Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Juan Lu

Second Advisor

Andrew Barnes

Third Advisor

Robert Perera

Fourth Advisor

Elizabeth Prom-Wormley


BACKGROUND: This project utilized opioid-misusing adults to investigate the association between type of opioid misuse and perceived readiness, financial, structural, and stigma-related barriers to accessing SUD treatment; identified classes of PSU and the association between patterns of PSU and perceived barriers, and evaluated effectiveness of an out-of-hospital opioid-treatment connection program.

METHODS: Respondents from 2015-2018 NSDUH included insured adults reporting past year opioid misuse. Multivariate logistic regression assessed relationship between type of opioid misuse and perceived barriers to SUD treatment. LCA identified patterns of PSU, and multivariate logistic regression assessed association between PSU classes and perceived barriers. EMS ePCRs for nonfatal OOD from February 1st 2016 – January 31st 2020 were utilized for SITSA and MITSA to evaluate association between implementation of an out-of-hospital opioid-treatment connection program and monthly trend of nonfatal OOD in the county of implementation and a control county.

RESULTS: Of 6,095 individuals, 3.7% perceived at least one barrier. LCA identified: Heroin injectors with high PSU, PPR users with low PSU, and PPR users with high PSU. Heroin injectors with high PSU faced significantly greater odds of perceiving readiness, structural, and stigma-related barriers compared to PPR users with low PSU. The county of implementation reported an immediate decrease in nonfatal OOD by 0.34% each month post-intervention, however there were no significant differences in pre- to post-intervention level or slope between counties.

CONCLUSIONS: The findings of this study can be used to develop public-health interventions targeted towards sub-populations perceiving barriers, and continue evaluation of out-of-hospital intervention programs.


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