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Article ; Online: Prenatal Opioid Use Disorder Treatment-the Importance of Shared Decision-Making.

Nguemeni Tiako, Max Jordan / Knight, Kelly R / Schiff, Davida M

2024 Volume 184, Issue 3, Page(s) 252–253

MeSH term(s)	Pregnancy ; Female ; Humans ; Opioid-Related Disorders/therapy ; Decision Making ; Decision Making, Shared
Language	English
Publishing date	2024-01-22
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2023.6976
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Article ; Online: Loneliness among homeless-experienced older adults with cognitive or functional impairments: qualitative findings from the HOPE HOME study.

Yuan, Yeqing / Knight, Kelly R / Weeks, John / King, Stephen / Olsen, Pamela / Kushel, Margot

BMC public health

2024 Volume 24, Issue 1, Page(s) 569

Abstract: Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about ...

Abstract	Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences. Methods: We purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis. Results: Twenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants' loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: (1) "lonely- distressed", characterized by physical impairment and severe isolation; (2) "lonely- rather be isolated", reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; (3) "lonely- transient", as a result of aging, acceptance and grieving; and (4) "not lonely"- characterized by stability and connection despite having experienced homelessness. Conclusions: Loneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.
MeSH term(s)	Male ; Humans ; Aged ; Loneliness/psychology ; Longitudinal Studies ; Social Isolation/psychology ; Ill-Housed Persons ; Cognition
Language	English
Publishing date	2024-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-024-18052-5
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Article ; Online: Using alone at home: What's missing in housing-based responses to the overdose crisis?

Fleming, Taylor / Boyd, Jade / Chayama, Koharu Loulou / Knight, Kelly R / McNeil, Ryan

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 24

Abstract: Background: Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments ...

Abstract	Background: Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis. Harm reduction and overdose prevention in housing: In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts. Conclusion: Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
MeSH term(s)	Humans ; Housing ; Drug Overdose/prevention & control ; Drug Overdose/drug therapy ; Substance-Related Disorders ; Harm Reduction ; Peer Group
Language	English
Publishing date	2024-01-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-00933-y
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Article: Women on the Edge: Opioids, Benzodiazepines, and the Social Anxieties Surrounding Women's Reproduction in the U.S. "Opioid Epidemic".

Knight, Kelly R

Contemporary drug problems

2017 Volume 44, Issue 4, Page(s) 301–320

Abstract: The current "opioid epidemic" provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of ... ...

Abstract	The current "opioid epidemic" provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the "opioid epidemic." Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that "every 25 minutes a baby is born suffering from opioid withdrawal," leading to costly hospital stays for infants and the potential for mother-child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.
Language	English
Publishing date	2017-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	190018-3
ISSN	0091-4509
ISSN	0091-4509
DOI	10.1177/0091450917740359
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Article ; Online: "

Checkley, Laura / Steiger, Scott / Knight, Kelly R

Substance abuse

2022 Volume 43, Issue 1, Page(s) 767–773

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Analgesics, Opioid/adverse effects ; Buprenorphine/therapeutic use ; Humans ; Methadone/therapeutic use ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Patient Preference ; Safety-net Providers ; United States
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2022-02-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1080/08897077.2021.2010251
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Article: Loneliness among older adults who have experienced homelessness: qualitative findings from the HOPE HOME study.

Yuan, Yeqing / Knight, Kelly R / Weeks, John / King, Stephen / Olsen, Pamela / Kushel, Margot

Research square

2023

Abstract: Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging. We know little about loneliness among older adults who have experienced homelessness. We aimed ...

Abstract	Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among older adults who have experienced homelessness and the individual, social, and structural conditions that shaped these loneliness experiences. Methods: We purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants' perceived social support and social isolation. We conducted qualitative content analysis. Results: Twenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants' loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: 1) "lonely - distressed", characterized by physical impairment and severe isolation; 2) "lonely - rather be isolated", reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; 3) "lonely - transient", as a result of aging, acceptance and grieving; and 4) "not lonely" - characterized by stability and connection despite having experienced homelessness. Conclusions: Loneliness is a complex and heterogenous social phenomenon, with older adults who have experienced homelessness exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.
Language	English
Publishing date	2023-11-13
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3517416/v1
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Article ; Online: "It's no foundation, there's no stabilization, you're just scattered": A qualitative study of the institutional circuit of recently-evicted people who use drugs.

Fleming, Taylor / Collins, Alexandra B / Boyd, Jade / Knight, Kelly R / McNeil, Ryan

Social science & medicine (1982)

2023 Volume 324, Page(s) 115886

Abstract: People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities (e.g., drug prohibition, discriminatory housing policies), and prejudicial or illegal evictions are common. In Vancouver, Canada, evictions ...

Abstract	People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities (e.g., drug prohibition, discriminatory housing policies), and prejudicial or illegal evictions are common. In Vancouver, Canada, evictions have proliferated in the Downtown Eastside, a historically low-income neighbourhood with high rates of drug use and housing instability, resulting in many PWUD being evicted into homelessness. This study characterizes housing trajectories of recently-evicted PWUD through the lens of the institutional circuit of homelessness, and explores how wider contexts of structural vulnerability shape experiences within this. Qualitative interviews were conducted with PWUD recently evicted in the Downtown Eastside (<60 days). Peer research assistants recruited 58 PWUD through outreach activities. All PWUD participated in baseline interviews on the causes and contexts of evictions. Follow-up interviews were completed with 41 participants 3-6 months later, focusing on longer-term impacts of eviction, including housing trajectories. Most participants were evicted into homelessness, remaining so at follow-up. Participants described patterns of residential instability consisting of frequent cycling between shelters, streets, and kin-based networks. While participants normalized this cycling as characteristic of their marginalized social positions, narratives revealed how the demands of the institutional circuit deepened vulnerabilities and prolonged experiences of homelessness. Experiences were framed by participants' (in)ability to navigate survival needs (e.g., shelter, drug use), with tensions and trade-offs between needs increasing participants' and their peers' risks of harms. Constructions of agency further shaped experiences; accounts highlighted tensions between the control inherent to indoor spaces and participants' need for autonomy. Findings demonstrate how the demands of the institutional circuit foregrounded structural vulnerabilities to perpetuate cycles of instability. Interventions that address survival needs and preserve agency will be necessary to mitigate risks within the institutional circuit, in tandem with upstream interventions that target housing vulnerability and broader social-structural conditions (e.g., poverty, affordability) that entrap recently-evicted PWUD in the institutional circuit.
MeSH term(s)	Humans ; Housing ; Residence Characteristics ; Substance-Related Disorders/epidemiology ; Canada ; Qualitative Research
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2023.115886
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Article ; Online: Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.

Jones, Benjamin L H / Geier, Michelle / Neuhaus, John / Coffin, Phillip O / Snyder, Hannah R / Soran, Christine S / Knight, Kelly R / Suen, Leslie W

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 80

Abstract: Background: Buprenorphine is an effective treatment for opioid use disorder (OUD); however, buprenorphine initiation can be complicated by withdrawal symptoms including precipitated withdrawal. There has been increasing interest in using low dose ... ...

Abstract	Background: Buprenorphine is an effective treatment for opioid use disorder (OUD); however, buprenorphine initiation can be complicated by withdrawal symptoms including precipitated withdrawal. There has been increasing interest in using low dose initiation (LDI) strategies to reduce this withdrawal risk. As there are limited data on withdrawal symptoms during LDI, we characterize withdrawal symptoms in people with daily fentanyl use who underwent initiation using these strategies as outpatients. Methods: We conducted a retrospective chart review of patients with OUD using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Two addiction medicine experts assessed extracted chart documentation for withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine. A third expert adjudicated disagreements. Data were analyzed using descriptive statistics. Results: There were 175 initiations in 126 patients. The mean age was 37 (SD 10 years). 71% were men, 26% women, and 2% non-binary. 21% identified as Black, 16% Latine, and 52% white. 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% who used amphetamines, 29% cocaine, 22% benzodiazepines, and 19% alcohol. Follow up was available for 118 (67%) initiations. There was deviation from protocol instructions in 22% of these initiations with follow up. 31% had any withdrawal, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 10 cases, or 8% of initiations with follow up. Of these, 7 had deviation from protocol instructions; thus, there were 3 cases with follow up (3%) in which precipitated withdrawal occurred without protocol deviation. Conclusions: Withdrawal was relatively common in our cohort but was mostly mild, and precipitated withdrawal was rare. Deviation from instructions, structural barriers, and varying fentanyl use characteristics may contribute to withdrawal. Clinicians should counsel patients who use fentanyl that mild withdrawal symptoms are likely during LDI, and there is still a low risk for precipitated withdrawal. Future studies should compare withdrawal across initiation types, seek ways to support patients in initiating buprenorphine, and qualitatively elicit patients' withdrawal experiences.
MeSH term(s)	Male ; Humans ; Female ; Adult ; Buprenorphine/therapeutic use ; Fentanyl ; Retrospective Studies ; Outpatients ; Opioid-Related Disorders/complications ; Opioid-Related Disorders/drug therapy ; Substance Withdrawal Syndrome/drug therapy ; Analgesics, Opioid/therapeutic use
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Fentanyl (UF599785JZ) ; Analgesics, Opioid
Language	English
Publishing date	2024-04-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-00998-9
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Article ; Online: "The idea is to help people achieve greater success and liberty": A qualitative study of expanded methadone take-home access in opioid use disorder treatment.

Suen, Leslie W / Castellanos, Stacy / Joshi, Neena / Satterwhite, Shannon / Knight, Kelly R

Substance abuse

2022 Volume 43, Issue 1, Page(s) 1143–1150

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Analgesics, Opioid/therapeutic use ; COVID-19 ; Drug Overdose/drug therapy ; Female ; Freedom ; Humans ; Male ; Methadone/therapeutic use ; Middle Aged ; Opioid-Related Disorders/epidemiology ; Pandemics ; Qualitative Research ; United States
Chemical Substances	Analgesics, Opioid ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2022-05-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1080/08897077.2022.2060438
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Article: Barriers and Facilitators to Resolving Older Adult Homelessness through Stays with Family: Qualitative findings from the HOPE HOME Study.

Cai, Christopher / Knight, Kelly R / Olsen, Pamela / Weeks, John / Handley, Margaret A / Kushel, Margot B

Journal of social distress and the homeless

2022 Volume 32, Issue 2, Page(s) 200–209

Abstract: Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We ... ...

Abstract	Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having stayed with housed family/friends for 1 or more nights in the prior 6 months. We conducted semi-structured interviews with 19 hosts of homeless participants and 11 stakeholders in housing and homelessness. We found that homeless older adults and hosts perceived staying with family or friends as a form of temporary housing rather than as a permanent exit to homelessness. Structural barriers to family and friends providing housing for temporary stays or permanent exits from homelessness included housing regulations restricting visitors and changing rent obligations; decreased eligibility and priority for shelter and permanent housing; geographic and transportation challenges; and environments inconducive to older adults. We suggest four areas for policy reform: providing subsidies to hosts and homeless individuals, removing disincentives for homeless older adults to stay with family, changing lease regulations, and expanding the supply of affordable housing.
Language	English
Publishing date	2022-02-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2017268-0
ISSN	1573-658X ; 1053-0789
ISSN (online)	1573-658X
ISSN	1053-0789
DOI	10.1080/10530789.2022.2035128
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