The US is unique in dispensing methadone for opioid dependent people only via opioid treatment programs (OTP), or “methadone clinics”. These OTP are governed by federal regulations which outline rules, such as mandatory counseling. Mandatory counseling in this context is a tool to determine which individuals may gain access to a sanctuary for safer drug use and who may not.This dissertation is an analysis of data previously collected from a larger parent study, but which had remained unexamined until now. Utilizing a qualitative thematic approach to data analysis, this study seeks to answer two central research objectives. Firstly, what does the mandatory counseling consist of and what is the professional background of the counselors. When participant responses were analyzed, it was found that clients at OTP were provided scarce details regarding the professional background of their counselors and which, if any, therapeutic modality is offered. Clients have very little control over their treatment plans or counseling, and the role of the counselor is focused more directly on surveillance than therapeutic goals. Secondly, this analysis explores client beliefs about mandatory counseling. While most participants generally held positive views about counseling independent of the mandate, responses bifurcated into two distinct groups. Participants were very supportive of the mandatory counseling, or they expressed a desire for more autonomy and freedom of choice regarding counseling. The findings of this dissertation indicate the need for comprehensive reform of methadone dispensation in the United States.

Cannabis use is increasing both medically and recreationally. Over the last decade studies have investigated sex differences associated with Parkinson’s disease (PD) diagnosis and degenerative symptoms. Previous research has shown that cannabis use has had either a beneficial or deleterious effect on PD symptoms. This research will examine whether sex differences exist among the positive or negative effects of cannabis use in PD. In this paper, an analysis of sex-based differences between male and female cohorts categorized across 2,700 participants is completed under the Fox Insight data set. Each cohort will be compared to 14 nonmotor symptoms and 8 motor symptoms commonly associated with PD. In each cohort mean age, cannabis intake, cannabis dose, cannabis type, and PD diagnosis are analyzed within groups. Each symptom (motor and nonmotor) was analyzed between cohort responses to indicate if there was beneficial or worsening effect within cannabis. Results indicated that the designated female cohort reported both beneficial and worsening effects of cannabis use regarding both motor and nonmotor symptoms. The positive symptoms primarily consisted of individual motor functioning (e.g. dyskinesia, stiffness, back pain, etc.) while the worsening symptoms primarily consisted of nonmotor functioning (e.g. anxiety and apathy). Meanwhile, the male cohort only reported beneficial effects towards nonmotor symptoms (e.g. dystonia, muscle cramps, heart rate). These findings suggest the need for further examination of nigrostriatal pathways and hypothalamic integrity in PD, as it may provide more information into the effects of cannabis use based on sex differences.

Over-prescription of opioid medications for chronic pain has been a major driver of the opioid abuse epidemic. Arizona has an opioid prescription rate of 50.7/100 persons annually, which is about the average US rate of 51.4/100 persons. Novel approaches to treat chronic pain and reduce opioid overuse are promptly needed. Using analysis of Medicaid prescribing data from across Arizona, Mountain Park Health Center was identified to have the lowest opioid prescribing rates among all Community Health Centers (CHC) in Arizona (14.2/100 persons) using analysis of Medicaid prescribing data from across Arizona. A healthy work culture of patient engagement, behavioral health integration into primary care (BHI), and active case management of SDoH issues were critical to successful opioid prescribing and management. In order to account for the complex systemic contributors towards opioid over-prescription, the underlying theoretical framework, positive deviance (PD), was used to uncover effective practices for notably low opioid prescribing. Focus groups of interdisciplinary provider teams (physicians, nurses, pharmacists, and behavioral health) were structured around the PD inquiry approach. Participants were asked about practice and culture factors that might foster or enable low-prescribing practices. Focus group interviews were audio-recorded and transcribed. Six critical themes were identified after extensive qualitative analysis of focus group transcripts: medication management; non-opioid pain management; service integration; preventive strategies; patient and family engagement; underlying factors (including medical/behavior comorbidity and socioeconomic factors). These findings illustrate that this CHC system has a culture which values a high level of care integration, internal systems, and community partnerships to address patient social determinants of health, and patient engagement and provider norms to provide alternatives to opioid prescription. Behavioral health integration into the care team is another key aspect of the culture. Our findings, if confirmed in other settings, could be useful in planning organizational interventions and training. We anticipate that efforts to implement and spread these approaches may be effective in decreasing opioid overuse, promoting health equity by targeting CHCs with room for improvement, and informing the larger research goals: to inform practice change and opioid prescribing across Arizona CHCs.