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Background and Objective: Alcohol pharmacotherapies pose unknown teratogenic risks in pregnancy and are therefore recommended to be avoided. This limits treatment options for pregnant individuals with alcohol use disorders (AUD). The information on the safety of these medications during pregnancy is uncertain, prompting a scoping review. The objective of this review was to investigate available information on the safety of alcohol pharmacotherapies in pregnancy. Methods: Studies published between January 1990 and July 2023 were identified through searches in BIOSIS, Embase, PsycINFO and MEDLINE databases, using terms related to pregnancy and alcohol pharmacotherapies. The alcohol pharmacotherapies investigated were naltrexone, acamprosate, disulfiram, nalmefene, baclofen, gabapentin and topiramate. Studies were screened by two independent reviewers. Covidence software facilitated the management, screening and extraction of studies. Results: A total of 105 studies were included in the review (naltrexone: 21, acamprosate: 4, disulfiram: 3, baclofen: 3, nalmefene: 0, topiramate: 55, gabapentin: 32) with some studies investigating multiple medications. Studies investigating naltrexone's safety in pregnancy focussed on opioid use disorders, with limited evidence regarding its safety in the context of AUD. Despite concerns about higher rates of some pregnancy complications, studies generally indicate naltrexone as a safer option compared with opioid agonists or alcohol during pregnancy. Acamprosate was not clearly associated with adverse effects of exposure in pregnancy, with two pre-clinical studies suggesting potential neuroprotective properties. Disulfiram has a high risk of congenital anomalies when used in pregnancy, believed to be due to its mechanism of action. Prenatal topiramate has also been associated with an increased risk of congenital anomalies, particularly oral clefts. There were mixed results concerning the safety of prenatal gabapentin and little to no literature investigating the safety of baclofen or nalmefene during pregnancy. Conclusions: There is insufficient research on the safety of alcohol pharmacotherapies in pregnancy. Despite this, given alcohol's teratogenic effects, naltrexone could be considered to help maintain abstinence in pregnant individuals with AUD, particularly when psychosocial treatments have failed. [ABSTRACT FROM AUTHOR]

Medications for alcohol use disorder (MAUD) and opioid use disorder (MOUD) are underutilized evidence-based treatments. While patients often receive treatment in multiple medical treatment settings, it is unknown whether certain treatment settings or combinations of settings are associated with increased receipt of MAUD or MOUD. Data from the cross-sectional 2019 National Survey on Drug Use and Health were used to identify treatment settings where adult respondents received any past year alcohol treatment (n = 476, 33% female) or, separately, opioid treatment (n = 337, 38% female). Three-stage latent class analysis assessed the patterns of treatment settings utilization and their associations with receipt of MAUD or MOUD, adjusting for potential confounders. Only 10.9% of those in alcohol treatment received MAUD while 40.9% of those in opioid treatment received MOUD. Analyzing different treatment settings visited by respondents, a four-class model best fit the MAUD sample while a three-class model best fit the MOUD sample. There were significant differences in receipt of MAUD by treatment setting classes in unadjusted models (p < 0.05). There were no significant differences in receipt of MOUD across treatment utilization classes, but MOUD receipt was associated with severity of opioid use in all treatment setting classes. People in treatment for alcohol or opioid use were more likely to receive medication if their use was more severe, and were more likely to receive MAUD if they accessed care in many settings. As MOUD and especially MAUD are underutilized, these findings highlight opportunities to increase access to evidence-based care for alcohol and opioid use disorders. [ABSTRACT FROM AUTHOR]

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization's transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model. [ABSTRACT FROM AUTHOR]

The opioid epidemic in the United States (US) has prompted innovative responses from law enforcement agencies including specialized units to refer overdose survivors to substance use treatment following an overdose. However, traditional law enforcement outreach does not address the multilevel barriers to treatment engagement that lead to repeat overdose-related calls for service. The current evaluation explored the process components and outcomes of a Comprehensive Opioid Abuse Program (COAP) initiative within a local law enforcement agency in the Southeast US. COAP funding supported a police-led recovery management team (RMT) to connect overdose survivors to substance use treatment. The RMT also utilized recovery management check-ups (RMCs) to provide sustained support to enhance substance use treatment engagement beyond the initial treatment referral. A mixed-methods approach was employed to examine participant demographic, substance use, mental health, treatment, and criminal justice characteristics (N = 65) and explore perceptions of programmatic strengths and potential areas for improvement (N = 15). The quantitative and qualitative analyses were informed by the Recovery Capital Model. Quantitative analysis revealed that the RMT connected many participants with various support services, notably including housing assistance and health insurance. Qualitative findings highlight program effectiveness in improving social, community, and personal recovery capital. These findings contribute to expanding research on police-led post-overdose initiatives and suggest that police-led RMCs can address multilevel barriers to treatment engagement and minimize law enforcement stigma. [ABSTRACT FROM AUTHOR]

Background and Objectives: Amidst increasing opioid‐related overdoses in the USA, opioid use disorder (OUD) treatment has seen few novel treatments emerge. High‐potency synthetic opioids (HPSOs) have altered clinical approaches, prompting evaluation of existing medications for opioid use disorder (MOUD) and interest in slow‐release oral morphine (SROM) as another therapeutic option. Here we survey addiction specialists on the influence of HPSOs on clinical practice, views on current MOUD regulations, and openness to novel therapies such as SROM. Methods: Anonymous, online survey conducted at a national conference of addiction specialists (N = 91). Pearson χ2 tests and Fisher's exact tests to compare respondent characteristics. Results: Approximately 89% of respondents (N = 91) acknowledge that HPSOs shifted addiction treatment in recent years, with 86% modifying their MOUD prescribing accordingly. Moreover, 84% report having patients who could benefit from other full opioid agonists beyond methadone for OUD management. Many report off‐label prescribing of full agonist opioids other than methadone for withdrawal symptoms or initiating MOUD. Eighty percent reported being in favor of incorporating SROM as a third‐line monotherapy for OUD. Discussion and Conclusion: This sample of addiction specialists supports innovative alternatives for MOUD in the USA to combat the challenges posed by fentanyl and related HPSOs. Future work should further addiction specialists' opinions on barriers to OUD treatment and exploration of these international strategies in the USA. Scientific Significance: This appears to be the first study exploring addiction specialists' perspectives on regulatory barriers to OUD treatment and their willingness to uptake internationally adopted strategies such as SROM. [ABSTRACT FROM AUTHOR]

Background and Objectives: National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. However, the extent of such disparities at the state level remains largely unexplored. This study aims to examine such disparities at the state level. Methods: We analyzed 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data. The primary outcome was the difference in median treatment duration between White people and racial and ethnic minorities. We also included a second outcome measurement to quantify the difference in median treatment duration among episodes lasting ≥180 days. Using quantile regressions, we examined racial and ethnic disparities in treatment duration, adjusting for the patient's age, sex, payment type, and calendar year of the treatment episode. All analyses were conducted at the state level. Results: Our study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and eight states displayed similar trends among episodes lasting ≥180 days. Five states exhibited longer treatment durations for White people in both overall and long‐term episodes. Fifteen states showed no racial and ethnic disparities. Conclusion and Scientific Significance: These results are among the first to indicate substantial statewide variations in racial and ethnic disparities in buprenorphine treatment episode duration, providing a critical foundation for targeted interventions to enhance buprenorphine treatment, especially in states confronting such pronounced racial and ethnic disparities. [ABSTRACT FROM AUTHOR]

Background and Objectives: Criminal‐legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in‐depth longitudinal analysis of state‐by‐state differences is lacking. Methods: The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset‐Admissions 2000–2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non‐CL referrals cumulatively over the 21‐year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state. Results: 2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non‐CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11–0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity. Discussion and Conclusions: While rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid‐related overdoses are more prevalent among those involved with the CL system, improving this has high impact. Scientific Significance: Provides the most comprehensive analysis of state‐by‐state inequities in MOUD access for CL relative to non‐CL referrals over a 21‐year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care. [ABSTRACT FROM AUTHOR]

Background and Objectives: History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high‐risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO. Methods: Secondary analysis of a pan‐Canadian pragmatic trial comparing flexible take‐home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO. Logistic regression was used to examine the impact of OAT on retention in the assigned or in any OAT at 24 weeks and analysis of covariance was used to examine the mean difference in opioid use between treatment arms. Results: Of the 272 randomized participants, 155 (57%) reported at least one NFO at baseline. Retention rates in the assigned treatment were 17.7% in the buprenorphine/naloxone group and 18.4% in the methadone group (adjusted odds ratio [AOR] = 0.54, 95% CI: 0.17–1.54). Rates of retention in any OAT were 28% and 20% in the buprenorphine/naloxone and methadone arms, respectively (AOR = 1.55, 95% CI: 0.65–3.78). There was an 11.9% adjusted mean difference in opioid‐free urine drug tests, favoring the buprenorphine/naloxone arm (95% CI: 3.5–20.3; p =.0057). Conclusions and Scientific Significance: Among adults with OUD and a history of overdose, overall retention rates were low but improved when retention in any treatment was considered. These findings highlight the importance of flexibility and patient‐centered care to improve retention and other treatment outcomes in this population. [ABSTRACT FROM AUTHOR]

Background: Outpatient facilities, such as family and adult practice offices, psychiatric offices, and substance use treatment centers, should be equipped to manage medical emergencies and facilitate hospital transfers. Clinics that treat patients with opioid use disorder must be especially prepared to address respiratory arrest due to opioid overdose. Purpose: The objective of this integrative review was to identify emergency response initiatives already investigated or developed that could be adapted to address opioid-related medical emergencies in the outpatient adult treatment setting. Methods: Initial and updated literature searches were conducted using MEDLINE and PubMed. These searches yielded 207 and 60 articles of interest, respectively, and a total of 6 and 18 were selected for retrieval. Of these, 5 and 8, for a total of 13, met the inclusion criteria. Results: We found few publications in the mental health literature to inform or guide outpatient practitioners in preparing their offices for emergencies. This integrative review draws from all areas of the medical literature to identify emergency response strategies that have been developed for outpatient settings. We identified 4 major themes in office emergency preparedness: simulation training, response team organization, equipment readiness, and emergency action protocols. Conclusion: These 4 themes can provide guidance for improving readiness in medical offices, and in ambulatory mental health and substance use clinics. Researchers will need to develop emergency response algorithms that address these themes and assess patient outcomes. The authors of this integrative review sought to identify emergency response initiatives in the literature that could be adapted to address opioid-related medical emergencies in the outpatient adult treatment setting. [ABSTRACT FROM AUTHOR]

Introduction: Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients. Methods: This prospective cohort study included adult patients (≥ 18 yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption. Results: We analyzed 344 patients (58 ± 15 years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3 days [IQR 1–5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7–20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0–7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98–0.99]), higher preoperative anxiety (1.02 [95%CI 1.00–1.04]), rectal resections (IRR 1.45 [95%CI 1.09–1.94]), and number of pills prescribed (1.02 [95%CI 1.01–1.03]). Conclusion: A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Xylazine is in 99% of the fentanyl supply in Philadelphia, PA and is on the rise throughout the United States. Perspectives about this emerging crisis among people who use opioids (PWUO) and harm reduction workers are lacking. Methods: We conducted focus groups with PWUO and harm reduction workers in Philadelphia, PA. Discussions focused on xylazine's impact on PWUO. Transcripts were coded for thematic analysis. Results: Themes across focus groups included xylazine withdrawal, wounds, safety concerns, and overdose response implications. Participants emphasized extreme xylazine withdrawal and the difficulty of withdrawal management. Groups explored potential roles of first responders in addressing xylazine-related wounds. PWUO were receptive to receiving help, but many harm reduction workers expressed reservations about partnering with police. Discussion: Results underscore the impact of xylazine withdrawal on PWUO. Emerging information on withdrawal management should be shared among care providers to identify optimal protocols. Safety-planning with PWUO should be explored, but structural interventions are imperative. While there may be a role for first responders in delivering harm reduction interventions, it is important to recognize historical harms by first responders against PWUO. [ABSTRACT FROM AUTHOR]

Background and Aims: Opioid use disorder (OUD) is treatable with buprenorphine/naloxone (buprenorphine), but many patients discontinue treatment prematurely. The aim of this study was to assess the influence of patient‐ and prescriber‐level characteristics relative to several patient outcomes following the initiation of buprenorphine treatment for OUD. Design: This was a retrospective observational investigation. We used the Public Health Data Warehouse from the Massachusetts Department of Public Health to construct a sample of patients who initiated buprenorphine treatment between 2015 and 2019. We attributed each patient to a prescriber based on information from prescription claims. We used multilevel models to assess the influence of patient‐ and prescriber‐level characteristics on each outcome. Setting: Massachusetts, USA. Participants: The study cohort comprised 37 955 unique patients and 2146 prescribers. Among patients, 64.6% were male, 52.6% were under the age of 35 and 82.2% were White, non‐Hispanic. For insurance coverage, 72.1% had Medicaid. Measurements The outcome measures were poor medication continuity, treatment discontinuation and opioid overdose, all assessed within a 12‐month follow‐up period that began with a focal prescription for buprenorphine. Each patient had a single follow‐up period. Poor medication continuity was defined as medication gaps totaling more than 7 days during the initial 180 days of buprenorphine treatment and treatment discontinuation was defined as having a medication gap for 2 consecutive months within the 12‐month follow‐up period. Findings The patient‐level rates for poor medication continuity, treatment discontinuation and opioid overdose were 59.7% [95% confidence interval (CI) = 59.2–60.2], 57.4% (95% CI = 56.9–57.9) and 10.3% (95% CI = 10.0–10.6), respectively, with 1.1% (95% CI = 1.0–1.2) experiencing a fatal opioid overdose. At the patient level, after adjustment for covariates, adverse outcomes were associated with race/ethnicity as both Black, non‐Hispanic and Hispanic patients had worse outcomes than did White, non‐Hispanic patients (Black, non‐Hispanic ‐‐ poor continuity: 1.50, 95% CI = 1.34–1.68; discontinuation: 1.44, 95% CI = 1.30–1.60; Hispanic ‐‐ poor continuity: 1.21, 95% CI = 1.12–1.31; discontinuation: 1.38, 95% CI = 1.28–1.48). Patients with insurance coverage through Medicaid also had worse outcomes than those with commercial insurance (poor continuity: 1.18, 95% CI = 1.11–1.26; discontinuation: 1.09, 95% CI = 1.03–1.16; overdose: 1.98, 95% CI = 1.75–2.23). Pre‐treatment mental health conditions and other types of chronic illness were also associated with worse outcomes (History of mental health conditions ‐‐ poor continuity: 1.11, 95% CI = 1.06–1.17; discontinuation: 1.05, CI = 1.01–1.10; overdose: 1.47, 95% CI = 1.36–1.60; Chronic health conditions ‐‐ poor continuity: 1.15, 95% CI = 1.05–1.27; discontinuation: 1.15, 95% CI = 1.05–1.26; overdose: 1.83, 95% CI = 1.60–2.10; History of substance use disorder other than for opioids ‐‐ poor continuity: 1.54, 95% CI = 1.46–1.62; discontinuation: 1.54, 95% CI = 1.47–1.62; overdose: 1.93, 95% CI = 1.80–2.07). At the prescriber level, after adjustments for covariates, adverse outcomes were associated with clinical training, as primary care physicians had higher rates of adverse outcomes than psychiatrists (poor continuity: 1.12, 95% CI = 1.02–1.23; discontinuation: 1.04, 95% CI = 1.01–1.09). A larger prescriber panel size, based on number of patients being prescribed buprenorphine, was also associated with higher rates of adverse outcomes (poor continuity: 1.36, 95% CI = 1.27–1.46; discontinuation: 1.21, 95% CI = 1.14–1.28; overdose: 1.10, 95% CI = 1.01–1.19). Between 9% and 15% of the variation among patients for the outcomes was accounted for at the prescriber level. Conclusions: Patient‐ and prescriber‐level characteristics appear to be associated with patient outcomes following buprenorphine treatment for opioid use disorder. In particular, patients' race/ethnicity and insurance coverage appear to be associated with substantial disparities in outcomes, and prescriber characteristics appear to be most closely associated with medication continuity during early treatment. [ABSTRACT FROM AUTHOR]

• The Family Check-Up Online (FCU-O) is a parenting program with telehealth coaching. • Parent participants faced challenges including mental illness and substance misuse. • Participants were primarily low income, and about one-third-resided in rural areas. • Findings offer preliminary support for the FCU-O among parents of young children. • The FCU-O improved parenting skills, parenting self-efficacy, and depressive symptoms. Online parenting interventions hold promise for increasing access to behavioral support for families with low income and who reside in rural areas. The current study evaluates the efficacy of a mobile app-based parenting support program, the Family Check-Up Online (FCU-O) with telehealth coaching support, for parents of children 1.5-5 years old at risk of experiencing parenting challenges. We tested effects of the FCU-O on parent wellbeing (parenting self-efficacy and symptoms of depression and anxiety) and parent-reported parenting skills (support for positive behavior, limit-setting, and proactive parenting) at the 3-month follow-up in a randomized controlled trial (FCU-O versus control). We also tested relationships between parents' baseline characteristics and their engagement with the app and telehealth coaching. Eligibility criteria included endorsing depressive symptoms or current or past substance misuse. Participants (N = 356) were predominantly White (72%) and low-income, with 43% of families residing in a rural area. Approximately one-third-of participants reported clinically significant symptoms of anxiety or depression and one-third-endorsed a lifetime history of opioid misuse. Intent to treat analyses tested effects of the FCU-O on parent wellbeing and parenting skills. The FCU-O was associated with improvements to parents' support for positive behavior, limit-setting, and proactive parenting skills, as well as parenting self-efficacy and depressive symptoms. Parents' initial symptoms of depression and anxiety significantly predicted greater telehealth coach engagement; low levels of initial self-reported skills positive behavior support and limit-setting significantly predicted greater app engagement. Results provide support for the FCU-O as a preventive parenting intervention for parents experiencing mental health challenges, with implications for reducing barriers to accessing parenting support for underserved families. [ABSTRACT FROM AUTHOR]

Fewer than 1% of United States' largest corrections facilities allow access to MOUD. The cascade of care is an organizing framework that quantifies treatment processes within and across systems of care ranging from screening to treatment discharge. This study highlights best practices for the implementation of MOUD across the cascade of care, addressing unique characteristics of legal settings and individuals within them. After reviewing best-practices for MOUD implementation in legal settings and examining jail and community provider's use of and goals toward improving these practices, this study concludes that despite interest from agencies to improve care considerable variation remains in treatment availability between agencies and within agencies at different stages of incarceration. Seamless systems of care require multiagency collaboration, staff and provider competency, and patient awareness of MOUD. These strategies will decrease punishment-oriented ideologies surrounding MOUD application in justice settings and improve access to resources that remove barriers to care. [ABSTRACT FROM AUTHOR]

Objectives. To determine whether the Communities That HEAL (CTH) intervention is effective in increasing naloxone distribution compared with usual care. Methods. The HEALing (Helping to End Addiction Long-Term) Communities Study (HCS) is a cluster-randomized, parallel-arm, wait-list controlled implementation science trial testing the impact of the CTH intervention on increasing the use of evidence-based practices to lower opioid-related overdose deaths. Communities (n = 67) highly impacted by opioid overdose in Kentucky, Massachusetts, New York, and Ohio were allocated to CTH intervention (n = 34) or wait-list comparison (usual care; n = 33) arms. The primary outcome for this study was the number of naloxone units distributed in HCS communities during the comparison period (July 1, 2021‒June 30, 2022), examined using an intent-to-treat negative binomial regression model. Results. Naloxone distribution was 79% higher in the CTH intervention versus usual care arm (adjusted relative rate = 1.79; 95% confidence interval = 1.28, 2.51; P =.001; adjusted rates of naloxone distribution 3378 vs 1884 naloxone units per 100 000 residents), when controlling for urban‒rural status, state, baseline opioid-related overdose death rate, and baseline naloxone distribution rate. Conclusions. The CTH intervention increased naloxone distribution compared with usual care in communities highly impacted by the opioid crisis. Trial Registration. ClinicalTrials.gov identifier: NCT04111939. (Am J Public Health. 2025;115(1):83–94. https://doi.org/10.2105/AJPH.2024.307845) [ABSTRACT FROM AUTHOR]

Opioid Use Disorder (OUD) is an ongoing worldwide public health concern. Genetic factors contribute to multiple OUD-related phenotypes, such as opioid-induced analgesia, initiation of opioid use, and opioid dependence. Here, we present findings from a behavioral phenotyping protocol using male and female rats from 15 genetically diverse inbred strains from the Hybrid Rat Diversity Panel (HRDP). We used a self-administration paradigm to measure the acquisition of oxycodone intake during ten 2-hour sessions and escalation of oxycodone use during ten 12-hour sessions. During both the acquisition and escalation phases of self-administration, we observed that genetic background and sex influence oxycodone intake. The heritability of oxycodone intake phenotypes ranged between 0.26 to 0.54, indicating that genetic background plays a major role in the variability of oxycodone consumption. Genetic background and sex also influenced additional phenotypes recorded during oxycodone self-administration including lever discrimination and timeout responding. The genetic contribution to these traits was slightly more moderate, with heritability estimates ranging between 0.25 to 0.42. Measures of oxycodone intake were highly positively correlated between acquisition and escalation phases. Interestingly, the efficacy of oxycodone analgesia was positively correlated with oxycodone intake during the escalation phase, indicating that the initial behavioral responses to oxycodone may predict self-administration phenotypes. Together, these data demonstrate that sex and genetic background are major contributors to oxycodone self-administration phenotypes. [ABSTRACT FROM AUTHOR]

The ability to adapt to changing circumstances has strong survival value. Individuals with substance use disorders tend to get "stuck" over-responding to drug-reward signals and pursuing drugs despite negative consequences. A lack of flexibility may be tied to impairments in neurocognition, including learning, memory, and executive function. However, results are often mixed, potentially due to heterogeneity in factors such as mental health, personality traits, or prior adversity. This study aimed to identify which factors influence neurocognitive variations within the opioid use disorder (OUD) population. Based on prior literature, we hypothesized that individuals with OUD would show deficits (vs. controls) in one or more neurocognitive domains, and that these cognitive difficulties might be greater in individuals with other known contributors to impaired cognition. This pilot project included 32 individuals receiving medication for OUD and 15 non-substance using controls (NSC). Questionnaires assessed addiction and relapse risk factors, such as impulsiveness, social function, depressive symptoms, and childhood adversity. Neurocognitive performance was measured via the Penn Computerized Neurocognitive Battery (P-CNB), including tasks that probe attention, working memory, episodic memory, cognitive flexibility, and complex cognition, and was compared between the OUD and NSC groups. OUD participants (vs. NSCs) exhibited significantly lower performance on the conditional exclusion task (CET) (Accuracy: 1.11 vs. 2.38, p < 0.001) and the n-Back task (NBT) (F1 Scores: 83% vs. 95%, p < 0.001). Impulsiveness, social function, and depressive symptoms were highly inter-related; however, only higher impulsiveness (r = -.48, p = 0.006) and more social impairment (r = -.47, p = 0.007) significantly correlated with decreased CET (but not n-Back) performance. This pilot study suggests that working memory and cognitive flexibility are impaired in people with OUD and that impulsiveness and social function are key factors in cognitive flexibility impairments in people with OUD. These results may offer insights for larger-scale investigations and potential interventions to reduce relapse risk. [ABSTRACT FROM AUTHOR]

Background: Coal mining involves heavy physical demand, which is associated with increased risk of injury and long‐term musculoskeletal health disorders and chronic pain. Management of chronic or recurrent pain is in turn associated with prescription opioid use and risk of opioid use disorder (OUD). Methods: We analyzed clinical data from 5463 coal miners evaluated between 2004 and 2015. Using an iterative text mining procedure, we analyzed structured clinical notes to extract information on occupational histories and clinical data. We evaluated associations along the causal chain using a series of multivariable logistic regression models to determine the relationship between (1) specific mining occupations and history of traumatic injury, (2) history of traumatic injury and current pain, and (3) current pain and current prescription opioid use. Results: Among these mostly‐former coal miners (mean age 62.4 years), the average coal mining tenure was 27.3 years; 88.4% reported being previously injured, 92.3% reported suffering from current pain and 39.2% reported current prescription opioid use. Occupations involving the most strenuous mining work were associated with a history of traumatic injury. A history of traumatic injury to body regions of the head/neck/back/spine was associated with current pain involving the head/neck/back/spine (adjusted OR = 5.04; CI 95%: 4.46, 5.70; p < 0.001). In a separate model, reported current pain of the head/neck/back/spine was associated with current prescription opioid use (aOR = 2.66; CI 95%: 2.35, 3.01; p < 0.001). Conclusions: These miners had a high prevalence of self‐reported current pain, and certain specific mining occupations were more strongly associated with a history of injury, pain, and prescription opioid use. [ABSTRACT FROM AUTHOR]

The representative bureaucracy theory literature has often focused on the viewpoints, attitudes, and actions of minoritized groups rather than the racial majority, with studies predominately analyzing representative capacities tied to race, ethnicity, and gender. The current research employs both racial and lived experience representation lenses to analyze the viewpoints of non-Hispanic white public servants regarding the deservingness of white, Black, and unidentified clients. Using the opioid crisis as the context, results from an exploratory analysis of a nationwide survey experiment of first responders show that white law enforcement workers view white clients with opioid use disorder as more deserving than Black and unidentified clients. Both indirect and direct lived experiences with substance use disorder predict positive attitudes toward clients. Direct lived experience nullifies the negative beliefs white law enforcement workers express about Black clients, highlighting the significance of the intersection of racial and lived experience representation. Practical implications include promoting organizational practices that leverage the strength of shared lived experience to mitigate racial biases and encourage compassion for clients. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To evaluate the data consistency and quality of Medicaid claims data on opioid use disorder (OUD) treatment, benchmarking the Transformed Medicaid Statistical Information System Analytic Files (TAF) against metrics reported by the Medicaid Outcomes Distributed Research Network (MODRN), which analyzed data obtained directly from 11 state Medicaid agencies.The primary data source was TAF claims for the years 2017 and 2018, limited to non‐dual, full‐benefit Medicaid beneficiaries aged 12–64 in one of the 11 states in our study sample.Using TAF data, we replicated performance on the following five OUD quality metrics reported by MODRN: number of enrollees receiving any OUD medication, receipt of behavioral health counseling, completion of urine drug screens, receipt of any opioid analgesic fill, and receipt of any benzodiazepine fill.Access to TAF data was facilitated through the Chronic Conditions Warehouse.There were 11% fewer Medicaid enrollees with OUD in TAF compared to MODRN (912,478 vs. 1,034,412). Patient characteristics were largely similar across the two datasets, with the exception of more missing race information in TAF (20.9% vs. 7.1%). Across the 11 states, performance on the six quality measures was similar. For example, the rate of use of any OUD medication in 2018 was 57.1% in MODRN and 58.6% in TAF. However, there were important discrepancies in the TAF data in individual states for single years.TAF data may undercount patients with OUD, but otherwise exhibited consistency with MODRN benchmarks, suggesting suitability of TAF for research on OUD treatment. Our results highlight several data quality issues with TAF that researchers who use these data should be aware of, including reporting of race and ethnicity. [ABSTRACT FROM AUTHOR]

Health-promoting lifestyle and behaviors play a crucial role in the prognosis of an illness as well as in healing. With the significant global burden of unhealthy lifestyle choices, their impact on individuals with substance use disorders can be particularly burdensome, hampering overall well-being. This study assesses health-promoting lifestyle and behavior and dietary habits among treatment-seeking male patients with opioid use disorders. This cross-sectional observational study enrolled 179 male patients undergoing treatment for opioid use disorder in a treatment center dedicated to addiction services. Data were collected using a semi-structured questionnaire, the Health-Promoting Lifestyle Profile II (HPLP-II), the Maudsley Addiction Profile, and a food frequency questionnaire adapted for the north Indian diet. The mean age of the sample was 31.5 years, and almost half of the participants were underweight (n = 86, 48.0%). Participants often engaged in some health-promoting behaviors, such as nutrition, stress management, spiritual growth, and interpersonal relations; and generally neglected aspects of physical activity and health responsibility. Over half of the participants consumed less energy than recommended, while about a fourth failed to meet daily protein intake recommendations. The study underscores the need to incorporate lifestyle and dietary assessment and modification alongside psycho-pharmacological treatment for patients with opioid use disorders. [ABSTRACT FROM AUTHOR]

Background: The lockdown measures during the SARS-CoV-2 pandemic could have influenced drug consumption patterns of persons with drug use disorder, especially due to a reduced availability of drugs, an increased consumption of sedating substances as a coping strategy, or a shift to novel psychotropic substances (NPS) associated with an increased drug buying in the internet. In this study, the consumption patterns of people mainly with opioid use disorder entering inpatient drug detoxification treatment were investigated in the same hospitals with the same methods before and during the pandemic. Methods: At admission, patients were interviewed regarding their consumption patterns using the EuropASI questionnaire. In addition, changes in the routes of drug acquisition were assessed. Results: In five hospitals in Western Germany, 213 (2021) and 175 persons (2018) were recruited. Sociodemographic data were similar in both cohorts (mean age around 40 years, mainly male, about 50% with migrant background, high unemployment rate). Rates of use of various drugs during the last 30 days were also similar. Differences were detected for gabapentinoids and opioid analgesics (increase >5%) as well as for cannabis (decrease >5%). Current use of NPS was low in both surveys. Only a minority of patients had experiences with drug acquisition in the internet. Discussion: The pandemic had only a minor influence on consumption patterns and routes of drug acquisition in this sample. It remains to be seen whether the increased use of gabapentinoids and opioid analgesics will continue despite the end of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorders constitute a vast disease burden, need for comprehensive treatment, and substantial costs to individuals, families, and society. The multifaceted needs of people with opioid dependence call for integrated care. The study aims to assess the added value of an integrated medically assisted rehabilitation (MAR) program providing opioid agonist therapy for patients with opioid dependence as compared to the standard of care (SoC) in Norway. Methods: The intervention includes a comprehensive tertiary care integrated MAR program in Bergen. SoC is a much less intense primary care program in Oslo. 682 and 609 patients from Bergen, and 864 and 771 patients from Oslo were included in 2017 and 2019, respectively. A multi-criteria decision analysis (MCDA) framework was used where the relative preferences of the importance of the outcomes were obtained from a discrete choice experiment among five different stakeholder-groups. Seven outcomes related to health, well-being, experience of the care process, and cost were measured. The performance scores were measured in a study with a quasi-experimental design. Scores were analyzed using linear mixed methods. Performance scores for the outcomes were standardized and multiplied by their relative preferences to obtain the overall value scores in the MCDA. Results: We found similar value scores for both care delivery models regarding physical functioning, psychological well-being, social relationships & participation, enjoyment of life, and total costs. The Bergen-model scored higher on continuity of care (0.733 versus 0.680), while the SoC-model scored higher on person-centeredness (0.772 versus 0.635). Overall value scores were marginally in favor of the MAR-Bergen (0.708 versus 0.705 for patients). Conclusion: Acknowledging the significance of different life aspects emphasizes the need for integrated care at a specific level for people with opioid dependence. We conclude that the two highly effective treatment approaches produce promising outcomes in a challenging population and are quite similar. However, further research with more robust longitudinal data is needed. [ABSTRACT FROM AUTHOR]

Background and aim: Considering opioid use disorder (OUD) as one of the major global concerns, methadone maintenance treatment (MMT) has been documented the core treatment for such dependence in the affected individuals. With regard to the significant role of quality of life (QoL) in evaluating the outcomes of various treatment methods in this line, the present study was to explore perceived QoL in long-term methadone-dependent patients (MDPs). Materials and methods: Applying a qualitative research design, this study was performed on 25 long-term MDPs, selected by purposive sampling with maximum variation. The data were also collected through semi-structured, in-depth interviews until data saturation was reached, and then analyzed via the MAXQDA10 software program and conventional content analysis. Results: The themes mined from the qualitative data were (i) satisfaction with improvements of physical-mental deterioration, with two main categories, viz. (a) improved physical efficiency and (b) improved mental efficiency; (ii) satisfaction with having a meaning in life, comprised of two categories, i.e., (a) hope for the future and (b) new beginnings in life; (iii) positive self-perception, made up of four main categories of (a) Increased Confidence and Self-Acceptance, (b) Positive Self-Acceptance and Improved Self-Image, (c) Improved Decision-Making Abilities, and (d) More Effective Coping with Stressful Situations; (iv) satisfaction with perceived social capital, consisting of two categories, namely, (a) strong social support and (b) no worry of the stigma of substance use; (v) growth in marital satisfaction, with two main categories of (a) increased libido and (b) effective communication with one's spouse; and (vi) physical-mental exhaustion caused by MMT, containing three categories, i.e., (a) fear of physical harm induced by MMT, (b) stigma and discrimination due to MMT, and (c) financial hardship following MMT. Conclusion: The study results revealed that QoL in MDPs was associated with their satisfaction with improvements of physical-mental deterioration, satisfaction with having a meaning in life, positive self-perception, satisfaction with perceived social capital, growth in marital satisfaction, and physical-mental exhaustion caused by MMT. Accordingly, it was suggested to reduce the negative impacts of MMT, such as stigma and discrimination due to MMT and the related treatments, on QoL in opioid-dependent patients (ODPs) and boost its benefits in their daily life. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Background Design Method Conclusions Impact to Nursing We offer a literature‐driven, empirically informed, and highly warranted recommendation for a multilevel approach tailored to nurse practitioners. This approach aimed to drive change at the individual level (nurse practitioner), dyadic level (nurse–patient therapeutic relationship), and systems level (organisational culture, education, and policy) to strengthen nurse practitioners' capacity to deliver optimal opioid use disorder care.The opioid overdose epidemic is a global public health crisis, with the United States facing the most severe impact. Access to evidence‐based treatment for opioid use disorder remains a significant barrier. Primary care nurse practitioners can play a crucial role in expanding access and bridging the treatment gap. Addressing factors influencing access to, quality of, and effectiveness of treatment requires urgent and careful consideration.This position paper highlights the multilevel barriers that inhibit nurse practitioners in managing opioid use disorder, negatively impacting treatment access and opioid use disorder‐related outcomes.The Advanced Practice Provider conceptual model was adapted to guide this paper. This adapted model illustrates the interconnected layers among nurse practitioners, clinical care, education, professional development, and organisational culture and policy in caring for patients with opioid use disorder.Equipping primary care nurse practitioners with the necessary tools to both understand opioid addiction and empower patients experiencing it can have a profound impact. This impact benefits the provider and patient and extends to addressing the opioid crisis at multiple levels. Future research should explore nurse practitioners' experiences when working with individuals with opioid use disorder, identify barriers that hinder positive interactions with patients seeking treatment, and pragmatically test and implement multilevel interventions designed to holistically benefit providers and patient outcomes.This American‐based reflection offers valuable insights to nurse practitioners worldwide as they consider effective strategies for addressing opioid use disorder in primary care settings. [ABSTRACT FROM AUTHOR]

Introduction: Despite the established effectiveness and relatively widespread availability of Medications for Opioid Use Disorder, individuals seeking treatment frequently encounter various structural and social barriers, including costs of treatment. This study aimed to understand the financial barriers that affect treatment continuation in individuals with opioid use disorder (OUD). Methods: In this qualitative study, seven semi-structured in-depth focus group interviews were conducted among 28 participants in treatment for OUD. Basic demographic information were collected in a pre-focus group survey. Focus group interviews were conducted from December 2021 to February 2022. A moderator guide was used to facilitate the discussion. Transcripts were managed using ATLAS.ti© v7. Data collected from the focus groups underwent deductive thematic analysis. Results: Data saturation was reached in 7 focus groups with a total of 28 participants (17 [60.7%] women; 27 [96.4%] white; 24 [85.7%] non-Hispanic). All three medications for OUD were represented (18 [64.3%] buprenorphine and naloxone, 5 [17.9%] methadone, 3 [10.7%] naltrexone, and 2 [7.1%] buprenorphine) and the time in treatment ranged from 1 month to over 36 months. Nearly all participants (27 [96.4%]) indicated a financial barrier that led to delayed treatment initiation and treatment retention. Two themes were identified from the focus group interviews: (1) OUD treatment-related financial burden- the direct and indirect cost associated with the treatment, and (2) psychosocial effects associated with the cost of OUD treatment -the mental, emotional, and social effects of the disease. Conclusions: Most participants described the desire and need for resources to offset the unaffordable cost that inhibits treatment initiation and retention. Further work is required to help identify individuals susceptible to financial barriers that can lead to early discontinuation in treatment. [ABSTRACT FROM AUTHOR]

Background: Section 1262 Consolidated Appropriations Act of 2023 eliminates the federal DATA waiver registration requirement to prescribe buprenorphine for opioid use disorder (OUD), along with patient limits, perhaps as a way to increase provider capacity to prescribe buprenorphine. Understanding the factors that influence provider capacity, patient access, and whether community need for MAT is met could inform how to capitalize on DATA waiver eliminations in the United States. Methods: This observational study utilized required reporting from two cohorts of the Rural Communities Opioid Response Program (RCORP). Consortia (N = 80) provided data on OUD/SUD-related services, service area information, consortium membership, and grant progress, including barriers to and facilitators of achievements. These data were combined with National Survey of Drug Use and Health (NSDUH) and U.S. Census Bureau's 2016−2020 American Community Survey (ACS) 5-Year Estimates Data to examine MAT capacity, access, and service area need. Results: A 79% increase in potential buprenorphine prescribers from 2019 to 2022 resulted in 1,060 rural providers with the ability to prescribe buprenorphine. The number of individuals who received MAT increased by 42% over the same three years, with over 20,000 individuals receiving MAT by the end of the funding period. While both capacity and access did increase, an additional 11,454 individuals could have potentially received buprenorphine if all waivered providers prescribed to a conservative patient limit of thirty patients. 70% of consortia provided MAT to at least 11.5% of their estimated service area need (national rate of MAT provision among individuals 18 years and older with an OUD), indicating unused MAT capacity was not related to lack of service area need. Provider (e.g., concerns of clinical complexity), patient (e.g., mistrust of the healthcare system), pharmacy (e.g., cost concerns), and pharmacist (e.g., stigma) barriers impacted MAT provision and availability. Conclusion: MAT treatment capacity is a necessary but not exclusive requirement for increasing access to MAT. Addressing the multi-faceted barriers to prescribing MAT, particularly buprenorphine, will be critical to ensure the Consolidated Appropriations Act of 2023 does in fact result in a larger workforce that actually prescribes buprenorphine and a pharmacy system that stocks these medications. [ABSTRACT FROM AUTHOR]

Background: Between 2012–2022 opioid-related overdose deaths in the United States, including Washington State, have risen dramatically. Opioid use disorder (OUD) is a complex, chronic, and criminalized illness with biological, environmental, and social causes. One-fifth of people with OUD have recent criminal-legal system involvement; > 50% pass through WA jails annually. Medications for Opioid Use Disorder (MOUD) can effectively treat OUD. WA has prioritized improving access to MOUD, including for those in jails. As patients in jail settings are systematically marginalized due to incarceration, it is critical to foster connections to MOUD services upon release, an acknowledged period of high overdose risk. Currently, there is insufficient focus on developing strategies to foster linkages between jail-based MOUD and referral services. The Systems Analysis and Improvement Approach (SAIA), an evidence-based implementation strategy, may optimize complex care cascades like MOUD provision and improve linkages between jail- and community-based providers. SAIA bundles systems engineering tools into an iterative process to guide care teams to visualize cascade drop-offs and prioritize steps for improvement; identify modifiable organization-level bottlenecks; and propose, implement, and evaluate modifications to overall cascade performance. The SAIA-MOUD study aims to strengthen the quality and continuity of MOUD care across jail and referral clinics in King County, WA, and ultimately reduce recidivism and mortality. Methods: We will conduct a quasi-experimental evaluation of SAIA effectiveness on improving MOUD care cascade quality and continuity for patients receiving care in jail and exiting to referral clinics; examine determinants of SAIA-MOUD adoption, implementation, and sustainment; and determine SAIA-MOUD's cost and cost-effectiveness. Clinic teams with study team support will deliver the SAIA-MOUD intervention at the jail-based MOUD program and three referral clinics over a two-year intensive phase, followed by a one-year sustainment phase where SAIA implementation will be led by King County Jail MOUD staff without study support to enable pragmatic evaluation of sustained implementation. Discussion: SAIA packages user-friendly systems engineering tools to guide decision-making by front-line care providers to identify low-cost, contextually appropriate health care improvement strategies. By integrating SAIA into MOUD care provision in jail and linked services, this pragmatic trial is designed to test a model for national scale-up. Trial registration: ClinicalTrials.gov NCT06593353 (registered 09/06/2024; https://register.clinicaltrials.gov/prs/beta/studies/S000EVJR00000029/recordSummary). [ABSTRACT FROM AUTHOR]

Background: US chiefs of police hold significant influence over the perceived acceptability and appropriateness of interventions for opioid use disorder (OUD) among the public, elected officials, and subordinate officers. This study assessed whether police chiefs' support for such interventions was sensitive to framing an intervention's benefits in terms that emphasize public health and harm reduction outcomes, versus terms typically indicative of public safety outcomes. Methods: A two-armed survey utilizing a randomized, between-subjects design tested framing-based variance in support among US chiefs of police for overdose prevention centers, syringe service programs (SSPs), Good Samaritan laws, police naloxone distribution, trustworthiness of officers in recovery from OUD, and related propositions. Of 1,200 invitations, 276 chiefs participated (23%). The two experimental arms (n = 133, n = 143) were demographically balanced between both each other and non-respondents. Results: Chiefs were more likely to agree that their mission was protecting public safety than protecting public health, even when both were defined using public health outcomes. Chiefs expressed significantly greater support for "overdose prevention sites" than "safe injection sites" (p =.018), low levels of support for SSPs regardless of framing (18% safety; 19% health), and comparably more support for Good Samaritan laws based on framing (62% safety vs. 54% health). Respondents voiced low levels of trust in officers recovering from OUD generally (31%), and significantly lower levels of trust when recovery involved the medication buprenorphine (10%; p <.001). Senior chiefs were significantly more likely to support SSPs (aOR 1.05; CI 1.01, 1.09) and overdose prevention sites (aOR 2.45; CI 1.13, 5.28) than less senior chiefs. Conclusions: In this cross-sectional survey experiment, support for some interventions for OUD was greater among US chiefs of police when framed to emphasize positive public safety outcomes. Research is required to better understand low support for SSPs, mistrust of officers in recovery for OUD, and greater support for OUD interventions among senior chiefs. [ABSTRACT FROM AUTHOR]

Highlights: Primary care clinic structures and operations may influence early MOUD discontinuation. Flexible scheduling can improve early MOUD retention but must be balanced with clinic efficiency. Multidisciplinary teams can improve retention but require additional resources. Addressing comorbid pain and polydrug use early in the treatment process can help prevent MOUD discontinuation. [ABSTRACT FROM AUTHOR]

Introduction: Receipt of medications for opioid use disorder (MOUD) critically reduces opioid-related mortality during the post-incarceration period. Optimal provision of this care to individuals on community supervision (i.e., probation) requires an understanding of this unique and complex system at the local level. Methods: We conducted in-depth individual interviews with key treatment providers and probation staff (n = 10) involved with the provision of MOUD to individuals on community supervision in the Northeast. Interviews explored perspectives on the provision of MOUD and support services during the community supervision period. Thematic analysis was conducted to describe inductive and deductive codes, subcodes, and themes. Results: Stakeholders shared diverse attitudes about the benefits and drawbacks of MOUD utilization. The provision of MOUD during the community supervision period was perceived to be influenced by both treatment and probation organizational characteristics, including the structures and values of the agencies. As such, the specific context of the community supervision setting facilitated and impeded MOUD delivery. Persistent challenges to enhancing MOUD delivery to this population remain including widespread MOUD stigma, inter-agency communication issues, and structural barriers to healthcare (i.e., transportation, finances). Conclusions: There are opportunities to enhance access to evidence-based OUD treatment for persons on community supervision by engaging probation agencies and community treatment staff in systems change. [ABSTRACT FROM AUTHOR]

Background/Objectives: As long-term prescription opioid use is associated with increased morbidity and mortality, timely dose reduction of prescription opioids should be considered. However, most research has been conducted on patients using heroin. Given the differences between prescription and illicit opioid use, the aim of this review was to provide an overview of pharmacological strategies to reduce prescription opioid use or improve clinical outcomes for people who experience long-term prescription opioid use, including those with opioid use disorder. Methods: We conducted a systematic database search of PubMed, Embase, CINAHL, and the Cochrane Library. Outcomes included dose reduction, treatment dropout, pain, addiction, and outcomes relating to quality of life (depression, functioning, quality of life). Results: We identified thirteen studies (eight randomized controlled trials and five observational studies). Pharmacological strategies were categorized into two categories: (1) deprescribing (tapering) opioids or (2) opioid agonist treatment (OAT) with long-acting opioids. Tapering strategies decreased opioid dosage and had mixed effects on pain and addiction. OAT with buprenorphine or methadone led to improvements in pain relief and quality of life, with a slight (non-significant) preference for methadone in terms of treatment retention (RR = 1.10 [CI: 0.89–1.37]) but not for other outcomes. Most studies had high dropout rates and a serious risk of bias. Conclusions: Tapering reduced prescription opioid doses had mixed effects on pain. OAT improved clinical outcomes without dose reduction. Based on our review findings, there is no clear preference for either tapering or OAT. Tapering may be considered first as it reduces dependency, tolerance, and side effects, but is associated with adverse events and not always feasible. OAT can be a suitable alternative. Non-pharmacological interventions may facilitate tapering. Further research is needed to identify novel pharmacological strategies to facilitate opioid tapering. Registration: PROSPERO 2022 CRD42022323468. [ABSTRACT FROM AUTHOR]

R-VK4-116 is currently being developed as a medication to treat opioid use disorder (OUD). To characterize in vitro safety properties of R-VK4-116, metabolic stability in hepatocytes or liver microsomes, metabolite identification, metabolism/transporter-mediated drug interactions, lysosomal perturbation, mitochondrial toxicity, off-target enzyme effects, cellular and nuclear receptor functional assays, electrophysiological assays, CiPA, KINOMEscanTM, plasma protein binding, phospholipidosis and steatosis assays were performed. Overall, R-VK4-116 was metabolically stable in hepatocytes and microsomes. Four major metabolites were detected: two mono-oxidation products, one di-oxidation product, and one demethylated plus di-oxidation product. CYP2D6 and CYP3A4 were major contributors in R-VK4-116 metabolism. Further, R-VK4-116 did not induce/inhibit CYP enzymes. However, R-VK4-116 inhibited BCRP/P-gp, and showed antagonist effects on α1A(h), H1(h) and agonist effect on hGABAA∞1β2γ2 at 10 μM. R-VK4-116 inhibited hERG and Kir2.1 at a high concentration of 100 μM. KINOMEscanTM provided 5 hits (CHEK2, HPK1, MARK3, SRPK2 and TNK1) with Kds of >10 μM. Further, R-VK4-116 was bound to human, rat and dog plasma proteins (~83–93%). R-VK4-116 did not induce lysosome perturbation, mitochondrial toxicity, phospholipidosis, or steatosis at ≤10 μM. These results demonstrated that R-VK4-116 possesses favorable in vitro safety properties and supports further development as a potential medication for OUD. [ABSTRACT FROM AUTHOR]

Background: The U.S. drug overdose epidemic is increasingly severe and steep increases have been seen among women. Objective: To explore trends in drug overdose deaths among women in the United States by race, ethnicity, and age group. Design: This study is a retrospective observational study of drug overdose deaths among U.S. women from 1999 to 2021. Methods: We use CDC WONDER Multiple Causes of Death files data using International Classification of Diseases, 10th Revision (ICD-10) codes X40–X44, X60–X64, X85, and Y10–Y14 to identify overall drug overdose deaths, T40.5 for cocaine-related deaths, T40.0–T40.4, T40.6 for opioid-related deaths, T42.4 for benzodiazepines, and T43.6 to identify psychostimulants. Race and ethnicity were defined as non-Hispanic Black, White, American Indian/Alaska Native (AI/AN), Asian, and Hispanic. We calculated overdose death rates per 100,000 women for all overdose deaths and for specific drugs by year, stratified by race and ethnicity. Results: From 1999 to 2021, overdose deaths among all women in the United States increased by 480%. Overdose deaths rose 750% for non-Hispanic AI/AN women, 490% for non-Hispanic Black women, 450% for non-Hispanic White women, 325% for Hispanic women, and 150% for non-Hispanic Asian or Pacific Islander women. Women ages 35–44 and 45–54 saw the largest increases in overall overdose deaths. Cocaine-related deaths were more prevalent among non-Hispanic Black women, opioid and methamphetamine-related deaths were more prevalent among non-Hispanic AI/AN women, and benzodiazepine-related deaths were more prevalent among non-Hispanic White women. Conclusion: Increases in overdose deaths were noted in all races, ethnicities, and age groups, with deaths continuing to accelerate in 2021. Our study highlights a need for interventions expanding access to medications for opioid use disorder, naloxone, fentanyl test strips, and contingency management while accounting for gendered roles and vulnerabilities. Plain language summary: Drug overdose deaths among women 1999–2021 in the United States: Differences by race/ethnicity and age Background: The U.S. drug overdose epidemic is increasingly severe and steep increases have been seen among women. The study aimed to explore trends in drug overdose deaths among women in the U.S. by race, ethnicity, and age group. From examining these differences, the researchers sought to offer insights to inform overdose prevention strategies for women who use drugs and face different treatment needs. Methods: We used CDC WONDER Multiple Causes of Death files data to identify drug overdose deaths overall and by type (cocaine-related, opioid-related, benzodiazepine-related, and psychostimulant-related) among U.S. women from 1999–2021. Race and ethnicity were defined as Non-Hispanic Black, White, American Indian/Alaska Native (AI/AN), Asian, and Hispanic. We calculated overdose death rates per 100,000 women for all overdose deaths and for specific drugs by year, grouped by race and ethnicity. Results: Increases in overdose deaths were noted in all races, ethnicities, and age groups, with deaths continuing to accelerate in 2021. Our findings were: Overdose deaths among all women in the United States increased by 480%. Specifically, overdose deaths rose by: 750% for Non-Hispanic AI/AN women 490% for Non-Hispanic Black women 450% for Non-Hispanic White women 325% for Hispanic women 150% for Non-Hispanic Asian or Pacific Islander women. Women ages 35–44 and 45–54 saw the largest increases in overall overdose deaths. Cocaine-related deaths were more prevalent among Non-Hispanic Black women. Opioid and methamphetamine-related deaths were more prevalent among Non-Hispanic AI/AN women. Benzodiazepine-related deaths were more prevalent among Non-Hispanic White women. Conclusions: Our study highlighted a need for interventions expanding access to medications for opioid use disorder (MOUD), naloxone, fentanyl test strips, and contingency management while taking roles and vulnerabilities specific to women into account. [ABSTRACT FROM AUTHOR]

Introduction: Opioid use disorder (OUD) is a serious and persistent problem in the United States with limited non-pharmacological treatment options, especially for the concomitant sleep disorders experienced by most individuals with addiction. While new, non-invasive interventions such as low-intensity focused ultrasound (LIFU) have shown promise in targeting the brain regions impacted throughout addiction and recovery, the devices used are not amenable to outpatient treatment in their current form factor and cannot be used at night during sleep. To bridge this gap and provide a much-needed treatment option for repeated, at-home use, we developed a wearable LIFU device out-of-clinic use. Methods: This study evaluated the feasibility and acceptability of the portable treatment device among individuals recovering from OUD in an unsupervised, at-home setting. 31 subjects were recruited from a Baltimore, Maryland (USA) outpatient treatment facility and, along with a separate group of 14 healthy controls (HC), were asked to wear a prototype EEG-only (non-LIFU) device for 7 consecutive nights to assess their willingness and adherence to nightly use. Participants used a smartphone application, TrialKit (ePRO), to self-report nightly sleep data (e.g. duration, quality, possible disturbances, and device comfort). Results: Of the 31 OUD participants recruited, 30 (97%) successfully completed the at-home study, and the majority responded that they would participate in future studies using the head wearable device (OUD, 87%; HC, 71%). OUD participants were statistically more likely than HCs to respond that they would consider using the device in the future to help them sleep (OUD, 70%; HC, 29%). Despite some participants facing technological issues (e.g. lack of reliable phone access or cellular data plans), the OUD group demonstrated high study compliance on par with the healthy control group. Discussion: Participant's daily ePRO and exit interview results established that at-home use of advanced treatment technology is feasible in a population group challenged with recovering from OUD. Even more so, numerous participants noted strong willingness to participate in future LIFU-enabled intervention studies to address their persistent sleep issues during recovery. [ABSTRACT FROM AUTHOR]

AbstractAsian Americans are highly underrepresented in opioid use research, despite recent studies demonstrating the presence of opioid use behaviors in Asian Americans and distinct negative outcomes of opioid use among Asian Americans in comparison to White adults. Emotional abuse and emotional neglect are important risk factors that may impact opioid use. Thus, the purpose of this study was to investigate (a) the associations between childhood emotional trauma (emotional abuse and emotional neglect) and opioid use, and (b) the role of distress intolerance as a moderator. 279 Asian American participants completed an online remote survey. Our findings revealed that childhood emotional abuse and emotional neglect were both significantly and positively associated with opioid use. We found that distress intolerance moderated the association between childhood emotional abuse and opioid use such that at low levels of emotional abuse, participants who exhibited greater distress intolerance displayed greater opioid use. These findings indicate that emotional abuse and neglect are specific forms of childhood trauma that are significantly associated with opioid use, perhaps as a maladaptive coping mechanism that capitalizes on the analgesic effects of opioids on the psychological pain from childhood emotional trauma. Additionally, marginalized populations that demonstrate distress intolerance may suffer negative health outcomes such as opioid use. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To determine how the rise of telehealth during the COVID‐19 pandemic impacted Medicaid enrollees' access to opioid use disorder (OUD) treatment.Electronic health records from Northwestern Medicine, a large midwestern academic health system, from January 1, 2019 to December 31, 2021.The exposure was the expansion of telehealth services during the COVID‐19 pandemic. A difference‐in‐differences design was used to determine the impact of telehealth on the probability of receiving any OUD care, any in‐person OUD care, and any telehealth OUD care in a month.The study included Medicaid and privately insured patients older than 18 years of age, diagnosed with OUD, who had any encounter with the Northwestern Medicine system. All outpatient visits with OUD as the primary diagnosis were included in the analysis. There were 486 individuals in the sample and 17,496 person‐month observations.After the onset of the COVID‐19 pandemic, Medicaid enrollees are 4.5 percentage points (percentage change, 43.7%; 95% confidence interval [CI] 8.7 to 0.3 percentage points; p = 0.035) less likely to receive any OUD care in a month, relative to privately insured patients. While no statistically significant differences in the likehood of receiving in‐person OUD care were detected between the groups after exposure, we did observe that Medicaid enrollees are 3.6 percentage points (percentage change 64.2%; 95% CI 6.0 to 1.1 percentage points; p = 0.004) less likely to receive any telehealth OUD care in a month relative to privately insured patients.While those with private insurance were able to maintain OUD treatment during the pandemic by supplementing in‐person care with telehealth, Medicaid enrollees experienced a drop in overall OUD treatment rates due to lower telehealth use. The rise of telehealth for OUD treatment might contribute to widening care gaps for Medicaid enrollees. [ABSTRACT FROM AUTHOR]

Background: Opioid misuse and addiction are at epidemic levels in the United States. Postoperative opioid prescription is inconsistent and often excessive, including for cesarean section patients. Technology, such as mobile applications and clinical decision support tools, can be used to decrease opioid use and misuse among patients, and to determine more appropriate prescribing practices for specific procedures. The objective of this study was to examine the preliminary impact of the Continuing Precision Medicine (CPM) mobile application to reduce the use of opioid pain medication among women who underwent cesarean section. The primary outcome is morphine milligram equivalents (MME), while the secondary outcomes will be delay to dosages, decrease of usage, and pain scores. Methods: Patients undergoing cesarean section were randomized to either a control group or an experimental group, which used the CPMRx mobile app to help manage postoperative pain. Logistic regression analyses were run to predict opioid misuse by group (control [electronic monitoring blister pack only] versus CPMRx [electronic monitoring blister pack plus mobile application]) and odds ratios (ORs) were calculated. Relative risk (RR) was also estimated by log-binomial regression. Results: In phase I, 105 patients were assessed for eligibility, however, 66 were excluded (not meeting criteria or declined to participate). In phase 2, 98 patients were assessed for eligibility, however, 48 were excluded for the aforementioned. Results of the logistic regression showed that opioid misuse differed significantly by group (χ2 = 7.27, p = 0.007) with participants in the CPMRx group experiencing a 92% reduction in odds of opioid misuse compared to blister packs only (OR = 0.08, p = 0.03). Relative risk estimation by log-binomial regression also revealed that patients in the control group were at 7 times higher risk of opioid misuse than those using the CPMRx app (Wald χ2 = 3.82, RR = 7.00, p = 0.05). Among the 21 participants in Phase I who did not misuse their prescription opioids, the average number of pills used was 2.7 (SD = 3.5); 95% of patients used 8 or fewer pills, 90% used 6 or fewer, 75% used 4 or fewer, and half of participants used 1 or fewer opioids. Conclusions: Women using the CPMRx mobile application were less likely to misuse their prescription opioids during the postoperative period following cesarean section. A prescription of 7 tablets of 5 mg oxycodone may be a more appropriate prescription size among this group. Systematically right-sizing prescriptions, including for subgroups, may decrease both patient- and community-level risk of opioid misuse and reduce public health burden. Trial registration: The study was registered at ClinicalTrials.gov (NCT05461196, 18/07/2022). [ABSTRACT FROM AUTHOR]

Background: Opioid-related overdose is a leading cause of death for criminal legal-involved individuals and, although naloxone distribution and medications for opioid use disorder (MOUD) are effective means for reducing post-release overdose death risk, jail-based availability is limited. This case report describes the challenges faced by three Ohio communities as they implemented evidence-based practices (EBPs) in jails to combat post-release opioid overdose deaths. Method: We present case examples of how barriers were overcome to implement jail-based EBPs in three Ohio communities (two urban and one rural) as part of the HEALing Communities Study (UM1DA049417; ClinicalTrials.gov Identifier: NCT04111939). Of the 18 participating Ohio HEALing Communities Study counties, we highlight 3 communities for the novelty of their EBPs implemented, the challenges that they faced, and their rural/urban status. We present descriptive data regarding the EBPs that they implemented and discuss the challenges identified by HEALing Communities Study staff with first-hand experience facilitating their implementation. Results: Newly implemented interventions included overdose education and direct provision of naloxone to incarcerated individuals upon release (2 of 3 communities), initiating MOUD prior to release (3 of 3), linkage to ongoing MOUD treatment in the community (2 of 3), peer support-facilitated treatment retention efforts (2 of 3) and emergency housing (1 of 3) in the immediate post-incarceration period. Common challenges that emerged included skepticism about the need and feasibility of implementing EBPs to reduce overdose and death, lack of knowledge about the options available and whether external agencies may assist, and difficulty engaging stakeholders to overcome inertia. Conclusions: Creative flexibility, calm persistence, technical facilitation, and collaboration with community service providers were assets that helped these Ohio jails implement evidence-based strategies that combat the opioid epidemic and reduce the likelihood of post-incarceration overdose and death in a high risk, formerly incarcerated population. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsDiscussionOpioid Use Disorder (OUD) often provokes dramatic consequences in terms of increased morbi-mortality. Two medications have mainly been worldwide used for OUD (MOUD), buprenorphine and methadone. Recently, however, some reports have highlighted the use of Morphine Sulfate (MS) mainly obtained without a prescription but used as MOUD by opioid users and especially People Who Inject Substances (PWIS). We propose to characterize the prevalence and distribution of MOUD and MS use in PWIS.This study examines the use of MOUD and MS amongst French PWIS recruited in harm reduction facilities and drug consumption rooms in the context of the COSINUS (Cohort to assess structural and individual factors in drug use) study.MOUD are prescribed, respectively, to one-third and one-fifth of PWIS, whereas a half of them declared MS consumption without prescription. MS users live with higher precariousness and are younger than non-users. MS is associated with salt cocaine and heroin use. It is often consumed with methadone and more rarely with buprenorphine and we hypothesized that this is probably linked to buprenorphine’s pharmacological antagonism.Our results show the high prevalence of MS consumption and highlight the importance of considering the highly restricted possibility of prescribing MS as MOUD. Its association with methadone raises the question of their synergistic action on craving and mental disorders. The profiles of opioid users who could benefit from MS with or without methadone must be examined to improve their care but with the utmost caution, given the risk of overdose. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is buprenorphine/naloxone associated with lower risk of treatment discontinuation and mortality compared with methadone? Findings: In this population-based retrospective cohort study that included 30 891 individuals initiating treatment for the first time during the study period, the risk of treatment discontinuation was higher among recipients of buprenorphine/naloxone compared with methadone (88.8% vs 81.5% within 24 months; adjusted hazard ratio, 1.58). The risk of mortality was low while in either form of treatment (0.08% vs 0.13%; adjusted hazard ratio, 0.57). Meaning: Individuals receiving methadone had a lower risk of treatment discontinuation compared with those who received buprenorphine/naloxone. The risk of mortality while receiving treatment was similar between medications. Importance: Previous studies on the comparative effectiveness between buprenorphine and methadone provided limited evidence on differences in treatment effects across key subgroups and were drawn from populations who use primarily heroin or prescription opioids, although fentanyl use is increasing across North America. Objective: To assess the risk of treatment discontinuation and mortality among individuals receiving buprenorphine/naloxone vs methadone for the treatment of opioid use disorder. Design, Setting, and Participants: Population-based retrospective cohort study using linked health administrative databases in British Columbia, Canada. The study included treatment recipients between January 1, 2010, and March 17, 2020, who were 18 years or older and not incarcerated, pregnant, or receiving palliative cancer care at initiation. Exposures: Receipt of buprenorphine/naloxone or methadone among incident (first-time) users and prevalent new users (including first and subsequent treatment attempts). Main Outcomes and Measures: Hazard ratios (HRs) with 95% compatibility (confidence) intervals were estimated for treatment discontinuation (lasting ≥5 days for methadone and ≥6 days for buprenorphine/naloxone) and all-cause mortality within 24 months using discrete-time survival models for comparisons of medications as assigned at initiation regardless of treatment adherence ("initiator") and received according to dosing guidelines (approximating per-protocol analysis). Results: A total of 30 891 incident users (39% receiving buprenorphine/naloxone; 66% male; median age, 33 [25th-75th, 26-43] years) were included in the initiator analysis and 25 614 in the per-protocol analysis. Incident users of buprenorphine/naloxone had a higher risk of treatment discontinuation compared with methadone in initiator analyses (88.8% vs 81.5% discontinued at 24 months; adjusted HR, 1.58 [95% CI, 1.53-1.63]), with limited change in estimates when evaluated at optimal dose in per-protocol analysis (42.1% vs 30.7%; adjusted HR, 1.67 [95% CI, 1.58-1.76]). Per-protocol analyses of mortality while receiving treatment exhibited ambiguous results among incident users (0.08% vs 0.13% mortality at 24 months; adjusted HR, 0.57 [95% CI, 0.24-1.35]) and among prevalent users (0.08% vs 0.09%; adjusted HR, 0.97 [95% CI, 0.54-1.73]). Results were consistent after the introduction of fentanyl and across patient subgroups and sensitivity analyses. Conclusions and Relevance: Receipt of methadone was associated with a lower risk of treatment discontinuation compared with buprenorphine/naloxone. The risk of mortality while receiving treatment was similar for buprenorphine/naloxone and methadone, although the CI estimate for the hazard ratio was wide. This population-based retrospective cohort study uses linked health administrative databases to assess the risk of treatment discontinuation and mortality among adults in British Columbia, Canada, receiving buprenorphine/naloxone vs methadone for the treatment of opioid use disorder. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Opioid use disorder (OUD) prevalence has increased threefold among Medicare beneficiaries 65 years and older (hereafter “older adults”) since 2013, with a prevalence of 15.7 per 1000 Medicare beneficiaries in 2018. Yet, access to treatment that addresses the needs of older adults with OUD is limited, including patterns of buprenorphine prescribing to older adults. Therefore, we sought to describe buprenorphine treatment patterns among older adults and prescribing clinician specialties.We conducted a retrospective observational study using 2019–2020 IQVIA Real World Data–Longitudinal Prescriptions. High‐prescribing clinicians are those who prescribed buprenorphine to >15 unique older adults within a calendar year. We used T‐test and chi‐square tests to compare characteristics associated with differences in prescribing.Among 26,202 clinicians prescribing buprenorphine to 67,921 unique older adults, 1232 (5%) prescribed to more than 15 older adults (mean 28.1, SD = 23.6), corresponding to buprenorphine prescribing for 24,672 (36%) older adults. Among older adults dispensed buprenorphine, the majority (58%) were 66–70 years of age and male (54%). Individuals older than 70 years (44%) and males (51%) were slightly more common among high prescribers than non‐high‐prescribing clinicians (41% and 49%, respectively). Primary care clinicians (42%) and advance practice providers (APPs) (29%) were the most common specialties prescribing buprenorphine. Most (87%) buprenorphine prescribers were in urban counties; with a slightly higher percentage of high‐prescribing clinicians in urban counties (91%).A relatively small subset of clinicians prescribes most buprenorphine to older adults. This work provides evidence of gaps in care delivery. Scalable systems‐level interventions should be developed and tested to improve treatment availability mindful of existing clinical infrastructure. [ABSTRACT FROM AUTHOR]

Background: The HEALing Communities Study (HCS) included health campaigns as part of a community-engaged intervention to reduce opioid-related overdose deaths in 67 highly impacted communities across Kentucky, Massachusetts, New York, and Ohio. Five campaigns were developed with community input to provide information on opioid use disorder (OUD) and overdose prevention, reduce stigma, and build demand for evidence-based practices (EBPs). An evaluation examined the recognition of campaign messages about naloxone and whether stigma and efficacy beliefs regarding OUD treatment and naloxone changed in HCS intervention communities. Methods: Data were collected through surveys offered on Facebook/Instagram to members of communities participating in the HCS intervention and wait-list control communities. Results: Participants in HCS intervention communities reported a reduction in stigma regarding OUD and increased efficacy beliefs regarding naloxone associated with recognition of campaign messages. However, this finding is cautiously interpreted as there was no clear evidence for recognition differences between the treatment/control conditions. Conclusion: Study findings indicate associations between campaign message recognition and positive outcomes. Results also highlight possible challenges concerning evaluations of social media campaigns using conventional evaluation techniques. Trial registration: ClinicalTrials.gov NCT04111939. [ABSTRACT FROM AUTHOR]

The article discusses the Quality Enhancement Research Initiative (QUERI) process used by the Department of Veterans Affairs (VA) to identify research priorities for chronic pain and opioid use disorder (OUD). The process involves steps such as identifying research gaps, gathering input from various stakeholders, finalizing priorities through an expert consensus panel, and integrating priorities into funding mechanisms. The application of the QUERI process helps align research efforts with clinical and organizational needs, ensuring that research supports health system needs in a timely manner. The process involves integrating knowledge from within the organization with external evidence and gathering feedback from multilevel partners and end users, including Veterans, to ensure that priorities are Veteran-centered. [Extracted from the article]

The article discusses the Quality Enhancement Research Initiative Rapid Response Teams within the Department of Veterans Affairs, which aim to address emerging health system challenges by aligning research with operational priorities. These interdisciplinary teams work to implement, evaluate, and improve programs and policies in a timely manner, supporting the VA's transformation into a Learning Health System. The Rapid Response Team process involves problem identification, subject matter expert review, matchmaking, development of a plan, implementation, and dissemination, ultimately aiming to bridge the gap between research and clinical practice in a large, integrated national health system. [Extracted from the article]

The article discusses the evolution of the Veterans Health Administration (VHA) as a learning health system over 25 years through the Quality Enhancement Research Initiative (QUERI) program. QUERI focuses on translating research into patient care and health systems improvement, initially targeting prevalent conditions among veterans. The program has expanded to address broader health system issues, implement evidence-based programs, and support evidence-based policymaking. QUERI's infrastructure has evolved to support rapid translation of research into practice, aligning with the VA's Strategic Plan and focusing on improving care access, quality, costs, equity, and experience. [Extracted from the article]

Objective: To assess the effectiveness of evidence‐based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings. Data Sources and Study Setting: We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data. Study Design: Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback. We established facility‐level interdisciplinary quality improvement (QI) teams and a regional‐level cross‐facility collaborative. We used a nonrandomized stepped wedge design with repeated cross sections to accommodate the phased implementation. Using aggregate facility‐level data from October 2015 to September 2022, we analyzed changes in patients receiving MOUD using hierarchical multiple logistic regression. Data Collection/Extraction Methods: Eligible patients had an opioid use disorder (OUD) diagnosis from an outpatient or inpatient visit in the previous year. Receiving MOUD was defined as having been prescribed an opioid agonist or antagonist treatment or a visit to an opioid substitution clinic. Principal Findings: The probability of patients with OUD receiving MOUD improved significantly over time for all eight facilities (average marginal effect [AME]: 0.0057, 95% CI: 0.0044, 0.0070) due to ongoing VHA initiatives, with the probability of receiving MOUD increasing by 0.577 percentage points, on average, each quarter, totaling 16 percentage points during the evaluation period. The seven facilities engaging in EBQI experienced, on average, an additional 5.25 percentage point increase in the probability of receiving MOUD (AME: 0.0525, 95%CI: 0.0280, 0.0769). EBQI duration was not associated with changes. Conclusions: EBQI was effective for expanding access to MOUD in nonspecialty settings, resulting in increases in patients receiving MOUD exceeding those associated with temporal trends. Additional research is needed due to recent MOUD expansion legislation. [ABSTRACT FROM AUTHOR]

Objective: To describe a learning health care system research process designed to increase buprenorphine prescribing for the treatment of opioid use disorder (OUD) in rural primary care settings within U.S. Department of Veterans Affairs (VA) treatment facilities. Data Sources and Study Setting: Using national administrative data from the VA Corporate Data Warehouse, we identified six rural VA health care systems that had improved their rate of buprenorphine prescribing within primary care from 2015 to 2020 (positive deviants). We conducted qualitative interviews with leaders, clinicians, and staff involved in buprenorphine prescribing within primary care from these sites to inform the design of an implementation strategy. Study Design: Qualitative interviews to inform implementation strategy development. Data Collection/Extraction Methods: Interviews were audio‐recorded, transcribed verbatim, and coded by a primary coder and secondary reviewer. Analysis utilized a mixed inductive/deductive approach. To develop an implementation strategy, we matched clinical needs identified within interviews with resources and strategies participants had utilized to address these needs in their own sites. Principal Findings: Interview participants (n = 30) identified key clinical needs and strategies for implementing buprenorphine in rural, primary care settings. Common suggestions included the need for clinical mentorship or a consult service, buprenorphine training, and educational resources. Building upon interview findings and in partnership with a clinical team, we developed an implementation strategy composed of an engaging case‐based training, an audit and feedback process, and educational resources (e.g., Buprenorphine Frequently Asked Questions, Rural Care Model Infographic). Conclusions: We describe a learning health care system research process that leveraged national administrative data, health care provider interviews, and clinical partnership to develop an implementation strategy to encourage buprenorphine prescribing in rural primary care settings. [ABSTRACT FROM AUTHOR]

Background: Pharmacists play a key role in combating the opioid-related overdose epidemic in the United States (US), but little is known about their experience and willingness to deliver preventive services for opioid use disorder (OUD). Aims: This study seeks to identify correlates of pharmacists' concerns about drug use problems (prescription drug misuse/use disorder and illicit drug use/use disorder) as well as their practice experience delivering preventive services for OUD (e.g., asked about opioid use, provided advice, made a referral) and willingness to provide services to patients with drug use problems. Design: An online survey of licensed US pharmacists was conducted. Participants were recruited from Community Pharmacy Enhanced Services Networks (CPESN) and state pharmacist associations (N = 1146). Findings: Overall, 75% of surveyed pharmacists indicated having concerns about opioid use problems, and 62% had concerns about non-opioid drug use problems at their pharmacies. Pharmacists who were White, practiced at a rural location, worked at a chain pharmacy, had not received opioid-related training in the past year, or practiced screening patients for opioid use had elevated odds of perceiving concerns about opioid use problems in their practice settings. Pharmacists who were White, practiced at a rural location, or had not received opioid-related training in the past year had elevated odds of perceiving concerns about non-opioid (illicit) drug use problems. Being male, being White, or having received opioid-related training were associated with increased odds of screening patients for opioid use problems. Being White, having practiced at a rural location (vs. an urban location), being a pharmacy owner/manager, or having received opioid-related training were associated with increased odds of delivering opioid-related advice/intervention. Being male or having received opioid-related training were associated with increased odds of making a referral to OUD treatment. Finally, being male, being White, having practiced pharmacy services for under 6 years, having received opioid-related training for 2 h in the past year, or having performed OUD-related preventive services (asked about opioid use, provided advice, or made a referral) were associated with increased levels of commitment/readiness for providing care to patients with drug use problems. Conclusions: The overall findings highlight pharmacists' involvement with OUD preventive services. It is critical to promote opioid-related preventive service training for pharmacists and provide incentives/tools to help initiate a structured practice of delivering such preventive services. [ABSTRACT FROM AUTHOR]