1. Development of MiREA-AOC utilizing Motivational Interviewing Theoretical Constructs to address Intervention for Cannabis and Opioids in College Students

Donna Kazemi, PhD, FIANN; USC CON; Columbia, South Carolina

Background In the United States, college students have the highest rates of substance use compared to any other age group.1,2 Mobile technologies have rapidly grown (e.g., smartphones, computers, text messaging).3 Brief Intervention (BI) is a personalized evidence-based approach using Motivational Interviewing (MI). MI (used in BI) is a collaborative conversational style that seeks to resolve ambivalence toward change with the client by evoking personal reasons for change.4,5 The aim of this study is to increase the scope of our MI theory-based alcohol-based MiREA-A a smartphone intervention, by adapting our existing mHealth-delivered application to include content on cannabis and opioid use (refined MiREA-AOC). Purpose We will integrate content on opioids and cannabis into the existing MiREA-A features. The adapted MiREA-AOC will be designed to deliver enhanced user visual, auditory, and contextual experiences through a built-in UX/UI interface (e.g., chatbot coach, personalized feedback, behavior tracking logs, text messaging). Then we will determine the feasibility, acceptability, and efficacy of the adapted intervention (MiREA-AOC ) on alcohol, opioid, and cannabis. Results The project is in progress, with completion planned by November 15, 2023. Tasks will consist of a) developing the adapted spMiREA-AOC with integrated MI content; b) conducting theater and field testing, and focus groups on the new app with students (n=20) to obtain feedback on the feasibility, clarity, usability, and acceptability of the content, and to obtain data that will guide the final components of the spMiREA-AOC intervention; and c) final refining of our new intervention based on student feedback.

10. Tianeptine, an Emerging Public Health Problem: Clinical Case Presentation

Brayden Kameg, DNP, PMHNP-BC, CARN-AP, CNE; Pittsburgh, Pennsylvania

Tianeptine is an atypical antidepressant that is not currently Food and Drug Administration (FDA)-approved in the United States, but is available in several European, Asian, and Latin American countries for the treatment of depressive symptoms. Structurally similar to a tricyclic antidepressant, it has been suggested that tianeptine functions as a full agonist at mu-opioid receptors and to a lesser extent a delta-opioid receptor agonist. Given its mechanism of action, it has been established that tianeptine use is associated with not only anxiolytic and mood-enhancing effects, but also with euphoria, and thus tianeptine can be associated with misuse, a risk which is heightened in those with opioid use disorders. Thus, health care providers, including nurses and advanced practice nurses who work in substance use treatment settings, must be cognizant of tianeptine misuse, which is an emerging, potential public health threat. This clinical case presentation describes a 39-year-old male Veteran with a history of opioid use disorder, posttraumatic stress disorder, and depression, who began using tianeptine while maintained on medications for opioid use disorder (MOUD), including buprenorphine/naloxone. Identification and management of tianeptine use will be discussed, utilizing a patient-centered and harm reduction-focused framework.

11. Using Innovative Teaching Methods to Decrease Stigma Towards Those with Substance Use Disorder

Kimberly Dion, Ph.D., RN, CNE, CARN, FIAAN; University of massachusetts Amherst; Amherst, Massachusetts

Problem: In 2021, an estimated 46.3 million people worldwide had a substance use disorder (SUD). Nursing programs lack adequate SUD education, and nurses report feeling unprepared to care for people with SUD. Purpose: To determine if targeted anti-stigma interventions improved nursing students' attitudes and perceived stigma toward people with SUD. Methods: First-semester junior university nursing students (n=289) received six hours of training on how to care for people with SUD. Training included the physiology of addiction, screening, and brief intervention, stigma-reducing language, naloxone training, presentations by persons with a lived experience, role-play, virtual scenarios, and an electronic repository. The 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ) and 8-item Stigma of Substance Abuse Scale (PSAS) were completed at baseline, post-intervention, and six months later. The theory of therapeutic commitment served as the framework. Results: Using a Wilcoxon signed rank test, across all 20 DDPPQ measures, participants showed statistically significant (Prob |z| < .05) improvement in scores and maintained this through the six-month follow-up survey. Using a Wilcoxon signed rank test, across all 8 PSAS measures, students showed statistically significant improvement in six of eight measures and their overall PSAS score. Sixty-four percent of the students participated in harm reduction education in the clinical setting. Conclusions: It is possible to improve student nurses’ both perceived stigma and therapeutic attitudes through a six-hour multimodal training. Anti-stigma interventions led to a decrease in stigma and an improvement in overall therapeutic attitudes toward people with SUD.

12. Mapping Key Components of Substance Use Disorder Stigma Awareness/Reduction Education: A Scoping Review

Erin Kitt-Lewis, PhD, RN, CNE; Penn State; University Park, Pennsylvania

Stigma awareness and reduction education is essential component to prepare nurses and healthcare providers who provide care to people with substance use disorders (SUD). However, the types and quality of stigma awareness and reduction educational programs is not well documented in the literature. The purpose of this scoping review is to identify what educational programs are being used to train individuals about stigma towards people with SUD. The research team was a collaboration between two academic nurses and one librarian. The librarian conducted a comprehensive search using CINAHL, PubMed, PsychINFO, and Web of Science. Duplicate articles were removed. Articles (n=1099) were uploaded to JBI SUMARI. Two rounds of reviews for completed by each of the researchers: Title and abstract review (n=1099) and full text review (n=450). Results yielded 86 articles for extraction. The researchers created an extraction table, and a preliminary code book was developed. Content analysis was conducted by two researchers independently. The researchers met and discussed analysis until consensus was reached. Findings were organized into the following categories related to educational program: quality (content development, instrument development and testing, program evaluation); scope; and intended audience. Currently there is no one program that meets all the criteria for an evidence-based sustainable program focused on stigma awareness/reduction for healthcare professionals including nursing. These findings can inform evidence-based program development and evaluation. Stigma awareness/reduction education could be standardized and broadly disseminated to reach nurses, healthcare professionals and the community at large. This type of education could positively impact people with SUD.

14. The Inequitable National Response to the Opioid Epidemic: Low-Threshold Treatment Is the Path Forward

Derrick Glymph, PhD, DNAP, CRNA, CHSE, FAANA, FAAN; Duke; Holly Springs, North Carolina

The United States (US) is failing in its response to the opioid epidemic. Low threshold treatment (LTT) is patient centered and flexible, providing uninterrupted access to life saving medication for opioid use disorder (MOUD). LTT with buprenorphine represents a solution to the current failing national response to this problem. However, at present there are four distinct buprenorphine protocols with treatment selection considerations remain unanswered. In this manuscript, we highlight differences and similarities in the five treatment selection considerations: safety and efficacy, current opioid polysubstance use, patient and provider preferences, time to stabilization and socio- contextual treatment factors that warrant consideration prior to treatment selection of LTT buprenorphine protocols.

15. Improving Recognition, Assessment and Treatment of Alcohol Withdrawal Syndrome Through Focused Continuing Education

David Mischel, DNP, APNP, PMHNP, CARN-AP, FIAAN; Eau Claire, Wisconsin

Background: Registered Nurses (RNs) in the state of Wisconsin are often tasked with providing care for individuals with alcohol withdrawal syndrome. Many times, the RNs are not provided focused continuing education on the best treatment of these individuals. This education is especially important in Wisconsin due to the concerns with alcohol consumption throughout the state. Methods: An educational intervention was created using two 30-minute educational videos. Pre-and post-intervention surveys were conducted to capture the knowledge improvement after the intervention. The surveys were also used to measure whether the RNs would recommend the educational interventions. Statistical analysis using the SPSS was completed on the results of the surveys. The intervention was given to RNs in multiple types of patient care units. Results: The educational intervention results showed a cumulative knowledge gain for the RNs who completed the surveys. 89.1% of RNs recommended the first intervention and 84.3% of the RNs recommended the second intervention for all RNs who could be assigned to care for individuals with alcohol withdrawal symptoms. Discussion: Focused continuing education training RNs on recognition, assessment, and treatment of alcohol withdrawal symptoms can be applied to multiple patient care units and improve patient outcomes. It is not necessary to modify this education for different departments. Key Words: registered nurses, alcohol withdrawal syndrome, education, training, CIWA-AR

16. Gabapentin abuse: A case presentation on how to manage this growing concern

Jason Gregg, DNP, APRN, FNP-BC, PMHNP-BC; University of Cincinnati; Cincinnati, Ohio

Gabapentin was first approved by the US Food and Drug Administration in 1993 as an adjunct treatment of epilepsy. In 2004, another indication of pain associated with post-herpetic neuralgia was added. Misuse of gabapentin dates back to 2010 while surging recently to the tenth most commonly prescribed medication in 2016. Abuse can be as high as 65% for even those who legally obtained the medication through a prescription. It is used off-label up to 95% of the time despite limited evidence of it efficacy particularly with multiple pain types. The surge in misuse can be attributed off-label use along with an assumption of no abuse potential coupled with clinicians seeking alternative treatment options to the opioids. More common side effects include sedation, dizziness, and cognitive difficulties. However, even normal dosing can produce side-effects similar to other addictive substances: euphoria, talkativeness, and increased energy (opioids); sedation (benzodiazepines); and dissociation (hallucinogens). In fact, some states will or have already added gabapentin to the controlled substance rosters even though no federal designation is in place. Identified risks for gabapentin misuse in the literature are limited with the exception of a history of or current substance abuse, particularly opioids. Unfortunately, gabapentin is often co-prescribed with opioids lending to a heightened risk of opioid-related mortality. Clinicians must understand that gabapentin is not effective for a variety of pain conditions nor is a routine substitute for opioids. In addition, close monitoring practices often associated with opioids and benzodiazepines should be applied to that of gabapentin.

17. Cannabidiol: A case presentation on the shortcomings in clinical application

Jason Gregg, DNP, APRN, FNP-BC, PMHNP-BC; University of Cincinnati; Cincinnati, Ohio

Nearly four percent of the global population consumes cannabis with the highest prevalence among young people. Proponents of its use boast a myriad of benefits, including relief of pain, depression, anxiety, and insomnia. Pharmacologic research on cannabidiol (CBD) first occurred in the late 1970s, and more recently has garnered expanded focus due to mounting consumption despite a dearth of evidence in health efficacies. Tetrahydrocannabinol (THC) is deemed to be the intoxicating component of the flowering plant, lending to psychoactive outcomes, including euphoria and psychosis. Conversely, CBD is not thought to be psychotropic in nature. While there are a number of considerations regarding the utilization of CBD, emphasis is placed on the fact that medical-use indication is limited to its anti-seizure effects. In addition, high-grade evidence-based research data regarding the use of CBD for other medical diseases is deficient. Negative health consequences for consumers who may be unaware that inaccurate labeling and dose variability across the product backdrop is problematic. All things considered, counsel against the use of CBD products may be a judicious clinical approach.

19. Understanding Mothers' experiences of caring for and about an adult child with substance use disorder: A phenomenological study

Kathleen Elliott, DNP; University of Massachusetts Dartmouth; Dartmouth, Massachusetts

This presentation aims to uncover the voice of mothers who have experienced caring for adult children with SUD. Mothers have been blamed, shamed, isolated, and misrepresented in intervention models for over a century, partly because their voice has been subsumed under "family dynamics" and silenced by embarrassment and fear. Method: A Phenomenological approach guided the researcher to use open-ended questions to reveal the participant's lived world. Follow-up probes helped deepen an understanding of these mothers' intended meanings and specific experiences. Ten women participated in this phenomenological study that sought to uncover their lived experience of mothering an adult child with SUD. Face-to-face interviews were conducted, recorded, transcribed, and analyzed using Van Manen's (1990) thematic modes. Each interview lasted from 1 to 1.5 hours. Once transcripts were completed and before thematic analysis, the researcher read the entire transcript and responded aesthetically to the mother's story. This process proposed by Reason and Hawkins (1995) directs the researcher to "deepen the story" rather than immediately analyze it. Each text was analyzed holistically, selectively, and then line by line (VanManen, 1990) for themes, and then transcripts were compared for similarities. Results: The themes of mothering an adult son/daughter with SUD are described and examples of the lived experiences of the themes will be shared. Mothers' experiences of strength, of challenge, and instances of supportive interventions are revealed. Additionally, the researcher will offer one of her aesthetic responses to a mother's story.

21. “Breaking Down the Walls of Stigma”: Partnering with the Recovery Community to Bring Authenticity and Lived Experience to Addictions-Focused Simulations in Nurse Practitioner Education

Kathleen Schachman, PhD, PMHNP-BC, FNP-BC, FIAAN; Saginaw Valley State University; University Center, Michigan

Problem: Recovery communities can positively impact nursing education through participation in addictions-focused simulations. Realistic portrayals of individuals in recovery have the potential to challenge stereotypes and reduce the stigma associated with addiction. Effective integration of such simulations into nursing curricula requires a better understanding of student and recovery community viewpoints. Aim: This qualitative study examines the perspectives of both nurse practitioner (NP) students and members of the recovery community who participated in an addictions-focused simulation. Methods: A peer recovery organization volunteered to develop and implement a day-long simulation for nurse practitioner students to improve their confidence, competence, and readiness to provide care to individuals with substance use disorders. In-depth interviews were conducted with members of the recovery community, while NP students completed a self-reflection paper. Thematic analysis was used to better understand the perspectives of both groups in this joint educational endeavor. Results: Interviews were conducted with 11 peer recovery volunteers, and 63 NP students completed a written self-reflection. A number of overlapping themes were identified, including increased compassion gained through better understanding of each other, reduced stigma by seeing the “real person”, enhanced empowerment and hope, and instilling a sense of gratitude and purpose. Furthermore, peer recovery volunteers valued the ability to “give back” to foster the education of future healthcare professionals and felt that the experience strengthened their personal recovery journey. Conclusion: Partnering with a peer recovery organization brings authenticity and realism to addictions-focused simulations and offers significant benefits to both NP students and individuals living in recovery.

22. Opioid Use Disorder Community Outreach: Reducing Stigma and Building Community Access to Narcan

Paige Pickerl, LCSW, MSW; Rush University Medical Center; Chicago, Illinois

The Rush Substance use Disorder (SUD) Center of Excellence, tasked by the Illinois Department of Human Services, Substance Use Prevention Recovery Services with identifying SUD issues of need, collaborating with statewide agencies in the development of SUD treatment capacity, and facilitating ongoing efforts to address the opioid crisis, have identified a key area of intervention through engaging and providing educational content for community members and facilitating discussions surrounding perceptions of SUD, stigma, Naloxone training, and principles of harm reduction. The educational sessions were conducted during various community outreach events, with bars, restaurants and music venues, and various community outlets and businesses. Through this research the team sought to examine how building education and OUD literacy in local communities and businesses increased awareness of life saving interventions, and harm reduction, while decreasing stigma and misperceptions. Through a brief 12 question survey offered to individuals who received Narcan and training from staff, the team was able to assess the above objective, while also asking the community what information and collaboration could be further offered.

23. Project ECHO Resonates in Building Confidence and Competence in Addictions Nursing

Kathleen Schachman, PhD, FNP-BC, PMHNP-BC, FIAAN; Saginaw Valley State University; University Center, Michigan

Problem: Despite the increasing prevalence of addiction-related health issues, many nurse practitioner (NP) students do not feel adequately prepared to deliver effective addiction care upon graduation. Curricular gaps in nurse practitioner education may lead to suboptimal identification and treatment of individuals with a substance use disorder (SUD), contributing to the perpetuation of public health challenges. An addictions-focused Project ECHO is an innovative educational strategy that utilizes tele-mentoring to leverage community expertise to build competence and confidence in addictions care among NP students. Aim: This qualitative study examines the perspectives of psychiatric NP students who participated in an addictions-focused Project ECHO. Methods: Psychiatric NP students attended an addictions-focused Project ECHO and presented a complex clinical case to an interdisciplinary expert hub team. Following this educational experience, students composed a self-reflection paper to share their insights. Thematic analysis was used better understand the perspectives of NP students. Results: Over a four-year period, 108 psychiatric NP students completed a self-refection paper following their Project ECHO experience. A number of themes were identified, including an appreciation of the collaborative nature and diverse viewpoints of the interdisciplinary team, opportunities for professional networking and support, access to specialized knowledge and resources, and the practical application and impact on practice. Conclusion: These themes highlight the value and effectiveness of Project ECHO in enhancing the knowledge, skills, and confidence of NP students in managing addictions. Through tele-mentoring, Project ECHO provides a supportive environment that enables students to develop and hone these essential competencies.

24. Closing the opioid treatment gap through advance practice nursing activation: Curricular design, implementation, and evaluation

Adam Leonard, MS, MPH, CPNP, AAHIVS; University of California, San Francisco School of Nursing; San Francisco, California

Problem: Opioid use remains a prominent and avoidable cause of unintentional injury and death--especially for people of color, rural populations, and adolescents and young adults (AYA)--and underutilization of opioid use disorder (OUD) treatments is a significant driver. . Advanced Practice Registered Nurses (APRNs) have notable potential to increase provision of medications for OUD (MOUD) in underserved communities. Evidence: APRNs prescribe MOUD at overall higher rates than physicians and are more likely to care for Medicaid patients, rural populations, and disengaged AYA, thereby reducing critical disparities in MOUD provision. Implementation: We implemented 30 hours of asynchronous didactic, synchronous case-based, and clinical observation content. Asynchronous content was available to students early in the quarter to provide ample flexibility. Similarly, students were able to select from many clinical observation sessions to match their schedule and interest. Finally, synchronous content was planned far in advance in consultation across specialty programs to schedule sessions with minimal to no course scheduling conflicts. Evaluation: Sixty-six students participated in year one. There was high course satisfaction. On average, participants rated the course 3.83/4 on advancing MOUD knowledge and skill. At 30-day follow-up, 94% indicated course participation resulted in practice change. Lessons: Incorporating content on social determinants of health and MOUD into the curriculum was essential to engaging learners and preparing them to increase equitable access to MOUD. Implementation of equity-focused MOUD content into core APRN curriculum that includes strategies to address structural barriers to care is feasible and acceptable.

25. The Opioid Use Disorder Team: An interdisciplinary approach to managing patients with complex opioid use disorder in an acute care setting.

Wendy Williams-Gilbert, PhD, RN; University of Washington, ADAI; Spokane, Washington

Over the last 4 years the team at Multicare Deaconess has collaborated with the State Opioid Response grant and the University of Washington Addictions Drug and Alcohol team to create an interdisciplinary team that works with patients to address the nuances of OUD best practices. Patients who present into the ED with a history of OUD, present with overdose or are going through acute withdrawal are referred to this team which consists of a nurse care manager and a care manager/peer support. This team collaborates across disciplines to help address withdrawal, the challenges of fentanyl use and referral and follow up with community support. Many health care professionals shy away from patients with OUD due to bias, stigma and/or just not understanding the complexities of managing OUD. By providing the expertise patients are able to receive quality care that assists in addressing both the OUD and/or other medical condition that brought them to the acute care setting. This case study presentation will identify the roles, engagement and trajectory of care of a complex patient with OUD.

27. Exploring the Scope of Practice of Peer Support Workers in Addiction and Mental Health

Sam Perry; Calgary, Canada

The occupation of Peer Support Workers (PSWs) has been steadily growing in addiction and mental health settings. The duties of a peer support worker can vary greatly by setting; however, their fundamental role is characterized as an individual who has lived experience in mental health and/or substance use, who works as a mentor to support patient care. While PSWs are valued members of the health care team, the role of PSWs in interprofessional teams is ill-defined and without a clear scope-of-practice. As a result, expectations of the PSWs’ duties vary considerably, leading to confusion among the health care team and job dissatisfaction for PSWs. This ambiguity impacts the quality of care to service users seeking support in the addictions and mental health setting. This project aims to explore the question: how do peer support workers understand and navigate their scope of practice? We are exploring this by conducting one-on-one interviews with PSWs currently employed within the substance-use field. We are using reflexive theme analysis to analyze these interview data for themes. We will present our findings at IntNSA, specifically for those working in the field of addictions and mental health. Our goal is to use this research to move towards a regulatory body of practice, as well as empower PSWs to work to their full scope of practice in outpatient mental health services.

28. Understanding the Surge in Public Drug Consumption: Exploring Preferences, Risks, and Nursing Harm Reduction Strategies among People with Unsecured Housing using Drugs in Public

Miriam Woo, Bachelor of Nursing; WISHES lab; Calgary, Canada

In recent years, the prevalence of public drug consumption in Canada has risen, resulting in mortality rates related to substance use. This study aims to identify the preferred locations of drug consumption for people with unsecure housing using drugs in public, and why these areas are preferable to supervised consumption services or similar. This study seeks to uncover the underlying reasons for the surge in public drug consumption among people with unsecure housing using drugs in public, including privacy, belonging, available methods of consumption, and accessibility to existing harm reduction resources. We will complete 1:1 interviews with people with unsecure housing using drugs in public to ask about what they prefer about their locations of public drug consumption. The study will employ an interpretive description approach to analyze the environment's characteristics and structure of public spaces to people with unsecure housing using drugs in public that serve as safe environments meeting their unique needs, distinguishing them from existing shelters. At this presentation, we will discuss our forthcoming findings and propose how nurses can address these underlying issues, including how nurses can provide support to people with unsecured housing using drugs in public through a harm reduction lens to mitigate overdose risks and disease transmission. Additionally, the research will present findings that intends to enhance community safety by approaching public drug consumption spots in a manner that respects individual rights, public safety, and legal requirements. This approach seeks to prevent discriminatory policing and instead prioritize public health and client-centered nursing.

29. Race as a Predictor for Substance Use Disorders 'Relapse Potential' in the Rural South of the US.

Serge WANDJI, PhD, MBA, RN-BC, NEA-BC, CNL; Columbia, South Carolina

In 2021, approximately 162 million people in the US used substances regularly and more than 100,000 drug-related overdose deaths were recorded, a 30% increase from the previous year with the fastest increase in African American (AA) population. AA are disproportionally affected by the negative health and social consequences of SUD, and those in rural areas are particularly at risk due to disadvantaged socioeconomic conditions and persistent race-related stressors. A recent study in South Carolina found that the largest percentage change in synthetic opioid-involved deaths occurred among AA males which increased 2234%. The Concept of Perceived Need for SUD Treatment has been directly linked to Positive Treatment Outcomes, due to Increased Treatment Acceptance (TA) and Decreased Relapse Potential (RP). The first Aim consisted of characterizing differences on ‘Treatment Acceptance’ and ‘Relapse Potential’ by Race and Gender. The second Aim consisted of determining factors associated with TA and RP. A quantitative cross-sectional study was conducted to explore gender and racial differences of factors associated with TA and RP. Thus, a descriptive predictive correlational design. Racial differences were noted. Approximately 74% of Blacks presented no signs/evidence of withdrawal risk compared to 64% of Whites. Also, Race was statistically significant by ‘Relapse Potential’ (P-Value < .04). Blacks were 2 times more likely to relapse compared to Whites. This study have the potential of informing the design of a contextual and culturally-responsive nurse driven intervention model of SUD care among rural AAs in the South, which would increase capacity building through strategic partnerships.

31. HRV Biofeedback for substance use disorders and behavioral addictions

Lakshmi Nair, PMHNP-BC; Arizona State University; Phoenix, Arizona

Heart rate variability (HRV) measures the changes in the time intervals between consecutive heartbeats. Advancements in HRV research in the past two decades have greatly popularized its use as an indicator of psychophysiological constructs and psychopathological disorders. The higher the HRV, the better the individual's ability to adaptively respond to their world. HRV is thus now considered a robust biomarker of health, wellness, and stress resilience and the simplest way to understand HRV is less variable heart rate indicates individuals to adaptively respond to their world. HRV biofeedback involves pacing breathing at inhalation/exhalation cycle to ~0.1 Hz (6 breaths per minute) which matches the real-time phasic peaks to optimize and maximize HRV and has been studied extensively with good effect in several cardiovascular, respiratory, and other systemic illnesses. It has also been studied extensively on depression, anxiety, and emotional dysregulation-related disorders. However, research using HRV in substance use and addictive behaviors is in its nascent state. This presentation will provide a systematic review of current evidence for HRV and HRV Biofeedback in substance use and behavioral addictions, recommendations for protocols for clinical use in addiction nursing, and its application as an adjunct treatment modality for the management of substance use disorders and behavioral addictive disorders.

32. “I just want my children to be okay”: Promoting sustained recovery in parents with opioid use disorders.

Angela Nash, PhD, APRN, CPNP-PC, PMHS; University of Texas Health Science Center Houston (UTHealth); Houston, Texas

Problem/Purpose An estimated 623,000 parents with opioid use disorders (OUD) live with children. OUD co-occurs with mental health challenges, placing strain on the parent-child relationship, and often family disruption. Little research has explored parents’ perspectives on the impact of OUD on their family. Aim To explore OUD-affected parents’ concerns for their children and the resources relied upon during their addiction and recovery. Design Interpretive Qualitative Methods Adult parents (N =16, 3 M) in an outpatient treatment program that includes MOUD, counseling, peer coaching, and family support services were interviewed. Thematic content analysis was employed for analysis. Results During addiction concerns were meeting their child’s basic needs, fear of harm from exposure to drugs, unsafe environments, witnessing them overdose, or losing custody. Some relied on supportive family, but most felt alone and four lost custody of their children causing ongoing distress and often triggering relapse. Stigma and lack of knowledge limited access to resources. In recovery most expressed regrets for missing out on time with their children and longing for their children’s wellbeing and a good parent-child relationship. Peer coaches, recovery communities, counselors, and family were sources of support. Sustained recovery resulted in improved quality of life and for some, improvement in the parent-child relationship. Concerns for the children’s mental health and risk for addiction continued. Conclusions This study suggests OUD treatment and recovery support programs should focus on promoting strong recovery support networks and teach parents relational parenting skills to promote sustained recovery in parents and subsequent resilience in children.

33. Exploring Gender Differences in Rates of Overdoses at Supervised Consumption Services

Eron Muel; University of Calgary; Calgary, Canada

As opioid related deaths continue to increase internationally, a gender gap has been identified, with men overdosing more frequently than women. However, the gender gap in overdose mortality has narrowed in recent years, as fatal opioid overdose rates have increased in among women. The reason for these differences has not been widely explored. We aimed to assess the presence of a gender gap in overdose rates at a local supervised consumption site (SCS), as well as explore underlying reasons for differences in outcomes. The first phase of this explanatory sequential mixed-methods study was an analysis of client charts at a SCS in Calgary, Alberta. We defined overdose as an instance after drug consumption where a client needed a documented health intervention. We found that men were more likely to overdose at the SCS, but also more likely to receive naloxone and have a hospital transfer via EMS than women. It was unclear whether men were experiencing worse overdoses or women were experiencing inequity in their post-overdose care. In the second phase of this study, we aimed to understand the mechanisms underlying these discrepancies in overdose rates and follow up care. We are conducting interviews with healthcare professionals at the SCS to understand their perceptions of differences in overdoses. At the time of the conference, we will present findings on both phases of this study and discuss how these findings can inform care to decrease overdose rates overall and ensure equitable care is provided to all clients who access SCSs.

35. Implementing an Addiction Training Team to Improve Patient Outcomes in an Urban Academic Medical Center

Noreen Peyatt, APRN, ACNS-BC, APPMN; Emory Healthcare; Atlanta, Georgia

Our institution is focused on reducing opioid-related adverse outcomes through a multifaceted approach that focuses on prevention, treatment, and harm reduction. We recently created the Emory Addiction Training Team to educate providers on safe opioid prescribing methods, the use of naloxone and medications for opioid use disorder. Our Addiction Training Team consists of 7 interdisciplinary team members including addiction physicians as well as a clinical nurse specialist in pain management, and a licensed clinical social worker. Our team curates lectures for our providers and hosts harm reduction training sessions in the community. Using internal data from October 2022 to April 2023, we identified departments that would benefit from improved education and awareness of safe opioid practices. Specialties with the highest number of naloxone prescribers in our institution include Internal Medicine, Emergency Medicine, and Family Medicine. Among these departments, Family Medicine led with 302 unique prescriptions by 70 prescribers, which was 11.8% of the total naloxone prescriptions. Interestingly, Geriatric Medicine had 7 prescribers accounting for 271 unique prescriptions, which was 10.6% of the total naloxone prescriptions. This indicates that a small subsect of providers prescribe the majority of naloxone in our institution, especially in the case of geriatric patients. Data for unique opioid prescriptions was not available though we infer a higher utilization of short-term opioid use in surgical specialties. This data set highlights the increasing need for provider education on naloxone prescribing, especially in surgical specialties.

38. Brief Intervention protocol by telephone delivered by nurses to patients with risk or harmful alcohol use in primary health care: a feasibility trial

Divane de Vargas; Nursing School of University of São Paulo; São Paulo, Brazil

Introduction: The Brief Intervention (BI) carried out remotely by the nurse can bring individuals closer to the therapeutic process. However, there are few studies that address BI performed remotely by nurses. Objective: to analyze the feasibility of a BI protocol by telephone delivered by nurses to patients with risk or harmful alcohol consumption in Primary Health Care units. Method: non-randomized, single-arm feasibility study. The intervention protocol was developed and implemented in four stages: (1) training of intervention nurses; (2) recruitment of participants; (3) carrying out the brief intervention by telephone (T0), and (4) 3 months (T1) and 6 months (T2) follow-up calls. The inclusion criteria were: being over 18 years old, having a scheduled appointment in primary health care, understanding Portuguese enough to understand the interviewer's questions and obtaining AUDIT-C scores: women – above 3, and men – above of 4. Results: The study took place between January and November 2021, 165 met the inclusion criteria and received the BI by a nurse by telephone. 48% reported a positive experience receiving the Brief Intervention from nurses and 44% reported a decrease in their alcohol consumption. Conclusion: The BI delivered by nurses over the telephone proved to be feasible and well accepted by the participants. They also noticed an improvement in alcohol consumption patterns after receiving the intervention. Nurses are in a position to identify and evaluate individuals with risky or harmful alcohol patterns, contributing to improving the subject's quality of life, in addition to to be well received by users.

39. Nurse Driven Patient Safety Initiatives during Introduction of Maternal Substance Use Disorder Program on Women’s Health Unit

Alessia Tozzi, BSN, RN, RNC-MNN, C-EFM; Penn State Health Milton S. Hershey Medical Center; Hershey, Pennsylvania

Maternal substance use disorder (SUD) is a growing international health concern and has been identified as a key initiative by the Pennsylvania Perinatal Quality Collaborative (PAPQC). Maternal and fetal effects from SUD during pregnancy and postpartum are devastating. Specialized treatment programs are recommended to identify and support this high-risk population. A pilot Maternal Substance Use Disorder Program was initiated on a Women’s Health unit to meet the needs of this population. It quickly became apparent, however, that the unit was lacking the necessary skills, knowledge, infrastructure, and confidence to support the safety of staff and patients. Therefore, the program was paused and these patients were redirected to an internal medicine unit until changes were initiated on the Women’s Health unit. Implementation strategies for practice change occurred via a multidisciplinary team approach, including education and awareness for nursing and provider staff, identification of nursing champions, and infrastructure preparation including building patient specific order sets. Lessons learned included the importance of including nursing leadership and preparing frontline staff before program introduction following operational medical leadership approval. The need for clear escalation guidelines, and procurement of resources and medications on site is essential for a smooth transition of these patients to the Women’s Health unit. Maternal SUD patients represent a vulnerable population and we are called to action to support their recovery in a safe and inclusive manner by way of meaningful partnerships. By following the appropriate channels, we are able to support addiction recovery in the pregnant and postpartum population.

4. "You can't punish the pain out of people" Using art to decrease stigma toward people who use drugs

Kimberly Dion, Ph.D., RN, CNE, CARN, FIAAN; University of Massachusetts Amherst; Amherst, Massachusetts

Problem: The stigma associated with substance use disorder (SUD) harms the lives of people who use drugs (PWUD). People with SUD will delay health care, not disclose their drug use to their providers, and seek alternative ways to manage their healthcare needs. Experiential learning is an effective methodology for learning and changing stigmatic behaviors. Purpose: The purpose was to determine if a documentary focused on the experiences of PWUD, followed by an expert panel discussion, improved attendees perceived stigma towards PWUD from baseline to post-intervention. Methods: Attendees (n=212) were invited to participate in a pre/post survey. A 77-minute film using art to explore harm reduction concepts in promoting human rights, value neutrality, and a non-judgmental approach was shown, with a 45-minute expert panel discussion following. The 8-item Perceived Stigma of Substance Abuse Scale (PSAS) was administered pre and post-intervention with additional open-ended questions regarding intention to change behaviors following the intervention. Results: A total of 144 individuals completed the baseline survey, and 44 completed the post-survey. Overall, PSAS scores showed a statistically significant decrease in stigma from baseline to posttest (Prob > |z= .0454). Comparison and thematic analysis were performed, and findings of reported changes in perception, including the recognition of stigma, cognitive changes, and behavioral and societal actions, were identified. Conclusions: It is possible to improve perceived stigma and intention to change stigmatizing behaviors through the use of art and discussions with people with lived experiences.

41. Initiating an Addictions Nursing Course for Hospital-based Nurses

Todd Harvey, MSN, RN, CARN; UPMC Mercy; Pittsburgh, Pennsylvania

Persons living with substance use disorder (SUD) increasingly fill U.S. hospital emergency departments and inpatient units for care directly and indirectly related to SUD. Each of these hospital visits represents an opportunity to engage individuals in goals related to their substance use and health, regardless of the patient’s reason for presentation. Unfortunately, those living with SUD feel stigmatized by the healthcare system and are hesitant to trust healthcare providers and healthcare providers often hold negative attitudes towards those with SUD. Due to this situation, there is a need for skilled, compassionate providers to engage hesitant patients. Hospitals have not met the demand by equipping themselves to meet medical and behavioral health needs of those living with SUD. Thus, continuing education for healthcare professionals working with patients with addiction is paramount, as pre-licensure medical and nursing training fail to address this need. The site hospital is a key institution in addressing addiction in its own neighborhood and throughout the greater metropolitan area. Nurse educators developed the course based on in-person interviews with nursing staff with the aim of increasing their role security and commitment to working with patients with addictions. Nurses self-select into the course and are evaluated by pre- and post- course surveys related to their commitment and role security in treating patients with addictions. The pre- and post- course surveys are based on the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ). Comparison of pre- and post-test scores will be discussed in the presentation.

42. Integrating the Buprenorphine Nurse Care Manager Role into the Interdisciplinary Approach to Treatment for Patients with Opioid Use Disorder

Emily Scognamiglio, MPH, RN; Mount Sinai Hospital; New York, New York

A 45-year-old cis-gender man with opioid use disorder (OUD), stimulant use disorder and unclear psychiatric history, presented to a primary care clinic for people who use drugs after an Emergency Department (ED) visit for nonfatal opioid overdose. This patient was given a 3-day supply of buprenorphine in the ED and was told to find outpatient care upon discharge. Patient was unable to find a quick outpatient follow up and returned to opioid use while remaining motivated to restart buprenorphine treatment. The patient had family support to assist with linkage to care. Upon initial presentation, the patient reported regularly using intravenous heroin/fentanyl and cocaine daily. He also reported receiving various forms of psychiatric treatment over the years, but never felt medications were helpful for him. At this visit, the patient was educated by the Buprenorphine Nurse Care Manager regarding buprenorphine home initiation and assessed by the primary care provider. A referral to the integrated psychiatrist for evaluation and support was placed. After the initial visit, he had multiple failed attempts regarding initiation and was offered close support from the Nurse Care Manager, which consisted of weekly phone calls and biweekly in person visits. After one month of engaging with the primary care team, he was successfully initiated onto and stabilized on buprenorphine, which significantly decreased his opioid use. The interdisciplinary team, including primary care providers, psychiatrist, patient navigators, social work, and Nurse Care Manager met weekly to discuss his case, which was integral to optimizing his care.

43. Leveraging Opioid Use Disorder Nurse Care Mangers to expedite HCV Treatment

Addy Adwell, RN, BSN, AMB-BC; Harborview Medical Center; Seattle, Washington

The current epidemic of HCV is closely associated with injection drug use related to the opioid epidemic. High prevalence among people who use drugs (PWUD) makes HCV a major threat to the health and well-being of individuals and on-going transmission is a concern for their communities. The existence of direct-acting antiviral (DAAs) for HCV creates a historic opportunity to eliminate HCV, but current efforts are falling short. Achieving HCV elimination will require a restructuring of care to extend treatment into the hands of PWUD where they most frequently access care. This poster will review HCV elimination goals and the importance of treating/curing PWUD, present quantitative data from an OBOT program in Seattle, WA, that investigated its pathway for HCV screening and treatment, and share tools developed to leverage nurse care managers to expedite the pathway to HCV treatment during early OUD treatment engagement.

44. Trauma and Violence Informed Care: Knowledge mobilization, Skill building and Attitude shifting towards clients with mental health and addictions.

ARCHANA PAUL, RN, MSC N; York University; Toronto, Canada

Trauma affects everyone differently. Trauma and violence-informed care (TVIC) is an approach to care grounded in understanding the impact of trauma and violence on individuals’ lives and behaviours, situated in physically and emotionally safe environments, and offers strengths-based, capacity-building support that fosters coping and resilience (Government of Canada, 2018). According to the College of Nurses of Ontario’s Entry to Practice Competencies, student nurses/registered nurses are expected to utilize trauma-informed care principles that prioritize trauma survivors’ safety, choice, and control (CNO, 2023). Although some principles of TVIC may have been introduced in the nursing curriculum, students often lack the required skills and attitudes to develop confidence in providing care to people with known histories of trauma, ongoing violence, discrimination related to mental health and addictions etc. Education and training on the TVIC approach will help nursing students understand the health effects of current and past experiences of trauma and violence and equip them to strive to make care safe for individuals, families, and communities. This study will use a mixed methods design to meet the objectives. Quantitative data will be collected with a pre-education and post-education questionnaire on the day of TVIC education. Qualitative data will be collected with one focus group conducted at least three months after the TVIC education day.

46. Dangerous but often legal: The perils of gas station drugs tianeptine and kratom

Jessica Skarda, MSN, CRNP, PMHNP-BC, CARN-AP; University of Alabama at Birmingham; Birmingham, Alabama

Tianeptine and kratom (mitragyna speciosa) are legal in much of the United States. Neither is regulated by the FDA and they are often sold in gas stations or online. However, both function as opioid agonists on mu receptors, and have been touted on the internet by the public as treatment for opioid use disorder to help people discontinue use. While there is a paucity of scientific literature available, kratom and tianeptine are increasingly linked to dependence, withdrawal, addiction, toxicity, life-threatening complications, and overdose. At an Office Based Addictions Treatment Center in Alabama, many patients are on opioid agonist therapy for opioid use disorder because of these substances. Therefore, this clinician wishes to raise awareness of these drugs, discuss the available literature, and share clinical pearls while highlighting interdisciplinary collaboration among various stakeholders in Alabama. The purpose of this presentation is to raise awareness of these drugs that are still legal in much of the United States and worldwide. The presenter will discuss available literature, share clinical pearls from one practice, and highlight the work of various stakeholders in Alabama. Implications for nursing practice include managing opioid use disorder related to tianeptine and kratom use, recognizing signs of withdrawal and intoxication, promoting collaboration among stakeholders to enact change, and the need for more research on treating addictions related to these drugs.

47. Identifying barriers for RNs returning to work after substance use disorder treatment

Jordan Ferris, MSN, RN; Washington State University; Spokane, Washington

Substance use disorders (SUDs) among nurses pose significant concerns for patients and healthcare systems with limited insights regarding nurses’ journey to recovery. This study investigated the experiences of nurses with licensure discipline due to SUDs and the barriers they encountered when rejoining the workforce. The purpose of this study is to provide an understanding of the challenges in resuming professional roles after licensure discipline from SUD. The research employed Group Concept Mapping (GCM), a structured methodology for organizing the ideas of a group and representing those ideas visually. Forty-three participants were invited to contribute online in brainstorming statements regarding barriers in returning to work after SUD treatment. From this, 14 contributors generated 69 responses. Data analysis identified key themes and relationships. Findings uncover many obstacles faced by nurses returning to work following SUD-related licensure discipline. Reported barriers span personal, institutional, and societal dimensions, reflecting the complexity of reintegration journeys. Key themes include stigmatization, discrimination, legal and regulatory requirements, and need for ongoing recovery support. Recognizing barriers in returning to work is crucial for institutions, regulatory bodies, and policymakers. The data collected can inform the development of evidence-based strategies that facilitate the successful return of nurses to their practice. Results will be used to create recommendations aimed at enhancing the reintegration of nurses with SUD. Addressing these barriers can foster successful reintegration of nurses, improve the overall well-being of these individuals, and uphold the quality of patient care in healthcare systems.

48. Climate Change and its influence on Addictions: Uncovering Relationships. Pathways and the role of Nursing

Devon Noonan, PhD, MPH, FNP-BC, FIAAN; Duke University; Durham, North Carolina

Climate change is one of the single greatest health threats facing humanity today (WHO, 2021) and the effects of climate change on health and health outcomes are numerous. Extreme and prolonged severe weather events have been linked both directly and indirectly to mental health issues and in particular elevated temperatures have been linked to hospitalization for substance use disorders (Parks et al., 2023). The effects of climate change on substance use and commonly co-occurring mental health outcomes have implications for the practice of addictions nursing. The purpose of this presentation panel is threefold: 1) First, we will provide a summary of the literature on the relationship between addictions and climate change; 2) Second we will describe the probable pathways that climate change is related to addictions across the spectrum of addictive substances from an empirical and clinical perspective; and 3) Third we will highlight the role of the addictions nurse in addressing climate change with a focus on education, practice, research and policy. Finally, we will illicit feedback from the audience from a global perspective on the effects of climate change on addictions that will serve as the start of developing action-oriented solutions to mitigating the health impacts associated with the intersection of climate change and addictions.

49. Integrated Nurse-Led, Peer-Facilitated Diabetes Prevention Program Among Clients Receiving Treatment for Substance Use Disorders in North-Central Nigeria.

Oluremi Adejumo, DNP, MS., RN, BSN, FIAAN, CGNC; UNIVERSITY OF MD SCHOOL OF NURSING; Baltimore, Maryland

Background: Diabetes Mellitus (DM) is a chronic, physical health problem associated with increased morbidity and premature mortality in the substance-using population (Centers for Disease Control and Prevention [CDC], 2022; Lambert et al., 2023; Substance Abuse and Mental Health Service Administration [SAMHSA], 2013, SAMHSA, 2023). Oxidative stress underlies the progression of substance use disorders (SUD) to the pathogenesis of type 2 diabetes (T2DM), the most commonly diagnosed DM in 90-95% of people with diabetes (Amo-Shiinoki et al., 2021; Berrios-Carcamo et al., 2020; Ojo et al., 2018; Sanchez-Roige et al., 2022; Viola et al., 2023; WHO, 2023). Implementation: Upon the receipt of medical ethics approval from both the Nigeria-based and U.S.-based institutions, the collaborators facilitated recruitment campaigns at a Drug abuse, treatment, and rehabilitation center. The inclusion criteria include non-diabetic consenting adults aged 18 years and older and non-pregnant females with scores of ≥ 15 on the FINDRISC diabetes assessment tool. The exclusion criteria include individuals aged 18 and younger (i.e., male and female) with low to moderate scores on the FINDRISC diabetes assessment tool. Results: The 20-wee-preliminary outcomes of a 26-session (a year-long) “Integrated Nurse-led, Peer Facilitated DPP” in a SUD outpatient treatment center, consisting of 28 (23 males and five females) with a mean age of 36.4 years (SD=9.2) ranging from 22 years to 59 years, were remarkable. There were statistically significant decreases between the participants’ baseline weight and 20 week’s weight (t=11.63, p<.001, paired t-test), and in the participants’ baseline BMI and 20 week’s BMI (t=10.18, p<.001, paired t-test).

52. Culturally Responsive Treatment Practices in Serving Indigenous Populations

laVonne Fox, Phd Higher Education and Leadership. Occupational Therapist Registered; Turtle Mountain Community College; Belcourt, North Dakota

This presentation will address the limitations of the current systems of care and support that are not responsive to the cultural needs of Indigenous populations in the prevention and treatment of substance use disorders. A dearth of evidence-based practices is of significant concern especially where evidence-based practices are critical to making informed decisions The presenters will describe the interplay between historical trauma, cultural genocide, unresolved grief and addiction. Understanding complex factors such as genetic disposition, environmental influences, psychological factors and social dynamics, to name a few, contribute to more positive outcomes. A trauma-informed approach will be underscored with effective models provided in toolkits the presenters have authored. A review of culturally appropriate treatment programs that are effective in the treatment of substance use disorders will be presented. These programs will include the White Bison-Culturally Based Healing for Indigenous Peoples, Red Road Programs, Lakota Seven Direction Model, RexRiders, Healing of the Canoe Project, Talking Circles, and Use of the Medicine Wheel to support care through Strengthening Resilience Among Indigenous Youth. The focus of the presentation will be to provide guidance on how to prevent the perpetuation of stigma about substance abuse and to support programs that address the specific needs of Indigenous populations.

53. A Call for Change in Treatment: Complicated grief disorder (CGD) for individuals with substance use disorder (SUD).

Ruthanne Palumbo, DNP, RN, CNE, CARN; University of North Carolina-Wilmington; Wilmington, North Carolina

54. The Case for a CARE Team

Samara Touchton, FNP-C, CARN-AP; REACH Medical and Cayuga Health System; Ithaca, New York

Cayuga Health System, in collaboration with REACH Medical, is addressing the need for evidence-based, high-quality, equitable integrated healthcare that aims to serve medically underserved populations, specifically in the area of substance use disorders (SUDs). With the help of funding from the Rural Health Equity Training Collaborative (RHETC) program, this collaboration has resulted in the CARE (Consults for Addiction, Recovery, and Equity) Team, which is composed of advanced practice nurses and physicians board certified in Addiction Medicine. The CARE Team has gained support from both inpatient and community stakeholders and is working to improve care and health outcomes for patients with SUDs and high risk social determinants of health. Taking a multidisciplinary approach, the CARE Team is building a continuity of care pathway for addiction services and streamlining workflows by leveraging our EMR to bring acute care patients with SUDs the necessary resources. In-person and remote consultation, development of screening tools, referrals, inpatient rounding, standardized order sets and nursing assessments, treatment pathway navigation, and system wide education has been developed in order to effect immediate change as well as develop a culture that supports patient-centered, non-stigmatizing, trauma-informed care in order to increase access and linkage to treatment for the medically underserved. Since its implementation over one year ago, the health system has seen more patients connected to outpatient services with increased health engagement. Additionally, the team also provides quarterly educational initiatives for the health system on topics relating to substance use and health equity to keep current on best practices.

55. Addressing Disparities for Persons with Substance Use Disorders in Rural Communities

Thomasine Heitkamp, LCSW Chester Fritz Distinguished Professor Emeritus; University of North Dakota; Grand Forks, North Dakota

This presentation presents an exploration of the formidable obstacles that hinder access to vital intervention, treatment, and recovery support services for people with substance use disorders in rural communities. It explores multifaceted challenges faced by those seeking assistance in these underserved regions, encompassing issues related to accessibility, availability, affordability, and acceptability of care. Drawing upon both the distinctive needs of rural communities and evidence-based practices, this session outlines pragmatic and evidence-based recommendations for enhancing access to care. These include strategies for addressing the dearth of care providers in rural areas, equipping professionals with the knowledge and commitment to adopt evidence-based practices, and advancing a population health approach. The presentation also confronts the pervasive issue of stigma, which hinders substance use intervention and treatment accessibility, advocating for the adoption of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework and integrated care. It emphasizes the importance of culturally competent care, overcoming funding limitations in rural areas, and harnessing technology to facilitate telehealth services. Implementation of these recommendations aims to strengthen the current and future health and behavioral health workforce who serve in rural communities. This holistic approach addresses the disparities experienced by rural residents in securing treatment for substance use disorder and expands access to early intervention services. Participants will leave with practical recommendations that can be applied to improve the delivery of substance abuse services in rural settings, ultimately reducing disparities and expanding access to evidence-based practices.

56. Implementation and Expansion of an OTP-Based Hepatitis C Treatment Program

Jennifer Hatton, BSN, RN, CARN; United Health Services; Binghamton, New York

Approximately 1% of adults in the United States are infected with hepatitis C, with intravenous drug use as the single most common risk factor. Although oral direct-acting antivirals have greatly improved the treatment outlook for hepatitis C, significant barriers to treatment still remain which disproportionately impact PWID. Innovative, patient-centered approaches are necessary to overcome these barriers and promote safe, effective hepatitis C treatment, even among persons who may continue to use substances throughout their course of treatment. Opioid treatment programs (OTPs) represent an often overlooked avenue for hepatitis C treatment due to their frequency and duration of contact with PWID. The hepatitis C treatment program at the UHS MAT Clinic has over 60 confirmed hepatitis C cures to date, and continues to expand services even as national treatment rates are on the decline. Treatment is part of the conversation starting from the day of admission, with opt-out testing included as part of the admission process. At this time, more than 70% of clinic patients with a current detected hepatitis C viral load are either receiving treatment or are actively involved in treatment considerations. Ongoing partnerships with pharmacy, outreach and support services ensure both access to and engagement in treatment, resulting in a treatment success rate of 96.8% at time of SVR12 testing. These efforts have so far resulted in an overall prevalence rate of active infection among the clinic’s hepatitis C antibody positive patients of under 30%, substantially lower than baseline estimates among those without access to treatment.

57. Elevating the voices of People Who Use Drugs: Implications for nurse leaders and researchers

Amanda Fallin-Bennett, PhD, RN; University of Kentucky; Lexington, Kentucky

Many people who use drugs (PWUD) report delaying or avoiding needed healthcare due to associated stigma and poor treatment. However, PWUD are experts in the needs of their own community. Toward this aim, a community advisory board, the Survivors Union of the Bluegrass (SUB), was established to meaningfully involve PWUD in the development, design, and dissemination of research. The purpose of this presentation will be to describe the formation and activities of the SUB and examples of lessons learned for nurse researchers. The SUB, formed in early 2022, currently has 15 members who are Kentucky residents identifying as PWUD or in non-abstinence based recovery. UK researchers apply to discuss their research in 45-minute blocks and are reviewed for approval by SUB members prior to attendance. To date, 19 researchers (including three nurse researchers), have consulted the SUB covering topics such as reproductive health, barriers to treatment seeking, and parental decision making among PWUD. Our presentation will highlight example lessons learned. For example, members shared experiences of stigma when discussing sexual health with healthcare providers. SUB members also shared hesitation to seek treatment because most providers have an abstinence-only orientation. Finally, members advised nursing researchers about the pervasive hesitancy among parents who are PWUD to engage in healthcare for fear of losing custody of their children. Researchers described SUB input as valuable to study design and intervention implementation. Nurse leaders and researchers should recognize PWUD’s expertise and seek meaningful partnership with them in the research process.

63. Nurse scientists partner with peers to create and evaluate a low barrier intervention to promote reproductive well-being for the recovery community

Jeremy Byard, BA; Arthur Street Hotel; Louisville, Kentucky

People who can get pregnant who use drugs have high rates of unintended pregnancy (>75%). Recovery community centers (RCCs) provide recovery support services and are primarily staffed with people with lived experience with using drugs. RCCs employ recovery coaches who help participants improve their recovery capital through person-centered strengths-based approaches. Although reproductive health and the prevention of unintended pregnancy can greatly impact recovery capital, recovery coaches generally do not have training to address this complex issue. We aimed to fill this gap by forming a partnership between nurses and recovery coaches to co-create and evaluate a bundled model intervention tailored for RCCs (training and the provision of low-barrier resources including pregnancy tests, prenatal vitamins, and emergency contraception) to promote reproductive well-being. We will describe the training and present on the mixed methods to assess pre-post knowledge, belief, and comfort with the bundled model (n=20) and further explored perceptions of the training qualitatively to inform future training iterations (n=58). Results included significant gains in all three domains following the training, as well as favorable perceptions that the model will enhance recovery capital. Most were empowered and ready to champion the model, asking for more information about the three resources, perinatal health, and referral information. By integrating reproductive well-being into recovery community center programming, we hope to improve access to care, reduce stigma, and improve outcomes for individuals seeking reproductive and perinatal health services.

64. Champion Peer linkage model to improve equity, access, and uptake of reproductive healthcare for People who Use Drugs: A Nursing and recovery community pilot study

Hartley Feld, PhD, MSN; University Of Kentucky; Lexington, Kentucky

People who use drugs (PWUD) experience significant reproductive and perinatal health disparities and have the highest burden of unintended pregnancies (>75%). Inequitable access and uptake of reproductive healthcare can lead to unintended pregnancy which is associated with depression and stress and can erode recovery efforts and contribute to overdose risk. Barriers to reproductive and perinatal healthcare utilization for PWUD include fear, stigma, and competing priorities that are further exacerbated by gender disparities related to exploitation, violence, legal/child custody concerns and access to treatment. Nurse scientists partnered with peers and the recovery community to develop an innovative champion linkage model and are implementing this in 2 recovery and harm reduction organizations in Kentucky. Specifically, we hired and trained a ‘champion’ peer as research staff to implement a linkage program that entails weekly support/peer coaching for PWUD, barrier reduction to seeking perinatal and reproductive healthcare, and advocacy for reproductive well-being. We are enrolling 25 people who can get pregnant or are pregnant to work with the champion(linkage intervention), as well as 25 eligible people who choose not to enroll in the champion linkage program. We will present group differences in recovery capital and sexual/reproductive and perinatal empowerment at enrollment, 1 month and 3 months. We hypothesize the intervention group will have earlier entry into healthcare and have higher recovery capital and empowerment scores. Findings from this pilot will inform a scalable model with the potential to improve reproductive and maternal child health outcomes for PWUD for generations.

65. Harm Reduction, HIV, and Hepatitis C: Improving Linkage to Care and Patient Outcomes

Sean Owen, MS, FNP-BC; Trillium Health; Rochester, New York

People who use drugs (PWUD) are at an increased risk for both HIV and hepatitis C infection. The risk is higher for people who inject drugs (PWID). Stigma and social determinants of health often negatively impact the diagnosis and treatment of HIV and hepatitis C in PWUD. This clinical case scenario explores harm reduction strategies to improve linkage to and retention in care for PWUD who are living with HIV and/or hepatitis C. The patient was unhoused, uninsured and was injecting heroin, fentanyl, and cocaine daily. He had multiple equivocal results with rapid HIV tests performed at the syringe service program (SSP) and by outreach workers in the community before being lost to follow-up. A team-based approach was employed that included coordination between SSP workers and mobile clinic clinicians. Once connected to care, the patient received a confirmatory diagnosis of HIV infection and a diagnosis of hepatitis c reinfection. By providing low-barrier medications for opioid use disorder (MOUD), the patient was able was to start antiretroviral therapy for HIV and become virally suppressed. The patient was also able to start treatment for their hepatitis C reinfection and they were connected to resources to obtain housing and health insurance.

67. Opioid Overdose Prevention and Improving patient care for PWUD: A Curricular Strategy.

Meredith Kerr, DNP, CRNP, FNP-C; Johns Hopkins University School of Nursing; Baltimore, Maryland

There is a knowledge and confidence gap among nurses on providing trauma-informed, non-stigmatizing, evidence-based nursing care for persons who use drugs (PWUD), and PWUD suffer poorer health outcomes as a direct result. These gaps are partly due to lack of curricular content in nursing education, and partly because of cultural and individual stigma and bias against PWUD. Though it is ambitious to supplement existing curricula with additional substance use disorder (SUD) and Harm Reduction content, this project reveals a critical need to do so. This project evaluates the incorporation of a 2-hour SUD and Harm Reduction skills workshop into a prelicensure Master’s in Nursing program at a high-ranking University in the Mid-Atlantic United States. Evaluation of the effects of the workshop were based on student responses to a Qualtrics survey emailed 12- and 36-weeks post-training. Prior to the training, <9% of respondents (n=34) felt prepared to provide competent nursing care to PWUD and 69.8% identified that they had not received any prior training on the topic. Following the training, 97% correctly identified signs of an opioid overdose, which only dropped to 88.9% when measured 36 weeks later, indicating considerable knowledge retention. Qualitatively, students recognized their biases towards PWUD, sharing "now I know that [my judgement] interferes with my care for my patients and I am working on improving my harm reduction practices." Numerous students shared similar sentiments, this paired with the quantitative data demonstrates the effectiveness of the skills workshop and a recognition of the importance on this subject matter.

70. Kratom Exposure During the Perinatal Period

Mary Ellen Wright, PhD, APRN, CPNP-PC; Clemson University; Clemson, South Carolina

The proposed oral presentation will focus on perinatal Kratom exposure. Mitragyna speciosa is also known as Kratom and is sold legally through the United States with availability in many countries. The active alkaloids of Kratom in a low dose act as a stimulant and in a higher dose have opioid like effects binding to the mu-receptors. Differing types of Kratom will be presented that have varying concentration of active alkaloids, which changes the potency and opioid-like effect. The reasons kratom is used include pain management, anxiety, mood disorders and as an opioid substitute. The presenter will discuss the historical use of Kratom, the active alkaloids that cause opioid-like effects, and her original research on perinatal Kratom exposure. The presenters original research includes: 1.) case studies on effects on mothers and infants after prenatal Kratom exposure; 2.) the creation of umbilical cord tissue toxicology; 3.) original bench science using maternal rats and rat offspring, that have prenatal Kratom exposure; 4.) internet research of mothers’ experiences using Kratom during pregnancy and the postpartum experiences. Kratom is often underrecognized due to lack of screening and toxicology. The interdisciplinary , research and public policy approaches are needed to address Kratom exposures will be threaded throughout the presentation. The presenter will invite participants to share any questions or experiences with Kratom exposure in their practice. The participant will also be invited to create history/screening questions that address the use of Kratom and other psychoactive substances.

71. Optimizing a Brief intervention delivery: A new proposal to PHC

Erika Gisseth León Ramírez, PhD; Guarulhos Universtiy; Guarulhos, Brazil

Background. The brief intervention using the FRAMES model has proven to be effective in reducing alcohol consumption, different formats of this intervention have been tested, including group formats, by digital means, by telephone, showing the effectiveness of the brief intervention, however, some difficulties permeate the implementation processes, ranging from professional overload, meeting goals, lack of engagement of health professionals and patients' resistance to discussing alcohol use. Materials and methods. Non-randomized feasibility study, in which the procedures for inclusion, acceptability and satisfaction of 77 participants in primary health care, in São Paulo - Brazil - who received the brief intervention in the FAES model between June and December 2021 were evaluated. Results. 27 individuals answered questions related to satisfaction, 37% indicated that the intervention helped a lot to rethink their alcohol consumption, 54% indicated that consumption decreased after receiving guidance from the research team, in addition, 85% would not change anything regarding the performance of the intervention. Regarding the effect, participants decreased by an average of 2 percentage points in the 90-day follow-up, a measure that was maintained up to one year after the intervention. Conclusions. The brief intervention in the FAES model applied by telephone proved to be feasible with preliminary evidence of effectiveness in reducing alcohol use in the primary health care population, being a possibility to facilitate its implementation, as it becomes easier and quick to apply.

72. Proceed with Caution: Understanding the Pitfalls of Reliance on Research Reporting Race/Ethnic Differences in Pain and Substance Use Outcomes

Lisa Domenico, PhD, RN, CARN; University of Florida; Gainesville, Florida

Ethnic/race group differences in pain-related experiences and opioid use patterns are well-established. However, identifying ethnic/race (e/r) group differences in pain and substance use patterns may lend to oversimplification of a very complex problem, and lead to inaccurate conclusions regarding key factors that contribute to opioid and other substance use disorders. A majority of research examining e/r differences report significant sociodemographic imbalances between comparison groups. However, a burgeoning body of evidence indicates that when socioenvironmental factors are accounted for and groups are balanced across sociodemographic variables, previously observed ethnic/race differences are no longer indicated. We will present two research studies conducted within our lab, illustrating the impact of socioenvironmental factors on e/r differences in pain related outcomes. The first study examined the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain. The second examined environmental and sociocultural contributions to structural differences in pain-related brain regions, as identified using fMRI. Both studies found that e/r group differences significantly decreased and in some cases were eliminated when sociocultural and environmental characteristics were accounted for. Findings support the value of transitioning away from a paradigm grounded in identifying and comparing e/r group differences, and toward viewing differences between populations through a structural racism/discrimination framework. Structural racism and discrimination refers to macro-level conditions (e.g. residential segregation and institutional policies) that limit opportunities, resources, power, and well-being of individuals and populations based on race/ethnicity and other statuses.

74. Community Health Worker-Led Substance Use Prevention Model for Recently Incarcerated Persons

Timothy Sowicz, Ph.D., RN; The University of Arizona College of Nursing; Tucson, Arizona

Problem/purpose: In early 2023 a call was issued for applications for the United States’ National Institute on Drug Abuse’s (NIDA) Primary Care Challenge. The “challenge” was to create a substance use prevention intervention to identify people misusing substances to prevent the development of a substance use disorder within primary care practices. Objective (specific aims): Our purpose is to explain the development of a substance use prevention intervention for recently incarcerated adults and those on probation in rural southeastern Arizona. Design/Methods: A team of three doctorally-prepared (DNP and Ph.D.) nurse practitioners and researchers developed a community health worker-led substance use prevention model for recently incarcerated persons. The model includes three phases: identifying recently incarcerated persons, screening for substance use using the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool, and determining and implementing preventive services. Results/Conclusions: Thirty submissions for the NIDA Primary Care Challenge were received. The model described above was one of only three chosen for a $25,000 prize. Additionally, four honorable mention winners were selected. The winners of the Challenge were featured on the NIDA website, as well as discussed by the NIDA Director on their blog. Additionally, the winners presented their models during a NIDA-sponsored webinar. The team members have created a plan for using the prize money to collect pilot data to support a larger, multi-year study during which the model will be translated into practice and tested. This project spotlights a successful collaboration between DNP and Ph.D. nurses to intervene upon substance use.

75. “You do more difficult things than this:” A national study of nurse practitioner buprenorphine prescribing

Chandra Speight, PhD, RN, NP-C, CNE; College of Nursing, East Carolina University; Greenville, North Carolina

Problem/purpose: Despite efforts to decrease opioid misuse and increase access to opioid use disorder (OUD) treatment, nearly 300 Americans die each day from unintentional drug overdoses, most of which involve opioids. The medication buprenorphine is associated with significant reductions in OUD-related mortality and morbidity. Nurse practitioners (NPs) could play a key role in providing this treatment, but few NPs prescribe buprenorphine for OUD. Objective: This study aims to deepen understanding of NP buprenorphine prescribing by exploring NP perceptions toward buprenorphine prescribing using data from a national survey of NPs working in primary care settings (n=74) Design: A descriptive, correlational design was used to examine quantitative data. Content analysis of open-ended questions was used to identify themes. Results: Analysis found significant associations between state practice environment and prescribing status, with more buprenorphine prescribers working in full practice states. Regardless of prescribing status, respondents shared medication misperceptions including that buprenorphine therapy must be accompanied by substance use counseling or “talk therapy.” Prescribing respondents commented on the ease of proving this therapy while non-prescribers felt it should be limited to specialty care settings. Conclusion: Additional education on buprenorphine prescribing, including liability concerns and medication effectiveness is needed. Future studies must look carefully at the impact of state restrictions on NP practice and the effect they have on OUD treatment access.

9. Customizing a digital support intervention for mothering women with substance use disorders

Phyllis Raynor, PhD, PMHNP-BC, CARN-AP, APRN; University of South Carolina College of Nursing; Columbia, South Carolina

Evidence suggests digital technology may be leveraged to promote social connectedness and access to meaningful substance use disorder (SUD) recovery support networks. Pregnant and early parenting women (PEPW) with SUD are at significantly higher risk for continued harmful drug use related to decreased peer networks and an inability to balance parenting and recovery needs. Purpose: To explore meaningful themes of parenting and recovery supports for PEPW initiating recovery from SUD that informed the development of a tailored digital platform. Method: Using a community-based participatory approach, PEPW (n=30) were recruited from a women’s residential drug recovery facility in a Southeastern state. After informed consent, participants were interviewed using a semi-structured interview guide. The interviews were digitally recorded and transcribed. Themes regarding tailored supports were identified using thematic analysis and results were integrated in the digital application. Results: The five broad themes from participant interviews were (1) guilt and shame, (2) limited access to recovery supports in rural areas, (3) lack of social support for recovery, (4) lived grief and loss experiences, and (5) parenting and recovery-related educational supports. Tailored supports included parenting resources, parenting skills, parenting education, housing supports, recovery supports, childcare resources, occupational supports, and spirituality. Conclusion: Visual examples of the digital application’s customization will be demonstrated and discussed. Implications: Future research will need to examine the extent to which the use of community guided and theory- based tailored digital technology can provide the level of parenting and recovery support needed for PEPW seeking recovery from SUD.