Background: Overdose deaths involving illicitly manufactured fentanyl have risen sharply, particularly among young people, who are increasing exposed to counterfeit pills. While much is known about adult populations, little research explores how young people perceive and respond to the risks of fentanyl. Methods: From October 2023 to March 2024, we conducted semi-structured interviews with 21 young people in Oregon (ages 15 to 25) who had reported lifetime use of non-prescription pills. Interviews explored knowledge, experiences, risk reduction practices, and trusted information sources related to fentanyl and counterfeit pills. Transcripts were analyzed using thematic analysis. Results: Participants demonstrated broad awareness of the dangers of fentanyl and counterfeit pills and described fentanyl as potent, lethal, and increasingly prevalent. Knowledge varied, however, with some holding misconceptions (e.g., risk of overdose from touch). Participants reported practicing risk reduction strategies, including avoiding pills of uncertain sources, using fentanyl test strips, carrying naloxone, and monitoring peers’ safety. Barriers such as limited access to resources, inconsistent availability of drug checking tools, and stigma constrained their ability to reduce risk. Participants described strong peer-to-peer networks that emphasized safety and mutual support. Finally, participants expressed a desire for accurate, fact-based, nonjudgmental education about fentanyl and drug use. They emphasized the importance of schools, parents, and public health organizations providing open dialogue, risk reduction information, and accessible supports such as mental health services, hotlines, and treatment. Conclusion: Young people in Oregon who have used non-prescription pills are aware of fentanyl’s presence in the drug supply and are motivated to stay safe but encounter barriers that limit their ability to consistently practice risk reduction. Tailored, age-specific interventions that build on existing peer-to-peer networks and expand access to risk reduction resources—including naloxone, fentanyl test strips, and fact-based education—are urgently needed to reduce overdose risk and support young people’s wellbeing.

BACKGROUND:Given well-established efficacy of contingency management (CM), demand grows for effective implementation support. Coaching-to-criterion is a strategy for assuring workforce capability to deliver CM programming with fidelity. To what extent this preparative strategy is comparably useful for addiction professionals and peer specialists is unknown. METHODS:Two ongoing endeavors-state opioid response-funded implementation support for 7 sites implementing CM programming and an National Institute of Health-funded hybrid type 1 effectiveness/implementation trial testing peer-delivered CM at 9 sites-share a coaching-to-criterion process as common methodology. For workforce members, participation in serial group coaching sessions eventuated in completion of an observed standardized patient encounter with Likert-rating of 6 CM Competence Scale domains (1 = very poor, 7 = excellent). A coach provides immediate, performance-based feedback, and if an a priori benchmark ("adequate" ratings of 4) is not initially reached, a skill-specific replay opportunity is undertaken. Non-inferiority analysis tested scale score equivalence of addiction professionals (n = 51) and peer specialists (n = 64), relative to a 0.25 standard deviation (SD) margin. Comparative resourcing of coaching efforts, scale psychometrics, and patterns of CM skillfulness were also examined. RESULTS:As intended, all workforce members (N = 115) met the criterion, and the mean scale score (M = 29.74, SD = 3.67) exceeded the benchmark by +1.56 SDs. Independent-samples t-test confirmed absence of between-group difference, with effect magnitude (Cohen's d = 0.13) well within the non-inferiority margin. Similar resourcing of coaching efforts was evident, with a majority (61%-66%) of addiction professionals and peer specialists achieving the criterion on initial attempt. Psychometric analyses confirmed robust item-scale correlations (r = 0.58-0.66), and no consistent pattern was found in domain-specific skills. CONCLUSIONS:As demand grows for CM implementation, so too will the diversity of workforce needed to capably deliver it. This report documents that a coaching-to-criterion process sufficiently prepared both addiction professionals and peer specialists to deliver CM and that resulting skill among these groups did not appreciably differ nor did the required coaching efforts.

BackgroundA collective identity is a set of shared values and value propositions that an investigator network projects as they deliver data and knowledge generated through their studies to community partners, policymakers, research participants, public health authorities, and prospective end users. The strategic process of identifying common values and establishing procedures to ensure the consistent communication of a collective identity across a diverse network of research teams is often not considered in research networks' dissemination of results. This paper describes how the HEAL Research on Interventions for Stability and Engagement (RISE) network co-created communication pillars that embody a set of common values and shared research imperatives to frame dissemination activities.MethodsEarly in the development of RISE, project teams participated in an in-person workshop to identify attributes and core values that they believed to be representative of their individual research programs. Dissemination coordinators analyzed and synthesized themes from workshop material, including presentations and posterboard illustrations, and used Mural whiteboarding software to distill these themes into core values and value propositions to collectively share across the research sites.ResultsThe four communication pillars, which encompass our collective identity and are the foundation of our dissemination program, are (1) Doing Research with Communities, (2) Centering on the Lives and Experiences of People Who Use Drugs, (3) Emphasizing Scientific Rigor and Integrity; and (4) Focusing on Social Determinants. We present examples of how project teams are demonstrating the pillars throughout the research process and outline how the communication pillars inform the planning and dissemination of RISE-produced evidence to end users.ConclusionsApplying concepts from strategic communication and social marketing, we demonstrate how a research network of independent investigators can create a collective identity, formulate a cogent narrative communicating their contributions to a field of practice, and establish a foundation for a successful research dissemination program.

Objectives: The PINPOINT (PaIn aNd oPiOId maNagemenT) intervention in Oregon aimed to support primary care clinics in applying evidence-based guidelines for pain management and opioid use disorder treatment. We evaluated the impact of this intervention on opioid use disorder treatment and overdose outcomes. Methods: Data from the voluntary Oregon All Payer All Claims datasets were integrated with several administrative datasets to create the Provider Results of Opioid Management and Prescribing Training dataset, which tracks clinical and prescribing activities at the provider level. We employed difference-in-differences models to assess the impact of PaIn aNd oPiOId maNagemenT enrollment on changes in opioid use disorder treatment and overdose outcomes. The intervention sample consisted of 289 primary care providers from clinics participating in PaIn aNd oPiOId maNagemenT, compared with 2000 control providers identified through administrative claims. Results: The difference-in-differences models indicated statistically significant associations between intervention enrollment and treatment with medications for opioid use disorder (incidence rate ratio [IRR] = 1.214, 95% confidence interval [CI] = 1.100-1.340), any substance use disorder treatment (IRR = 1.120, 95% CI = 1.070-1.172), and any outpatient opioid use disorder treatment (IRR = 1.102, 95% CI = 1.034-1.175) compared to controls. No statistically significant changes were observed in overall non-fatal drug overdoses, non-fatal opioid overdoses, and naloxone overdose reversals, though absolute event rates were low. Conclusions: We found that multi-faceted, evidence-based approaches to improve clinical practice in primary care settings were associated with increased treatment for opioid use disorder, however differences in overdose outcomes were not observed. Further research is needed to assess the scalability and clinical impact of these interventions across diverse care environments.

Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Management (PEER-CM) study compares the effectiveness of two peer-facilitated CM interventions: (1) an experimental approach incentivizing achievement of client-identified harm reduction goals and (2) an enhanced standard of care approach incentivizing peer visit attendance. Applying a hybrid type 1 effectiveness-implementation framework and stepped-wedge design across 14 community-based peer services sites across Oregon, the PEER-CM study trains peers to conduct CM. All sites implement the standard CM approach of incentivizing peer visit attendance. Every 2 months, two sites are randomly assigned to initiate the experimental CM condition of incentives for achieving client-directed harm reduction activities. Peers monitor progress and manage incentives. In the experimental approach, peers facilitate client progress on goal-related activities (selected from a standardized list of goals) to support the primary study outcome of reducing opioid overdoses and stimulant overamping. The intended study enrollment is approximately 80 clients per site (N = 1,120). Peer specialists participate in skills-focused coaching-to-criterion coaching process to document proficient CM delivery skills. This includes a series of group coaching sessions and an individual assessment with a standardized patient, observed and rated according to core dimensions of the Contingency Management Competence Scale. The primary study outcome is time until peer-reported fatal or first participant-reported non-fatal overdose or overamp (acute stimulant toxicity). Secondary outcomes include achievement of client-identified harm reduction goals and engagement in substance use disorder treatment. We will also demonstrate the feasibility of our coaching-to-criterion process by documenting peer proficiency in CM skills. Qualitative interviews with peers and their clients will explore the optimal context and implementation strategies for peer-facilitated CM. PEER-CM is among the first trials to test the effectiveness of peer-facilitated CM for achieving harm reduction goals and reducing overdose in non-treatment-seeking people who use stimulants. The findings will generate evidence for peer-facilitated delivery of CM and application of CM to client-identified harm reduction goals. Trial Registration: This study is registered at ClinicalTrials.gov (NCT 05700994).

Novel strategies are needed to engage people who use stimulants into the continuum of addiction care. Contingency management (CM) is the most effective intervention for stimulant use disorder and may engage non-treatment-seeking populations, especially when delivered by peer recovery support specialists (peers). We describe development and training for a novel peer-delivered CM program for stimulant use harm reduction and treatment engagement. We used a community based participatory research (CBPR) process to develop a CM program focused on self-identified goals for harm reduction and treatment engagement. A steering committee of peers guided study design, CM rewards, schedule, and incentivized goals. Peers completed coaching-to-criterion of six CM skills based on the CM Competence Scale (CMCS), then completed a one-on-one roleplay with a standardized patient. Coaches rated peer performance of each CMCS skill according to its Likert scale (1 = Very Poor to 7 = Excellent) and an a priori rating criterion of 4 (‘adequate’). Roleplays included feedback and a ‘replay’ of skills, if necessary. The steering committee devised two CM interventions: an enhanced standard-of-care incentivizing peer visits (20 for weekly peer visits) and an intervention that additionally incentivized self-directed goals (20 for weekly peer visits and 30 for completed goal-related activities). Self-identified goal-related activities were chosen through a collaborative process and organized into 6 domains: (1) overdose/overamping prevention (2) substance use supports/treatment (3) daily living/housing (4) education/employment (5) mental/physical/spiritual health (6) social relationships. Forty-seven peers across nine peer-led organizations (three rural and six urban organizations across Oregon) completed CM training. All 47 peers met the a priori criterion in their roleplay, with seventeen (36

BACKGROUND:Efforts to distribute naloxone have equipped more people with the ability to reverse opioid overdoses but people who use drugs are often reluctant to call 911 due to concerns for legal repercussions. Rural communities face unique challenges in reducing overdose deaths compared to urban communities, including limited access to harm reduction services as well as greater concerns about stigma and privacy. METHODS:The Rural Opioid Initiative was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural US communities and consists of eight studies spanning ten states and 65 counties. Each study conducted semi-structured qualitative interviews with people who use drugs to understand contextual factors influencing drug use and health behaviors. We analyzed qualitative data from seven studies with data available at the time of analysis to understand peer response to overdose. RESULTS:Of the 304 participants interviewed, 55% were men, 70% were white, 80% reported current injection drug use, and 60% reported methamphetamine use. Similar to what has been found in studies focused on urban settings, people who use drugs in rural communities use a range of strategies to reverse overdoses, including non-evidence-based approaches. Several reported that multiple doses of naloxone are needed to reverse overdose. Three themes emerged around the willingness to call 911, including (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement. CONCLUSION:People who use drugs employ multiple strategies to attempt overdose reversal, including non-evidence-based approaches. Greater education about the most effective and least harmful strategies is needed. Reluctance to call 911 is rooted in concerns about potential legal consequences as well as perceptions about law enforcement officers, which may be heightened in rural communities where people who use drugs are more easily identified by law enforcement. People who use drugs will go to great strides to connect their peers to needed medical services, suggesting that comprehensive interventions to reduce interactions with law enforcement officers and eliminate legal consequences for reporting overdoses are critical.

INTRODUCTION:Nonpharmaceutical fentanyl has reconfigured the U.S. illicit drug market, contributing to a drastic increase in overdose drug deaths. While illicit fentanyl has subsumed the drug supply in the Northeast and Midwest, it has more recently reached the West. For this study, we explored knowledge, attitudes, and behaviors among people who use drugs in Oregon in the context of the emergence of fentanyl in the drug supply.METHODS:We conducted in-depth interviews by phone with 34 people who use drugs in Oregon from May to June 2021. We used thematic analysis to analyze transcripts and construct themes.RESULTS:People who use drugs knew about fentanyl, expressed doubt that fentanyl could be found in methamphetamine; believed those who were younger or less experienced were at higher risk for harm; and received information about fentanyl from drug dealers, syringe service programs, or peers (other people who use drugs). Preference for fentanyl's presence in drugs like heroin or methamphetamine was mixed. Some felt that their preference was irrelevant since fentanyl was unavoidable. Participants reported engaging in harm reduction practices, including communicating about fentanyl with dealers and peers, testing for fentanyl, using smaller quantities of drugs, switching from injecting to smoking, and using naloxone.CONCLUSION:People who use drugs are responding to the rise of fentanyl on the West Coast and are concerned about the increasing uncertainty and hazards of the drug supply. They are willing and motivated to adopt harm reduction behaviors. Harm reduction promotion from syringe service programs and public health agencies is essential to reduce injury and death from nonpharmaceutical fentanyl.

In this narrative review, we outline the literature describing the history, training, certification, and role of peer recovery support specialists working with people with substance use disorders at different stages of active use and recovery. We explore the impact of peer recovery support specialists serving people in various settings, including the community, hospitals and emergency departments, jails and prisons, and treatment and recovery agencies; and describes considerations for future expansion of peer recovery support services, including supervision needs, compassion fatigue and burnout, and scope of practice. Finally, we make recommendations to support the broad implementation of peer recovery support services as a sustainable, cohesive, and replicable component of harm reduction and addiction services. We also make recommendations for research to continue to evaluate peer recovery support specialist interventions across settings and outcomes.

Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

Introduction Online data collection methods can increase study accessibility and ease the burden of data collection for participants. Asynchronous Online Focus Groups are a promising method for data collection among healthcare professionals. Methods In this article, we describe the use of, and lessons learned from conducting 19 Asynchronous Online Focus Groups across four research studies. Results We describe our experiences preparing for, recruiting for, and conducting Asynchronous Online Focus Groups. We highlight decision points around timeframe, eligibility, recruitment, participation, focus group assignment, moderation, and participant engagement. We found that removing geographic barriers was advantageous for collecting data, focus group attrition is a concern for asynchronous formats, and group assignment may affect data. Conclusions Asynchronous Online Focus Groups are a promising method for data collection among healthcare professionals. When conducting Asynchronous Online Focus Groups researchers should consider the suitability and the unique implications of this data collection method for data quality.

Objectives The objective of this study was to examine COVID-19 vaccination acceptance and explore reasons for COVID-19 vaccine hesitancy among people who use drugs (PWUDs), a population with increased COVID-19 transmission and morbidity. Methods We conducted semi-structured in-depth interviews with PWUDs in 7 Oregon counties from May 11 to June 25, 2021. Participants (n = 34) were recruited in partnership with syringe service programs and local community organizations staff, participant-referrals, and flyer advertising. Research staff conducted interviews via telephone to assess participants’ acceptance of the COVID-19 vaccine, find knowledge gaps where new educational information about vaccination would be helpful, and identify who would be perceived as a trustworthy source of information. Interviews were transcribed and coded using thematic analysis with a deductive approach. Results Most participants had not received the COVID-19 vaccine and were not planning on or were unsure about receiving it. Participants were mistrustful of the rapid COVID-19 vaccine development process, the agencies involved in the development, and vaccines in general. Participants shared varied and contrasting responses about who they would trust to provide information about the COVID-19 vaccine, including peer recovery support specialists, doctors, or other health care professionals, and specified federal agencies or media outlets. Conclusions As addiction medicine and public health staff continue to respond to the evolving impacts of COVID-19, vaccination planning should be tailored to the unique needs of PWUD to increase COVID-19 vaccine acceptance in this high-risk population.

Coronavirus Disease 2019 (COVID-19) may influence HIV/HCV transmission risk behaviors in rural communities. We conducted semi-structured qualitative interviews with people who use drugs (PWUD) in five rural Oregon counties and asked about COVID-19 impact on substance use and harm reduction practices and their advice for improving public health responses. Participants (n = 36) reported using only methamphetamine (52.8%), only heroin (16.7%), or both (30.6%); 75% of participants reported recent injection. Three thematic categories emerged: SSP adaptations and accessibility, PWUD harm reduction practices, and policy suggestions. Participants noted the importance of SSPs to COVID-19 prevention and wellbeing, though some experienced increased barriers, leading to increased risky injection practices. Participants suggested need-based rather than one-for-one exchange, increasing syringe delivery services, encouraging secondary exchange by PWUD, and peers as trusted voices for information exchange. Rapid implementation of policy and practice changes are urgently required to improve SSP access, reinforce safer use, and prevent HIV/HCV and COVID-19 transmission.

Abstract Background Drug overdose is the leading cause of death after release from prison, and this risk is significantly higher among women compared to men. Within the first 2 weeks after release, the risk of death from drug overdose is 12.7 times higher than the general population, with risk of death further elevated among females. Although female inmates have higher rates of opioid use disorder and post-release overdose fatality, justice-involved women are under-represented in studies of medications for opioid use disorder. The Reducing Overdose After Release from Incarceration (ROAR) pilot intervention and evaluation (recruitment June 2019 through December 2020) aims to reduce opioid overdose among women released to the community following incarceration in state prison. The evaluation further assesses induction, acceptance and effectiveness of extended release naltrexone in a female post-prison population. Methods/design In the week prior to their release, female adults in custody with moderate to severe opioid use disorder start treatment with extended release naltrexone, an injectable opioid antagonist that blocks the effects of opioids for up to 1 month. All ROAR participants receive training to use naloxone rescue kits and are provided nasal naloxone at release. Ongoing support from a certified recovery mentor to facilitate sustained engagement with treatment for substance use disorders begins in the month prior to release from prison and continues for 6 months in community. We evaluate the association between ROAR participation and the primary outcome of opioid overdose. Using administrative data provided by the Oregon Department of Corrections and the Oregon Health Authority, we compare the odds of overdose among ROAR participants versus a comparison group of females released from prison during the study period. Evaluation activities in community includes survey and qualitative interviews for 6 months post release, as well as a review of clinic records to assess retention on medication among the pilot cohort (N = 100). Discussion ROAR is a collaboration between Oregon’s public health, criminal justice, and medical communities. The ROAR intervention and evaluation provide critical information on improving interventions to prevent opioid overdose and improve retention on treatment in community in an overlooked, high-risk population: incarcerated women re-entering the community. Trial registration Clinical Trials.gov TRN: NCT03902821 .

Objectives: The objective of this study was to investigate the impact of COVID-19 on the mental health, substance use, and overdose concerns among people who use drugs (PWUDs) in rural communities to explore reasons for changes and ways to mitigate COVID-19 impact in the future. Methods: We conducted semi-structured in-depth interviews with PWUDs in 5 rural Oregon counties with high overdose rates. Participants were identified through participant-driven sampling along with flyer and text advertising (n = 36). Research staff conducted audio-recorded in-depth interviews via telephone, assessing COVID-19 effects on substance use, mental health, and overdose risk. Transcribed interviewers were coded for themes using a semantic approach. Results: Participants reported various mental health symptoms and experiences due to COVID-19, including increased feelings of boredom, loneliness, and depression; increased worry and stress; and increased suicidal ideation. Participants described varying impacts of COVID-19 on substance use. Overall, participants who used only methamphetamine reported decreased use and people who used only heroin or heroin with methamphetamine reported increased use. Most participants reported that they were not concerned about overdose and that COVID-19 did not impact their concerns about overdose, despite increases in risky use and suicidal ideations. Conclusions: As rural communities respond to the evolving impacts of COVID-19, there is increasing need to identify strategies to address PWUD's mental, physical, and social health needs during COVID-19.

Background: Community-based participatory research (CBPR) brings academics and community members into research partnerships. Although power is central to CBPR, little is known about community partners' experience with empowerment in CBPR with people with developmental disabilities. We interviewed 15 community partners with and without developmental disabilities about empowerment in CBPR. Community partners identified empowered mindsets and behaviors and CBPR factors that facilitated or hindered their empowerment. Our findings indicate CBPR provides opportunities for people with developmental disabilities to gain and develop important qualities, such as empowerment. However, CBPR partnerships need to be carefully constructed and monitored to fully realize positive outcomes.

BACKGROUND:Community-based participatory research (CBPR) seeks to improve the responsiveness of science to community priorities and foster positive community change through equitable research collaborations between scientists and community members. CBPR resonates with disability rights principles, and is increasingly being used in disability research, though there are few studies of its use with people with developmental disabilities. OBJECTIVE:We conducted a prospective qualitative study to explore the experiences of scientists and community members in a multi-year CBPR project with people with developmental disabilities. METHODS:Over the four project years, we conducted periodic individual interviews and focus groups with members of the CBPR project, and used an inductive thematic analysis to identify and develop relational themes. RESULTS:We identified factors that contributed to the success of the CBPR project and factors that presented challenges to the CBPR project. We also identified potential individual, project, and societal level impacts of the CBPR project. CONCLUSIONS:CBPR with people with developmental disabilities is possible and fruitful, and can serve as an effective model for the full inclusion of people with developmental disabilities in science and society at large.

Action research-research collaborations between professional researchers and community members to address community concerns-has become increasingly popular in developmental disability research. Advocates of these approaches argue that they reflect the value of including people with disabilities in matters that affect them and generate benefits for people with disabilities and for research. However, it is not clear how well action research with adults with developmental disabilities reflect core action research principles. The authors identified 21 action research projects with adults with developmental disabilities in English-language referred journals. The authors found that the majority of these projects took place in the UK or the United States, with individuals with intellectual disabilities, were published in or after 2005, and used qualitative methods to examine research aims on social issues important to adults with developmental disabilities. They reviewed common challenges, facilitators, and indicators of success described by authors and found that relatively few projects can be classified as high on the continuum of shared power. Based on these findings, the authors recommended a continued focus on the accurate understanding and application of action research models, building our knowledge of and evidence base for effective tools, strategies, resources, and personal characteristics for action research with adults with developmental disabilities, adequately funding this research, and pursuing a broader array of research methods. The projects studied herein provide evidence for the promise and possibility of action research with adults with developmental disabilities.