Substance abuse最新文献

{"title":"Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician.","authors":"Cara Zimmerman,&nbsp;Seth Clark,&nbsp;Michael E Guerra,&nbsp;Jeffrey Bratberg,&nbsp;Kathleen K Adams","doi":"10.1177/08897077231196417","DOIUrl":"https://doi.org/10.1177/08897077231196417","url":null,"abstract":"<p><p>Low dose buprenorphine initiation (LDBI) is a dosing strategy used to transition patients from full opioid agonists to buprenorphine. The purpose of LDBI is to circumvent obstacles associated with disruption in analgesia, precipitated withdrawal, and prerequisite opioid withdrawal prior to initiating buprenorphine, as not all patients are able to tolerate physical withdrawal symptoms recommended by national guidelines. No literature exists directly comparing traditional buprenorphine initiation to LDBI. Until information on long-term outcomes is available, these dosing strategies should be reserved for patients unable to tolerate traditional buprenorphine initiation. Available published research suggests LDBI strategies will allow some patients to successfully transition to buprenorphine with minimal or no symptoms of withdrawal. Ensuring access to pharmacotherapy during hospital admission is a crucial time for potential intervention and should be considered when appropriate. This narrative review discusses the background of LDBI strategies as well as practical clinical and operational considerations for the inpatient clinician.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 3","pages":"121-129"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Opioid Dose Reduction Rates and Overdose Among Patients Prescribed Long-Term Opioid Therapy.","authors":"Jason M Glanz, Stanley Xu, Komal J Narwaney, David L McClure, Deborah J Rinehart, Morgan A Ford, Anh P Nguyen, Ingrid A Binswanger","doi":"10.1177/08897077231186216","DOIUrl":"10.1177/08897077231186216","url":null,"abstract":"<p><strong>Background: </strong>Tapering long-term opioid therapy is an increasingly common practice, yet rapid opioid dose reductions may increase the risk of overdose. The objective of this study was to compare overdose risk following opioid dose reduction rates of ≤10%, 11% to 20%, 21% to 30%, and >30% per month to stable dosing.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study in three health systems in Colorado and Wisconsin. Participants were patients ≥18 years of age prescribed long-term opioid therapy between January 1, 2006, and June 30, 2019. Five opioid dosing patterns and drug overdoses (fatal and nonfatal) were identified using electronic health records, pharmacy records, and the National Death Index. Cox proportional hazard regression was conducted on a propensity score-weighted cohort to estimate adjusted hazard ratios (aHRs) for follow-up periods of 1, 3, 6, 9, and 12 months after a dose reduction.</p><p><strong>Results: </strong>In a cohort of 17 540 patients receiving long-term opioid therapy, 42.7% of patients experienced a dose reduction. Relative to stable dosing, a dose reduction rate of >30% was associated with an increased risk of overdose and the aHR estimates decreased as the follow-up increased; the aHRs for the 1-, 6- and 12-month follow-ups were 5.33 (95% CI, 1.98-14.34), 1.81 (95% CI,1.08-3.03), and 1.49 (95% CI, 0.97-2.27), respectively. The slower tapering rates were not associated with overdose risk.</p><p><strong>Conclusions: </strong>Patients receiving long-term opioid therapy exposed to dose reduction rates of >30% per month had increased overdose risk relative to patients exposed to stable dosing. Results support the use of slow dose reductions to minimize the risk of overdose.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"209-219"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10278644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce.","authors":"Matthew R Heerema, Alicia S Ventura, Samantha C Blakemore, Ivan D Montoya, Danna E Gobel, Mathew V Kiang, Colleen T LaBelle, Angela R Bazzi","doi":"10.1177/08897077231179601","DOIUrl":"10.1177/08897077231179601","url":null,"abstract":"<p><strong>Introduction: </strong>Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants.</p><p><strong>Methods: </strong>We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control.</p><p><strong>Results: </strong>Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points.</p><p><strong>Conclusions: </strong>NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"164-176"},"PeriodicalIF":2.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10688578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems.","authors":"Khadejah F Mahmoud,&nbsp;Deborah S Finnell,&nbsp;Susan M Sereika,&nbsp;Dawn Lindsay,&nbsp;Janet Cipkala-Gaffin,&nbsp;Ann M Mitchell","doi":"10.1177/08897077231186232","DOIUrl":"10.1177/08897077231186232","url":null,"abstract":"<p><strong>Background: </strong>There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems.</p><p><strong>Methods: </strong>A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems.</p><p><strong>Results: </strong>The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems.</p><p><strong>Conclusions: </strong>The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"146-153"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging National Data and Regional Innovations to Right-Size Tobacco Treatment Policy for Behavioral Health in a Midwestern State.","authors":"Nathalia Munck Machado,&nbsp;Rick Cagan,&nbsp;Babalola Faseru,&nbsp;Won S Choi,&nbsp;Andrew Brown,&nbsp;Ginny Chadwick,&nbsp;Ja'net Jackson,&nbsp;Kevin D Everett,&nbsp;Tristi Bond,&nbsp;Kimber Richter","doi":"10.1177/08897077231188239","DOIUrl":"10.1177/08897077231188239","url":null,"abstract":"<p><strong>Background: </strong>People with mental health (MH) and substance use disorders (SUD) have high rates of tobacco use and tobacco-related mortality. They want to stop smoking and studies have shown they can quit, but few behavioral health facilities provide tobacco treatment. The purpose of this paper is to describe how a midwestern statewide behavioral health collaboration used regional data to pinpoint strengths and weaknesses in tobacco treatment trends, identified policies in neighboring states that were associated with high rates of tobacco treatment, and worked with state leaders to implement these policies to enhance treatment.</p><p><strong>Methods: </strong>We used publicly available data from 2 SAMHSA annual national surveys of MH/SUD facilities to describe <b>tobacco treatment</b> services and policies in behavioral health facilities in Kansas and 3 neighboring states (Missouri, Nebraska and Oklahoma). We interviewed neighboring state leaders to identify policies they had implemented to boost tobacco recovery services in behavioral health. We collaborated with our state behavioral health agency to encourage adoption of similar policies.</p><p><strong>Results: </strong>Using 7 years of survey data (2014-2020), rates for screening, counseling, and medications for tobacco dependence were highest in Oklahoma and Missouri facilities. Oklahoma had the highest percentages of facilities reporting smoke-free campuses. In all states, rates of tobacco service provision and smoke-free campuses were lower among SUD facilities than in MH facilities. State leaders associated several policies with high performance, including (a) requiring programs contracting with the state to conduct screening, provide counseling, and adopt smoke-free campuses (Oklahoma and Missouri); (b) state-based collection of tobacco treatment service provision data (Oklahoma); (c) providing facilities with free NRT for clients (Oklahoma); (d) setting benchmarks for service provision (Oklahoma); (e) comprehensive Medicaid coverage of cessation medications (Missouri). Upon review of these findings, Kansas behavioral health officials adopted a 2-year process to implement similar policies and are integrating tobacco treatment requirements into the state Certified Community Behavioral Health Clinic program.</p><p><strong>Conclusions: </strong>Summarizing and sharing freely-available data across states laid the groundwork for cross-border networking and policy change. State and federal agencies should integrate these policies into contracts and block grants to reduce tobacco-related disparities among individuals with behavioral health conditions.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"235-240"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10226961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Patient-Reported Experiences with Opioid Use Disorder Treatment and Unmet Treatment Needs and Discontinuation Among Virginia Medicaid Members.","authors":"Sarah J Marks,&nbsp;Huyen Pham,&nbsp;Neil McCray,&nbsp;Jennifer Palazzolo,&nbsp;Ashley Harrell,&nbsp;Jason Lowe,&nbsp;Chethan Bachireddy,&nbsp;Lauren Guerra,&nbsp;Peter J Cunningham,&nbsp;Andrew J Barnes","doi":"10.1177/08897077231186218","DOIUrl":"10.1177/08897077231186218","url":null,"abstract":"<p><strong>Background: </strong>Many payers, including Medicaid, the largest payer of opioid use disorder (OUD) treatment, are pursuing treatment-related quality improvement initiatives. Yet, how patient-reported experiences with OUD treatment relate to patient-centered outcomes remains poorly understood.</p><p><strong>Aim: </strong>To examine associations between Medicaid members' OUD treatment experiences, outpatient treatment settings, demographic and social factors, and members' self-report of unmet needs during treatment and treatment discontinuation.</p><p><strong>Methods: </strong>A sample of Virginia Medicaid members aged 21 years or older with OUD diagnoses who received outpatient OUD treatment completed a mail survey between January 2020 and August 2021 (n = 1042, weighted n = 9244). A treatment experience index was constructed from responses to four items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) relating to feelings of involvement, safety, and respect and having treatment explained in an understandable way; two additional CAHPS items: \"given options for treatment\" and \"able to refuse treatment\" were also assessed. Weighted imputed logistic regressions tested adjusted associations between members' treatment experiences, demographic and social factors, and two outcomes capturing unmet needs during treatment and treatment discontinuation.</p><p><strong>Results: </strong>More positive scores on the treatment experiences index were associated with lower adjusted odds of reporting unmet needs during treatment (aOR: 0.52, 95% CI: 0.41-0.66) and discontinuation (aOR: 0.63, 95% CI: 0.47-0.79). Respondents with serious psychological distress had higher odds of reporting unmet needs during treatment (aOR: 1.69 95% CI: 1.14-2.51) and discontinuation (aOR: 1.84, 95% CI: 1.21-2.82), as did individuals with housing insecurity (unmet needs: (aOR: 1.65, 95% CI: 1.11-2.44); treatment discontinuation: (aOR: 1.56, 95% CI: 1.04-2.36)).</p><p><strong>Conclusion: </strong>Using a first-of-its-kind survey of Medicaid members with OUD, we found that members who had more positive treatment experiences were less likely to report unmet treatment needs and discontinue treatment. Care approaches focused on improving patient experience are critical to delivering effective, high-quality OUD treatment.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"196-208"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends in Buprenorphine Treatment for Opioid Use Disorder From 2007 to 2018.","authors":"Megan S Schuler, Brendan Saloner, Adam J Gordon, Andrew W Dick, Bradley D Stein","doi":"10.1177/08897077231179576","DOIUrl":"10.1177/08897077231179576","url":null,"abstract":"<p><strong>Background: </strong>Buprenorphine is a key medication to treat opioid use disorder (OUD). Since its approval in 2002, buprenorphine access has grown markedly, spurred by major federal and state policy changes. This study characterizes buprenorphine treatment episodes during 2007 to 2018 with respect to payer, provider specialty, and patient demographics.</p><p><strong>Methods: </strong>In this observational cohort study, IQVIA Real World pharmacy claims data were used to characterize trends in buprenorphine treatment episodes across four time periods: 2007-2009, 2010-2012, 2013-2015, and 2016-2018.</p><p><strong>Results: </strong>In total, we identified more than 4.1 million buprenorphine treatment episodes among 2 540 710 unique individuals. The number of episodes doubled from 652 994 in 2007-2009 to 1 331 980 in 2016-2018. Our findings indicate that the payer landscape changed dramatically, with the most pronounced growth observed for Medicaid (increased from 17% of episodes in 2007-2009 to 37% of episodes in 2016-2018), accompanied by relative declines for both commercial insurance (declined from 35 to 21%) and self-pay (declined from 27 to 11%). Adult primary care providers (PCPs) were the dominant prescribers throughout the study period. The number of episodes among adults older than 55 increased more than 3-fold from 2007-2009 to 2016-2018. In contrast, youth under age 18 experienced an absolute decline in buprenorphine treatment episodes. Buprenorphine episodes increased in length from 2007-2018, particularly among adults over age 45.</p><p><strong>Conclusions: </strong>Our findings demonstrate that the U.S. experienced clear growth in buprenorphine treatment-particularly for older adults and Medicaid beneficiaries-reflecting some key health policy and implementation success stories. Yet, since the prevalence of OUD and fatal overdose rate have also approximately doubled during this period, the observed growth in buprenorphine treatment did not demonstrably impact the pronounced treatment gap. To date, only a minority of individuals with OUD currently receive treatment, indicating continued need for systemic efforts to equitably improve treatment uptake.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"154-163"},"PeriodicalIF":2.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9632684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention.","authors":"Rachel Winograd, Zach Budesa, Devin Banks, Ryan Carpenter, Claire A Wood, Alex Duello, Paul Thater, Christine Smith","doi":"10.1177/08897077231186213","DOIUrl":"10.1177/08897077231186213","url":null,"abstract":"<p><strong>Background: </strong>Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a \"Medication First\" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients.</p><p><strong>Methods: </strong>This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions.</p><p><strong>Results: </strong>White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients.</p><p><strong>Conclusion: </strong>In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"184-195"},"PeriodicalIF":2.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10591854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis.","authors":"Sarah Casey,&nbsp;Susan Regan,&nbsp;Evan Gale,&nbsp;Zoe M Adams,&nbsp;Eugene Lambert,&nbsp;Faith O Omede,&nbsp;Sarah E Wakeman","doi":"10.1177/08897077231185655","DOIUrl":"10.1177/08897077231185655","url":null,"abstract":"<p><strong>Background: </strong>Outpatient methadone guidelines recommend starting at a low dose and titrating slowly. As fentanyl prevalence and opioid-related mortality increases, there is a need for individuals to rapidly achieve a therapeutic methadone dose. Hospitalization offers a monitored setting for methadone initiation, however dosing practices and safety are not well described.</p><p><strong>Methods: </strong>Retrospective, observational analysis of hospitalized patients with opioid use disorder seen by an inpatient addiction consult team in an academic medical center who were newly initiated on methadone between 2016 and 2022. We calculated initial daily dose, maximum daily dose, timing interval of dose escalation, whether patients were connected to an opioid treatment program (OTP) prior to discharge, whether adverse effects or safety events occurred during the hospitalization, and whether such events were definitely or probably related versus possibly related or unrelated to methadone.</p><p><strong>Results: </strong>One hundred twelve patients were included. The mean initial daily methadone dose administered was 32 mg (range: 10-90 mg). The mean maximum dose reached was 76.8 mg (range 30-165 mg). The mean number of days from initial to peak dose was 5.6 days (range 1-19 days). Overall, 30% of patients experienced a safety event, most commonly sedation. Only 4 safety events were deemed probably or definitely related to methadone. In regression analyses, there was no significant difference between starting doses among patients with or without sedation but there was a relationship between last dose and the likelihood of any possibly related event, with those ending at a dose of 100 mg or higher having a higher likelihood event, compared to those ending at lower doses (47.8% vs 12.4%, <i>P</i> < .001). Seventy-six percent were connected to OTP before discharge.</p><p><strong>Conclusion: </strong>Among hospitalized patients initiating methadone, rapid dose titration was infrequently associated with related safety events and most were connected to community-based methadone treatment before discharge.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":"44 3","pages":"177-183"},"PeriodicalIF":3.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will the End of the X-Waiver Expand Access to Buprenorphine Treatment? Achieving the Full Potential of the 2023 Consolidated Appropriations Act.","authors":"Brendan Saloner, Barbara Andraka-Christou, Bradley D Stein, Adam J Gordon","doi":"10.1177/08897077231186212","DOIUrl":"10.1177/08897077231186212","url":null,"abstract":"<p><p>The 2023 Consolidated Appropriations Act repealed the special waiver for prescribing buprenorphine to patients with opioid use disorder, a bipartisan goal long sought by advocates. The change has symbolic importance in recognizing that buprenorphine is a mainstream medical treatment. We argue that the maximum potential of the law can be achieved by addressing three bottlenecks. First, it is important that new training requirements for all controlled substances prescribers be grounded in scientific principles of addiction treatment and are robustly evaluated to ensure they meet quality standards. Second, even with the elimination of the waiver, there are potential constraints from state law such as state-specific requirements that practitioners require counseling or obtain a separate credential, and many states also have limiting scope of practice regulations. We recommend that these requirements are eased wherever possible to improve treatment access. Third, it is critical to build onramps to treatment in settings such as primary care, hospitals, and correctional facilities. While we anticipate that buprenorphine prescribing will primarily occur in high-volume practices, there is the potential to activate a broader workforce to serve as entry points to care. We conclude that the stage is set for significant increases in lifesaving treatment but the difficult task ahead is ensuring that the resources and training are available to build strong capacity.</p>","PeriodicalId":22108,"journal":{"name":"Substance abuse","volume":" ","pages":"108-111"},"PeriodicalIF":2.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10719867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}