IMPORTANCE Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids. OBJECTIVES To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types. DESIGN, SETTING, AND PARTICIPANTS This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study. MAIN OUTCOMES AND MEASURES Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type. RESULTS Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69). CONCLUSIONS AND RELEVANCE The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.

Background Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. Objective In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. Methods Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. Results Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). Conclusions Text-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.

Posttraumatic stress disorder (PTSD) symptoms are prominent among firefighters and related to suicidal ideation and behavior, a major public health concern among first responders. The role of sleep disturbance in the associations between PTSD symptoms and suicide risk is not well understood. Objective: The present study examined the moderating effect of global sleep disturbance and three disturbance facets (i.e., sleep efficiency, perceived sleep quality, and daily disturbances), on the association between PTSD symptom severity and suicide risk among firefighters. Method: The sample was comprised of 802 trauma-exposed firefighters (93.5% male; M age = 38.68; SD = 8.53), recruited from a large urban fire department in the southern U.S., who completed an online survey. Results: Results indicated significant main and interactive effects of PTSD symptom severity and global sleep disturbance (and each disturbance facet) with regard to global suicide risk. Covariates included gender, years in the fire service, trauma load, and occupational stress. Models accounted for 24.1%-28.4% of variance in suicide risk. Conclusion:This study is the first to concurrently examine these variables among firefighters, and this line of inquiry has the potential to inform evidence-based policy as well as prevention and treatment programs for this vulnerable, understudied population. Clinical Impact StatementThis study suggests that sleep disturbance may be a promising clinical factor with relevance to both posttraumatic stress disorder (PTSD) and suicide risk among firefighters. Mental health prevention and intervention programs for firefighters may benefit from incorporating sleep disturbance screeners and adjunctive psychoeducational or skills-based interventions to target suicide risk. Targeting sleep disturbance via occupational policy reform and/or specialized cognitive-behavioral interventions designed for the unique needs of the fire service may have the potential to reduce PTSD symptoms and suicide risk in firefighter populations.

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters ( N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood ( ∆R2’s = .028–.042; p’s < .01); AS social concerns was incrementally associated with PTSD avoidance ( ∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.

No abstract