Impact of inspiratory muscle training on inspiratory muscle metaboreflex in patients with heart failure with preserved ejection fraction.

Despite recent decreases, the overdose epidemic continues to persist as one of the deadliest and most socially disruptive public health crises in the history of the United States (US). With more than a million deaths over the past two decades, the massive loss of life from this epidemic has contributed to a reduction in the national life expectancy rate and resulted in widespread trauma throughout society. One of the difficulties in addressing this epidemic is that it evolved and worsened across multiple waves. In the first wave of the epidemic, increases in overdose mortality were driven primarily by prescription opioids. The second wave was marked by a rise in heroin deaths, which increased even as prescription opioid deaths remained elevated. The third wave emerged in the mid-2010s as fentanyl, a synthetic opioid being illicitly manufactured, entered the drug supply and drove overdose deaths from approximately 40,000 in 2011 to more than 100,000 by 2021. Given the persistent role of opioids throughout the overdose epidemic, national resources have gone towards expanding access to evidence-based overdose prevention strategies that are opioid-specific. For example, there is research demonstrating the effectiveness of FDA-approved medications for opioid use disorder (MOUD). Persons receiving these medications, specifically methadone and buprenorphine, have significantly reduced risk of overdose mortality. There is also research demonstrating effectiveness of harm reduction strategies—syringe service programs, overdose prevention centers, and naloxone distribution— to prevent overdose deaths. While the ability to implement these evidence-based strategies varies based on factors at the national and state levels, their delivery ultimately depends on local communities through which medications and other overdose prevention tools like naloxone are dispensed. The fact that only 25% of Americans who could benefit from MOUD are treated with it indicates that US communities continue to fall short in successfully implementing evidence-based strategies. To address this gap between research and practice in responding to the overdose epidemic, countless community collaborations (e.g., task force, coalition, advisory board, steering committee, working group) have been launched across the US. Within these is a group of interest holders from multiple sectors who bring a wide range of knowledge and attitudes on the topic of overdose prevention. Sometimes these attitudes can be divergent, polarizing, and rooted in stigma and misinformation, both in the general population but especially among the criminal-legal system (CLS) practitioners who are tasked with implementing drug enforcement activities. Overdose fatality review (OFR) teams represent a sustained microcosm of these collaborations as multidisciplinary teams that collect information from regularly scheduled in-depth case reviews to identify trends and make localized recommendations to prevent overdose deaths. These teams can range from 10 to over 25 members and can include representatives from healthcare, law enforcement, social services, education, and others who have stake in overdose fatality prevention. The OFR team concept builds on earlier fatality review models (child death review) with representatives from institutions representing public health, treatment, recovery, healthcare, and the CLS (e.g., police, jails, courts, community supervision).