A MAHEC medical librarian periodically searches several databases for any articles in which there is mention of MAHEC in the title, abstract, or author affiliations. The Davidson Impact Fellow that works with the Substance Use Disorders (SUDs) Taskforce identifies from the that main list those that have been published in SUDs by MAHEC affiliated authors. The tabbed box to the right lists publications by year. It is based on latest MAHEC Publications List.
These listings are based on the latest MAHEC Publications List
2024
Bass, R., Flinchum, G., Ramage, M., Galvin, S. L., Cabello-De La Garza, A., Caron, O., & Marietta, A. (2024). Accessing perinatal substance use disorder care in your local community: A case study of an innovative hub and spoke network in western North Carolina. Journal of Substance Use and Addiction Treatment, 158, 209268. https://doi.org/10.1016/j.josat.2023.209268
Bechtol, A.C., Ramage, M., Krulikas, L.J., Futrell, K., Caron, O. (2024). Naloxone access in perinatal substance use disorder. Journal of the American Pharmacists Association. doi:10.1016/j.japh.2024.01.022
Kopak, A. M., & Hoffmann, N. G. (2024). Key criteria within DSM-5 substance use disorder diagnoses: evidence from a correctional sample. Journal of Offender Rehabilitation, 63(1), 37–57. https://doi.org/10.1080/10509674.2023.2286655
Zedonks D, Fan X, Bhatt S, and Wyatt SA. Chapter 103, Co-Occurring Psychosis and Substance Use Disorders. In: The ASAM Principles of Addiction Medicine 7th Ed. 2024. [Book Chapter].
2023
Ahmed S, Alam D, Colistra A, Kang N, Minkoff K, Wyatt SA. Chapter 12: Integrating Care for Co-occurring Mental Health Conditions. (2023). In: ASAM Criteria 4th Ed. [Book chapter].
Galvin, S. L., & Coulson, C. C. (2023). Addressing cannabis consumption among patients with hyperemesis gravidarum. AJOG Global Reports, 3(2), 100180. https://doi.org/10.1016/j.xagr.2023.100180
Gamble, T. M., Kopak, A., & Hoffmann, N. (2023). A multisite study of amphetamine use disorders, length of detention and readmission in rural jails. Drugs, Habits and Social Policy, 24(2), 133–142. https://doi.org/10.1108/DHS-10-2022-0038
Hughes, P. M., Carda-Auten, J., DiRosa, E. A., Carpenter, D., & Rosen, D. L. (2023). “You can get a couple of ramen noodle packs for a Buspar(Ⓡ)”: A qualitative examination of medication access, policy, and procedures in southern jails. Res Social Adm Pharm, 19(9), 1298–1306. https://doi.org/10.1016/j.sapharm.2023.05.013
Hughes, P. M., Harless, C., Ramage, M., Fusco, C., & Ostrach, B. (2023). Opioid Use Disorder Practice by Licensure Category in North Carolina. North Carolina Medical Journal, 84(3). https://doi.org/10.18043/001c.74508
Hughes, P. M., Ostrach, B., & Tak, C. R. (2023). Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010–2019. Journal of Substance Use and Addiction Treatment, 155, 209171. https://doi.org/10.1016/j.josat.2023.209171
Hughes, P. M., Phillips, D. C., & Fagan, E. B. (2023). Prescribing psychologists: Forgotten providers in the battle against opioid use disorder. Addiction, 118(7), 1398–1399. https://doi.org/10.1111/add.16204
Hughes, P. M., Ramage, M., Gigli, K. H., & Tak, C. R. (2023). Assessing the Cost-Effectiveness of Removing Supervision Requirements for Nurse Practitioners Prescribing Buprenorphine for Opioid Use Disorder. Journal of Nursing Regulation, 14(3), 44–54. https://doi.org/10.1016/S2155-8256(23)00112-6
Johnston, H., & Kopak, A. M. (2023). A Prospective Study of Injection Drug Use and Jail Readmission in Two Western North Carolina Counties. North Carolina Medical Journal, 84(5). https://doi.org/10.18043/001c.83928
Julienne K. Kirk, P., Charlotte T. Boyd, M. A., Lisa Cassidy-Vu, M. D., Linda P. McRae, P., Heather E. Strickland, N.-C., & Ernest Blake Fagan, M. D. (2023). High-dose tramadol conversion to buprenorphine-naloxone. Journal of Opioid Management, 19(2), 187–190. https://doi.org/10.5055/jom.2023.0774
Kopak, A. M., & Singer, A. J. (2023). Substance Use Disorder, Bail Reform, and Failure to Appear in Court: Results From a Naturalistic Study. Journal of Drug Issues, 53(2), 183–195. Scopus. https://doi.org/10.1177/00220426221107561
Kopak, A., & Raggio, A. (2023). Substance use disorder and rural detention center readmission: Results from a 3-year prospective cohort study. Journal of Rural Mental Health, 47(3), 129–138. APA PsycInfo. https://doi.org/10.1037/rmh0000231
Singer, A. J., Kopak, A. M., & Hoffmann, N. G. (2023). Mental Health Conditions, Substance Use Disorders, and Jail Readmission in Four Rural Counties. International Journal of Offender Therapy and Comparative Criminology, 0306624X231188234. https://doi.org/10.1177/0306624X231188234
West, H. C. (2023). A Quality Improvement Initiative: Embedding OUD treatment in academic primary care. Journal of Addiction Medicine, 17(5), e320. https://www.embase.com/search/results?subaction=viewrecord&id=L643071517&from=export
West, H. C., Williams, J., Bigelow, S. M., Wheeley, V., Lafata, J. E., Amburn, J., Ratner, S., Huemmer, M., Reilly, K., & Moore, H. (2023). EXPANDING OUTPATIENT ACCESS TO OPIOID USE DISORDER (OUD) TREATMENT IN AN ACADEMIC INTERNAL MEDICINE CLINIC. Journal of General Internal Medicine, 38(S2), 81–799. https://doi.org/10.1007/s11606-023-08226-z
2022
Blake, E., Major, E., Cody, T., Galvin, S. L., Tak, C. R., & Ramage, M. (2022). Perinatal Substance Use Care Coordination: The Need for One Care Plan. N C Med J, 83(3), 231. https://doi.org/10.18043/ncm.83.3.231
Calandra, J., Shukla, S., & Grandy, R. (2022). Addressing equity and access to care: How an academic family medicine practice manages human immunodeficiency virus, hepatitis C, and substance use disorders in rural Appalachia. JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, 5(8), 921–927. https://doi.org/10.1002/jac5.1670
Caron, O., Fay, A. E., Pressley, H., Seamon, G., Taylor, S. R., & Wilson, C. G. (2022). Four models of pharmacist‐integrated office‐based opioid treatment. JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, 5(4), 413–421. https://doi.org/10.1002/jac5.1607
Felsen, U. R., Tlamsa, A., Moir, L., Shukla, S., Thompson, D., Weiss, J. M., Heo, M., & Litwin, A. H. (2022). Comparing Routine HIV and Hepatitis C Virus Screening to Estimate the Effect of Required Consent on HIV Screening Rates Among Hospitalized Patients. Public Health Reports, 137(1), 102–109. https://doi.org/10.1177/0033354921999170
Galvin, S. L., & Ramage, M. (2022). Response to Avoiding NICU Transfer for Newborns With Neonatal Opioid Withdrawal Syndrome (NOWS): A Quality Improvement Initiative to Manage NOWS on the Mother-baby Unit. J Addict Med, 16(3), 371–372. https://doi.org/10.1097/adm.0000000000000904
Garza, A. C.-D. la, Harless, C., Ostrach, B., & Fagan, B. (2022). Increasing North Carolina’s Workforce Capacity for Prescribing Buprenorphine Products. North Carolina Medical Journal, 83(4), 288–293. https://doi.org/10.18043/ncm.83.4.288
Harless, C., Lugo, B., & Ostrach, B. (2022). Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff. Southern Medical Journal, 115(7), 422–428. https://doi.org/10.14423/SMJ.0000000000001409
Hughes, P. M., Ostrout, T. L., Pèrez Jolles, M., & Thomas, K. C. (2022). Adverse Childhood Experiences Across Birth Generation and LGBTQ + Identity, Behavioral Risk Factor Surveillance System, 2019. American Journal of Public Health, 112(4), 662–670. https://doi.org/10.2105/AJPH.2021.306642
Leiner, C., Antono, B., & Ostrach, B. (2022). Perinatal OUD Treatment Provider Understandings of Rural Patients’ Experiences. J Addict Med, 16(2), 177–182. https://doi.org/10.1097/adm.0000000000000858
Pressley Byrd, D., Galvin, S., Ramage, M., & Johnson, E. (2022). Advanced Practice Provider–Led Medication for Opioid Use Disorder Programs for Pregnant and Parenting Women. Journal of Midwifery & Women’s Health, 67(3), 384–393. https://doi.org/10.1111/jmwh.13372
Ranney, L., Kowitt, S., Mottus, K., McDowell, S., Beane, A., Denslow, S., Sturm, K., Rice, N., Hernandez, M., Jaspers, I., Hickman, E., & Halladay, J. (2022). A Mixed Methods Approach to Improving Provider Counseling of Patients Who Vape. HCA Healthcare Journal of Medicine, 3(5). https://doi.org/10.36518/2689-0216.1443
Shelton, D., Ramage, M., Hughes, P., & Tak, C. (2022). Factors associated with contraceptive use among postpartum women with substance use disorder. Sexual & Reproductive Healthcare, 33, 100764. https://doi.org/10.1016/j.srhc.2022.100764
2021
Caron, O. A., Ramage, M., & Galvin, S. L. (2021). Stimulant misuse in pregnant patients at a rural perinatal substance use program. Journal of Addiction Medicine, 15(5), E55. Embase. https://doi.org/10.1097/ADM.0000000000000902
Coulson, C. C., Lorencz, E., Rittenhouse, K., Ramage, M., Lorenz, K., & Galvin, S. L. (2021). Association of Maternal Buprenorphine or Methadone Dose with Fetal Growth Indices and Neonatal Abstinence Syndrome. American Journal of Perinatology, 38(01), 028–036. https://doi.org/10.1055/s-0039-1694729
Fontaine, D., & Hoffman, M. R. (2021). Management of Acute Pain Due to Traumatic Injury in Patients with Chronic Pain and Pre-injury Opioid Use. Current Trauma Reports, 7(1), 24–32. https://doi.org/10.1007/s40719-020-00207-5
Godar, E. A., & Jhaveri, R. (2021). A Survey of Practices in the United States Regarding Hepatitis C Screening in Pregnant Women. Clinical Therapeutics, 43(4), 780–784. https://doi.org/10.1016/j.clinthera.2021.01.016
Hughes, P. M., Verrastro, G., Fusco, C. W., Wilson, C. G., & Ostrach, B. (2021). An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic. The Journal of Rural Health, 37(3), 467–472. https://doi.org/10.1111/jrh.12570
Leiner, C., Cody, T., Mullins, N., Ramage, M., & Ostrach, B. M. M. (2021). “The elephant in the room;” a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia. BMC Pregnancy Childbirth, 21(1), 143. https://doi.org/10.1186/s12884-021-03596-w
Ostrach, B., Buer, L., Armbruster, S., Brown, H., Yochym, G., & Zaller, N. (2021). COVID‐19 and Rural Harm Reduction Challenges in the US Southern Mountains. The Journal of Rural Health, 37(1), 252–255. https://doi.org/10.1111/jrh.12499
Ostrach, B., Carpenter, D., & Cote, L. P. (2021). DEA Disconnect Leads to Buprenorphine Bottlenecks. Journal of Addiction Medicine, 15(4), 272. https://doi.org/10.1097/ADM.0000000000000762
Ramage, M. A., Blake, E. H., Tak, C. R., Sullivan, M. H., Kauffman, S. V., Galvin, S. L., & Jones, H. E. (2021). Before You Write Your First Buprenorphine Prescription; A Readiness-Assessment for Prenatal Care Providers. Journal of Women’s Health and Gynecology, 8(2). https://doi.org/10.17303/jwhg.2021.8.203
Ramage, M., Tak, C., Goodman, D., Johnson, E., Barber, C., & Jones, H. E. (2021). Improving access to care through Advanced Practice Registered Nurses: Focus on perinatal patients with Opioid Use Disorder. Journal of Advanced Nursing, 77(1), 4–10. https://doi.org/10.1111/jan.14544
Trull, G., Major, E., Harless, C., Zule, W., Ostrach, B., & Carpenter, D. (2021). Rural community pharmacist willingness to dispense Suboxone® - A secret shopper investigation in South-Central Appalachia. Explor Res Clin Soc Pharm, 4, 100082. https://doi.org/10.1016/j.rcsop.2021.100082
Wilson, C. G., Ramage, M., & Fagan, E. B. (2021). A Primary Care Response to COVID‐19 for Patients with an Opioid Use Disorder. The Journal of Rural Health, 37(1), 169–171. https://doi.org/10.1111/jrh.12438
2020
Alemu, B. T., Olayinka, O., Young, B., Pressley-Byrd, D., Tate, T., & Beydoun, H. A. (2020). Patient and Hospital Characteristics of Newborns with Neonatal Withdrawal Syndrome. Southern Medical Journal, 113(8), 392–398. https://doi.org/10.14423/SMJ.0000000000001130
Boggiano, V., Gilmore Wilson, C., Fagan, E. B., Kirk, J., Bossenbroek-Fedoriw, K., & Tak, C. R. (2020). The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency. J Am Board Fam Med, 33(6), 998–1003. https://doi.org/10.3122/jabfm.2020.06.200127
Farrar, M., White, Z., Hulkower, S., Fagan, E. B., & Wilson, C. G. (2020). A Financial Model for Team-Based Opioid Use Disorder Treatment. The Journal of the American Board of Family Medicine, 33(1), 124–128. https://doi.org/10.3122/jabfm.2020.01.190228
Galvin, S. L., & Ramage, M. (2020). Perinatal Cannabis Use Unrelated to Illicit Opioid Use When Prescribed OUD Medications. Journal of Addiction Medicine, 14(6), e409. Embase. https://www.embase.com/search/results?subaction=viewrecord&id=L634656471&from=export
Galvin, S. L., Ramage, M., Leiner, C., Sullivan, M. H., & Fagan, E. B. (2020). A Cohort Comparison of Differences Between Regional and Buncombe County Patients of a Comprehensive Perinatal Substance Use Disorders Program in Western North Carolina. North Carolina Medical Journal, 81(3), 157–165. https://doi.org/10.18043/ncm.81.3.157
Galvin, S. L., Ramage, M., Mazure, E., & Coulson, C. C. (2020). The association of cannabis use late in pregnancy with engagement and retention in perinatal substance use disorder care for opioid use disorder: A cohort comparison. J Subst Abuse Treat, 117, 108098. https://doi.org/10.1016/j.jsat.2020.108098
Hughes, P., Denslow, S., Ostrach, B., Fusco, C., & Tak, C. (2020). Exploration of the STOP Act and Opioid Deaths in North Carolina, 2010–2018. American Journal of Public Health, 110(10), 1573–1577. https://doi.org/10.2105/AJPH.2020.305748
Hughes, P., & Ostrout, T. (2020). Adverse Childhood Experiences as Predictors of Perceived Health: Assessing the ACE Pyramid Model Using Multiple-Mediation. HCA Healthcare Journal of Medicine, 1(5). https://doi.org/10.36518/2689-0216.1103
Jackson, T., Antono, B., Grandy, R., Smith, E., Hulkower, S., & Stigleman, S. (2020). How effective is direct acting antiviral therapy in curing chronic hepatitis C among individuals who actively inject drugs? Evidence-Based Practice, 23(4), 1. https://doi.org/10.1097/EBP.0000000000000773
Jarvi, A., Hughes, P., Shepherd, J. G., Hedgepeth Kennedy, M. L., & Wilson, C. G. (2020a). Impact of elective on students’ perceptions of treating patients with a substance use disorder. Journal of the American Pharmacists Association, 60(4), e43–e46. https://doi.org/10.1016/j.japh.2020.01.021
Jarvi, A., Hughes, P., Shepherd, J. G., Hedgepeth Kennedy, M. L., & Wilson, C. G. (2020b). Reprint of: Impact of elective on students’ perceptions of treating patients with a substance use disorder. J Am Pharm Assoc (2003), 60(5s), S84-s87. https://doi.org/10.1016/j.japh.2020.08.033
Kane, C., Leiner, C., Harless, C., Foley, K. A., Fagan, E. B., & Wilson, C. G. (2020). The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective. J Am Board Fam Med, 33(4), 611–615. https://doi.org/10.3122/jabfm.2020.04.190389
Major, E., Fusco, C. W., White, Z., Wilson, C. G., & Fagan, E. B. (2020). Long-acting, Injectable Buprenorphine: Great Promise, but Significant Barriers to Use. North Carolina Medical Journal, 81(3), 210–211. https://doi.org/10.18043/ncm.81.3.210
Mullins, N., Galvin, S. L., Ramage, M., Gannon, M., Lorenz, K., Sager, B., & Coulson, C. C. (2020). Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. Journal of Addiction Medicine, 14(3), 185. https://doi.org/10.1097/ADM.0000000000000562
Roe, M., Wilson, C. G., Fusco, C. W., Hulkower, S., & Stigleman, S. (2020). Does XR injectable naltrexone prevent relapse as effectively as daily sublingual buprenorphine-naloxone? The Journal of Family Practice, 69(10), E14–E15.
Wells, S. S. (2020). How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. Journal of the American Academy of Child & Adolescent Psychiatry, 59(4), 567–569. https://doi.org/10.1016/j.jaac.2020.02.004
2019
Austin, R. C., Fusco, C. W., Fagan, E. B., Drake, E., Pacious, J., Dickens, H., Galvin, S. L., & Wilson, C. G. (2019). Teaching Opioid Tapering Through Guided Instruction. Fam Med, 51(5), 434–437. https://doi.org/10.22454/FamMed.2019.502509
Byrd, D. P., & Bartlett, R. (2019). Harm Reduction Strategies: Imperatives and Implications for Nurses. Journal of Psychosocial Nursing and Mental Health Services, 57(6), 4–5. https://doi.org/10.3928/02793695-20190430-02
Cariveau, D., Fay, A. E., Baker, D., Fagan, E. B., & Wilson, C. G. (2019). Evaluation of a pharmacist-led naloxone coprescribing program in primary care. Journal of the American Pharmacists Association, 59(6), 867–871. https://doi.org/10.1016/j.japh.2019.07.012
Fagan, E. B., & Kane, C. (2019). MAHEC Distributes Opioid Awareness Flyer to 171 Schools Across Western North Carolina. North Carolina Medical Journal, 80(1), 63–65. https://doi.org/10.18043/ncm.80.1.63
Gilmer, B., Hulkower, S., Wilson, C. G., Macdonald, B., Pozner, J., & Stigleman, S. (2019). Which oral nonopioid agents are most effective for OA pain? J Fam Pract, 68(7), 417–418.
Lorenz, K., Gannon, M., Ramage, M., Coulson, C. C., Wilson, C., & Galvin, S. L. (2019). Psychotropic medications do not appear to increase NAS risk in women on MAT. American Journal of Obstetrics and Gynecology, 220(1), S224–S225. https://doi.org/10.1016/j.ajog.2018.11.342
Mullins, N., Ramage, M., Ostrach, B., & Leiner, C. (2019). Addressing Patient Fears in Perinatal Substance Use Treatment. Obstetrics & Gynecology, 134, 44S. https://doi.org/10.1097/01.AOG.0000585496.98784.1a
Nathan, A., Galvin, S., Coulson, C. C., Ramage, M., Mullins, N. H., & Gannon, M. (2019). Impact of an Integrated, Comprehensive Perinatal Substance Use Disorders Program for an At-Risk, Rural Population [34F]. Obstetrics & Gynecology, 133, 71S. https://doi.org/10.1097/01.AOG.0000559065.95262.da
Ostrach, B., & Leiner, C. (2019). “I didn’t want to be on Suboxone at first…” – Ambivalence in Perinatal Substance Use Treatment. Journal of Addiction Medicine, 13(4), 264. https://doi.org/10.1097/ADM.0000000000000491
Zaller, N., & Ostrach, B. (2019). HCV, injection drug use, and the importance of harm reduction in Kenya. The Lancet Infectious Diseases, 19(11), 1158–1159. https://doi.org/10.1016/S1473-3099(19)30407-4
2018
Carpenter, D. M., Roberts, C. A., Westrick, S. C., Ferreri, S. P., Kennelty, K. A., Look, K. A., Abraham, O., & Wilson, C. (2018). A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders. Research in Social and Administrative Pharmacy, 14(10), 968–978. https://doi.org/10.1016/j.sapharm.2017.11.011
Carpenter, D., Roberts, C., Ferreri, S., Westrick, S., Kennelty, K., Look, K., Abraham, O., & Wilson, C. (2018). Review of online naloxone continuing education courses. Journal of the American Pharmacists Association, 58(3), e197. Embase. https://doi.org/10.1016/j.japh.2018.04.004
Coulson, C. C., Lorencz, E., Ramage, M. A., Gannon, M., & Galvin, S. (2018). 213: Comparison of buprenorphine versus methadone exposure in utero on fetal growth indices and neonatal abstinence syndrome. American Journal of Obstetrics and Gynecology, 218(1), S141. https://doi.org/10.1016/j.ajog.2017.10.090
Ramage, M., Ostrach, B., Fagan, B., & Coulson, C. C. (2018). Stabilizing the Mother-Infant Dyad for Better Outcomes from OB to FM: Caring for Patients with Perinatal Opioid Use Disorder through the 4th Trimester. N C Med J, 79(3), 164–165. https://doi.org/10.18043/ncm.79.3.164
2017
Pattison-Sharp, E., Estrada, R. D., Elio, A., Prendergast, M., & Carpenter, D. M. (2017). School nurse experiences with prescription opioids in urban and rural schools: A cross-sectional survey. J Addict Dis, 36(4), 236–242. https://doi.org/10.1080/10550887.2017.1361725
Wilson, C. G., & Fagan, E. B. (2017). Providing Office-Based Treatment of Opioid Use Disorder. Annals of Family Medicine, 15(5), 481–481. https://doi.org/10.1370/afm.2139
Wilson, C. G., Rodriguez, F., Carrington, A. C., & Fagan, E. B. (2017). Development of a targeted naloxone coprescribing program in a primary care practice. Journal of the American Pharmacists Association, 57(2), S130–S134. https://doi.org/10.1016/j.japh.2016.12.076
2014
Parlier, A. B., Fagan, B., Ramage, M., & Galvin, S. (2014). Prenatal care, pregnancy outcomes, and postpartum birth control plans among pregnant women with opiate addictions. South Med J, 107(11), 676–683. https://doi.org/10.14423/smj.0000000000000189
2013
Langlois, J. P. (2013). Pain management: lessons from palliative care. North Carolina Medical Journal, 74(3), 226–228.
Rowe, J., & Caprio, A. J. (2013). Chronic Pain: Challenges and Opportunities for Relieving Suffering. North Carolina Medical Journal, 74(3), 201–204. https://doi.org/10.18043/ncm.74.3.201
2009
Harper, M., Luna-Orea, P., & Lendle, S. (2009). 589: Increases in accidental deaths from prescription opioids among recently pregnant women. American Journal of Obstetrics and Gynecology, 201(6), S218. https://doi.org/10.1016/j.ajog.2009.10.454
2005
Smith, K. D., Scott, M. A., Ketterman, E., & Smith, P. O. (2005). Clinical inquiries. What interventions can help patients stop using chewing tobacco? The Journal of Family Practice, 54(4), 368–369.
2003
Lin, L. P. M. C., Galvin, S. L., & Dixon, S. D. (2003). Smoking cessation in an Ob/Gyn residency clinic. Primary Care Update for Ob/Gyns, 10(6), 265–269. Scopus. https://doi.org/10.1016/S1068-607X(03)00065-9