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Aim: To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. Design: We engaged a qualitative descriptive study design. Methods: Semi‐structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. Results: Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow‐up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse‐managed office‐based opioid treatment, and (2) Novel methods to engage patients. Conclusions: Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in‐person visits. Nurse‐managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call‐in' lines to engage patients. Implications for the profession and/or patient care: Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office‐based opioid treatment by conducting assessments and expanding capacity for other wrap‐around services. Impact: We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse‐managed care. Reporting method: The consolidated criteria for reporting qualitative research. Patient or Public Contribution: Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study. [ABSTRACT FROM AUTHOR]

Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 – 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change. [ABSTRACT FROM AUTHOR]

Depression and other adverse mental health outcomes are prevalent among Black men who have sex with men (BMSM). Social support can be protective against symptoms of depression, the effects of which may be amplified by experiences of a shared social identity. We explored the associations between BMSM-specific social support and depressive symptoms among a sample of 280 BMSM. We used chi-square and t-tests to examine bivariate associations between social support, depressive symptoms, and key correlates, and logistic regression to adjust the relationship between social support and depressive symptoms. Most participants reported high (43.2%) or moderate (41.8%) levels of BMSM-specific social support, 38% reported depressive symptoms, and 47.6% were living with HIV. Adjusting for socioeconomic and structural vulnerabilities, health, and involvement in the gay community, high social support was associated with a marginal decrease in the odds of depressive symptoms compared to low social support. Results indicate that BMSM-specific social support is protective against depressive symptoms even in the context of other socioeconomic and structural vulnerabilities, suggesting that strengths-based interventions focused on building community and mutual support among BMSM may be valuable tools to prevent depression and promote positive mental health outcomes for members of this population. [ABSTRACT FROM AUTHOR]

Within the United States, transgender women face a disproportionate burden of violence, experiencing increased rates of multiple forms of violence compared with cisgender women and other sexual/gender minority groups. Among transgender women, further racial/ethnic disparities in experiences of violence exist. Resilience has been shown to be protective against the adverse impacts of violence on mental and physical health outcomes, yet little is known about unique sources of resilience, coping, and strength among transgender women. Sixteen in-depth interviews were conducted with a racially diverse sample of transgender women between May and July, 2020 in Los Angeles. Participants were between the ages of 23 and 67 years. Four participants identified as African American/Black, four as Latina, four as White, two as Asian, and two as Native American. Participants were recruited from a local social service organization. Interview questions assessed social network characteristics, experiences of violence, coping mechanisms, and sources of resilience in response to violence. Deductive and inductive coding schemes were used to identify common themes, and data analysis focused upon experiences of violence and sources of resilience/coping. Violence was common among members of the sample, with every participant reporting a history of multiple forms of violence. Violence perpetration came from many sources, including cisgender male strangers, family members, intimate partners, and other transgender women. Women also reported multiple sources of strength and coping, including engaging in self-care and leisure activities, behavioral adaptations, mentorship/support from other transgender women, and striving to "pass" as cisgender. Despite having faced extensive violence, the participants in this sample were resilient, demonstrating many internal and external coping mechanisms and sources of strength. These findings can inform programs and services that target transgender women, providing participants with opportunities to build resilience and other coping mechanisms to buffer the harmful mental and physical health impacts of exposure to violence. [ABSTRACT FROM AUTHOR]

In addition to the pervasive anti‐Black racism faced by Black people in the United States, Black men who have sex with men (BMSM) face sexual minority stigma and, among BMSM living with HIV, HIV‐related stigma. These multilevel social forces shape social networks, which are important sources of resources, support, and behavior regulation. This study quantitatively examined the relationship between social network characteristics and sexual minority stigma (e.g., homophobia, biphobia), assessed by reported concerns around disclosing one's sexual minority status, among BMSM in Baltimore, Maryland in 2014 (N = 336). A majority of participants (63.7%) reported experiencing medium or high levels of sexual minority disclosure concern. In a multiple linear regression model, participants with higher sexual minority disclosure concerns reported lower network density and fewer good friends who are gay or bisexual men. Stratifying the same multiple linear regression model by HIV status supports the importance of an intersectional understanding of sexual minority and HIV‐related stigma. These findings can help health‐related programs address the complex relationships between sexual minority stigma, social networks, and HIV status within this multiply‐marginalized and high‐priority population. [ABSTRACT FROM AUTHOR]

Background: As overdose remains a major public health concern in the United States, it is important to understand the experiences people who inject drugs (PWID) have with overdose. Past experiences during such emergencies are an important determinant of future behavior, including help seeking, which can be lifesaving. Methods: We explored experiences with overdose, using data from 21 in-depth interviews collected from PWID in a rural county in West Virginia (Cabell County). We used an iterative, modified constant comparison approach to synthesize resulting interview data. Results: Participants reported pervasive experiences with overdose, including through their own personal overdose experiences, witnessing others overdose, and losing loved ones to overdose fatalities. Experiencing emotional distress when witnessing an overdose was common among our participants. Many participants reported regularly carrying naloxone and using it to reverse overdoses. Multiple participants described believing the myth that people grow immune to naloxone over time. Concerns about the presence of fentanyl in drugs were also common, with many participants attributing their own and others' overdoses to fentanyl. Conclusions: Our findings have important implications for naloxone access and education, as well as policies and practices to encourage help seeking during overdose events among rural PWID. Participant concerns about fentanyl in the drug supply highlight the need for access to drug checking technologies. [ABSTRACT FROM AUTHOR]

Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion—or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US. • Arrest and incarceration of people who use drugs are linked to negative health outcomes. • Prosecutorial discretion can be used to enact de facto decriminalization of drug possession. • Little is known about how these nascent policies are developed and implemented in the U.S. • We describe shared and distinct features of emerging policies in 14 jurisdictions nationally. • Findings have implications for evaluating impacts on health and racial equity. [ABSTRACT FROM AUTHOR]

Objectives: Xylazine is a rapidly spreading adulterant in the United States' drug supply and is increasingly associated with overdoses and severe wounds, but there is a dearth of information about the clinical presentation or means of treatment for human xylazine exposure. The objective of this study was to explore personal attitudes about xylazine in the drug supply and experiences with xylazine-related use among people who reported using drugs and contributed content to social media site Reddit., Methods: To conduct a retrospective qualitative content analysis, the study team extracted all posts and comments from Reddit, which mentioned the terms "xylazine" or "tranq." Content was extracted from 10 Reddit forums, or subreddits, specific to drug use, and included content created on or before the extraction date of January 2023. In total, 3284 posts were identified and 1803 were qualitatively coded using an inductive approach until meaning saturation was reached., Results: Three themes emerged across comments and posts: (1) personal experiences with xylazine, including a negative impact on overdose, withdrawal, and wounds; (2) behavior changes in response to xylazine in the drug supply, including devising and sharing new harm reduction and detection tips, and reducing or abstaining from drug use altogether; (3) a perceived lack of treatment options for xylazine withdrawal and information sharing to help others self-treat withdrawal symptoms, most often with clonidine., Conclusions: This study of people who reported using drugs with xylazine provides new insights into how xylazine is perceived, possible treatment modalities, and potential clinical research approaches., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 American Society of Addiction Medicine.)