Browsing by Author "Wright, Eric R."
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Item Assessment of Risk Behaviors in Patients With Opioid Prescriptions: A Study of Indiana’s Inspect Data(Wiley, 2017-12) Greene, Marion S.; Chambers, Robert Andrew; Yiannoutsos, Constantin T.; Wright, Eric R.; Steele, Gregory K.; Zollinger, Terrell W.; Health Policy and Management, School of Public HealthBackground and Objectives Prescription Drug Monitoring Programs (PDMPs) can serve as screening tools and support the clinical decision‐making process in patients receiving opioids. The objective of the study was to utilize 2014 INSPECT (Indiana's PDMP) data to identify factors that increase patients’ likelihood to engage in opioid‐related risk behaviors. Methods Based on a literature review, four risk behaviors were identified: Receiving >90 morphine milligram equivalents (MME), having >4 opioid prescribers, obtaining opioids from >4 pharmacies, and concurrent use of opioids and benzodiazepines. Two binary logistic regression analyses (engaging in at least one risk behaviors; engaging in all four risk behaviors) and an ordinal regression analysis (engaging in 0–4 risk behaviors) were conducted to identify factors associated with these opioid‐related risk behaviors. Results Of the 1,538,120 unique opioid patients included in the study, 18.4% engaged in one, 5.3% in two, 1.6% in three, and .4% in all four risk behaviors. Depending on the model, prescribing a second monthly opioid increased patients’ odds to engage in risk behaviors by a factor of 10 or more and prescribing two or more benzodiazepines annually increased the odds at least 13‐fold. Conclusions and Scientific Significance About one‐fourth of all patients consuming opioids engaged in one or more risk behaviors; higher number of opioid prescriptions and addition of even a small number of benzodiazepine prescriptions dramatically increased these odds. PDMPs can be helpful in identifying opioid users at high‐risk for misuse. This information could be used to target efforts to reduce the prescription drug epidemic.Item Homeless in Indianapolis: Characteristics of the Sheltered and Long-Term Homeless(2014-02-25) Barnes, Brian David; Haas, Ain E.; Foote, Carrie E.; Wright, Eric R.Virtually every society can, at some point, be affected by homelessness. In recent years in the United States, homeless rates have hovered around three percent of the entire population. Although this marginalized population has been studied before, little is known regarding the possible characteristics that can keep an individual in homelessness or affect their living conditions while being homeless. This thesis provides an in-depth look at specific characteristics that could be factors in the length of the homeless experience, as well as how these same characteristics could impact the shelter status while an individual is homeless. The study reveals that homelessness in Indianapolis was mostly experienced by those who were male, African-American, and between the ages of 31-50. Furthermore, the majority were found to live in shelters and be homeless for twelve months or less.Item Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment(Elsevier B.V., 2015-06-06) Norwood, Connor W.; Wright, Eric R.Background Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. Objectives The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. Methods A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. Results Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. Conclusions Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice.Item Key Findings and Recommendations from the 2013 IPLA INSPECT Knowledge and Use Survey(IU Richard M Fairbanks School of Public Health, 2014-06) Kooreman, Harold; Carnes, Neal; Wright, Eric R.The Center for Health Policy in collaboration with the Indiana Professional Licensing Agency and the State Prescription Drug Abuse Prevention Task Force’s Education Committee developed a web-based survey to gather information on prescribers’ and dispensers’ knowledge, use, and opinions of INSPECT as well as to assess prescribers’ and dispensers’ attitudes and beliefs about prescribing and dispensing opioids. Key findings suggest that both providers and dispensers are strongly supportive and frequent users of the INSPECT program; the majority of users believe INSPECT is generally effective and a valuable tool in state-wide efforts to reduce the misuse, abuse, and diversion of prescription drugs.Item Leadership of the Consortium for Health Policy, Law and Bioethics(Office of the Vice Chancellor for Research, 2010-04-09) Meslin, Eric M.; Kinney, Eleanor D.; Wright, Eric R.The Consortium for Health Policy, Law, and Bioethics completed another successful year of educational programs, public outreach, and collaborative research. Educational highlights include (1) offering for the second time, an innovative graduate course co-taught by the three Consortium-directors (Wright, Kinney, Meslin) that is open to students in law, public health, philosophy; (2) The addition of a new “concentration in international research ethics” (offered in the Philosophy Department that is now eligible for joint-degree status with the JD; and (3) approval of a new JD/MSW. Research highlights include (1) twenty publications (2) several grants awarded to Consortium co-directors; $4,958,909.75 and (3) the establishment of year-long a multidisciplinary study group focusing on ethical, legal, social, and policy issues involving comparative effectiveness research. Outreach highlights include nine presentations to community groups, professional associations, and academic institutions.Item The Meanings Gay Men Attribute to Meth and Sex: A Qualitative Study(2013-10-07) Carnes, Neal A.; Wright, Eric R.; Foote, Carrie E.; Williams, Colin J.Sexual encounters among gay men produce distinct meanings when methamphetamine is involved. Few studies have inquired about the meanings gay men ascribe to their meth and sex encounters. We have yet to ask, what meanings do these experiences hold and how are they constructed? Using qualitative data gathered from one-on-one semi-structured interviews with eleven men, at least 18 years of age and who report using meth during sex with another man in the past 90 days, this study explored the meanings constructed from the participants’ meth-sex experiences. The analysis revealed several important themes helping to explain why these men use meth and have sex with other men including belonging; being in, searching for and falling out of love; having sex for 12 hours; dealing with HIV; and, confronting addiction. The findings impart a meaningful role for belonging, love, sex and disease as socially constructed through the intersection of the body, mind, social interaction and the environment in which lived experiences unfold. Previous research supports several of these themes while at least one theme, i.e. love, extends our understanding of meth and sex among gay men. I assert belonging binds the themes together. The desire to belong came across more powerful and determining in its meaningfulness than the risks associated with sexual encounters where meth is present.Item Perceived Mental Illness Stigma Among Youth in Psychiatric Outpatient Treatment(Sage, 2012-03) Elkington, Katherine S.; Hackler, Dusty; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.; Sociology, School of Liberal ArtsThis research explores the experiences of mental illness stigma in 24 youth (58.3% male, 13–24 years, 75% Latino) in psychiatric outpatient treatment. Using Link and Phelan’s (2001) model of stigmatization, we conducted thematic analysis of the interview texts, examining experiences of stigma at individual and structural levels, in addition to the youths’ social-psychological processes. Youth in psychiatric treatment acknowledged that their larger cultural context holds pejorative viewpoints toward those with mental illness and reported experiences of stigma within their families and social networks. Our results also offer insight into the social-psychological processes of stigma, highlighting how labeling may influence their self-concept and the strategies in which youth engage to manage a stigmatized identity. We discuss differences in stigma experiences by gender, age, and diagnosis. Findings provide new information on the stigma experiences of youth in psychiatric treatment and suggest that a multilevel approach to reduce stigma is warranted.Item Perceived mental illness stigma, intimate relationships and sexual risk behavior in youth with mental illness(Sage, 2013) Elkington, Katherine S.; Hackler, Dusty; Walsh, Tracy A.; Latack, Jessica A.; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.; Health Policy and Management, Richard M. Fairbanks School of Public HealthThe current study examines the role of mental illness-related stigma on romantic or sexual relationships and sexual behavior among youth with mental illness (MI), including youths' experiences of stigma, the internalization of these experiences, and the behavior associated with managing stigma within romantic and sexual relationships. We conducted in-depth interviews with N=20 youth with mental illness (MI) (55% male, 16-24 years, 75% Latino) from 4 psychiatric outpatient clinics in New York City. We conducted a thematic analysis to investigate shared experiences of MI stigma and its impact on youth's sexual or romantic relationships and associated behaviors. Our analysis revealed four main themes: 1) societal perceptions of those with MI as partners (societal stigma); 2) individual experiences of stigma within relationships (individual level); 3) internalized stigma of self as a partner (social-psychological processes); and 4) managing a stigmatized identity, of which some of the behaviors directly placed them at increased risk for HIV. We found that just under half of the sample (n=9/20) endorsed all themes, including engaging in HIV/STI sexual risk behaviors as a method to manage a stigmatize identity, which suggests that MI stigma and sexual risk may be linked. We discuss differences by gender and diagnosis. Findings provide new information for providers and researchers to address on the role of stigma experiences in the romantic and sexual behavior of youth in psychiatric treatment. Implications for stigma and HIV/STI prevention interventions are discussed.Item Predicting Treatment Response of Adolescents with Serious Emotional Disturbance(2012-03-19) Oruche, Ukamaka Marian; Gerkensmeyer, Janis E.; Austin, Joan Kessner; Wright, Eric R.; Rawl, Susan M.; Perkins, Susan M.Serious emotional disturbance, including disruptive disorders (i.e., attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder), affects large numbers of adolescents, with costly and tragic consequences. Adolescents with disruptive disorders are likely to be arrested, drop out of school, and have poor treatment outcomes. There is an urgent need to identify strengths-based factors associated with improvement in adolescents’ behavioral and social functioning to help them achieve their full potential. The purpose of this study was to determine whether change in adolescent personal strengths and change in family functioning over 12 months predicted changes in behavioral and social functioning for adolescents with disruptive disorders who participated in a System of Care (SOC) program and if findings varied by race. De-identified data from 179 adolescents, aged 12-17 years, with disruptive disorders and their caregivers were included in this secondary analysis. Data were analyzed using Pearson correlations, t-tests, chi-square tests, and multivariate multiple regressions. Upon admission to the program, caregiver ratings indicated that African American adolescents had greater personal strengths (p = .001), fewer behavior problems (p < .001), and less functional impairment (p < .001) compared to their Caucasian counterparts. Girls had more behavior problems (p = .05) and fewer personal strengths than boys (p < .001). Increase in caregiver-rated adolescent personal strengths was significantly associated with improvement in caregiver-rated adolescent behavioral and social functioning (p < .001). Change in caregiver-rated family functioning was not significantly associated with change in caregiver-rated adolescent behavioral and social functioning (p = .171). The strength and direction of predictors did not vary by race. The adolescents in the study participated in a SOC program that emphasized their strengths versus, primarily, focusing on their deficits. Change in caregiver ratings of adolescent personal strengths was a significant predictor of change in adolescent behavioral and social functioning over a 12 months period. Findings provide evidence for psychiatric mental health professionals to focus on enhancing adolescent personal strengths to improve behavioral and social functioning in adolescents with disruptive disorders. Future research is needed to understand the impact of family variables on adolescents’ treatment outcomes.Item Prescription drug monitoring program inquiry in psychiatric assessment: detection of high rates of opioid prescribing to a dual diagnosis population(Physicians Postgraduate Press, 2014-07) Hackman, Daniel T.; Greene, Marion S.; Fernandes, Taya J.; Brown, Ashley M.; Wright, Eric R.; Chambers, R. Andrew; Department of Psychiatry, IU School of MedicineOBJECTIVE: An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. METHOD: In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. RESULTS: The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95% CI, 1.016-1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95% CI, 1.001-1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. CONCLUSIONS: Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved prevention and treatment strategies for addictions as facilitated by more research and clinical use of prescription drug monitoring in psychiatric care are warranted.