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Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. However, there are several limitations to this strategy that are underrecognized. This article reviews the primary literature supporting the use of PrEP and explores the unintended consequences associated with its use. Current public health messaging indicates that PrEP reduces the risk of HIV transmission during sex by 99 percent; however, this figure is based on modeling rather than study findings, and real-world efficacy may be significantly lower. PrEP has been associated with increased rates of sexually transmitted infections, risk compensation, HIV drug resistance, low adherence, and drug side effects. To make fully informed decisions, medical professionals and patients should be aware of these pitfalls. Additionally, this article explores the bioethical implications of prescribing PrEP from a Catholic perspective. Although not always morally illicit, PrEP is most often prescribed in the context of sexual activity outside of marriage between a biological male and female, placing the prescriber in cooperation with activity deemed to be immoral by the Catholic Church. While all medical professionals seeking the common good should aim to reduce the transmission of HIV, not all means are morally licit. Conscience protection for medical professionals opposed to this strategy has become increasingly relevant. Thoughtful discernment is necessary when considering PrEP. Summary: The use of CDC material (figure 1) in this article does not imply endorsement by CDC. The material is in the public domain and available on the CDC website free of charge. [ABSTRACT FROM AUTHOR]

New data published in the Journal of Correctional Healthcare suggest a steadily increasing need for behavioral health services in jail settings and a growing presence of psychotropic medication treatments in response. [ABSTRACT FROM AUTHOR]

At a time when restrictions on the prescribing of buprenorphine have been relaxed nationally in order to expand access to evidence‐based treatment, a group of physicians in Kentucky has expressed concern that state regulators are dangerously moving in the opposite direction. [ABSTRACT FROM AUTHOR]

Community mental health facilities see a significant presence of patients with opioid use disorder (OUD), but the availability of evidence‐based medication treatment for individuals in these settings remains disappointingly low, newly published results of a RAND survey suggest. [ABSTRACT FROM AUTHOR]

The largest substance use prevention and treatment implementation study ever conducted is reporting highly disappointing results on its primary outcome: Local communities' implementation of evidence‐based strategies to combat opioid overdose had no significant impact on opioid overdose death rates. [ABSTRACT FROM AUTHOR]

After a spate of reports showing that physicians don't want to or can't prescribe treatment for opioid use disorder (OUD) (see ADAWhttps://onlinelibrary.wiley.com/doi/10.1002/adaw.34212), the American Society of Addiction Medicine (ASAM) has reiterated its July recommendations that pharmacists play a greater role in providing medications. In "The Role of Pharmacists in Medications for Addiction Treatment," ASAM noted that pharmacists already help by dispensing buprenorphine. However, some pharmacies are reluctant to provide it, "possibly conflating harms associated with diversion of medications like oxycodone and alprazolam with buprenorphine's diversion risks," ASAM wrote in the introduction to the policy statement. "Pharmacies are crucial to accessing and improving the utilization of medications for addiction treatment, however." [ABSTRACT FROM AUTHOR]

New York Governor Kathy Hochul has proposed cutting the budget of the state's Office of Addiction Services and Supports (OASAS) by more than 13% and supplanting the funding with money from the opioid settlement fund. This, according to treatment providers and other experts, is not good policy. [ABSTRACT FROM AUTHOR]

On Feb. 2 the Substance Abuse and Mental Health Services Administration (SAMHSA) released its final rule for opioid treatment programs and methadone, just as ADAW went to press (see SAMHSA issues final rule updating OTP methadone rules, ADAW Feb. 5; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023). The American Association for the Treatment of Opioid Dependence (AATOD), which represents more than 1,300 opioid treatment programs (OTPs) in the United States, last week commended SAMHSA for the guidance, which it called "enlightened and thoughtful." In a Feb. 5 press statement, AATOD president Mark Parrino noted that the regulations have been reviewed by the Drug Enforcement Administration (DEA). For the final rule, go to https://www.federalregister.gov/documents/2024/02/02/2024‐01693/medications‐for‐the‐treatment‐of‐opioid‐use‐disorder. [ABSTRACT FROM AUTHOR]

The article focuses on the remarks by past presidents Pat Jackson, of the Association for Professionals in Infection Control and Epidemiology (APIC), and Deborah Yokoe of the Society for Healthcare Epidemiology of America (SHEA) at a webinar on the link between APIC and their colleagues in the SHEA. Topics include the competing priorities between infection prevention and control programs, ways to reduce burnout, and an aspect of their one year as president of their respective associations.

The article focuses on two cohort studies investigating the impact of metformin use on the risk of dementia in older adults with type 2 diabetes mellitus, both concluding that metformin is associated with a reduced risk of diabetes-associated dementia.

The article discusses the concept of using food as medicine, known as "farmacy," as an alternative to traditional drug treatments for chronic diseases such as diabetes, heart disease, and cancer. It highlights the success of programs like the Fresh Food Farmacy, which provides healthy foods and education to patients, resulting in improved health outcomes. Research has shown that a healthy diet can be more effective in preventing and treating diseases than medication. The article also emphasizes the cost benefits of using food as medicine, with potential savings in healthcare expenses. However, it acknowledges the challenges of promoting healthy eating in an environment dominated by processed foods and suggests strategies such as nutrition education and cooking workshops. The Mediterranean diet is highlighted as an example of a healthy diet that has been proven to reduce the risk of chronic diseases. The article concludes by advocating for the integration of food as medicine into the healthcare system. [Extracted from the article]

The article focuses on a multi-institutional observational study revealing that discrepant measurements in assessing aortic stenosis (AS) are not uncommon. Topics discussed include challenges in determining AS severity, a significant mortality burden across all AS severities, and low aortic valve replacement rates for severe AS.

Efforts to combat the risk of overdose and substance use disorder (SUD) associated with prescription stimulant misuse could receive a boost from new meta‐analytic findings that higher‐than‐recommended doses of the medications show little benefit in the treatment of attention deficit hyperactivity disorder (ADHD). [ABSTRACT FROM AUTHOR]

The article provides information on a study comparing diagnostic stewardship and antibiotic stewardship strategies for the treatment of asymptomatic bacteriuria (ASB). The study, conducted in 46 hospitals in Michigan over three years, found that diagnostic stewardship was more effective in reducing unnecessary antibiotic use in ASB cases, with diagnostic interventions being key to achieving this outcome.

The article focuses on challenges faced by Texas physicians, particularly in Medicaid, due to sudden changes in the state's preferred drug list (PDL), causing disruptions in treatment plans and difficulties in prescribing necessary medications. Topics include the complexity of the Vendor Drug Program (VDP), the impact of administrative issues on patient care, and ongoing efforts by the Texas Medical Association to advocate for reforms in the program.

Last week the Drug Enforcement Administration (DEA) announced that it would extend exceptions that went into effect at the start of the COVID‐19 pandemic for telemedicine prescribing of buprenorphine. The exceptions, started in March 2020 (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664), allow for prescribing buprenorphine even in cases where there is no in‐person medical evaluation and were initially meant to limit the spread of the virus. Now, however, they are discussed as ways to limit the overdose crisis. The proposal applies, moreover, to all controlled substances, not just to buprenorphine. [ABSTRACT FROM AUTHOR]

The article offers information on the rise in the retail drug spending and discusses about the prescription drug affordability. It mentions that Centers for Medicare & Medicaid Services forecasts the annual growth of the retail drug spending. It discusses the drug approval by the U.S. Food and Drug Administration.

Billing the Department of Defense for prescriptions for people who were ineligible for those benefits — 6 to 20 per week — and giving out too many controlled substances in extremely large amounts without any controls are just two of the results reported in a blistering evaluation by the Department of Defense Office of Inspector General (DoD OIG) last week. The report is dated Jan. 8 but was not released until almost four weeks later. [ABSTRACT FROM AUTHOR]

An analysis of data from a clinical trial involving youths with attention deficit hyperactivity disorder (ADHD) has found no evidence that use of stimulant medication in childhood increases the risk of substance use or a substance use disorder (SUD) in adolescence and young adulthood. The study's investigators also reported no protective effect of childhood stimulant use on later substance use, a finding contrary to that of some prior studies. [ABSTRACT FROM AUTHOR]

A personal narrative of the author's experience of finding opiates in a used necklace box, highlighting the potential dangers associated with prescription drugs, is presented.

Nurses can help the NHS to make respiratory care more sustainable safely. Heather Henry explains how [ABSTRACT FROM AUTHOR]

The article informs the Centers for Disease Control and Prevention (CDC) issued updated guidelines in 2022 to help physicians prescribe opioids safely, aiming to correct confusion caused by its 2016 guidelines. The 2016 guidelines were misinterpreted and misused, resulting in arbitrary cutbacks on opioid prescriptions and access to pain medication, leading to patient harm including untreated pain, withdrawal symptoms, overdose, and suicidal ideation and behavior.

Mark Parrino, founder and President of the American Association for the Treatment of Opioid Dependence (AATOD), highlighted some of the reasons for the current outlook on opioid treatment programs (OTPs) – which for a few months or years, depending on your perspective, has not been great. The main reason is the American Society of Addiction Medicine (ASAM), which used to be a solid partner of AATOD and OTPs (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.30330), but which in recent years has had a change in leadership and advocacy. What ASAM wants now is for MOTAA to pass – a bill which would allow ASAM‐certified physicians to prescribe methadone for opioid use disorder (OUD) to their patients. Under current federal law and regulation, only federally certified OTPs can provide (prescribe and dispense) methadone, and they do a lot more than just provide the medication. [ABSTRACT FROM AUTHOR]

The article focuses on improving antimicrobial stewardship by addressing issues in antibiotic prescribing practices. It highlights concerns over antibiotic resistance due to overprescription and examines studies that reveal gaps in documentation and coding practices. It emphasizes the need for better documentation to improve stewardship efforts and reduce inappropriate antibiotic use.

Antidepressant dispensing to adolescents and young adults was rising even before the COVID‐19 outbreak and substantially increased even more afterward, according to researchers of a recent study published in Pediatrics. The change was driven by increased antidepressant dispensing to female patients, they added. [ABSTRACT FROM AUTHOR]

The article discusses the views of the U.S. Representative, Richard Neal on the U.S. former, Representative, Elijah E. Cummings' Lower Drug Costs Now Act. It mentions that Cummings' act delivers on a Democratic promise to meaningfully stabilize and lower the very high costs of prescription drugs in the U.S.

The article offers information about on how rise in prescription drug costs and the associated out-of-pocket spending burden on consumers in U.S. It mentions efforts of U.S. government for protecting consumers from rising drug prices by using an external reference pricing (ERP) system that refers to the practice of using the price of a pharmaceutical product.

A highly unusual meeting took place in 2014—a group of experts, including federal officials, and top legislators – namely, former senators Carl Levin (D‐Michigan) and Orrin Hatch (R‐Utah) met in June of that year to discuss changing the Drug Addiction Treatment Act of 2000 (DATA 2000), which regulated buprenorphine prescribing up until it was eviscerated in the spending bill last month (see https://onlinelibrary.wiley.com/doi/epdf/10.1002/adaw.20431). The lawmakers wanted to raise the maximum number of patients one physician could have (at the time, it was 30 under DATA 2000, and 100 under the 2006 amendment; since then it has been raised further). [ABSTRACT FROM AUTHOR]

To avert a government shutdown and get key provisions into the spending bill before a new Congress is seated this month, Congress and President Biden passed and signed a spending bill for fiscal year (FY) 2023 on Dec. 23. The $1.7 trillion proposed appropriations bill, referred to as an "omnibus," includes proposed spending for the National Association of State Alcohol and Drug Abuse Directors' (NASADAD) priority programs within the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention, the Health Resources and Services Administration (HRSA) and other federal agencies. [ABSTRACT FROM AUTHOR]

Objectives. To determine the level of adherence to clinical guidelines in prescribing amoxicillin to children younger than 5 years with pneumonia in outpatient settings in Colombia from 2017 to 2019, and assess the factors associated with adherence Methods. This was a cross-sectional study of secondary data from the Colombian Integrated Social Protection Information System database. Adherence was defined as prescription of oral amoxicillin for bacterial and unspecified pneumonia and non-prescription for viral pneumonia. Variables examined included: age (< 1 year, 1-4 years) of child; sex; cause of pneumonia (bacterial, viral, unspecified); region (Andean, Amazonian, Pacific, Caribbean, Insular, Orinoquian); and payment mechanism (without prior authorization, capitation, direct payment, pay per case, pay for event). Results. Of 215 925 cases of community-acquired pneumonia reported during 2017-2019, 64.8% were from the Andean region, 73.9% were bacterial pneumonia and 1.8% were viral pneumonia. Adherence to guidelines was observed in 5.8% of cases: this was highest for children diagnosed with viral (86.0%) compared with bacterial (2.0%) pneumonia. For children diagnosed with bacterial pneumonia, 9.4% were prescribed any antibiotic. A greater proportion of children covered by capitated payments (22.3%) were given treatment consistent with the guidelines compared with payment for event (1.3%). Conclusion. In this first study from Colombia, adherence to guidelines for outpatient treatment of children with bacterial pneumonia was low and was better for viral pneumonia. Further qualitative studies are needed to explore the reasons for this lack of adherence and why bacterial pneumonia was the most commonly reported etiology. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted by researcher N. Bansal and his team to analyze the association between antidepressant use and adverse events, which found increased risks of cerebrovascular disease for non-selective serotonin reuptake inhibitors (SSRI) types of antidepressants.

A report from King Abdulaziz University in Jeddah, Saudi Arabia, discusses the appropriate use of antibiotics in dental practice. The research emphasizes the importance of limiting antibiotic prescriptions to cases with documented infections or when prophylaxis is indicated to prevent antibiotic resistance and unnecessary side effects. Collaboration between dentists and pharmacists is encouraged to develop antibiotic prescription protocols and promote antibiotic stewardship in dental practice. The study provides guidelines and recommendations for dentists to prescribe antibiotics wisely and only when necessary. [Extracted from the article]

A study conducted by the University of Bordeaux examined antibiotic prescribing practices for children under 5 in West African countries, specifically Burkina Faso, Guinea, Mali, and Niger. The research focused on the use of the WHO AWaRe classification and found varying rates of antibiotic prescriptions in different countries. While high proportions of antibiotics were prescribed to outpatient children, further investigation into the appropriateness of these prescriptions is needed. The study concluded that in each country, the proportion of antibiotic prescriptions met the minimum threshold recommended by the WHO. [Extracted from the article]

The article discusses the potential impacts of outpatient antiviral treatment in reducing influenza-associated hospitalizations in the United States. It highlights the importance of initiating antiviral treatment as soon as possible for outpatients with suspected or confirmed influenza, especially those at higher risk of complications. The study's probabilistic model suggests that antiviral treatment could result in a significant reduction in hospitalizations, particularly among older adults and individuals with medical conditions that increase the risk of influenza complications. Improving access to prompt testing and treatment for outpatients with suspected influenza is recommended to reduce hospitalizations effectively. [Extracted from the article]

A recent study conducted at the Michael E. DeBakey VA Medical Center in Houston, Texas, focused on the use of pharmacogenetic testing to inform opioid prescribing among veterans. The research found that only 10% of providers were aware of their patients' pharmacogenetic test results, with 55% believing that pharmacogenetic testing is valuable for guiding pain medication prescriptions. The study concluded that there are modifiable factors within the Veterans Health Administration that could be addressed to optimize pharmacogenetic testing for pain management. [Extracted from the article]

A recent study conducted at Durham University in the United Kingdom assessed the feasibility of implementing a non-pharmacological intervention, known as the GOTT (Gabapentinoid and Opioid Tapering Toolkit), in a primary care setting in North-East England. The study aimed to reduce the prescribing of opioids and gabapentinoids for chronic non-cancer pain, particularly high-dose prescriptions. Results showed a substantial decrease in opioid and gabapentinoid prescriptions during the intervention period, with an increase in clinician confidence in supporting chronic pain self-management. The GOTT intervention program demonstrated potential in addressing the lack of confidence in skills to support self-management and reduce the use of strong opioids and gabapentinoids. [Extracted from the article]

A study conducted at Northern Border University in Saudi Arabia examined the prescribing patterns of Proton Pump Inhibitors (PPIs) and their association with adverse drug reactions (ADRs). The research found that 31% of patients were prescribed PPIs, with inappropriate prescribing leading to concerns about ADRs. Factors such as gender, age, and number of prescribed medications were identified as contributing to the risk of ADRs associated with PPI use. The study highlights the importance of re-evaluating PPI prescribing practices to ensure effective therapy with minimal risk of ADRs. [Extracted from the article]

A study conducted at three academic hospitals in South Africa examined the impact of age on antimicrobial prescriptions in hospitalized children. The research found that neonates and infants received a higher number of antimicrobials compared to older children, with watch antibiotics like carbapenems being commonly prescribed. Factors such as HIV infection, length of stay, and surgical procedures were associated with an increased risk of healthcare-associated infections in young children. The study concluded that tailored antimicrobial stewardship and enhanced surveillance are necessary to address inappropriate antimicrobial use in high-risk hospitalized children. [Extracted from the article]

A study conducted at Universitas Warmadewa in Bali evaluated drug prescriptions to foreign travelers in two travel clinics using WHO prescribing indicators. The research found instances of irrational prescribing, including polypharmacy, low use of generic names, non-compliance with the national formulary, high antibiotic and injection prescriptions. The study concluded that there is a phenomenon of irrational prescribing in these travel clinics, highlighting the need for improved practices in drug prescribing for foreign travelers in Bali. [Extracted from the article]

The University of Iowa Carver College of Medicine conducted a study on antibiotic prescribing for respiratory tract diagnoses in walk-in clinics. The research found that factors such as patient age and comorbidities were associated with increased odds of antibiotic use. Providers who prescribed antibiotics more frequently tended to code certain conditions and prescribe antibiotics for nonresponsive conditions. The study concluded that a provider-level metric for antibiotic prescribing in respiratory tract diagnoses showed validity and acceptability as an assessment tool. [Extracted from the article]

The California Workers' Compensation Institute analyzed opioid prescription data from 2017 to 2023, showing a decrease in opioid use among workers' comp patients. The study found a correlation between the duration of opioid use and the average strength of the daily dose with addiction and harmful side effects. The report also highlighted a decline in the number of Californians prescribed opioids, with workers' comp patients accounting for a small percentage of the total. The findings suggest that reforms in California's workers' comp system have contributed to the reduction in opioid use, exceeding the decline seen in the general population. [Extracted from the article]

The Treatment Advocacy Center (TAC) and other advocates are trying to convince the Food and Drug Administration (FDA) to end the Risk Evaluation and Mitigation Strategy (REMS) requirements for clozapine. The requirements, they said, reduce the number of providers who will prescribe this "gold standard medication" that works for many people with serious mental illness. [ABSTRACT FROM AUTHOR]

A recent study conducted at the University of Stirling focused on the clinical outcomes of benzodiazepine prescribing for individuals receiving opioid agonist treatment. The research found that co-prescribing benzodiazepines with opioids increased all-cause mortality by 75-90% and indicated a higher risk of overdose death. However, there was a positive effect on treatment retention, suggesting improved retention in those prescribed benzodiazepines with opioid agonist treatment. The study recommended further trials due to existing confounders such as psychiatric comorbidity. [Extracted from the article]

A recent study conducted at Emory University focused on developing a risk-adjusted model to predict antibiotic prescribing among hospitalists in an academic healthcare network. The study analyzed data from inpatient encounters at four acute care hospitals between January 2020 and June 2021 to identify predictors of antibiotic prescribing and provider-specific trends. The research concluded that provider-specific benchmarking among inpatient providers is achievable and could be a valuable tool for inpatient stewardship efforts. For more information, the full article can be accessed for free at https://doi.org/10.1017/ash.2024.422. [Extracted from the article]

A report from St Vincent's Hospital in Dublin, Ireland, discusses the underutilization of the antipsychotic medication clozapine in the treatment of refractory schizophrenia. The study surveyed 77 consultant psychiatrists in Ireland and found that while clinicians were knowledgeable about clozapine's effectiveness and guidelines, there were perceived barriers to its use, including patient concerns about effectiveness and tolerability. The report suggests that structured patient education and professional development programs focused on managing side effects and rechallenge may promote the use of clozapine. The research has been peer-reviewed and is available in the Irish Journal of Psychological Medicine. [Extracted from the article]