International Journal of Drug Policy最新文献

{"title":"Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada","authors":"Nadine Kronfli ,&nbsp;Andrea Mambro ,&nbsp;Lindsey R. Riback ,&nbsp;David Ortiz-Paredes ,&nbsp;Camille Dussault ,&nbsp;Sylvie Chalifoux ,&nbsp;Lina del Balso ,&nbsp;Apostolia Petropoulos ,&nbsp;Mona Lim ,&nbsp;Alexandros Halavrezos ,&nbsp;Giada Sebastiani ,&nbsp;Marina B. Klein ,&nbsp;Bertrand Lebouche ,&nbsp;Joseph Cox ,&nbsp;Matthew J. Akiyama","doi":"10.1016/j.drugpo.2024.104624","DOIUrl":"10.1016/j.drugpo.2024.104624","url":null,"abstract":"<div><h3>Background</h3><div>Patient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison.</div></div><div><h3>Methods</h3><div>Ten semi-structured interviews were conducted with adult (age ≥18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach.</div></div><div><h3>Results</h3><div>The median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator.</div></div><div><h3>Conclusions</h3><div>Interventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104624"},"PeriodicalIF":4.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slamsex as slow edgework: Sexualized drug use and harm reduction in post-AIDS Taiwan","authors":"Poyao Huang","doi":"10.1016/j.drugpo.2024.104613","DOIUrl":"10.1016/j.drugpo.2024.104613","url":null,"abstract":"<div><h3>Background</h3><div>Since the mid-2010s, slamsex—sexualized drug use involving intravenously injecting meth—has rapidly emerged in metropolitan gay communities as a sociosexual practice necessitating harm reduction interventions. However, its impact on gay men's sociosexual lives and HIV technologies is not well understood. This paper addresses this gap by investigating two intertwined temporal dimensions of slamsex, viewing it as a form of <em>slow edgework</em> in post-AIDS Taiwan.</div></div><div><h3>Methods</h3><div>Ethnographic research was conducted in Taiwan between 2022 and 2024, involving 30 interviews with gay men who practice slamsex and 7 HIV/AIDS NGO representatives. Semi-structured interviews focused on slamming events, covering their edge, transition, and healthcare network.</div></div><div><h3>Results</h3><div>Findings reveal paradoxes within edgework, demonstrating that slamsex can be both extreme and risky, as well as slow and mundane. Participants navigated state surveillance and the materiality of syringes through meticulous risk calculations and digital-savvy strategies for acquiring clean syringes. The practice involved risk and a networked economy of care services provided by other injectors. In response to HIV technologies (PrEP and viral load disclosure), gay men in this study normalized HIV/AIDS while developing a sense of vulnerability to their own infection.</div></div><div><h3>Conclusion</h3><div>In the era of HIV/AIDS normalization, slamsex as slow edgework underscores the need for temporally and spatially nuanced discussions on drug policy. This study highlights the importance of culturally tailored interventions that consider slow, networked interactions to provide harm reduction for men on the chemsex scene, as well as the needs for more evidence-based, non-discriminatory research on queer sexual health and drug studies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104613"},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historic and current achievements of the temperance movement in the control of alcohol and its adverse health consequences","authors":"David Dunt ,&nbsp;Heng Jiang ,&nbsp;Robin Room","doi":"10.1016/j.drugpo.2024.104608","DOIUrl":"10.1016/j.drugpo.2024.104608","url":null,"abstract":"<div><h3>Setting</h3><div>The study aims to assess firstly, the historical (pre-2000) achievements in the control of alcohol and its adverse health consequences in the nine developed countries with mass temperance movements. Currently (post-2000), it looks at achievements in developed countries more generally, including these nine countries.</div></div><div><h3>Methods</h3><div>The study is a policy analysis conducted within an historical timeframe. This principally involves the historical impacts on government schemes regulating alcohol as well as individual alcohol consumption and its consequences. Trends since 2000 in alcohol consumption in young people in high-income temperance cultures are also examined.</div></div><div><h3>Results and conclusion</h3><div>Substantial alcohol-related public health impacts have occurred in almost all of the nine countries, either on relevant government schemes and/or individual alcohol consumption. Regarding government schemes, five of the nine temperance countries, and in part a sixth (the US), retain government store monopoly systems, offering heavily-taxed spirits with limits on their accessibility. Impacts on individual consumption in these countries, where studied, were positive. Consumption in young people since 2000 in high income countries is lower in temperance than non-temperance countries.</div><div>It is concluded that temperance culture has had substantial and enduring governmental and individual public health impacts relating to alcohol consumption.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104608"},"PeriodicalIF":4.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do relational practices co-constitute care for people who use drugs? The social and political dimensions of peer-led harm reduction","authors":"Timothy Piatkowski ,&nbsp;Kate Seear ,&nbsp;Steph Reeve ,&nbsp;Emma Kill","doi":"10.1016/j.drugpo.2024.104614","DOIUrl":"10.1016/j.drugpo.2024.104614","url":null,"abstract":"<div><h3>Introduction</h3><div>People who use drugs have a long history of mobilising to reduce harm within their communities, significantly influencing harm reduction efforts globally. Peers with lived experience contribute through needle exchange programs, harm reduction education, and community-based research. Despite facing stigma, their initiatives have generated multiple benefits for communities. Collaborations between peers and researchers are increasingly recognised, emphasising meaningful participation in decisions affecting their lives. This paper focuses on the role of peers in mitigating drug-related risks and harms through community care.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 30 people who use drugs, exploring peer support and harm reduction. Data were analysed by the lead author and a coding framework was developed in which key theme-categories were organised. Theoretical framing from science and technology studies informed analysis, recognising the political dimensions of research.</div></div><div><h3>Results</h3><div>Peers play a crucial role in bridging gaps in formal services, offering stigma-free, relational care spaces. These spaces, both physical and social, affirm dignity and solidarity, countering marginalisation. Participants highlight the importance of peer involvement in driving change, promoting safer use practices, and advocating for a holistic harm reduction approach that considers systemic factors.</div></div><div><h3>Conclusions</h3><div>Our data highlight the vital role of peer connections and peer-led harm reduction practices in fostering safety, solidarity, and connection among communities of people who use drugs. Future research should continue to explore peer-led initiatives within evolving healthcare contexts, considering broader social dynamics and employing innovative conceptual frameworks to promote equitable peer-led harm reduction strategies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Züri Can study: Can regulated cannabis sales promote lower-risk cannabis use? Mini-review and study protocol","authors":"Maximilian Buschner,&nbsp;Nadine Heckel,&nbsp;Patricia Dürler,&nbsp;Etna J․ E. Engeli,&nbsp;Sophie Schneider,&nbsp;Eva M. Havelka,&nbsp;Carlos Nordt,&nbsp;Marcus Herdener","doi":"10.1016/j.drugpo.2024.104610","DOIUrl":"10.1016/j.drugpo.2024.104610","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Recreational use of cannabis is illegal in most countries. Despite this, it is the third most commonly used psychoactive substance worldwide. As a result of this discrepancy, a growing number of countries have begun to reassess their legal approach to cannabis in recent years. While the health risks of cannabis and potential harm reduction measures are increasingly well understood, there are still significant gaps in knowledge about which regulatory and supply models are effective in promoting lower-risk cannabis use.</div><div>In this paper, we outline the Züri Can study, which implements and evaluates a regulatory framework for cannabis sales in the city of Zurich, Switzerland, between 2023 and 2026. In addition, we illustrate how the study addresses current knowledge gaps to provide further insight into the potential future regulation of cannabis in Switzerland.</div><div>To embed the study in the present scientific and political context, we first provide a brief overview of the state of knowledge on cannabis-related health risks and means of reducing them, along with lessons learned from other countries that have implemented varying regulatory systems.</div></div><div><h3>Design and Measurements</h3><div>2,100 participants will be able to legally purchase cannabis either at a pharmacy, a cannabis social club, or the municipal drug information center over a three-year period. As part of this observational study, participants will be evaluated regarding their cannabis use habits and motives, their knowledge of lower-risk use, and their mental and physical health, among other parameters.</div><div>Established harm reduction strategies are implemented as an integral part of the study design.</div></div><div><h3>Comments</h3><div>The study will contribute to a better understanding of the impact of different cannabis distribution models on cannabis use patterns and related health outcomes. The results are expected to assist Swiss and international policy makers in developing evidence-based and public health-oriented regulatory frameworks for cannabis.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104610"},"PeriodicalIF":4.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in alcohol expenditure among risky drinkers: A population study in England, 2014–2023","authors":"Sarah Jackson ,&nbsp;Melissa Oldham ,&nbsp;Colin Angus ,&nbsp;Claire Garnett ,&nbsp;Luke Wilson ,&nbsp;John Holmes ,&nbsp;Jamie Brown","doi":"10.1016/j.drugpo.2024.104615","DOIUrl":"10.1016/j.drugpo.2024.104615","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to estimate time trends in alcohol expenditure among risky drinkers in England over the past decade, to understand whether these trends are driven by changes in prices paid or volumes purchased, and to explore differences between population subgroups.</div></div><div><h3>Methods</h3><div>Nationally-representative monthly cross-sectional survey. Participants were 44,382 adults (≥18y) drinking at risky levels (AUDIT-C ≥ 5; ‘risky drinkers’). Linear regression modelled trends between March-2014 and October-2023 in (i) mean weekly inflation-adjusted expenditure on alcohol, (ii) mean weekly alcohol consumption in units, and (iii) mean inflation-adjusted expenditure per unit of alcohol, overall and by age, gender, social grade, region, and smoking status.</div></div><div><h3>Results</h3><div>There was an uncertain decrease in mean weekly expenditure from £18.90 [95 %CI=£18.30-£19.50] in March-2014 to £17.90 [£17.60-£18.30] in May-2016, then an uncertain increase to £18.60 [£18.30-£18.90] between May-2016 and June-2018. This was followed by a further decline to £16.90 [£16.60-£17.30] by April-2021 and subsequent rise to £18.60 [£17.90-£19.40] by October-2023. Changes in weekly alcohol expenditure were more closely mirrored by changes in mean expenditure per unit of alcohol than by changes in mean weekly alcohol consumption in units. Notable subgroup differences included sharp rises in weekly alcohol expenditure since 2021 among younger ages (driven by a rise in expenditure per unit of alcohol) and current smokers (driven by a rise in weekly units of alcohol consumed).</div></div><div><h3>Conclusions</h3><div>In England, the average amount adult risky drinkers reported spending on alcohol each week has fluctuated since 2014, with a notable decrease around the start of the COVID-19 pandemic in 2020 and a subsequent rise since restrictions were lifted and since the cost-of-living crisis has led to high rates of inflation. Except for current smokers, this pattern appears to have been driven predominantly by changes in the price paid per unit rather than changes in consumption.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104615"},"PeriodicalIF":4.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of misuse and symptoms of dependence among people who use gabapentinoids: A qualitative systematic review","authors":"Amy G. McNeilage ,&nbsp;Alison Sim ,&nbsp;Suzanne Nielsen ,&nbsp;Bridin Murnion ,&nbsp;Claire E. Ashton-James","doi":"10.1016/j.drugpo.2024.104605","DOIUrl":"10.1016/j.drugpo.2024.104605","url":null,"abstract":"<div><h3>Background</h3><div>Gabapentinoids are among the most widely prescribed pain medications worldwide. However, there is growing evidence of harms associated with their use. The aim of this study was to systematically review and synthesise qualitative research exploring lived experiences of gabapentinoid (pregabalin and/or gabapentin) misuse and symptoms of dependence.</div></div><div><h3>Methods</h3><div>Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) and grey literature sources were searched from inception to September 2023. The methodological quality of included studies was appraised using a modified 11-item version of the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies were prioritised in the thematic synthesis. Confidence in the overall findings of the review was assessed using the GRADE-CERQual approach. The review was prospectively registered on PROSPERO (CRD42023401832).</div></div><div><h3>Results</h3><div>Twenty-six articles representing 21 original studies were included. The majority used interview methods and were of high methodological quality. Motives for gabapentinoid misuse included getting high, potentiating or offsetting the effects of other drugs, self-medicating for pain, distress, insomnia, or withdrawal symptoms, and substituting for another drug. Symptoms of dependence included the rapid development of tolerance and a severe withdrawal syndrome often involving psychiatric symptoms. Harms including dissociation, loss of consciousness, and overdose were generally reported as a consequence of polysubstance use. Confidence in most of the review findings was moderate with low confidence in one finding.</div></div><div><h3>Conclusion</h3><div>This review provides rich qualitative insights into the potential motives for gabapentinoid misuse as well as the diverse lived experiences of dependence symptomatology. Considering the increasing prescribing of these medications globally, and the potential for public health challenges resulting from misuse, the findings of this review can be used to develop more effective harm reduction strategies.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104605"},"PeriodicalIF":4.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychomodulatory substances: New legislative framework for control of psychoactive substances in Czechia","authors":"Viktor Mravčík ,&nbsp;Jana Michailidu ,&nbsp;Petr Pleva ,&nbsp;Matyáš Lucký ,&nbsp;Lucia Kiššová ,&nbsp;Jindřich Vobořil","doi":"10.1016/j.drugpo.2024.104603","DOIUrl":"10.1016/j.drugpo.2024.104603","url":null,"abstract":"<div><div>This article challenges drug prohibition advocated by UN conventions as the prevailing regulatory model for psychoactive substances, highlighting its ineffectiveness, harmfulness and outdated nature. At the same time, the conventions exclude some psychoactive substances from international regulation, leaving control to individual countries. Presenting an innovative approach, this article outlines an approach to the legal regulation of psychomodulatory substances (psychoactive substances with low health and societal risk) in non-medical contexts. Acknowledging the potential benefits of such psychoactive substances and balancing them with potential harms, it suggests stringent rules for marketing, safety, and preventing sales to minors. This approach aims to quell illicit markets, safeguard vulnerable populations, and encourage controlled use. Through a case study of the Czech Republicʼs introduction of a new category of psychomodulatory substances, this article showcases a paradigm shift from the prevailing repressive approach to drug regulation. This adaptive model effectively navigates the regulatory void, offering a viable alternative to the UNʼs prohibition framework.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104603"},"PeriodicalIF":4.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of health utility in cost-utility analysis: A systematic review in substance use disorders","authors":"Anh Dam Tran ,&nbsp;Xin Zhan ,&nbsp;Annaëlle Vinzent ,&nbsp;Lorelie Flood ,&nbsp;Tian Bai ,&nbsp;Erinn Gallagher ,&nbsp;Gregory S. Zaric","doi":"10.1016/j.drugpo.2024.104570","DOIUrl":"10.1016/j.drugpo.2024.104570","url":null,"abstract":"<div><h3>Background and aim</h3><div>We aim to identify within-trial and modelled Cost-Utility Analysis (CUA) in substance use disorders (SUD) and review the applicability assessment associated with health utility used in modelled CUA.</div></div><div><h3>Study design and methods</h3><div>We searched Medline, Embase, EconLit and the Pharmaceutical Benefits Advisory Committee (PBAC) databases. A global systematic literature search was undertaken to determine the CUA of SUD interventions. Key characteristics of the studies and use of health utility were described. The applicability assessment associated with health utility used in modelled CUA was reviewed using The Health Utility Application Tool (HAT).</div></div><div><h3>Results</h3><div>The final review retrieved 49 CUA (14 within-trial and 35 modelled CUA). Three major health utility measurements were used - standard gamble, EQ-5D-5L and SF-6D. EQ-5D-5L was mainly used in within-trial CUA, whereas standard gamble, EQ-5D-5L and SF-6D were equally cited in modelled CUA and within-trial CUA. Twenty-nine articles using modelled CUA citing health utilities from published literature were assessed. Only half and one-third of CUA studies described the type of quality-of-life measure and value sets used in health utility studies, respectively. Only two-thirds showed the authors addressed questions about the similarities in clinical conditions, and health state description between health utility studies and economic evaluation studies.</div></div><div><h3>Conclusion</h3><div>Justifications for chosen health utilities in modelled CUA studies were mostly absent in SUD. We suggested health economists use the HAT to make judgements when assessing health utility from published estimates. The use of this tool will increase the reliability of economic evaluation carried out to assist government and policymakers in making informed decisions around health topics.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104570"},"PeriodicalIF":4.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access and care for people with opioid use disorder in U.S. skilled nursing facilities: A policy commentary","authors":"Shivani Nishar ,&nbsp;Jon Soske ,&nbsp;Rahul Vanjani ,&nbsp;Simeon D. Kimmel ,&nbsp;Corinne Roma ,&nbsp;Patience M. Dow","doi":"10.1016/j.drugpo.2024.104607","DOIUrl":"10.1016/j.drugpo.2024.104607","url":null,"abstract":"<div><div>Referrals for people with opioid use disorder (OUD) to skilled nursing facilities (SNFs) are increasing in the United States (U.S.). Further, legal guidance from the U.S. Department of Justice states that people with OUD cannot be discriminated against by health care institutions because of OUD or treatment with medications for OUD (MOUD). As such, SNFs are an important touchpoint for initiating or continuing MOUD, particularly amid rising drug-related overdose deaths among older adults and because people with OUD experience frailty and other geriatric syndromes at younger chronological ages. Informed by research, clinical expertise, and lived experience, this commentary describes policy and practice opportunities to help address challenges faced by people with OUD in gaining access to care and MOUD in SNFs. We propose opportunities to intervene against barriers that impede SNF placement and access to MOUD for people with OUD, including further revisions to 42 CFR Part 8 regulations to extend waivers for certification as opioid treatment programs (OTPs) to SNFs, allowing them to administer and dispense methadone in the same way as hospitals. If passed, proposed federal changes under the Modernizing Opioid Treatment Act would eliminate the requirement for methadone to be dispensed through OTPs, offering another opportunity to improve access to methadone for SNF residents. Also, we propose national and state-level investment in mobile substance use disorder services and partnerships with OTPs and hospital-based addiction consult services. We also recognize the need for more compassionate attitudes toward people with OUD in healthcare settings and discuss opportunities to address stigma. Although people with OUD are referred to SNFs for skilled care needs and not specifically for OUD care, it is essential for SNFs to be prepared to continue MOUD. It is both legally mandated and imperative that people with OUD have access to high quality and equitable SNF care.</div></div>","PeriodicalId":48364,"journal":{"name":"International Journal of Drug Policy","volume":"133 ","pages":"Article 104607"},"PeriodicalIF":4.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}