Journal of substance use and addiction treatment最新文献

{"title":"Different forms of stigma and rural primary care professionals' willingness to prescribe buprenorphine","authors":"Berkeley Franz ,&nbsp;Lindsay Y. Dhanani ,&nbsp;Sean Bogart ,&nbsp;Cheyenne Fenstemaker ,&nbsp;William C. Miller ,&nbsp;O. Trent Hall ,&nbsp;Daniel Brook ,&nbsp;Vivian Go","doi":"10.1016/j.josat.2025.209633","DOIUrl":"10.1016/j.josat.2025.209633","url":null,"abstract":"<div><h3>Introduction</h3><div>Buprenorphine and other medications for opioid use disorder (MOUD) are highly effective but substantially under prescribed in the rural United States. Among the most cited barriers to buprenorphine prescribing is stigma, yet little progress has been made in developing successful strategies to reduce stigma and increase access to life-saving medication. One of the key challenges to developing successful implementation strategies is understanding the different types of stigma that limit implementation.</div></div><div><h3>Methods</h3><div>This study draws from qualitative interviews with 23 primary care professionals (PCPs) in rural Ohio. We conducted semi-structured interviews focused on prior experiences with buprenorphine, willingness to prescribe it, prior buprenorphine training, and barriers to prescribing. Thematic analysis resulted in 3 forms of stigma that must be addressed to improve implementation.</div></div><div><h3>Results</h3><div>PCPs discussed 3 key forms of stigma that limit buprenorphine prescribing in rural areas: 1) stigma towards patients—PCPs feared being harmed by patients with opioid use disorder (OUD) if they began prescribing buprenorphine; 2) stigma towards providers—PCPs believed their clinics would be stigmatized if they began treating addiction; and 3) stigma towards buprenorphine—PCPs worried they might unintentionally harm patients through prescribing a partial opioid agonist.</div></div><div><h3>Conclusions</h3><div>Stigma remains a critical barrier to buprenorphine prescribing among rural PCPs but is not limited to negative attitudes towards people with OUD. Buprenorphine is also stigmatized and PCPs fear becoming stigmatized if they prescribe the medication. Implementation research is urgently needed to test whether multicomponent stigma-reduction strategies increase access to buprenorphine in rural communities.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209633"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived organizational support for the treatment of opioid use disorder and its association with primary care provider treatment willingness and medication prescribing","authors":"Lindsay Y. Dhanani ,&nbsp;William C. Miller ,&nbsp;Vivian Go ,&nbsp;Janet E. Simon ,&nbsp;Berkeley Franz","doi":"10.1016/j.josat.2025.209623","DOIUrl":"10.1016/j.josat.2025.209623","url":null,"abstract":"<div><h3>Introduction</h3><div>Buprenorphine is a highly effective medication for opioid use disorder (MOUD; OUD), which can be prescribed alongside naloxone in the primary care setting as part of a harm reduction approach to OUD. Despite this potential, implementation challenges have limited adoption of MOUD. To address barriers at the organizational level, we need better tools to measure perceived organizational support for the treatment of OUD and use of MOUD in the primary care setting. In this study, we developed an OUDSUPPORT measure to assess the relationship between organizational culture and critical treatment attitudes and behaviors in primary care.</div></div><div><h3>Methods</h3><div>We conducted a statewide survey of 404 primary care-aligned health professionals (PCPs) in Ohio. We analyzed the survey data using descriptive and bivariate statistics. Additionally, three stepwise multivariable regression models assess the relationship between organizational support and three primary outcomes: willingness to treat OUD; receipt of the X-waiver, which was previously required to prescribe buprenorphine; and naloxone prescribing, independent of individual and county-level predictors.</div></div><div><h3>Results</h3><div>The OUDSUPPORT measure demonstrated satisfactory psychometric properties, and was associated with meaningful treatment outcomes. PCPs perceived the strongest organizational support for a shared mission of providing care to people with OUD. The least commonly endorsed form of organizational support was for prescribing buprenorphine. Perceived organizational support was associated with increased willingness to treat OUD (b = 0.26; 95 % CI: 0.17, 0.35); higher odds of having received the X-waiver (OR = 1.63; 95 % CI: 1.26, 2.12); and higher odds of naloxone prescribing (OR = 1.71; 95 % CI: 1.30, 2.25).</div></div><div><h3>Conclusions</h3><div>OUDSUPPORT is a multidimensional measure of perceived organizational support for the treatment of OUD, which was associated with treatment willingness, receipt of buprenorphine prescribing training, and naloxone prescribing among PCPs. Implementation strategies to increase buprenorphine prescribing in the primary care setting must include efforts to decrease stigma, and address hesitance related to MOUD and harm reduction at the administrative level, in addition to addressing well known barriers at the individual prescriber level.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209623"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and acceptability of the delivery of a group telehealth intervention for support persons of patients receiving buprenorphine for opioid use disorder","authors":"Elizabeth Ueland ,&nbsp;Katherine Nameth ,&nbsp;Jennifer K. Manuel ,&nbsp;Karen Chan Osilla","doi":"10.1016/j.josat.2025.209628","DOIUrl":"10.1016/j.josat.2025.209628","url":null,"abstract":"<div><h3>Background</h3><div>Opioid-related overdoses increased substantially during the COVID-19 pandemic, eliciting an urgent demand for accessible treatment for individuals with opioid use disorder (OUD) and those who support them (support persons). Support persons can improve treatment initiation and retention in their individuals with OUD. Additionally, support persons may have their own mental health needs related to their loved one's OUD. Unfortunately, few treatment options exist for support persons of individuals with an OUD. A support person-focused group telehealth intervention (referred to as eINSPIRE) that is accessible and feasible could help fill the treatment gap for support persons and bolster outcomes for individuals with OUD.</div></div><div><h3>Methods</h3><div>The study interviewed patients receiving buprenorphine (n = 9), their support persons (n = 12), and clinic staff members (n = 6) about their perceptions on a group telehealth intervention designed for support persons. Patient and support person dyads were recruited from two community health clinics to participate in a qualitative interview and/or focus group. Using classic content analysis, we then analyzed this data to evaluate the feasibility, acceptability, and usability of a group telehealth intervention for support persons.</div></div><div><h3>Results</h3><div>The eINSPIRE intervention was deemed generally acceptable, feasible, and usable. All support persons (n = 12) agreed that group telehealth was acceptable and those who completed an eINSPIRE demo session found it usable (IUS = 72.5). Patients indicated that eINSPIRE would be beneficial for support persons, and could provide services that are unattainable to them in their immediate community, but that groups sometimes lacked intimacy. Participants also found group telehealth to be more accessible than in-person alternatives and suggested how to improve the delivery of the intervention.</div></div><div><h3>Conclusions</h3><div>Group telehealth may be a feasible and acceptable option for delivering an intervention to support persons and could reduce barriers to treatment that this population often experiences due to competing demands. However, due to sample size limitations, more participant perspectives and future research are needed.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209628"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study exploring the feasibility and acceptability of embedding an overdose prevention sites in a U.S. hospital","authors":"Rachel French ,&nbsp;Rachal McFadden ,&nbsp;Margaret Lowenstein ,&nbsp;Nicole O'Donnell ,&nbsp;Jeanmarie Perrone ,&nbsp;Shoshana Aronowitz ,&nbsp;Ashish P. Thakrar ,&nbsp;Allison Schachter ,&nbsp;Eleanor Turi ,&nbsp;Peggy Compton","doi":"10.1016/j.josat.2024.209620","DOIUrl":"10.1016/j.josat.2024.209620","url":null,"abstract":"<div><h3>Introduction</h3><div>Community-based overdose prevention sites (OPS) are recognized for reducing overdose deaths and the spread of HIV and hepatitis C among people who use drugs (PWUD). While some hospitals in Europe and Canada have successfully integrated OPS into their facilities, such integration remains illegal in the United States. This study explores the feasibility and acceptability of implementing an OPS at the Hospital of the University of Pennsylvania (HUP), situated in an urban area with high rates of overdose.</div></div><div><h3>Methods</h3><div>Using semi-structured interviews, we engaged 28 stakeholders, including clinicians, hospital leadership, security personnel, and PWUD. The study presented participants with a hypothetical scenario depicting a PWUD hospitalized multiple times for injection-related endocarditis to elicit nuanced responses.</div></div><div><h3>Results</h3><div>Thematic analysis of the qualitative data revealed a complex landscape of perceived benefits and challenges associated with embedding an OPS at HUP. Stakeholders acknowledged potential advantages, such as harm reduction, including patient and community safety, education, and stigma reduction. However, concerns were raised regarding acceptability among PWUD, hospital staff, leadership, and the broader Philadelphia community. Hesitancy stemmed from uncertainties about trust-building, safety protocols, clinician stigma, and institutional support. Feasibility concerns, including patient eligibility criteria, drug policy, staffing, and suitable location, were also highlighted.</div></div><div><h3>Conclusions</h3><div>Despite political and cultural barriers, participants proposed strategies to garner support for a hospital-based OPS, emphasizing clinical education, anti-stigma training, and community engagement. They discussed a vision for an OPS at HUP that could serve as a haven for PWUD during hospitalization, potentially reducing patient-directed discharges and improving adherence to medical treatments, thus decreasing morbidity and readmissions. This study underscores the need to address multifaceted concerns before implementing OPS within hospital settings. Once legal and cultural impediments are addressed, insights from this research can inform the design and operation of OPS at HUP and similar institutions, contributing to enhanced patient outcomes and community well-being.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209620"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first five years of implementing Missouri's medication first approach to opioid use disorder treatment: Plateaus, regressions, and underbellies of progress","authors":"Rachel P. Winograd ,&nbsp;Brandon Park ,&nbsp;Bridget Coffey ,&nbsp;Rashmi Ghonasgi ,&nbsp;Brittany Blanchard ,&nbsp;Paul Thater ,&nbsp;Katherine C. Brown","doi":"10.1016/j.josat.2025.209622","DOIUrl":"10.1016/j.josat.2025.209622","url":null,"abstract":"<div><h3>Introduction</h3><div>Missouri's Medication First (“MedFirst”) approach promotes same-day and long-term low-threshold access to medications for opioid use disorder (MOUD). Since 2017, Missouri's SAMHSA-funded State Targeted and State Opioid Response (STR/SOR) grants have supported MedFirst services (both medical and psychosocial) for uninsured individuals with opioid use disorder at state-contracted treatment programs. Though MedFirst demonstrated early success, results – with attention to possible racial disparities – must be revisited after five years of implementation.</div></div><div><h3>Methods</h3><div>Using state behavioral health claims, we examined four outcomes: (1) MOUD utilization, (2) time-to-medication, (3) psychosocial service volume, and (4) substance use disorder (SUD) treatment retention. Models compared four groups: (a) individuals in MedFirst during the first and fifth year of implementation (2018 vs. 2022), (b) individuals in MedFirst compared to non-MedFirst, (c) individuals prior to MedFirst (2017) compared to individuals during MedFirst's fifth year (2022), and (d) White compared to Black individuals within and outside MedFirst.</div></div><div><h3>Results</h3><div>Overall, MedFirst outcomes were superior to non-MedFirst outcomes. Among individuals in MedFirst, however, outcomes were generally poorer in 2022 than in 2018, and Black individuals had shorter treatment episodes and were less likely to receive MOUD than White individuals. Overall, Missourians had only slightly better outcomes in 2022 than prior to STR/SOR initiation.</div></div><div><h3>Conclusions</h3><div>Since Missouri's initial implementation of STR/SOR-funded MedFirst, select overall treatment outcomes have improved. Within MedFirst programs, however, outcomes worsened over time, and racial disparities were evident. Though fentanyl's dominance of the drug supply alongside the COVID-19 pandemic contributed to these results, fidelity drift, particularly due to financial implications of MedFirst, likely also negatively impacted sustainability.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209622"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation science in higher education: Identifying key determinants in the selection of evidence-based alcohol and substance prevention and treatment","authors":"Ashley C. Helle ,&nbsp;Karla T. Washington ,&nbsp;Joan Masters ,&nbsp;Kenneth J. Sher ,&nbsp;Gregory A. Aarons ,&nbsp;Kristin M. Hawley","doi":"10.1016/j.josat.2024.209617","DOIUrl":"10.1016/j.josat.2024.209617","url":null,"abstract":"<div><h3>Introduction</h3><div>Although there are evidence-based strategies (EBSs) for alcohol and other drug (AOD) prevention and treatment for college students, there has been little focus on evaluating AOD EBS implementation in higher education. The use of implementation strategies in higher education may help bridge the gap between research and practice and improve students' access to EBSs. However, it is important to first understand determinants of AOD EBS program implementation to support AOD EBS selection and implementation strategy selection.</div></div><div><h3>Methods</h3><div>We used mixed-methods to examine determinants occurring in the EBS selection and adoption process for AOD prevention and treatment using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework (<span><span>Aarons et al., 2011</span></span>), with a focus on the inner organizational context and early EPIS phases. Participants (<em>N</em> = 142) were student affairs professionals across 23 campuses engaged in a statewide prevention coalition. Participants completed a survey assessing constructs relevant to EBS selection. A subset of participants (<em>n</em> = 16) completed semi-structured interviews designed to generate an in-depth understanding of the EBS implementation process on their respective campuses. Content analysis was employed to identify determinants present in the EBS selection process.</div></div><div><h3>Results</h3><div>Provider perspectives of Inner Context aligning with the exploration phase suggested higher education contexts were generally supportive of EBS implementation via ratings of absorptive capacity (e.g., mechanisms supporting knowledge acquisition) and implementation climate. Leadership support was rated as present “to a moderate extent”. Qualitative data highlighted the importance of attending to six key determinants of the implementation process for substance EBSs: collaboration, evidence for initiative, leadership, institution priorities, resources, and student needs and perspectives. Collectively, the integration of qualitative and quantitative data suggests there are important facilitators to address with implementation strategies, and support is needed across campuses to prepare for implementation.</div></div><div><h3>Conclusions</h3><div>Student affairs professionals within a statewide coalition identified features of EPIS Inner Context (climate, readiness, leadership support) that align with EBS selection and implementation processes and identified key determinants to selecting and adopting AOD prevention EBSs in higher education. Addressing these areas may help build capacity and scale up EBS selection.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209617"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classes of outpatient quality of care among individuals with substance-related disorders, based on a survey and health insurance registry","authors":"Marie-Josée Fleury ,&nbsp;Zhirong Cao ,&nbsp;Guy Grenier ,&nbsp;Christophe Huỳnh ,&nbsp;Xianghei Meng","doi":"10.1016/j.josat.2024.209619","DOIUrl":"10.1016/j.josat.2024.209619","url":null,"abstract":"<div><h3>Objectives</h3><div>Improving quality of care for individuals with substance-related disorders (SRD) should be a priority considering SRD are associated with high morbidity. This study aimed to identify classes of individuals with SRD based on their clinical characteristics and the quality of outpatient care they received, and to verify whether better quality of care was associated with other respondent characteristics and more favorable subsequent outcomes.</div></div><div><h3>Methods</h3><div>Data came from the 2013–14 and 2015–16 Canadian Community Health Survey (<em>N</em> = 42,099), merged with administrative data from Quebec's health insurance registry. Investigating a cohort of 1473 individuals with SRD, we conducted Latent class analysis based on the respondents' diagnoses and outpatient quality of care indicators such as access, diversity, continuity and regularity of care received in the 12 months preceding interview. Chi-Square, Fisher's exact tests or <em>t</em>-tests, and logistic regression associate classes with sociodemographic and health behavior (e.g., suicidal behaviors) correlates, and outcomes (repeated emergency department use, hospitalization, quality of life) over the three months following interview, respectively.</div></div><div><h3>Results</h3><div>The study identified four classes: (1) Individuals with polysubstance-related disorders and other health disorders, receiving high diversity and moderate regularity of care (6 % of sample); (2) Individuals with alcohol-related disorders, receiving low quality of care (41 %); (3) Individuals with drug-related disorders, receiving high overall quality of care (9 %); and (4) Individuals with alcohol-related disorders, receiving high continuity of family doctor care (44 %). Classes 2 and 4 showed better social conditions (e.g., higher education), health behaviors, and subsequent outcomes than Classes 1 and 3, despite receiving lower quality of care – especially mental healthcare.</div></div><div><h3>Conclusion</h3><div>Study outcomes related more to health and social conditions than to the quality of outpatient care received, especially as outpatient care alone might not meet needs of Classes 1 and 3 individuals having important health and social issues, unmet care needs and worse outcomes. Results suggest that interventions like assertive community treatment or intensive case management with integrated SRD-mental health disorders treatment could better respond to the needs of Classes 1 and 3. Overall, enhanced care, including peer support, might benefit all individuals with SRD.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209619"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(24)00287-X","DOIUrl":"10.1016/S2949-8759(24)00287-X","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209575"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(24)00288-1","DOIUrl":"10.1016/S2949-8759(24)00288-1","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"168 ","pages":"Article 209576"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of implementing a mail-based overdose education and naloxone distribution program in community supervision settings during COVID-19","authors":"Carrie B. Oser ,&nbsp;Margaret McGladrey ,&nbsp;Douglas R. Oyler ,&nbsp;Hannah K. Knudsen ,&nbsp;Sharon L. Walsh ,&nbsp;Susannah Stitzer ,&nbsp;Michael Goetz ,&nbsp;Marisa Booty ,&nbsp;Erica Hargis ,&nbsp;Sarah Johnson ,&nbsp;Michele Staton ,&nbsp;Patricia R. Freeman","doi":"10.1016/j.josat.2024.209618","DOIUrl":"10.1016/j.josat.2024.209618","url":null,"abstract":"<div><h3>Introduction</h3><div>This study uses the <em>Exploration, Preparation, Implementation</em>, and <em>Sustainment</em> (EPIS) model to retrospectively describe the mail-based overdose education and naloxone distribution (OEND) program developed in collaboration with the Kentucky Department of Corrections (DOC) for use in the HEALing Communities Study in Kentucky (HCS-KY) and details the reach of this innovative delivery model.</div></div><div><h3>Methods</h3><div>HCS-KY is a community-engaged cluster-randomized trial assessing the effects of implementing evidence-based practices, including OEND, on overdose death reduction across 16 communities highly impacted by the opioid epidemic in Kentucky.⁶ The study launch coincided with the COVID-19 pandemic. All coalitions in the 16 HCS-KY counties selected OEND implementation in community supervision offices; however, pandemic limitations on in-person reporting made face-to-face OEND unfeasible. This study uses the EPIS phases to understand how the unique inner and outer contextual factors of the pandemic drove innovation, including five implementation strategies to promote the mail-based OEND program. Internal study management trackers data measured implementation reach.</div></div><div><h3>Results</h3><div>Implementation occurred in all 16 counties. All promotional strategies used in the first 8 counties (Wave 1) were carried over to the second 8 counties (Wave 2), except letters were not sent to community supervision clients in Wave 2 counties. Across both waves, 1759 people accessed the Typeform™ website to receive overdose education, complete a brief demographic survey, and 1696 had naloxone shipped to their homes. Greater reach occurred in Wave 1 and in rural counties. Of the participants, 81.13 % were white, 61.17 % were female, 51.79 % were between the ages of 35–54, 18.82 % had previously experienced an overdose, and 69.07 % had witnessed an overdose. Sites sustained three of the five implementation strategies for publicizing the OEND website at the study's end but not letters and texting.</div></div><div><h3>Conclusions</h3><div>Mail-based OEND programs are an appropriate delivery method for ensuring access to life-saving medication for people on community supervision and may encourage treatment. Strategies to promote the OEND program that were high-effort for agency and study staff, such as letters, or high-cost, such as texting, were not sustainable. Implications for OEND best practices, including innovative technology use within community supervision settings are addressed.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"170 ","pages":"Article 209618"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}