Melody Glenn

Interests

Research

Harm Reduction, Addiction Medicine, Emergency Medical Services, Health Policy

Teaching

Harm Reduction, Addiction Medicine, Narrative Medicine

Courses

No activities entered.

Scholarly Contributions

Books

• Glenn, M. (2025).

  Mother of Methadone

  . Beacon Press.
• Glenn, M. (2022). Marie's Methadone [MFA Thesis]. Mills College Library
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  This is the thesis for my Master of Fine Arts in Creative Writing

Journals/Publications

• Baker, N., Glenn, M., Rice, A. D., Hospodar, J., Bullock, J., Bradley, G., Spaite, D. W., Derksen, D., & Gaither, J. B. (2025). Barriers to Implementation of Screening, Brief Intervention, and Referral to Treatment in the Prehospital Setting. Prehospital Emergency Care, 29(Issue 4). doi:10.1080/10903127.2024.2447566
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  Objectives: The Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework is a validated process that is used to identify individuals with substance use disorders (SUDs) and then encourage them to engage in and facilitate entry into treatment. It is not known how well SBIRT can be incorporated into prehospital practice and what barriers to Emergency Medical Services (EMS) implementation of an SBIRT program might arise. The aim of this project was to implement a pilot EMS based SBIRT program. Then, after program implementation, to identify barriers to the prehospital use of SBIRT programs. Methods: This was a mixed methodology study utilizing a retrospective review of program quality improvement data and structured interviews to collect both objective and subjective data on the prehospital SBIRT implementation. Eight EMS agencies participated in the SBIRT pilot program. Paramedics and Emergency Medical Technicians (EMT) were trained to use the SBIRT process then asked to use the SBIRT tool during their day to day activities. The screening tools utilized were the Drug Abuse Screening Test (DAST) and the Alcohol Use Disorders Identification Test (AUDIT). Referral tools were tailored to the unique SUD treatment programs available in each community. The pilot program was run for 6 months after which time structured focus group meetings were conducted to identify barriers to broader SBIRT program utilization. Results: In total, 28 EMS clinicians from 8 agencies attended the train the trainer SBIRT education session. None of the agencies subsequently implemented the routine use of the SBIRT model or DAST/AUDIT tools. The agencies reported significant barriers to implementation on EMS calls, including short transport times, current drug and/or alcohol intoxication, and hesitation of patients to participate. Community paramedicine clinicians, who typically spend more time with patients, found the tools more useful but found limited opportunities to implement them. Common cited themes were the lack of local community-based organizations and frequent personnel turnover within local agencies. Conclusions: Although EMS clinicians found the SBIRT training to be useful, they did not incorporate the use of the SBIRT model into their prehospital patient care, citing too many barriers to its implementation and use.
• Gagnon, D., Glenn, M., Quaye, A., & Erstad, B. (2025). Buprenorphine in the Intensive Care Unit: Commentary on the Unanswered Questions. Annals of Pharmacotherapy, 59(2). doi:10.1177/10600280241254528
  More info

  The removal of the X-waiver in the Mainstreaming Addiction Treatment (MAT) Act of 2023 has substantial implications for buprenorphine prescribing as one of the options to treat opioid use disorder. The purpose of this commentary is to discuss the unanswered questions regarding buprenorphine in the intensive care unit (ICU) including how the passage of the MAT Act will affect ICU providers, which patients should receive buprenorphine, what is the most appropriate route of administration and dose of buprenorphine, what medications interact with buprenorphine, and how can transitions of care be optimized for these patients.
• Gaither, J. B., Derksen, D., Spaite, D. W., Bradley, G., Bullock, J., Hospodar, J., Rice, A. D., Glenn, M., & Baker, N. (2025).

  Barriers to Implementation of Screening, Brief Intervention, and Referral to Treatment in the Prehospital Setting

  . Prehospital Emergency Care, 29(Issue 4). doi:10.1080/10903127.2024.2447566
  More info

  Objectives: The Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework is a validated process that is used to identify individuals with substance use disorders (SUDs) and then encourage them to engage in and facilitate entry into treatment. It is not known how well SBIRT can be incorporated into prehospital practice and what barriers to Emergency Medical Services (EMS) implementation of an SBIRT program might arise. The aim of this project was to implement a pilot EMS based SBIRT program. Then, after program implementation, to identify barriers to the prehospital use of SBIRT programs. Methods: This was a mixed methodology study utilizing a retrospective review of program quality improvement data and structured interviews to collect both objective and subjective data on the prehospital SBIRT implementation. Eight EMS agencies participated in the SBIRT pilot program. Paramedics and Emergency Medical Technicians (EMT) were trained to use the SBIRT process then asked to use the SBIRT tool during their day to day activities. The screening tools utilized were the Drug Abuse Screening Test (DAST) and the Alcohol Use Disorders Identification Test (AUDIT). Referral tools were tailored to the unique SUD treatment programs available in each community. The pilot program was run for 6 months after which time structured focus group meetings were conducted to identify barriers to broader SBIRT program utilization. Results: In total, 28 EMS clinicians from 8 agencies attended the train the trainer SBIRT education session. None of the agencies subsequently implemented the routine use of the SBIRT model or DAST/AUDIT tools. The agencies reported significant barriers to implementation on EMS calls, including short transport times, current drug and/or alcohol intoxication, and hesitation of patients to participate. Community paramedicine clinicians, who typically spend more time with patients, found the tools more useful but found limited opportunities to implement them. Common cited themes were the lack of local community-based organizations and frequent personnel turnover within local agencies. Conclusions: Although EMS clinicians found the SBIRT training to be useful, they did not incorporate the use of the SBIRT model into their prehospital patient care, citing too many barriers to its implementation and use.
• Glenn, M. J., & Erstad, B. L. (2025). Challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal in the emergency department and the role of the pharmacist. American Journal of Health-System Pharmacy, 82(Issue 2). doi:10.1093/ajhp/zxae212
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  Purpose: To demonstrate the challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal secondary to naloxone the emergency department (ED) setting and describe the role of the emergency medicine (EM) pharmacist in its management. Summary: There are no standardized criteria to define precipitated opioid withdrawal syndrome, so the diagnosis is typically based on sentinel signs and symptoms and time course. Complicating factors include a positive urine toxicology screen for nonopioid substances, comorbidities and associated medications prior to admission, medications given in the ED, and a fluctuating patient course during the ED stay that likely involves all these issues. Although buprenorphine is frequently recommended as the primary treatment for precipitated withdrawal, its use can be complicated if patients are on methadone maintenance or other long-Acting opioids. The EM pharmacist plays a key role in managing patients with precipitated withdrawal. Conclusion: Practice changes related to the diagnosis and treatment of opioid use disorder (OUD) with precipitated withdrawal in the ED are needed. EM pharmacists as part of the interprofessional care team have an important role in the management of patients with OUD, including those patients undergoing possible precipitated withdrawal.
• Glenn, M., Crowe, R., Dorsett, M., Taigman, M., Herring, A. A., Mercer, M., Joiner, A., Venkatesh, A., Davis, C., Hawk, K., Hern, H. G., Carroll, G., Cabañas, J. G., D’Onofrio, G., & Samuels, E. A. (2025). A Prehospital Quality Improvement Framework to Reduce Mortality and Other Harms Associated with Opioid Use Disorder. Prehospital Emergency Care, 29(Issue 4). doi:10.1080/10903127.2024.2428671
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  Objectives: In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD). Methods: A multidisciplinary team of subject matter experts in addiction medicine, EMS, public health, and QI was convened to develop recommendations for a model QI framework for prehospital OUD prevention, harm reduction, and treatment based on the Model for Improvement framework. Results: This article introduces a comprehensive EMS QI framework, aimed at not only addressing acute opioid-related emergencies but also fostering long-term strategies to mitigate mortality and other adverse outcomes among individuals with OUD. Conclusions: Grounded in evidence-based practices and informed by collaborative expertise, this framework represents a pivotal step toward enhancing the effectiveness and responsiveness of EMS in combating the multifaceted challenges posed by OUD.
• Glenn, M., Stratton, D., Primeau, K., & Rice, A. (2025). Epidemiology of 911 Calls for Opioid Overdose in Nogales, Arizona. Western Journal of Emergency Medicine, 26(Issue 3). doi:10.5811/westjem.18597
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  Objective: Drug overdose is the leading cause of unintentional death in the United States, and individuals identifying as BIPOC (Black, indigenous and people of color) and those of low socioeconomic status are over-represented in this statistic. The US-Mexico border faces several unique challenges when it comes to healthcare and the drug overdose crisis, due in large part to health inequities. Although the US Centers for Disease Control and Prevention recommends that overdose prevention programs address health inequities, little is known about opioid overdoses in this rural, primarily Spanish-speaking region. As emergency medical services (EMS) records collect countywide data, they represent a high-quality source for epidemiologic surveillance. Methods: We conducted a retrospective chart review based on a local quality assurance program in which two years of EMS records were reviewed with the primary objective of characterizing patients receiving prehospital care for opioid overdoses in a rural, borderland community, and the secondary objective of characterizing EMS’s fidelity to a naloxone distribution protocol. We included electronic patient care records for analysis if they included the EMS clinician’s impression of overdose, opiate abuse, or opiate-related disorder from November 1, 2020–October 31,2022. The following data points were abstracted: date; patient initials/gender/age; police presence; response location; bystanders on scene; naloxone administration prior to EMS arrival; distribution of naloxone kit (yes/ no); substance reported; and disposition. We analyzed descriptive statistics. Results: A total of 74 cases met inclusion criteria over two years with the majority of cases involving men (82%) with a median age of 28. Almost half of overdoses occurred at private residences (46%), and slightly more than half (57%) reported fentanyl use prior to overdose. Family or friends were usually (64%) on scene, and law enforcement was often (77%) the first 911 to arrive. Naloxone was administered on scene in almost all cases (91%), usually by EMS (44%) or law enforcement (43%). The EMS clinicians distributed naloxone kits at 61% of calls. Conclusion: Opioid overdoses along the US-Mexico border occurred primarily among young men using illicit fentanyl in private residences. Although family/friends were often present, they rarely administered naloxone. Law enforcement was often the first 911 responder to arrive. Emergency medical services is a suitable setting for naloxone distribution programs.
• Joiner, A. P., Wanthal, J., Murrell, A. N., Cabañas, J. G., Carroll, G., Hern, H. G., Sasser, M., Poland, C., Mercer, M. P., & Glenn, M. (2025). A Scoping Review and Consensus Recommendations for Emergency Medical Services Buprenorphine (EMS-Bupe) Programs. Prehospital Emergency Care, 29(Issue). doi:10.1080/10903127.2024.2445739
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  Objectives: Emergency Medical Services (EMS) agencies are beginning to provide low-barrier access to treatment for opioid use disorder (OUD) through the development of EMS buprenorphine (EMS-Bupe) programs. However, evidence-based practices for these programs are lacking. Our aim was to review the current literature on EMS and emergency department (ED) based buprenorphine treatment programs to provide consensus recommendations on the EMS-Bupe program development. Methods: We performed a scoping review of EMS-Bupe programs and ED medication for OUD (MOUD) programs. We searched Ovid MEDLINE(R), Embase.com, Cochrane Central Register of Controlled Trials and Web of Science (Science Citation Index) for English language articles and abstracts. Additional articles/abstracts as identified independently by coauthors were added. Recommendations were generated through consensus based on the findings of the scoping review and other relevant literature. Results: We identified a total of 9 EMS-Bupe articles/abstracts and 21 ED MOUD abstract, representing 5 EMS-Bupe programs in 4 states. There was significant variability between programs, from infrastructure, medication dosing, and retention rates. Results and recommendations were grouped into 8 categories: EMS program infrastructure, withdrawal classification thresholds, EMS protocol inclusion/exclusion criteria, buprenorphine dosing and adjunct medications, EMS disposition and scene times, EMS clinician training, referrals, and EMS data collection and quality management. Conclusions: The EMS-Bupe program data are limited but show important variability. In general, we recommend that programs respond to community needs by establishing relationships with local resources. We also favor protocols that increase patient eligibility and treatment retention. Lastly, programs should consider low-barrier, patient-centered strategies aimed at preventing gaps in treatment.
• Joiner, A., Kamara, M. i., Powell, S., Hart, L., Sawin, G., Glenn, M., Vleet, L. V., Supples, M., Chan, B., Starks, M., & Blewer, A. L. (2025). Barriers to bystander interventions in suspected opioid-associated out-of-hospital cardiac arrests: A multiple methods study of 9-1-1 calls. Resuscitation, 215(Issue). doi:10.1016/j.resuscitation.2025.110748
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  Introduction: Opioid-associated out-of-hospital cardiac arrests (OA-OHCA) is a significant problem in the United States. Layperson interventions, including bystander CPR and naloxone may improve survival, but barriers may differ compared to other OHCA. This study aims to describe characteristics of 9-1-1 callers and patients in suspected OA-OHCAs and identify barriers to B-CPR and naloxone administration. Methods: This was a retrospective multiple methods study of transcribed 9-1-1 calls for suspected OHCA from two counties in North Carolina (5/2022–12/2023). Adult, non-traumatic OHCAs were included. Data were analyzed using descriptive statistics and Student's t-test/Chi2. We used thematic analysis and a combined deductive and inductive approach. Results: Patients with suspected OA-OHCA were younger than non-suspected OA-OHCA patients (39 vs 58 years [p < 0.01]). Most patients were in a residence, however, this percentage was smaller in suspected OA-OHCA compared with non-suspected OA-OHCA (68 % vs 88 % [p < 0.01]). Most callers in the suspected OA-OHCA group were a friend of the patient (35 %), whereas most callers in the non-suspected OA-OHCA population were a family member (34 %) [p < 0.01]. Qualitative barriers unique to suspected OA-OHCA included: conflicting responsibilities, fear of drugs, and fear of the patient. Naloxone-specific barriers included lack of availability and lack of knowledge of use. Conclusion: We found significant differences in demographics between suspected OA-OHCA compared with non-suspected OA-OHCA. We also identified unique barriers in this population as well as previously described barriers which may be amplified in the setting of suspected drug use. A different approach towards cardiac resuscitation may be needed to maximize treatment and survival.
• Vandergrift, L. A., Rice, A. D., Primeau, K., Gaither, J. B., Munn, R. D., Hannan, P. L., Knotts, M. C., Hollen, A., Stevens, B., Lara, J., & Glenn, M. (2025). Precipitated Withdrawal Induced by Prehospital Naloxone Administration. Prehospital Emergency Care, 29(Issue 4). doi:10.1080/10903127.2024.2449505
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  Objectives: Buprenorphine is becoming a key component of prehospital management of opioid use disorder. It is unclear how many prehospital patients might be eligible for buprenorphine induction, as traditional induction requires that patients first have some degree of opioid withdrawal. The primary aim of this study was to quantify how many patients developed precipitated withdrawal after receiving prehospital naloxone for suspected overdose, as they could be candidates for prehospital buprenorphine. The secondary objective was to identify associated factors contributing to precipitated withdrawal, including dose of naloxone administered, and identify rate of subsequent transport. Methods: A retrospective cohort study reviewing electronic patient care reports (ePCRs) from March 2019 to April 2023 in a single Emergency Medical Services (EMS) system was performed. Cases were included if naloxone was administered during the prehospital interval and excluded if the patient was in cardiac arrest upon arrival and died on scene. Precipitated opioid withdrawal was defined using reliably available ePCR data points measured by the Clinical Opiate Withdrawal Scale: administration of an antiemetic or sedative, persistent tachycardia, or new tachycardia after naloxone. Descriptive statistics were calculated to quantify the incidence of precipitated withdrawal. Risk ratios were calculated to identify variables associated with outcomes of interest. A subgroup analysis was performed examining patients explicitly diagnosed with an overdose by EMS. Results: During the study period, 4561 individuals were given naloxone, and 2124 (46.2%) met our proxy criteria for precipitated withdrawal. Patients who received multiple doses of naloxone were more likely to meet our precipitated withdrawal definition versus those who received a single dose (RR 1.2, 95% CI 1.12–1.28). Patients who experienced precipitated withdrawal were more likely to accept transportation than those who did not experience withdrawal (RR 1.08 95% CI 1.04–1.12). Persistent tachycardia (80.3%) was the most common criterion met for our definition of precipitated withdrawal. Conclusions: Almost half of patients who received a dose of prehospital naloxone for suspected overdose met our proxy criteria for precipitated withdrawal. Patients who met our precipitated withdrawal definition were more likely to have received greater doses of naloxone and were more likely to accept transport to an emergency department.
• Gagnon, D. J., Glenn, M. J., Quaye, A. A., & Erstad, B. L. (2024). Buprenorphine in the Intensive Care Unit: Commentary on the Unanswered Questions. The Annals of pharmacotherapy, 10600280241254528.
  More info

  The removal of the X-waiver in the Mainstreaming Addiction Treatment (MAT) Act of 2023 has substantial implications for buprenorphine prescribing as one of the options to treat opioid use disorder. The purpose of this commentary is to discuss the unanswered questions regarding buprenorphine in the intensive care unit (ICU) including how the passage of the MAT Act will affect ICU providers, which patients should receive buprenorphine, what is the most appropriate route of administration and dose of buprenorphine, what medications interact with buprenorphine, and how can transitions of care be optimized for these patients.
• Glenn, M. J., & Erstad, B. L. (2024). Challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal in the emergency department and the role of the pharmacist. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.
  More info

  In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
• Glenn, M., Crowe, R., Dorsett, M., Taigman, M., Herring, A. A., Mercer, M., Joiner, A., Venkatesh, A., Davis, C., Hawk, K., Hern, H. G., Carroll, G., Cabañas, J. G., D'Onofrio, G., & Samuels, E. A. (2024). A Prehospital Quality Improvement Framework to Reduce Mortality and Other Harms Associated with Opioid Use Disorder. Prehospital emergency care, 1-9.
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  In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD).
• Karra, R., Rice, A. D., Hardcastle, A., V Lara, J., Hollen, A., Glenn, M., Munn, R., Hannan, P., Arcaris, B., Derksen, D., Spaite, D. W., & Gaither, J. B. (2024). Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System. The western journal of emergency medicine, 25(5), 777-783.
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  Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers.
• Karra, R., Rice, A., Hardcastle, A., Lara, J., Hollen, A., Glenn, M., Munn, R., Hannan, P., Arcaris, B., Derksen, D., Spaite, D., & Gaither, J. (2024). Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System. Western Journal of Emergency Medicine, 25(5). doi:10.5811/westjem.18427
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  Background: Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. Methods: This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. Results: The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019–September 10, 2020) and the post-implementation period (September 11, 2020–December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45–2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as “good.” Conclusion: In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as “good.”
• Erstad, B. L., & Glenn, M. J. (2023). Considerations and limitations of buprenorphine prescribing for opioid use disorder in the intensive care unit setting: A narrative review. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.
  More info

  In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
• Erstad, B. L., & Glenn, M. J. (2023). Management of Critically Ill Patients Receiving Medications for Opioid Use Disorder. Chest.
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  Critical care clinicians are likely to see an increasing number of patients admitted to the ICU who are receiving Food and Drug Administration-approved medications for opioid use disorder (MOUDs) given the well-documented benefits of these agents. Oral methadone, multiple formulations of buprenorphine, and extended-release naltrexone are the three types of MOUD most likely to be encountered by ICU clinicians; however, these drugs vary with respect to formulations, pharmacokinetics, and adverse effects.
• Friedman, N. M., Molina, C. A., & Glenn, M. J. (2023). Harm reduction and emergency medical services: Opportunities for evidence-based programming. The American journal of emergency medicine, 72, 85-87.
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  Overdose fatalities are increasingly attributed to synthetic opioids, including fentanyl, which may be added to samples of illicit substances unknowingly to the user. As recently as April 2023, the Centers for Disease Control and Prevention has also raised awareness of the risks of xylazine, an animal tranquilizer that has been found in adulterated samples of illicit substance. A growing body of evidence supports the use of drug testing services, including fentanyl and xylazine test strips, to reduce the risks associated with substance use and prevent fatal overdoses. Emergency medical services clinicians serve on the frontline of the opioid epidemic and are uniquely positioned to distribute harm reduction materials. In this article, we advocate for emergency medical services to distribute fentanyl and xylazine test strips. We also critically evaluate legal and other barriers to implementation.
• Glenn, M., & Stratton, D. (2022). EMS Distribution of Naloxone Kits to High-Risk Patients in a United States-Mexico Border Town. Prehospital Emergency Care, 26(1), 160-161.
• Arcaris, B., Gaither, J. B., Glenn, M. J., Hannan, P., Hollen, A., Jado, I., Mcdonough, S., Primeau, K., Rice, A. D., & Spaite, D. W. (2021). Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 25(1), 46-54. doi:10.1080/10903127.2020.1834656
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  To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone..This is a retrospective cohort study in which the incidence of refusals after naloxone administration in a single EMS system was evaluated. The number of refusals after naloxone administration was compared across the before-pandemic interval (01/01/20 to 02/15/20) and the during-pandemic interval (03/16/20 to 04/30/20). For comparison the incidence of all other patient refusals before and during COVID-19 as well as the incidences of naloxone administration before and during COVID-19 were also reported..Prior to the widespread knowledge of the COVID-19 pandemic, 24 of 164 (14.6%) patients who received naloxone via EMS refused transport. During the pandemic, 55 of 153 (35.9%) patients who received naloxone via EMS refused transport. Subjects receiving naloxone during the COVID-19 pandemic were at greater risk of refusal of transport than those receiving naloxone prior to the pandemic (RR = 2.45; 95% CI 1.6-3.76). Among those who did not receive naloxone, 2067 of 6956 (29.7%) patients were not transported prior to the COVID-19 pandemic and 2483 of 6016 (41.3%) were not transported during the pandemic. Subjects who did not receive naloxone with EMS were at greater risk of refusal of transport during the COVID-19 pandemic than prior to it (RR = 1.39; 95% CI 1.32-1.46)..In this single EMS system, more than a two-fold increase in the rate of refusal after non-fatal opioid overdose was observed following the COVID-19 outbreak.
• Davis, C., Carr, D., Glenn, M., & Samuels, E. (2020). Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder. Annals of Emergency Medicine, 14.
• Davis, C., Derek, C., Glenn, M., & Samuels, E. (2021). Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder. Annals of Emergency Medicine, 78(1), 102-108. doi:10.1016/j.annemergmed.2021.01.017
• Gaither, J. B., Spaite, D. W., Arcaris, B., McDonough, S., Hannan, P., Jado, I., Hollen, A., Primeau, K., Rice, A., & Glenn, M. (2021). Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehospital Emergency Care, 25(1), 46-54. doi:10.1080/10903127.2020.1834656
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  Glenn MJ, Rice AD, Primeau K, Hollen A, Jado I, Hannan P, McDonough S, Arcaris B, Spaite DW, Gaither JB: Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehosp Emerg Care. 2020. Epub 2020 November 3. DOI: 10.1080/10903127.2020.1834656. PubMed PMID: 33054530
• Glenn, M. (2021). #it'sOurShot: The Pregnancy Edition. FeminEM.
• Glenn, M. (2021). Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic. Prehospital Emergency Care. doi:10.1080/10903127.2020.1834656
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  To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone. This is a retrospective cohort study in which the incide...
• , ., Bobrow, B. J., Barnhart, B. J., Rice, A. D., Glenn, M., Spaite, D. W., Silver, A. E., Rice, A. D., Mullins, T., Mullins, M., Mcdannold, R., Keim, S. M., Hu, C., Glenn, M., Gaither, J. B., Chikani, V., Bradley, G., & Barnhart, B. J. (2020). Abstract 156: Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. Circulation, 142(Suppl_4). doi:10.1161/circ.142.suppl_4.156
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  Background: Little is known about the ventilatory aspects of overdose-related OHCA (OD-OHCA). We compared maximum ETCO2 (mETCO2; each patient’s highest CO2 level) and mean for each recorded minute ...
• Glenn, M. (2020). Spilt Milk in the ER. Mutha Magazine.
• Glenn, M. J., Rice, A. D., Primeau, K., Hollen, A., Jado, I., Hannan, P., McDonough, S., Arcaris, B., Spaite, D. W., & Gaither, J. B. (2020). Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 25(1), 46-54.
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  To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone.
• Glenn, M., Hodroge, S., Breyre, A., Lee, B., Aldridge, N., Sporer, K., Koenig, K., Gausche-Hill, M., Salvucci, A., Rudnick, E., Brown, J., & Gilbert, G. (2020). Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care. Western Journal of Emergency Medicine, 21(4). doi:10.5811/westjem.2020.2.43896
• Hodroge, S. S., Glenn, M., Breyre, A., Lee, B., Aldridge, N. R., Sporer, K. A., Koenig, K. L., Gausche-Hill, M., Salvucci, A. A., Rudnick, E. M., Brown, J. F., & Gilbert, G. H. (2020). Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care. The western journal of emergency medicine, 21(4), 849-857.
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  We developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California.
• Trivedi, T. K., Glenn, M., Hern, G., Schriger, D. L., & Sporer, K. A. (2019). Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to "Medically Clear" Psychiatric Emergencies in the Field, 2011 to 2016. Annals of emergency medicine, 73(1), 42-51.
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  Patients with acute psychiatric emergencies who receive an involuntary hold often spend hours in the emergency department (ED) because of a deficit in inpatient psychiatric beds. One solution to address the lack of prompt psychiatric evaluation in the ED has been to establish regional stand-alone psychiatric emergency services. However, patients receiving involuntary holds still need to be screened and evaluated to ensure that their behavior is not caused by an underlying and life-threatening nonpsychiatric illness. Although traditional regional emergency medical services (EMS) systems depend on the medical ED for this function, a field-screening protocol can allow EMS to directly transport a substantial portion of patients to a stand-alone psychiatric emergency service. The purpose of this investigation is to describe overall EMS use for patients receiving involuntary holds, compare patients receiving involuntary holds with all EMS patients, and evaluate the safety of field medical clearance of an established field-screening protocol in Alameda County, CA.
• Glenn, M., Fisher, J., Barraza, L., Greco, W., Jenkins, K., Paode, P., Weidenaar, K., & Zoph, O. (2018). State Regulation of Community Paramedicine Programs: A National Analysis.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 22(2), 244-251. doi:10.1080/10903127.2017.1371260
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  Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs..To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP..We conducted a systematic review of laws, regulations, and policies from the 50 U.S. states in effect between February and June 2016 that define or apply to paramedic SOP. We determined whether each state's SOP included 21 potential skills applicable to CP within the following categories: assessment, treatment & intervention, referrals, and prevention & public health. Laws were also queried for mechanisms for expanding SOP, alternate destinations, and community paramedicine for each state. Additionally, we surveyed representatives from U.S. State Emergency Medical Services (EMS) agencies and asked which of these skills were a part of their current SOP. All data was coded into Excel™ and analyzed using descriptive statistics..All 50 U.S. states have laws relating to EMS. Forty-one states have a statewide SOP (82%), and 3 states have statewide protocols from which the SOP has been inferred for purposed of this study, but may not legally constitute SOP in this jurisdiction (6%). 20 states (40%) had a clearly defined mechanism for expanding SOP. Sixteen states (32%) had laws specific to CP. Seven states (14%) allowed for patients to be transported to alternate destinations. Of the 21 skills surveyed, on average there were 8.63 (6.41-10.85) fewer skills for paramedics found in state SOP laws and regulations than were reported as being a part of a state's paramedic SOP. All skills demonstrated variability between the legal review and survey results with 13.04-96.15% concordance..There is a lack of guidance and consistency regarding CP programs and scope of practice. Further studies are needed to understand best practices around regulation and oversight of CP.
• Glenn, M., Zoph, O., Weidenaar, K., Barraza, L., Greco, W., Jenkins, K., Paode, P., & Fisher, J. (2018). State Regulation of Community Paramedicine Programs: A National Analysis. Prehospital Emergency Care, 22(2). doi:10.1080/10903127.2017.1371260
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  Background: Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs. Objective: To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP. Methods: We conducted a systematic review of laws, regulations, and policies from the 50 U.S. states in effect between February and June 2016 that define or apply to paramedic SOP. We determined whether each state's SOP included 21 potential skills applicable to CP within the following categories: assessment, treatment & intervention, referrals, and prevention & public health. Laws were also queried for mechanisms for expanding SOP, alternate destinations, and community paramedicine for each state. Additionally, we surveyed representatives from U.S. State Emergency Medical Services (EMS) agencies and asked which of these skills were a part of their current SOP. All data was coded into Excel™ and analyzed using descriptive statistics. Results: All 50 U.S. states have laws relating to EMS. Forty-one states have a statewide SOP (82%), and 3 states have statewide protocols from which the SOP has been inferred for purposed of this study, but may not legally constitute SOP in this jurisdiction (6%). 20 states (40%) had a clearly defined mechanism for expanding SOP. Sixteen states (32%) had laws specific to CP. Seven states (14%) allowed for patients to be transported to alternate destinations. Of the 21 skills surveyed, on average there were 8.63 (6.41–10.85) fewer skills for paramedics found in state SOP laws and regulations than were reported as being a part of a state's paramedic SOP. All skills demonstrated variability between the legal review and survey results with 13.04–96.15% concordance. Conclusion: There is a lack of guidance and consistency regarding CP programs and scope of practice. Further studies are needed to understand best practices around regulation and oversight of CP.
• Seim, J., Glenn, M. J., English, J., & Sporer, K. (2018). Neighborhood Poverty and 9-1-1 Ambulance Response Time. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 22(4), 436-444.
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  Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity.
• Glenn, M. (2017). Another Drunk. Annals of emergency medicine, 69(6), 783-784.
• Glenn, M. (2017). Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States. Annals of Emergency Medicine, 69(6), 799. doi:10.1016/j.annemergmed.2017.02.009
• Glenn, M., Sanford, A., Gronowski, T., & Joshi, N. (2017). A Thousand Naked Strangers. Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2016.09.040
• Glenn, M., Zoph, O., Weidenaar, K., Barraza, L., Greco, W., Jenkins, K., Paode, P., & Fisher, J. (2017). State Regulation of Community Paramedicine Programs: A National Analysis. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 22(2), 244-251.
  More info

  Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs.
• Trivedi, T. K., Glenn, M., Hern, G., & Sporer, K. A. (2017). 98 EMS Utilization Among Patients on Involuntary Psychiatric Holds in Alameda County, April 2014-2016. Annals of Emergency Medicine, 70(4), S40. doi:10.1016/j.annemergmed.2017.07.123
• Glenn, M., Taira, B. R., & Joshi, N. (2016). When Breath Becomes Air. Annals of Emergency Medicine, 68(2), 252-253. doi:10.1016/j.annemergmed.2016.05.013

Proceedings Publications

• Barnhart, B. J., Keim, S. M., Glenn, M., Bobrow, B. J., Rice, A., Gaither, J. B., Bradley, G., Chikani, V., Mullins, T., Mullins, M., Silver, A. E., Spaite, D. W., Hu, C., & McDannold, R. (2020, Nov). Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. In Resuscitation Science Symposium, American Heart Association Scientific Sessions.

Presentations

• Glenn, M., Weinstein, S., & Mroue, L. (2023, February).

  Health System Support of Lactating Dyads with Substance and/or Opioid Use

  . Substance Use and Opioid Use During Lactation Conference. Virtual: Institute for the Advancement of Breastfeeding and Lactation Education.
• Glenn, M., Stratton, D., Dory, H., & Brady, B. (2022, March/April).

  History of the Stigma & Criminalization of OUD and its Treatment

  . ASAM Annual Conference. Hollywood, Florida: American Society of Addiction Medicine.
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  This was an hour long lecture at the National Confrence
• Glenn, M. (2021, Fall). Treating Opioid Use Disorder in the Emergency Department. Tribal Opioid Summit. Maricopa, AZ.
• Russell, D., & Glenn, M. (2021, Spring). Harm Reduction is Treatment. Winter Institute. Tempe: Arizona State University.

Poster Presentations

• R, S. E., Glenn, M., Lindsey, V., Amber, R., J, L., R, M., A, H., K, P., & J, G. (2023, Jan). Examination of the Relationship between Opiate Overdoses, EMS Refusals, and COVID-19 Case-Spikes. Annual Conference. Austin, Texas: National Association of EMS Physicians.
• Vandergrift, L., Hollen, A., Glenn, M., Rice, A., Munn, R., Hannan, P., Knotts, M., Murugesan, A., Schwyhart, R., Stevens, B., Carpio, H., & Gaither, J. (2024, Jan). Prehospital naloxone administration and subsequent treatment for precipitated opioid withdrawal.. Annual Conference. Austin, TX: National Association of EMS Physicians.
• Glenn, M., Munn, R., Stratton, D., & Arcaris, B. (2022, January). Naloxone 911: EMS Distribution of Naloxone Kits to High-Risk Patients in a US-Mexico Border Town. National Association of EMS Physicians Annual Meeting. San Diego, California: NAEMSP.
• Rice, A., Hannan, P., Gaither, J. B., & Munn, R. (2022, January). Comparison of Various Video Laryngoscope Devices in Indoor and Outdoor Simulated Endotracheal Intubation. NAEMSP Annual Meeting. San Diego, California.
• Stratton, D., & Glenn, M. (2022, Jan). Naloxone 9-1-1: EMS Distribution of Naloxone Kits to High-Risk Patients in a United States-Mexico Border Town. NAESMP Annual Conference. San Diego: NAEMSP.
• Stratton, D., Arcaris, B., & Glenn, M. (2022, March/April).

  The Epidemiology of Pre-Hospital Care for Opioid Overdoses in a US-Border Town.

  . ASAM Annual Conference. Hollywood, FL: American Society for Addiction Medicine.

Reviews

• Glenn, M. (2022. A Silent Fire: The Story of Inflammation, Diet, and Disease. Publisher’s Weekly Book Review..
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  Book Review
• Glenn, M. (2022. Horse at Night: On Writing. Publisher’s Weekly Book Review(p. 1).
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  Book Review
• Glenn, M. (2022. Our Red Book: Intimate Histories of Periods, Growing and Changing. Publisher’s Weekly Book Review..
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  Book Review

Others

• Amber, R., Philipp, H., Rachel, M., Gaither, J., Glenn, M., Beskind, D., French, R., Bradley, G., & Keeley, B. (2023, January).

  Rice AD, Hannan P, Munn R, Gaither JB, Glenn M, Beskind D, French R, Bradley G, Keeley B, Stevens B, Rutherford, T. University Emergency Medical Services Guidelines – Prehospital guidelines for the care of patients with emergency medical conditions 

  . https://emergencymed.arizona.edu/ems-private/public/admin-guidelines
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  These are a collection of evidence-based guildelines and corresponding instruction for EMT's and paramedics to follow
• Rice, A., Philipp, H., Rachel, M., Josh, G., Glenn, M., Dan, B., Robert, F., Gail, B., B, K., B, S., & T, R. (2023, Jan). University Emergency Medical Services Guidelines – Prehospital guidelines for the care of patients with emergency medical conditions. University of Arizona EMS Guidelines.. https://emergencymed.arizona.edu/ems-private/public/admin-guidelines
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  Evidence-based EMS guidelines used by EMTs and Paramedics in Southern Arizona.
• Barnhart, B. J., Keim, S. M., Glenn, M., Bobrow, B. J., Rice, A., Gaither, J. B., Bradley, G., Chikani, V., Mullins, T., Mullins, M., Silver, A. E., Spaite, D. W., Hu, C., & McDannold, R. (2020, Nov). Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. Circulation. https://www.ahajournals.org/doi/10.1161/circ.142.suppl_4.156