Master of Sciences, Case Western Reserve University, 2016, Biology

Mu Therapeutics is a new company that is focusing on the development of a novel, opioid addiction vaccine. The vaccine creates an antagonistic action against relapse and prevents patients from feeling any physiological effects from the targeted opioids of abuse. The vaccine takes a multivalent approach in targeting both heroin and structurally related prescription opioids. The life-saving vaccine represents a critical tool for clinicians combating the growing heroin and prescription opioid epidemic sweeping the globe. The vaccine is currently in preclinical development, but Mu Therapeutics is planning to rapidly finish the necessary preclinical studies to translate the vaccine into human patient populations in clinical trials. Mu Therapeutics represents an enticing opportunity for investors and potential acquiring companies to help change the flawed paradigm of addiction treatment. The heroin and prescription opioid epidemic has left millions of families suffering from the loss of loved ones and the anguish from watching a loved one battle the grasp of opioid addiction.

Committee: Christopher Cullis (Advisor); Emmitt Jolly (Committee Member); Brian Cummings (Committee Member); Roy Ritzmann (Committee Chair) Subjects: Biology; Entrepreneurship

DNP, Otterbein University, 2025, Nursing

In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include an erector spinae plane block and an opioid-sparing postoperative guideline; evidence shows that erector spinae plane blocks decrease postoperative opioid consumption and improve postoperative outcomes, specifically decreased postoperative mechanical ventilation time. The Johns Hopkins Evidence-Based Practice Guideline Model for Nurses and Healthcare Professionals will guide this process.

Committee: Regina Prusinski (Advisor); Amy Bishop (Committee Member); Joy Shoemaker (Committee Member); Brian Garrett (Committee Member) Subjects: Health Sciences; Medicine

DNP, Otterbein University, 2024, Nursing

In the United States, the rate at which cancer is diagnosed is on the rise. In women, breast cancer is the second most common cancer diagnosis, following skin cancer, with approximately one in eight women developing breast cancer in their lifetime. When a patient receives a breast cancer diagnosis, the oncologic team will discuss the most suitable treatment plan for the patient, this often includes chemotherapy, radiation therapy, and surgery. Within the last few decades, research has shown that there may be a correlation between anesthetic medications and breast cancer metastasis. This project aims to create an evidence-based anesthesia guideline for patients undergoing breast cancer surgery. Interventions will include a paravertebral block, total intravenous anesthesia (TIVA), and non-opioid analgesics; evidence has shown that volatile agents and opioids can decrease natural killer cell activity and increase postoperative metastasis. The Johns Hopkins Evidence-Based Practice Guideline Model for Nurses and Healthcare Professionals will be used to guide this process.

Committee: Brian Garrett (Advisor); Kerrie Rodgers (Committee Member); Joy Shoemaker (Committee Member) Subjects: Health Sciences; Medicine; Nursing

Doctor of Philosophy, The Ohio State University, 2023, Public Health

An estimated 2.4 million people in the U.S. are currently infected with the hepatitis C virus (HCV)1. The number of people with acute HCV infection has risen steadily since 20112 due to increased injection drug use (IDU)3. Among the estimated 6.6 million people who have ever injected drugs, the prevalence of HCV is 43%4. The growth of IDU has disproportionately contributed to acute HCV infections in rural communities as their incidence rates are more than twice those of urban areas5. The most injected drug in rural communities is heroin6, but nearly 60% of people living with opioid use disorders (OUD) have a non-alcohol co-occurring substance use disorder7. Stimulant use, defined as the use of methamphetamines, amphetamines, or cocaine, is resurging8,9. The polysubstance use of opioids and stimulants provide a synergistic high, balance opioid effects to help people function "normally"10-12 and is associated with a higher likelihood of syringe sharing13,14. While IDU of both opioids and stimulants is increasing, it is unclear if opioids, stimulants, or the polysubstance use of both increases the risk of HCV infection in rural areas. Management of HCV infection is described using the HCV cascade of care, including screening, access to care and treatment, and achieved sustained virologic response (SVR)15,16. A fraction of people who inject drugs (PWID) achieve each level of the Cascade of Care; the annual HCV testing rate is only 8% among those clinically identified as PWID in the U.S17. Among rural PWID who have tested positive for HCV, 59% contacted a healthcare provider within 18 months of receipt of their results, 14% reported seeking HCV treatment, and only 8% reported receiving HCV treatment18. Overall, HCV treatment adherence does not appear to be affected by opioid use; the impact of stimulant use is unclear19,20. The association of opioids, stimulants, and concurrent use on the HCV Cascade of Care have not been evaluated in rural areas, where the barriers (open full item for complete abstract)

Committee: Kathryn Lancaster (Advisor); David Kline (Committee Member); William Miller (Committee Member) Subjects: Epidemiology; Public Health

Doctor of Philosophy, The Ohio State University, 2023, Public Health

Drug-related overdoses are the leading cause of injury-related death in the United States. Previous drug overdose research has focused primarily on death-related outcomes and opioid-related overdoses. Currently, little is known about drug-related hospitalizations and non-opioid-related overdoses. A drug overdose occurs when a toxic amount of a drug or drugs overwhelms a person's body, limiting normal body functions. A better understanding of drug-related hospitalizations and ecological associations will aid in interventions and policy creation to lessen the severity of the Florida drug epidemic, and possibly the US drug epidemic. In this research project, I analyzed an extensive database of more than 63 million inpatient hospital billing records from all Florida hospitals collected by the Agency for Health Care Administration in Florida (AHCAF) from 1988 to 2012. The overall objective of this study was to elucidate trends and patterns of hospitalizations for drug-related overdoses during the study period. There were four specific aims of this study: examine epidemiological trends of drug-related overdose hospitalizations in Florida between 1988 and 2012, explore risk factors for predicting an intensive care unit admission during a drug-related overdose hospitalization in Florida from 2010 to 2012, examine the association between county-level demographics and county-level drug-related overdose hospitalization rates in Florida in 2010, and compare comorbid psychiatric condition profiles between Florida residents discharged to home and psychiatric care after a drug-related overdose hospitalization in 2010. Over the 25 years of the study, drug-related overdose hospitalization rates increased significantly for opioids and analgesics (908%), sedatives and hypnotics (38%), psychotropic agents (27%), and central nervous system stimulants (4550%). During the same period, the hospitalization rates due to central nervous system depressants and anesthetics decreased by 41% (open full item for complete abstract)

Committee: Randall Harris (Advisor); Jared Huling (Committee Member); Kathyrn Lancaster (Committee Member); Tasleem Padamsee (Committee Member) Subjects: Public Health; Public Policy

Doctor of Philosophy, University of Akron, 2022, Integrated Bioscience

Opioids have become one of the most misused classes of prescribed medication. Synthetic opioids (e.g., fentanyl) have been responsible for most opioid overdose deaths since 2017. As this epidemic shows no signs of slowing, it is imperative to study the effects of opioids on various aspects of health including bone maintenance. Endogenous opioids (e.g., met-enkephalin) are involved in osteogenesis and bone remodeling. Exogenous opioids can interfere with bone maintenance directly through binding to osteoblasts, limiting bone formation, or indirectly through a cascade of effects limiting sex hormone production. To understand how opioids affect bone microarchitectural and biomechanical properties we first examine bone microstructure throughout the human lifespan to see natural changes occurring without the effects of opioids. Using both Synchrotron Radiation micro-Computed Tomography and confocal laser microscopy, we found bone and lacunar volume fractions to decrease with advancing age while pore diameter increased in the anterior midshaft femur. After finding how bone changes with age under normal circumstances, we sought to examine how prolonged opioid administration affected trabecular microstructure in a model organism (rabbit). We used μCT to examine the proximal tibia by anatomical quadrant (e.g., anterior, posterior). We found that morphine animals had greater bone volume fraction and less trabecular separation than controls. Fentanyl animals had significantly thicker trabeculae and increased trabecular spacing than controls. Detected differences by anatomical region followed the same overall pattern, suggesting biomechanical or anatomical variation rather than due to opioids. We finally examined overall bone strength in a non-weight bearing bone (rib) of the rabbit using uniaxial compression testing to determine how opioids affect overall mechanical competency. We found no difference in mechanical variables between opioid and control groups. Only rib span leng (open full item for complete abstract)

Committee: Brian Bagatto (Advisor); Janna Andronowski (Committee Co-Chair); Henry Astley (Committee Member); David Cooper (Committee Member); Christine Dengler-Crish (Committee Member); Nita Sahai (Committee Member) Subjects: Biology; Biomechanics; Histology; Pharmaceuticals; Physiology

Master of Science (MS), Bowling Green State University, 2022, Forensic Science

There is not currently a prescribed and validated method to clean-up or degrade fentanyl to prevent accidental exposure or abuse. Studies in this area have indicated that a solution of peracetic acid (PAA) generated by mixing sodium percarbonate (SPC) and tetraacetylethylenediamine (TAED) is able to degrade fentanyl. Here, a 5:2 SPC:TAED solution (pH 10) was tested. Additionally, a purchased solution of peracetic acid was tested as received (pH 0) and again after being adjusted to a pH of 10. Each of these solutions were applied to fentanyl for a period of 5 minutes. After being exposed to the SPC/TAED solution, 4.12% of the fentanyl remained, and after PAA (pH 0) exposure, there was 7.00% of undegraded fentanyl remaining. After exposure to the PAA that was adjusted to a pH of 10, there was not enough fentanyl remaining for the peaks to be integrated after running on the Gas Chromatograph-Mass Spectrometer (GC-MS). Statistically, none of the degradants worked better than the others. However, the SPC/TAED would be the option that would be the safest to use. More testing needs to be done on the degradation power of SPC/TAED.

Committee: Travis Worst Ph.D. (Committee Chair); Jeremy Canfield M.S. (Committee Member); Crystal Oechsle Ph.D. (Committee Member) Subjects: Chemistry

Doctor of Nursing Practice, Mount St. Joseph University , 2021, Department of Nursing

Chronic pressure injuries are a common problem among the frail, debilitated, and those nearing the end of life. Most stressful is the pain particularly during and after dressing change (Briggs et al., 2013). Systemic analgesics are the mainstay for most patients but are dose-limiting in this population due to untoward side effects. Topical morphine-infused gel (MIG) has shown significant benefit for patients with pain at the wound site (Flock, 2003). The aim of this study was to determine whether hospice patients with painful PI's would be considered or initiated on MIG after completing an education module (e-module) and video demonstration of MIG application. In a large midwestern healthcare system, 177 bedside and licensed hospice nurses in one of 3 inpatient hospice facilities completed an e-module and video with a pre and post-test as part of their mandatory annual competency renewal. Thirty days later MIG became available to all the inpatient units through the hospice pharmacy for patients with painful wounds. Three months post MIG availability, data was collected and analyzed to determine if patients with painful wounds were considered or initiated on MIG. Results of pre and post-test showed a statistically significant increase in knowledge however the onslaught of the pandemic required modifications in evaluation and another way of seeing the utility of MIG in this setting.

Committee: Nancy Hinzman Dr. (Advisor) Subjects: Nursing

Doctor of Philosophy, Case Western Reserve University, 2021, Anthropology

In an effort to combat the staggeringly high rates of opioid overdose deaths in the US, Overdose Education and Naloxone Distribution (OEND) clinics were established. This study was a collaborative partnership with a local urban hospital committed to harm reduction through their community-based OEND clinic. This study's purpose was twofold. First, to understand who utilized OEND clinics and the factors affecting their HSB (i.e. number of Naloxone kits). Second, to understand how OEND clients framed their understanding of their SUD and if their model of addiction affected HSB. The study was comprised of three distinct phases. Phase 1 Quantitative assessment examined the demographic characteristics (i.e., gender, race, education, SES, occupation), mental health concerns (i.e., anxiety, depression & general distress), breadth and satisfaction of social support, and addiction beliefs in 235 clients from a local OEND clinic in Cleveland, Ohio. Since all participants in this study were already a part the OEND clinic, the number of naloxone kits will serve as a proxy for HSB. Phase 2 Qualitative Assessment explored how 61 of the enrolled clients framed their understanding of their substance use disorder (SUD). Qualitative interviews were coded for themes related to SUD beliefs, the type of stigma experienced by clients as a function of their drug use, and their motivation behind the decisions to seek out Naloxone. Phase 3 involved informal clinic observations to understand clients' experiences and interactions with OEND clinic staff. Gaining a better understanding of patients' health-seeking behaviors (HSB) at OEND clinics is a critical first step along the road to combatting the opioid epidemic. Phase 1 data revealed that clients who chose to engage in the HSB of OEND clinic were primarily unemployed, Caucasian males who were approximately 38 years of age. They were highly anxious, depressed, and in need of more social support to assist in their recovery. The majorit (open full item for complete abstract)

Committee: Lee Hoffer (Committee Chair); Janet McGrath (Committee Member); Jill Korbin (Committee Member); Brian Gran (Committee Member) Subjects: Behavioral Sciences; Cultural Anthropology; Health; Mental Health; Public Health; Social Research

Master of Arts (MA), Wright State University, 2020, Applied Behavioral Science: Criminal Justice and Social Problems

The study examines adverse childhood experiences among individual who use illicit opioids, focusing on emotional, physical, and sexual abuse. The study uses data collected from a sample of 357 individuals with opioid use disorder who were recruited in the Dayton area between May 2017 and October 2018. The study builds on the life course and social learning theories to examine the association between childhood experiences and drug use behaviors in later life. The key aims of the study are to: 1) assess the prevalence of adverse childhood experiences in the community-recruited sample of individuals with opioid use disorder; 2) analyze the relationship between adverse childhood experiences and family history when growing up, including economic hardship and parental history of mental and substance use problems, and 3) analyze the associations between adverse childhood experiences and selected drug use characteristics, such as age of first use, frequency of use, and whether or not they inject. Participants were recruited used targeted and respondent-driven sampling. Structured interviews were conducted by trained interviewers and covered history and patterns of drug use, sociodemographic characteristics, and adverse childhood experiences (ACE). Descriptive statistics and univariate analyses were used to characterize the sample. Chi-square test was used for categorical variables. One-way ANOVA was used to assess differences in drug use characteristics (continuous variables) between those who experienced childhood abuse and those who did not. Multiple linear regression analysis was used to assess the relationships between age heroin initiation (dependent variable) and childhood abuse experiences (independent variable), controlling for socio-demographics and family history when growing up. Multivariate Logistic Regression analyses were used to assess the association between a) early initiation of alcohol use (dependent variable) and childhood abuse experiences (independent) (open full item for complete abstract)

Committee: Raminta Daniulaityte Ph.D. (Advisor); La Fleur Small Ph.D. (Committee Member); Karen Lahm Ph.D. (Committee Member) Subjects: Behavioral Sciences; Early Childhood Education; Families and Family Life; Health Education; Mental Health

Doctor of Philosophy, The Ohio State University, 2021, Sociology

Amidst the continued impact of the opioid epidemic, this dissertation uses 75 in-depth interviews with former addicts to investigate the circumstances surrounding their initiation, escalation, and cessation of opioid use in order to better inform policy perspectives and criminological theory. In Part I, I detail how many individuals' addictions can be traced back to unchecked access to prescription opioid painkillers, often involving elaborate interstate doctor shopping operations and pill mill exploitation. Whether obtained through legal or illicit means, fundamental flaws surrounding the dispersal of pills allowed individuals to quickly develop addictions. Changing regulations and the closure of medical loopholes generated widespread desperation among addicts as pills became increasingly scarce. Borne out of necessity, many addicts transitioned to heroin use to combat withdrawal symptoms. In Part II, I detail how this switch was often accompanied by escalations in criminal involvement. I explore the suitability of deterrence-based principles for the policing of opioid addicts and the implications for punitive policy. My findings revealed that as addicts' chemical dependencies worsened, they were increasingly incapable of performing the internal calculus that rational choice theory is predicated upon. Absent the capacity to properly weigh risk versus reward, addicts formed a deep indifference to the threat of criminal justice contact. Further, justice contact, in the form of arrest and/or incarceration, did little to dissuade users from pursuing their addictions, nor did it influence their desistance from crime. In Part III, I examine the most salient factors contributing to addicts' respective decisions to get clean and the extent to which their thinking aligned with criminological theories on cognitive change. Posing challenges for policy development, addicts described the inability of social bonds, such as marriage, family ties, or employment, to impact their mo (open full item for complete abstract)

Committee: Ryan D. King Ph.D. (Advisor); Mike Vuolo Ph.D. (Committee Member); Paul E. Bellair Ph.D. (Committee Member); Hollie Nyseth-Brehm Ph.D. (Committee Member) Subjects: Criminology; Sociology

DNP, Otterbein University, 2019, Nursing

The purpose of this project is to decrease the footprint of the opioid epidemic by increasing awareness of proper disposal of unwanted, leftover, and expired household medications. The opioid epidemic is negatively affecting many U.S. communities, One way to combat the epidemic is to increase proper disposal of unwanted household medications. Increasing awareness and participation of proper disposal of household medications, including opioids, will not only help to decrease the footprint left by the opioid epidemic, but will potentially decrease the amount of accidental overdoses in household, decrease the impact of improperly disposed medications on the local environment, and decrease the amount of medication involved crime in the community.

Committee: John Chovan (Advisor); Brian Garrett (Committee Member); Cindy Zellefrow (Committee Member) Subjects: Health; Health Sciences; Medicine; Nursing

PhD, University of Cincinnati, 2020, Pharmacy: Pharmaceutical Sciences/Biopharmaceutics

Background: Prescription drugs in general, and opioids in particular, are now the second-most abused substance, after marijuana in young adults. More than 42,000 Americans died from opioid overdose in 2016, which is more than a 100% increase from 2010. Naloxone is a controlled substance that reverses the respiratory and central nervous system depression which is caused by opioid overdose. In the last few years many states have implemented a law called physician-approved protocol in order to increase the access to this life saving drug. Goal of this study was to evaluate the impact of this law on the naloxone dispensing rate. Objectives: To determine the association between a pharmacist naloxone dispensing law and naloxone dispensing rates in Ohio. To determine the impact of the physician-approved protocol on naloxone dispensing rates nationally. Methods For the first objective we used Ohio Medicaid and Kroger pharmacy claims for the 88 counties in Ohio. Area Health Resource File was used to incorporate the county level variables. Any patient 18 years or older with at least 1 naloxone order dispensed through Ohio Medicaid or filled by a Kroger pharmacy in Ohio during the study period of July 16, 2014, to January 15, 2017, was included in the study. A segmented regression analysis of an interrupted time series was performed for 30 consecutive months to evaluate the change in the naloxone dispensing rate before and after the implementation of the state law. For the second objective, we used national Kroger data which included data for 31 states and Area Heath Resource File (AHRF) data set for the state level variables. The study sample included all patients who received at least one naloxone prescription that was filled in any Kroger pharmacy during the study period from July 16, 2014 to January 16, 2017. A multiple regression analysis was performed for 30 consecutive months to evaluate the change in naloxone prescription dispensing rate. Results In th (open full item for complete abstract)

Committee: Pamela Heaton Ph.D. (Committee Chair); Jill Boone Pharm.D. (Committee Member); Stacey Frede Pharm.D. (Committee Member); Ana Hincapie Ph.D. (Committee Member); Roman Jandarov Ph.D. (Committee Member) Subjects: Pharmaceuticals

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2020, Pharmaceutical Sciences (Pharmacology/Toxicology)

Opioid drugs are of great importance in the management of acute and chronic pain conditions. They are recognized as being essential in the management of severe malignant and non-malignant pain (Mercadante, 2015). Pharmacokinetic differences among these drugs contribute to patients having differential responses, including bioavailability, metabolism, and elimination from the body. It is becoming more evident that genetics play a vital role in affecting the metabolism of opioid drugs. Three major enzyme systems, CYP450, UDP-glucuronosyltransferase (UGTs) and SULTs have been shown to be involved in their metabolism. Polymorphisms of these enzyme systems can result in an individual having distinct phenotypes: poor metabolizers which express two nonfunctional alleles, intermediate metabolizers at least one reduced functional allele, extensive metabolizers at least one functional allele, and ultra-rapid metabolizers express multiple copies of the functional allele. These genetic differences are partially explained by single nucleotide polymorphisms, (-SNPs), which encode for molecular entities involved in the pharmacodynamic and pharmacokinetic processes. Understanding how and to what degree the allozymes of different enzyme systems such as the CYPs, UGTs and SULTs affect drug metabolism can add new insights into gene therapy-based approaches and greatly improve the treatment of chronic pain (Peiro, 2016.) My thesis research was focused on the role of human SULTs in the metabolism of opioid drugs. Previous studies have demonstrated that of the eleven known SULTs, SULT1A3 was found to be involved in opioid drug metabolism (Bairam, 2018). By carrying out in vitro assays, we first determined the sulfating activity of SULT1A3 toward opioid drugs and subsequently the effects of SNPs of human SULT1A3/SULT1A4 genes on the enzymatic characteristics of SULT1A3 allozymes in mediating hydromorphone and pentazocine, two commonly used opioid drugs. The results obtained provided va (open full item for complete abstract)

Committee: Ming-Cheh Liu (Committee Chair); Frederick Williams (Committee Member); Caren Steinmiller (Committee Member) Subjects: Pharmaceuticals; Pharmacology

Doctor of Nursing Practice, Mount St. Joseph University , 2020, Department of Nursing

Substance abuse is a chronic disease. The evidence shows that many nurses lack the knowledge, skills, attitudes and confidence needed to help those struggling with substance abuse and this ultimately impacts patient outcomes. This project asked the question: for newly graduated registered nurses hired as nursing residents on adult, inpatient units at a large health system hospital centralized in Northwest Ohio, how does a 30-minute live in-service on substance abuse impact these RNs' perceived confidence in caring for patients with a history of substance abuse immediately and 30 days post-education in comparison to pre-education perceived confidence levels? In keeping with Knowles' Principles of Adult Learning and supported by evidence, substance abuse education was created for the target audience. An evidence-based survey tool, the DDPPQ, was used before and after the education was presented in order to assess the participants' confidence levels in caring for substance abuse patients. The analysis of the pre- and post-education survey results indicate that the participants' confidence levels significantly increased after receiving the education. These results will be disseminated in a variety of ways and adapted for larger audiences.

Committee: Nancy Hinzman Dr (Advisor) Subjects: Education; Nursing

Master of Arts, Miami University, 2020, Economics

This paper attempts to estimate the economic impact of the opioid epidemic on the state of Ohio at the county level. The paper employs both panel regression models with instrumental variables and propensity score matching in estimating this effect. The paper finds that the opioid epidemic has had a limited effect on the per capita GDP of the counties it has affected.

Committee: Jing Li (Advisor); Nam Vu (Committee Member); Jonathan Wolff (Committee Member) Subjects: Economics

Doctor of Philosophy, Case Western Reserve University, 2020, Pathology

Opioid peptides are released at sites of injury; their G-protein coupled opioid receptors (OR) are expressed on immune cells. Conflicting reports attribute immunostimulatory and immunosuppressive activity to opioids. From a cohort of methadone patients and controls, we found that chronic opioid use disrupts CD8+ T cell subset balance, via decreased T Effector Memory RA+ cells. Exposure of CD8+ T cells ex vivo to selective μ-OR or δ-OR agonists has differing outcome based on donor opioid use history, and the effects on surface marker expression are specific to subsets of cells. In opioid naive individuals, ex vivo opioid agonists differentially regulate thousands of protein coding and noncoding genes. Gene set enrichment analysis reveals that μ-OR more strongly regulates cellular processes, including immune response via interferon, IL-2, and mTOR signaling pathways. In resting cells triggering μ-OR has mixed stimulatory and inhibitory patterns, but when administered prior to TCR cross-linking, μ-OR uniformly inhibits activation. One striking finding is the strong linkage of μ-OR, but not δ-OR, signaling to the upregulation of lipid, cholesterol, and steroid hormone biosynthesis, which suggests lipid regulation is a mechanism for μ-OR-mediated immune suppression. Lipid rafts are cholesterol rich liquid-ordered membrane domains that function as a nexus for the initiation of signal transduction from cell surface receptors, including T cell receptor (TCR) and μ-OR. Ongoing to the project are efforts to further characterize the underlying mechanisms as they relate to G protein vs. β-arrestin signaling, functions of individual noncoding RNAs, and processes including glycosylation and transcription factor localization. Comparison of human CD4 vs. CD8 T cell responses to ligation of all three ORs (μ, δ, κ) are underway and reveals cell lineage specific pathway regulation, underscoring that opioid induced immune regulation is both cell type and OR subtype-specific. These stud (open full item for complete abstract)

Committee: Alan Levine (Advisor); David Canaday (Committee Chair); George Dubyak (Committee Member); Clive Hamlin (Committee Member); Alex Huang (Committee Member); Saba Valadkhan (Committee Member) Subjects: Immunology; Pathology

Master of Science (MS), Wright State University, 2020, Chemistry

Illicitly manufactured fentanyls (IMFs) have become a global and local epidemic and have recently caused an increase in the number of accidental exposures and overdoses in first responders and the community. The aim of the research is to explore a method to discriminate between IMFs and cutting agents in mock street samples using Raman Spectroscopy. Predominant Raman bands corresponding to the structural moieties of each individual illicit, licit drugs, and cutting agents were tracked, then used to discriminate between varying components in a mock street sample. In conclusion, discrimination between the components in the mixture was obtained using Raman Spectroscopy. The inquiry will provide the basis for a viable method in the prevention of accidental exposures and overdoses in first responders and the general public.

Committee: Ioana Pavel Ph.D. (Advisor); David Dolson Ph.D. (Committee Member); Steven Higgins Ph.D. (Committee Member) Subjects: Chemistry; Toxicology

Doctor of Philosophy, The Ohio State University, 2019, Public Health

In 2016, Congress enacted the Comprehensive Addiction and Recovery Act (CARA), legislation addressing the opioid crisis. CARA evidences a health-oriented definition of problem drug use, one that differs from narratives of deviancy used to describe past drug crises in the U.S. It was also accompanied by legislators proclamation that addiction was a public health issue. While the factors that contributed to this definition are likely many, scholarly research has demonstrated that legislators' consider the positions of organized interest groups and administrative agencies (pressure groups) when deciding how to approach a policy problem. One way in which pressure groups communicate their positions to legislators is through their testimony at congressional hearings. In doing so, they often use policy narratives that contain causal stories that support their preferred policy proposals. This dissertation examines pressure group use of policy narratives within the congressional hearing testimony from 2014-2016 on the opioid crisis to answer the following overarching questions: (1) How did pressure groups define the opioid crisis prior to CARA's enactment? (2) How did such a definition and its aligning solutions differ by the type of group testifying? The overall goals of this dissertation are to understand (1) how pressure groups may have influenced the definition of the opioid crisis as a health problem prior to CARA's enactment, (2) to characterize the types of narratives used to support such a re-definition, and (3) to explore how varying groups' interests may have contributed to the differing problem definitions. The results of this dissertation suggest that pressure groups defined the opioid crisis as both a supply and demand problem, but a problem which was best addressed by the healthcare system. Further, the results demonstrate that although a select few law enforcement groups clung to archaic narratives of strict deviancy, the majority of law enforcement actors (open full item for complete abstract)

Committee: Sandra Tanenbaum PhD (Committee Chair); Micah Berman JD (Committee Member); Thomas Wickizer PhD (Committee Member); Paul DeBoeck PhD (Committee Member) Subjects: Health; Health Care; Health Sciences; Public Health

Master of Humanities (MHum), Wright State University, 2018, Humanities

This thesis provides a foundational understanding of the ways in which Facebook is being used as a location for meaning making around the opioid epidemic in Dayton, Ohio. A content analysis of the Dayton Daily News Facebook page analyzes four posts that were randomly selected from 2017 and their corresponding 1,336 comments. This work will identify and describe discursive civility and incivility. This work adds to the growing conversation about incivility in political discourse by bringing the focus to the opioid epidemic and Facebook as a location where understandings of drug use and prevention are co-constructed. This construction, along with understandings of what is civil or uncivil, can both perpetuate and subvert power structures. The implications of this pilot study provide a framework to consider opportunities to create more civil and subversive locations on Facebook for meaning making.

Committee: Julianne Weinzimmer Ph.D. (Committee Chair); Jessica Barnett Ph.D. (Committee Member); Jen Ware Ph.D. (Committee Member) Subjects: Mass Communications