Psychopathic traits are linked to counterproductive work behaviours, white-collar crime, and unethical decision making. However, psychopathy remains underassessed in hiring due to concerns about clinical methods and susceptibility to faking in self-report tools. The Conditional Reasoning Test for Workplace Psychopathy (CRT-WP) offers a promising alternative by measuring implicit psychopathic reasoning through scenario-based reasoning tasks. This study evaluated the CRT-WP's fairness and equivalence across subgroups and languages within a Canadian context. Using data from 6,746 English and 2,182 French-speaking Canadian job applicants, item response theory and differential item functioning (DIF) analyses examined potential subgroup differences based on sex, ethnicity, indigeneity, disability, as well as potential differences between an English and French language version. Results showed minimal DIF for visible minorities, with small or negligible differences in overall scores. Although more DIF was observed across sex and language versions, particularly at extreme trait levels, these differences did not substantively alter overall score interpretation. Indigeneity and disability comparisons were explored with traditional mean comparisons and observed DIF methods due to limited sample size. The CRT-WP demonstrated resistance to subgroup bias and potential for use in diverse hiring contexts, though the French version may require refinement to be precisely comparable to the English version. CRT-WP scores were unexpectedly negatively correlated with cognitive ability, but after removing distractor choices, the relationship weakened. Findings suggest that the CRT-WP may be a fair and faking-resistant tool for assessing nonclinical psychopathic traits in hiring contexts, though continued research is needed to further validate its cross-cultural and linguistic applicability.

: Workplace psychopathy is linked to harmful outcomes, yet it is rarely assessed in hiring due to limitations of existing tools. The Conditional Reasoning Test for Workplace Psychopathy offers a promising alternative by using implicit reasoning to reduce faking. We examined whether test-takers could identify the test's purpose (ATIC) and how different types of disclosure impacted test-takers' reactions in two studies: a generic application scenario with (N = 187) students and a more ecologically valid scenario with (N = 230) active job-seekers. Most participants did not recognize the test assessed psychopathy. ATIC scores were unrelated (Study 1) or weakly related (Study 2) to test performance. Reactions were moderate, although disclosing that the test measures psychopathy (vs. personality) led to slightly lower justice perceptions and organization attraction.

Background: Methamphetamine-associated heart failure (MAHF) is increasingly prevalent in rural communities, where limited specialty care and barriers to healthcare engagement hinder early diagnosis and treatment. Peer-led screening with brain natriuretic peptide (BNP) testing, supported by telemedicine, may enhance early detection and linkage to cardiology care. Aim: PEER-Heart is a hybrid type 1 effectiveness-implementation trial to evaluate the feasibility, acceptability, and effectiveness of a peer-assisted point-of-care screening protocol and telecardiology intervention for MAHF in rural Oregon. Methods: We will recruit 122 adults reporting methamphetamine use within the past 30 days from two rural Oregon counties. Individuals will be screened for MAHF by peers using a symptom questionnaire, brain natriuretic peptide (BNP) testing, and a mobile electrocardiogram. Individuals who screen positive will be randomized to a peer-facilitated telecardiology intervention or enhanced usual care (EUC). Primary outcome is linkage to heart failure treatment at 2 months. Secondary outcomes include changes in symptom severity, knowledge, and engagement in guideline-directed medical therapy. Implementation barriers and facilitators will be assessed through interviews and focus groups using thematic analysis and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We hypothesize that peer-assisted telecardiology will result in higher linkage to care. The study will assess the feasibility and acceptability of peer-delivered cardiovascular screening and telecardiology in high-risk populations. Conclusion: PEER-Heart addresses a critical gap in early detection and management of heart failure for people who use methamphetamine in rural settings. Findings will inform efforts to scale peer-integrated telemedicine programs for underserved populations with complex needs.

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.

BACKGROUND:Stigma is a barrier to help-seeking in rural-dwelling people who use drugs. However, little is known about whether stigma is experienced in patterned ways, and what characteristics are associated with these patterns. METHODS:Data came from a cohort of people who use drugs at eight geographically diverse Rural Opioid Initiative sites (n = 3048). We used three-step latent class analysis to classify participants by patterns of felt substance use stigma, then used multinomial logistic regression to explore demographic, health, and substance-related covariates associated with class membership. RESULTS:Based on fit statistics and interpretability, we selected a five-class solution. Four classes were patterned by severity: Low Stigma (23.7%), Medium-Low Stigma (12.5%), Medium-High Stigma (34.9%), and High Stigma (24.7%). The fifth class ("High Fearers/Low Perceivers," 4.3%) reported high shame and fear of rejection but low perceived stigma from others. Members of higher stigma classes were more likely to have criminal-legal system involvement, inject drugs, and avoid healthcare and drug treatment. In contrast analyses, "High Fearers/Low Perceivers" were more likely to be younger and women, and less likely to have criminal-legal system involvement, experience homelessness, or inject drugs compared with other classes. CONCLUSION:Rural people who use drugs experience substance use stigma in distinct severity-based patterns, with four classes ranging from low to high stigma across all dimensions. A fifth, smaller class reports high internalized stigma despite low perceived stigma from others, potentially suggesting non-disclosure of substance use. These distinct profiles and their correlates offer targets for tailored stigma interventions.

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).

BACKGROUND:Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet <10% of PWUD in the United States access HCV treatment; access is especially limited in rural communities. METHODS:We randomized PWUD with HCV viremia and past 90-day injection drug or nonprescribed opioid use in 7 rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care [EUC]). Peers supported screening and pretreatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants. Generalized linear models estimated group differences in HCV viral clearance (primary outcome) and HCV treatment initiation and completion (secondary outcomes). RESULTS:Of the 203 randomized participants (100 TeleHCV, 103 EUC), most were male (62%), White (88%), with recent houselessness (70%), and used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five of 100 TeleHCV participants (85%) initiated treatment versus 13 of 103 (12%) EUC participants (relative risk [RR], 6.7 [95% confidence interval {CI}, 4.0-11.3]; P < .001). Sixty-three of 100 (63%) TeleHCV participants versus 16 of 103 (16%) EUC participants achieved viral clearance 12 weeks after anticipated treatment completion date (RR, 4.1 [95% CI: 2.5-6.5]; P < .001). CONCLUSIONS:The Peer TeleHCV treatment model substantially increased HCV treatment initiation and viral clearance compared to EUC. Replication in other rural and low-resource settings could further World Health Organization HCV elimination goals by expanding and decentralizing treatment access for PWUD. Clinical Trials Registration. NCT04798521.

BackgroundThe COVID-19 pandemic spurred relaxation of opioid treatment program (OTP) in-person daily dosing requirements. This policy change was met with widespread enthusiasm by patients and providers and did not increase illicit opioid use, overdose, or medication diversion. However, it is not known whether the policy change was effective at mitigating the COVID-19 public health emergency among people with opioid use disorder (OUD) receiving treatment at OTPs.ObjectiveTo evaluate the impact of treatment at OTPs on rates of COVID-19 infections and complications.DesignProspective cohort from 4/1/2020 to 3/31/2021.ParticipantsOregon Medicaid beneficiaries with an OUD diagnosis.Main MeasuresThe exposure was time-varying treatment for OUD, including (1) medication treatment at an OTP, (2) office-based opioid medication treatment (OBOT), (3) other treatment without medications for OUD, or (4) no treatment. Outcomes were COVID-19 diagnoses, COVID-related emergency department visits, and COVID-related hospitalizations.ResultsParticipants (N = 24,654) averaged 39 years old, most were female (53%), White (84%), and non-Hispanic (88%). Adjusted for characteristics and comorbidities, OTP patients demonstrated significantly reduced risk of COVID-19 diagnoses compared to all other groups: a 37% reduction compared to OBOT, a 52% reduction compared to non-MOUD treatment, and a 37% reduction compared to no OUD treatment. OTP treatment was also associated with a 40% risk reduction of COVID-related ED visits compared to OBOT, a 56% reduction compared to non-MOUD treatment, and a 46% risk reduction compared to no treatment. For inpatient stays, there was not a significant difference between OTP and OBOT treatment or no treatment, but OTP treatment was associated with a 64% risk reduction compared to non-MOUD treatment.ConclusionsLower risks of COVID-19 diagnoses and complications were observed among people with OUD receiving treatment at OTPs compared to other forms of treatment or no treatment.

New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon's early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023. Data collection included a review of public listings, contact with training programs, and facilitator survey. Results indicated that in the 16 active training programs, the mean tuition was $9,359 and half offered diversity scholarships. Survey respondents (n = 106) were relatively diverse; many had an existing healthcare license. The majority reported that training expenses were a moderate-to-severe financial strain. Most were satisfied with training. The mean planned price for a session was $1,388 and the most common areas of specialization were trauma, mental disorders, consciousness exploration, and spirituality. Facilitators requested ongoing training opportunities. In conclusion, Oregon's emerging psilocybin facilitator workforce and training programs are in early development. These findings are crucial for informing future policy and training program development to support a diverse and effective workforce.

BACKGROUND:Multiple injections per injection episode (MIPIE) is increasingly common among people who inject drugs (PWID). While MIPIE may lower overdose risk, it could elevate infectious disease risk. This study examined the prevalence of MIPIE among rural PWID in the United States and its associations with injection behaviors associated with disease transmission (e.g., syringe mediated drug sharing, receptive supply sharing) and health outcomes (e.g., hepatitis C virus (HCV) status, naloxone possession, and overdose). METHODS:The Rural Opioid Initiative includes eight research cohorts of rural people who use drugs from across the U.S., recruited from 01/2018 to 03/2020. MIPIE was dichotomized as any vs. none using the question: "How many times in the past 30 days did you inject more than one time in one sitting?" We employed a fixed effects meta-analytic approach to examine cross-sectional associations through adjusted regression analyses. RESULTS:Among 2441 PWID, most reported MIPIE (71% [n=1729]). In adjusted analyses, MIPIE was associated with a higher prevalence of past 30-day receptive syringe sharing (Prevalence Ratio (PR)=2.02; 95% confidence interval (CI)=1.74-2.34), syringe-mediated drug sharing (PR=1.92; 95%CI=1.69-2.18), receptive supply sharing (PR=1.99; 95%CI=1.75-2.26), distributive supply sharing (PR=2.30; 95%CI=1.99-2.65), HCV (PR=1.26; 95%CI=1.11-1.44), naloxone possession (PR=1.32; 95%CI=1.17-1.50), overdose ever (PR=1.42; 95%CI=1.25-1.57), and overdose in the prior 90 days (PR=2.09; 95%CI=1.52-2.87). CONCLUSIONS:MIPIE is a common practice among rural PWID and is associated with injection behaviors associated with disease transmission, HCV, and overdose. Intervention studies should develop harm reduction strategies that address both overdose prevention and infectious disease mitigation related to MIPIE.

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

We used structural equation modeling to test client meaningful experiences in counseling and the therapeutic working alliance (TWA) as predictors of affective distress, controlling for clients’ age, gender, race and ethnicity, and length of counseling relationship. In a sample of 306 adult clients engaging in counseling, we a found statistically significant relationship between client meaningful experiences in counseling and the TWA (r = 0.80, p < 0.001). There was a significant and negative direct effect from client meaningful experiences in counseling to affective distress (β = −0.45, p < 0.001). However, we did not find a significant direct effect of the TWA on affective distress (β = −0.00, p = 0.97). Implications for counselors, supervisors, and counselor educators are discussed.

INTRODUCTION:At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes. METHODS:A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington. The intervention was a fully telehealth-only (THO) app versus treatment as usual (TAU) in office-based settings with some telehealth. We assessed self-reported buprenorphine discontinuation at 4-,12-, and 24-weeks. Generalized estimating equations (GEE) calculated unadjusted and adjusted relative risk ratios (RR) for discontinuation averaged over the study period. Secondary outcomes included change in the Brief Addiction Monitor (BAM) and the visual analogue craving scale. Generalized linear models estimated average within-group and between-group differences over time. RESULTS:Participants (n = 103 THO; n = 56 TAU) had a mean age of 37 years (SD = 9.8 years) and included 52 % women, 83 % with Medicaid insurance, 80 % identified as White, 65 % unemployed/student, and 19 % unhoused. There were differences in gender (THO = 54 % women vs. TAU = 44 %, p = .04), unemployed status (60 % vs 75 %, p = .02), and stable housing (84 % vs 73 %, p = .02). Rates of buprenorphine discontinuation were low in the THO (4 %) and TAU (13 %) groups across 24 weeks. In the adjusted analysis, the risk of discontinuation was 61 % lower in the THO group (aRR = 0.39, 95 % CI [0.17, 0.89], p = .026). Decreases occurred over time on the harms subscale of the BAM (within-group difference - 0.85, p = .0004 [THO], and - 0.68, p = .04 [TAU]) and cravings (within-group difference - 13.47, p = .0001 [THO] vs -7.65, p = .01 [TAU]). CONCLUSIONS:A telehealth-only platform reduced the risk of buprenorphine discontinuation compared to office-based TAU. In-person evaluation to receive buprenorphine may not be necessary for treatment-seeking patients. CLINICAL TRIALS IDENTIFIER:NCT03224858.

Hepatitis C (HCV) treatment for people who use drugs (PWUD) decreases injection drug use and injection equipment sharing. We examined changes in injection drug use and injection equipment sharing following HCV treatment in a randomized trial comparing peer-assisted telemedicine for HCV treatment (TeleHCV) versus peer-assisted usual care in rural PWUD. We hypothesize that TeleHCV reduces risky behaviors and peers facilitate this change. We used mixed-effects logistic regression to describe participant-level (n = 203) associations between both injection drug use and injection equipment sharing and randomized groups, frequency of peer contact, HCV treatment initiation, HCV cure, and time. Risky behaviors were surveyed at baseline and 12 and 36 weeks after HCV treatment completion. Injection drug use declined more over time in TeleHCV participants vs. control at 12 weeks (adjusted odds ratio [aOR] = 0.42, 95% CI 0.20–0.87, p = 0.02) and 36 weeks (aOR = 0.48, 95% CI 0.21–1.08, p = 0.076). Injection drug use decreased more with a greater number of peer interactions, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 12 weeks (aOR = 0.75, 95% CI 0.57–0.99, p = 0.04). Similarly, injection equipment sharing decreased over time, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 36 weeks (aOR = 0.08, 95% CI 0.01–0.97, p = 0.047). Peer-assisted telemedicine for HCV treatment decreases injection drug use and injection equipment sharing; peers contribute to this effect.