retrospectively analyzed opioids prescription rates for abdominal pain, renal colic, migraines, …

Review Of Missing Data Elements For Client Enrollment In The Minority Aids Initiative For High-Risk Men Of Nj, Vrushank Shah

Rowan-Virtua Research Day

The Minority AIDS Initiative study funded in NMI seeks to enhance healthcare outcomes for underserved individuals. Implementing outreach programs, the initiative provides healthcare and post-treatment follow-up to this demographic. The proposed project, a component of this study, concentrates on individuals with substance abuse disorder, specifically targeting those who have been onboarded but subsequently lost to follow-up. In the United States, approximately 20 million people are diagnosed with substance abuse disorder, yet in 2016, only 3.8 million received treatment. Within this cohort, between 20% and 70% of individuals undergoing residential substance abuse treatment disengage before completion. Various factors hinder the sustained …

Bridging Gaps In Opioid Use Disorder Treatment: Prehospital And Emergency Department Interventions, Quin W. Buob, Zachary J. Noll

Rowan-Virtua Research Day

Since 2011, drug overdose has been the leading cause of accidental death in the United States, with two-thirds of these deaths related to opioid drugs. In 2020, the CDC reported an increase of over 91,000 overdose-related deaths. Also, non-fatal overdoses face a 5.5% one-year mortality rate post discharge, with a significant portion subsequently overdosing within 48 hours.

Access to Buprenorphine/Medication-Assisted Treatment (MAT) has been instrumental in reducing opioid-related mortality by over two-thirds, yet treatment initiation remains significantly low. Limited access stems from socioeconomic disparities and insufficient substance use treatment resources.

Emergency departments (EDs) have pioneered Buprenorphine inductions, showcasing variable success …

Efficacy Of Psilocybin In The Treatment Of Substance And Alcohol Use Disorders, Hanna Brancaccio

Rowan-Virtua Research Day

Introduction: Substance use disorder (SUD) and alcohol use disorder (AUD) are major public health crises, affecting millions of Americans. Current treatment options include behavioral therapies and medications. In this review, we explored psilocybin’s efficacy in treating SUD and AUD.

Methods: Key terms were used to search databases to identify articles that addressed psilocybin in the treatment of SUD. Included in the review were indexed, peer-reviewed, primary sources that were published within the last 10 years. Excluded studies were non-peer reviewed, not relevant to the thesis, and did not have an English translation.

Results: The psychodynamic antidepressant effects of psilocybin mark …

Intra-Accumbens Microinfusion Of The Dopamine D3 Receptor Partial Agonist (±)Vk4-40 Does Not Affect Basal Locomotion In Mice, Yeonwoo Sim, Nicole M. Hinds, Amy Hauck Newman, Daniel F. Manvich

Rowan-Virtua Research Day

The opioid epidemic remains a pressing public health crisis, prompting the search for alternative pharmacotherapies for Opioid Use Disorder (OUD). This study explores the potential of the dopamine D3 receptor (D3R) partial agonist, (±)VK4-40, as a novel treatment option. We investigated the impact of intra-nucleus accumbens (NAc) microinfusion of VK4-40 on basal locomotion in mice. Results indicate that VK4-40 did not significantly alter basal locomotion, suggesting that its therapeutic effects may not be mediated through disruptions in generalized motor function. Future research will focus on elucidating the neuropharmacological mechanisms underlying VK4-40's therapeutic actions and exploring its effects on psychostimulant-induced hyperlocomotion. …

Barriers In Obtaining A Naloxone Co-Prescription For Patients Who Are Prescribed Opioids For Pain Management, Sonika Vatsa

Rowan-Virtua Research Day

As the prevalence of chronic pain rises, the number of patients prescribed opioids is increasing. Consequently, the rate of opioid overdose has increased, becoming a public health concern.For these reasons, the Center for Disease Control and Prevention recommended co-prescribing naloxone, a medicine that reverses the effects of opioid overdose.While this medication can be lifesaving, it is not accessible or available to everyone in need of it. A systematic review of existing literature pertaining to the barriers in patients receiving naloxone was conducted to evaluate the major obstacles in patients receiving a naloxone co-prescription. The results show that the major deterrents …

Spot The Signs- 防范未然，及时干预- 培训, Kenny Kah-Keng Leng, Victoria Wong Murray, Alexus Weatherspoon, Amy Palen, Kenneth W. Stagliano, Stephen M. Scheinthal

Rowan-Virtua Research Day

Opiate overdose is an unfortunately common risk factor for suicide; suicide attempts accounted for an estimated 30% of fatal opioid overdoses during the pandemic, and patients with an episode of opiate overdose were at an 18 times higher risk of suicide in the following year. As a result, the Rowan School of Osteopathic Medicine Department of Psychiatry developed an Integrated Mental Health Awareness and Suicide Prevention program targeted at members of the community and frontline workers to increase awareness and provide brief interventions, which demonstrated an improvement of 89% in our English-speaking attendees.

Chinese is the second-most common non-English language …

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Ketamine Crisis: Case Report On The Complications Of Ketamine Usage And Its Rise In The United States, Shika Veera, Vajreshwari Shivaprakash Md

Rowan-Virtua Research Day

The recreational use of ketamine poses various health risks, including addiction, cognitive impairments, and physical harm.

The patient is a 24-year-old female who presented with 30 lbs. unintentional weight loss, generalized weakness, and urinary incontinence over four months. She endorses right upper quadrant and suprapubic pain with occasional gross hematuria. The patient denied recreational drug use. Urine drug screen was negative. Gynecologic exam and STI testing were without concerns. On exam, she had positive right lower quadrant tenderness, suprapubic tenderness, and costovertebral angle tenderness bilaterally. The patient was admitted to the ICU due to weakness and significant hyponatremia at 115. …

“Lupus, Marijuana, And Takotsubo: A Perfect Storm”: An Unusual Presentation Of Takotsubo Cardiomyopathy, Matthew Orap, Parth Patel, Haitham Dib

Rowan-Virtua Research Day

Takotsubo cardiomyopathy is a type of myocardial injury that is marked with left ventricular contraction dysfunction. Various regions of the left ventricular wall may exhibit hypokinetic or hypercontractile activity. There is no exact mechanism elucidated for Takotsubo cardiomyopathy, but it is often associated with a triggering stressful event that leads to a catecholamine surge. We describe a 38-year-old female who presented with typical Takotsubo cardiomyopathy, likely in the setting of worsening systemic lupus erythematosus (SLE) exacerbations and excessive cannabis use. The patient described her pain as a tight burning sensation that started on her right side and traveled to the …

Molecular Mechanisms Of Opioid Use Disorder In Human Brain Models, Emily Mendez

Dissertations & Theses (Open Access)

Opioid use disorder (OUD) is a national and global public health crisis with no end in sight. While studies from animal models hint at widespread epigenetic and transcriptomic alterations of opioid drugs, the molecular consequences of long-term exposure to opioid drugs in human brain is still unclear, and human-centered translational models are necessary to discern the human cell type-specific effects of OUD.

Using postmortem brain Brodmann area 9 (BA9) from the UTHealth Brain Collection for Research on Psychiatric Disorders, I identified angiogenic gene networks perturbed in the RNA and protein of OUD subjects, as well as downregulation of many neuron-correlated …

States’ Covid-19 Restrictions Were Associated With Increases In Drug Overdose Deaths In 2020, Douglas A. Wolf, Shannon M. Monnat, Jennifer Karas Montez, Emily E. Wiemers, Elyse Grossman

Population Health Research Brief Series

Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies …

Understanding The Perspectives And Attitudes Of 12-Step Participants Towards Medication-Assisted Treatment, Christopher Scott

Electronic Theses, Projects, and Dissertations

Background: The effects of living with a substance use disorder (SUD) are vast. Medication-assisted treatment (MAT) has grown increasingly popular as a recovery tool among substance users but does not align with the popular 12-step model, which demands complete abstinence from narcotics and mind-altering substances. Objective: The primary aim of this phenomenology study was to explore the perspectives and attitudes towards MAT among 12-step participants. The secondary aim was to compare the responses of treatment and non-treatment professionals. Methods: This study used non-probability sampling methods to recruit participants who reported regular participation in a 12-step program. Semi-structured …

Sufferance For Snuff Puffs: The Acceptability And Behavior Of Smoking Marijuana And Tobacco Inside The House, Eusabeia Silfanus, Oliver Lopez, Vincent Berardi

Student Scholar Symposium Abstracts and Posters

Secondhand smoke (SHS) released from indoor smoking contributes to household air pollution, releasing large quantities of fine particulate matter which can pose negative health outcomes, especially for developing children who spend most of their time at home. The increased legalization of marijuana increases its recreational and medicinal use along with its acceptability. With tobacco use remaining prevalent, the use of marijuana and/or tobacco remains common and may occur inside the home. Project Fresh Air conducted in San Diego County studies the air quality in households (n = 298) with at least one adult smoking tobacco and/or marijuana living with at …

Opioid-Related Emergency Department Visits Before And During Covid-19: Association With Community-Level Factors, Timothy F. Page, Weiwei Chen, François Sainfort, Julie A. Jacko

HCA Healthcare Journal of Medicine

Background

The purpose of the study was to investigate the relationship between community-level variables and emergency department (ED) visit rates before and during COVID-19. The focus was on opioid-related ED visits. Despite large declines in overall ED visits during COVID-19, opioid-related visits increased. While visits for avoidable conditions decreased, the opposite was true for opioid-related visits.

Methods

We combined data from Florida EDs with community-level variables from the 2020 American Community Survey. The outcome measures of the study were quarterly ZIP code tabulation-area-level ED visit rates for opioid-related ED visits as well as visit rates for all other causes. Associations …

Drivers Of Being Unhoused And The Prevalence Of Health Conditions Among Unhoused Individuals In Asheville, Nc, Andrea K. Yontz, Amber Beane, Tessa Frank, Amy Upham, Dustin V. Patil, Dan Pizzo, Steve Buie, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background

During the COVID-19 pandemic, there was an increase in the number of unhoused individuals in Asheville, North Carolina resulting in more tent encampments.

Understanding the physical, mental, and socially determined health characteristics associated with being unhoused can help guide stakeholders with policy development, healthcare program planning, and funding decisions to support unhoused individuals.

Methods

In this study, we used an observational cross-section methodology. Using a convenience sample approach, we interviewed 101 participants who were receiving services from 2 emergency hotel shelters, a day center, and a resource center. Data were analyzed using descriptive statistics, and open-ended responses were collected …

Medication Assisted Therapy And First Episode Psychosis: Evaluating Treatment And Readmission Rates, Kayla Sherea Williams Bsn, Rn, Hannah Lee Brenner Bsn, Rn, Madison Makenzie Yount Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc

Doctor of Nursing Practice Projects

Background The Centers for Disease Control and Prevention (CDC) found that each day more than 140 U.S. residents die from drug overdoses, specifically due to opioids. Due to this, alternatives were created to reduce overdoses and ensure safety. Medication assistance therapy (MAT) is an effective form of treatment for people with substance use disorders and is defined as the use of medication in conjunction with counseling or therapy for the treatment of substance use disorders. The efficacy of MAT is used adjunctively with psychotropic medications compared to using no MAT and using psychotropic medications alone with individuals who are experiencing …

Referral To In-Person Smoking Cessation Counseling As A Smoking Cessation Aid, Annie Mandrell Bsn, Rn, Matthew Keathley Bsn, Rn, Lewis Linden Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid

Purpose/Background

Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person …

Differential Behavioral Responses In Male And Female Mice Lacking Either Rgs2 Or Rgs4 Proteins After Acute Administration Of Antidepressants And Anxiolytics, Hiroyoshi Matsui, Sarah Seeley, Manoranjan S. D'Souza

ONU Student Research Colloquium

The overall objective of the study was to assess the acute behavioral effects of currently used antidepressants and anxiolytics in male and female mice lacking regulator of G protein-signaling (RGS) proteins 2 and 4 and their wild-type counterparts. RGS 2 and 4 proteins negatively modulate signaling pathways of G protein-coupled receptors (GPCRs), which play an important role in mediating the effects of monoamine neurotransmitters such as dopamine, norepinephrine, and serotonin. These neurotransmitters in turn play an important role in the action of antidepressant and anxiolytic medications. The study was undertaken because no studies till date have systematically assessed the behavioral …

Effects Of Kappa Opioid Receptor Manipulation On Methamphetamine-Induced Behavioral Sensitization In Adolescent Male And Female Rats, Hiroyoshi Matsui Mr, Sarah Seeley, Manoranjan S. D'Souza

ONU Student Research Colloquium

Methamphetamine abuse amongst adolescents has been on the rise in the United States. In this study, we assessed the effects of manipulation of KORs on methamphetamine-induced behavioral sensitization in adolescent male and female rats. Methamphetamine-induced behavioral sensitization is an animal model to study methamphetamine addiction. Behavioral sensitization usually occurs in animals who have been treated with methamphetamine followed by a period of withdrawal. It is hypothesized that brain circuits are altered during the period of withdrawal after methamphetamine exposure resulting in sensitized (increased) responses to methamphetamine at the end of the withdrawal period. The experiment was conducted over 28 days. …