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The properties of operant reinforcers are dynamic and dependent on a number of variables, such as schedule and effort. There has been sparse research on the generalized conditioned properties of token reinforcement. We evaluated leisure items, edible items, and tokens using a progressive ratio schedule with three children with diagnoses of ASD and developmental delays. The highest break points occurred during the token reinforcement condition for two out of three participants, but response rates tended to be higher with edibles. We then evaluated the effects of presession access to edibles on the break points of edible items and tokens with two participants. Break points decreased only in the edible reinforcement condition, and the participants chose to work for leisure items rather than edibles when presession access to edibles was in place. These findings suggest that the tokens functioned as generalized conditioned reinforcers.

Objective To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. Methods This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. Results Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. Conclusions MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.

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