Journal of substance use and addiction treatment最新文献

{"title":"Clinical decision support as an implementation strategy to expand identification and administration of treatment of opioid use disorder in the emergency department","authors":"Jacob A. Lebin ,&nbsp;Stuart Sommers ,&nbsp;Zhixin Lun ,&nbsp;Colin Hensen ,&nbsp;Jason A. Hoppe","doi":"10.1016/j.josat.2025.209653","DOIUrl":"10.1016/j.josat.2025.209653","url":null,"abstract":"<div><h3>Introduction</h3><div>US opioid overdoses and deaths continue to increase, despite historic national investment to mitigate risk and improve access to evidence-based treatment. Unfortunately, implementation of emergency department (ED) buprenorphine – an effective medical treatment for opioid use disorder (OUD) – has been limited. Our objective was to assess the effectiveness of an electronic health record (EHR)-integrated, interruptive clinical decision support (CDS) tool to improve rates of ED initiated OUD treatment.</div></div><div><h3>Methods</h3><div>This is an observational, pre-post study of a CDS tool designed to identify and facilitate treatment of patients with OUD using electronic health record data. Patients were included if treated at our urban, academic ED between May 1, 2022, and November 8, 2023. The CDS triggered based on a rules-based algorithm using routinely collected EHR data which were identified from a previously validated EHR OUD phenotype. Outcomes are organized under a modified RE-AIM framework, with the primary outcome, Effectiveness, measured by the proportion of OUD patients receiving buprenorphine (administered/prescribed; filled prescriptions). Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Chi Square tests and Bayesian structural time-series models evaluate differences in outcomes before and after CDS implementation (CausalImpact package v1.3.0 in R v4.4.0).</div></div><div><h3>Results</h3><div>There were 171,221 total ED visits during the study period. Patient characteristics before and after CDS implementation were similar. CDS triggered in 4.7 % (2754/58,173) of encounters after initiation of intervention, reaching 116 unique emergency medicine providers and 2566 ED patients. Clinicians adopted the CDS, accessing the OUD treatment pathway link or ordering a social work consult for substance use, in 27 % (1266/4746) of CDS alerts. When compared to the pre-implementation period, CDS implementation was associated with increased buprenorphine administration in the ED by 31 % (95 % CI: 16–47 %, <em>p</em> = 0.001), buprenorphine prescribing from the ED by 20 % (95 % CI: 5–38 %, <em>p</em> = 0.007), and the buprenorphine fill rate at an affiliated ED pharmacy by 17 % (95 % CI: 1–36 %, <em>p</em> = 0.017).</div></div><div><h3>Conclusions</h3><div>Implementation of an EHR-integrated, CDS was associated with increased ED buprenorphine administration, prescribing, and prescription fills among ED patients with OUD. Further efforts are needed to assess maintenance strategies that improve adoption, minimize interruptiveness, and optimize workflow congruence.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209653"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparations for rave music parties and consequences for attendees who consume psychedelic drugs","authors":"Yula Milshteyn,&nbsp;Moshe Bensimon","doi":"10.1016/j.josat.2025.209637","DOIUrl":"10.1016/j.josat.2025.209637","url":null,"abstract":"<div><h3>Introduction</h3><div>A few studies have shown that rave music parties (RMP) enabled long-term positive transformative experiences. However, phenomenological inquiry on the subjective meaning of RMP attendees' experience before and after such parties is scant. The present study explored the preparations for participation in RMP and the parties' consequences for attendees who consume psychedelic drugs.</div></div><div><h3>Method</h3><div>The study used interpretative phenomenological analysis to analyze transcriptions of semi-structured interviews with 27 Israeli rave party attendees.</div></div><div><h3>Results</h3><div>The study found five themes regarding attendees' preparations for RMP: physical preparations; anticipation and body sensations; cognitive preparations; social preparations; and logistic preparations. Four themes relate to the attendees' experienced consequences after RMP: physical consequences; emotional consequences; cognitive effects; and positive social consequences.</div></div><div><h3>Conclusions</h3><div>In light of liminality and rite of passage theories, the study highlights the importance of the pre-liminal rites of separation, including physical preparations, anticipation and body sensations, and cognitive, social and logistic preparations. The consequences after the party correspond to the post-liminal stage where the participants return to their normal life, yet with changes in physical, emotional, cognitive, and social aspects. Israeli policymakers should consider adopting European drug-checking policy as a harm reduction measure to minimize negative consequences of drug use in the pre-liminal and post-liminal stages of RMP.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209637"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploration of the multi-level barriers to scaling up methadone for HIV prevention among people who inject drugs in Kazakhstan","authors":"Amanda R. Liberman ,&nbsp;Yelena Rozental ,&nbsp;Roman Ivasiy ,&nbsp;Ainur Zh. Kussainova ,&nbsp;Sholpan Primbetova ,&nbsp;Lynn M. Madden ,&nbsp;Assel Terlikbayeva ,&nbsp;Frederick L. Altice","doi":"10.1016/j.josat.2025.209640","DOIUrl":"10.1016/j.josat.2025.209640","url":null,"abstract":"<div><h3>Introduction</h3><div>Kazakhstan's HIV epidemic is concentrated among key populations like people who inject drugs (PWID), with a prevalence of at least 7.6 %. Opioid agonist therapies like methadone are the most effective treatment for opioid use disorder and HIV prevention in PWID. Despite methadone being free in Kazakhstan since 2008, coverage has remained at &lt;0.5 % of those in need. This study explored barriers and solutions for methadone scaleup.</div></div><div><h3>Methods</h3><div>Using the Exploration-Preparation-Implementation-Sustainment framework, the research team explored barriers to methadone scaleup at the client, clinic, community, and policy levels. The study used nominal group technique (NGT) to assess PWID clients on methadone (N = 30, mean age 45.9, 73 % male) and not on methadone (N = 31, mean age 45.8, 74 % male), along with narcologists (N = 13, mean age 42.3, 46 % male) and community health workers (CHWs, N = 6, mean age 45.7, 17 % male) in four cities in Kazakhstan. In-depth interviews were conducted with methadone clinic directors (N = 4) and policymakers (N = 4). NGT, a mixed-methods focus group, produced rank-ordered lists that researchers analyzed across groups. Researchers conducted interviews in Russian, coded them thematically, and aligned barriers within the socioecological model to prioritize implementation opportunities.</div></div><div><h3>Results</h3><div>For clients, the top barriers to methadone scaleup were concerns about methadone safety (i.e., the belief that methadone was more harmful than heroin) (24 %), restrictive eligibility and program entry/retention requirements (18 %), and limited accessibility (18 %), although these barriers differed by those on and not on methadone. Narcologists and CHWs identified lack of accurate information about methadone as the largest barrier (35 %), with restrictive eligibility (21 %) and accessibility (11 %) also important. CHWs also noted a lack of alternative medications to methadone. For solutions, clients prioritized more flexible dosing of medications while clinicians prioritized easing treatment entry and engagement requirements.</div></div><div><h3>Conclusions</h3><div>Clients and clinicians viewed the program differently, underscoring the need to better understand the customer so that clinicians can improve implementation. Process improvements can address most barriers by easing demands on patients during entry and retention and by educating clients and community stakeholders about methadone. System changes are also necessary to reform governmental registration and methadone administration policies and to expand clinical sites nationwide.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209640"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of smoking cessation interventions tested among Indigenous populations in the United States","authors":"Samia Amin ,&nbsp;Riana M. Kawasaki ,&nbsp;Thaddeus A. Herzog ,&nbsp;Sung-Shim Lani Park ,&nbsp;Joseph Keawe'aimoku Kaholokula ,&nbsp;Pallav Pokhrel","doi":"10.1016/j.josat.2025.209643","DOIUrl":"10.1016/j.josat.2025.209643","url":null,"abstract":"<div><h3>Introduction</h3><div>Smoking remains highly prevalent among Indigenous populations in the U.S., contributing to cardiovascular and cancer health disparities. Tailored smoking cessation interventions can reduce these disparities among Indigenous people, but the current evidence regarding the effectiveness of such extant interventions is unclear. This review aimed to collate evidence about the smoking cessation interventions tested among Indigenous groups in the U.S.</div></div><div><h3>Methods</h3><div>The study systematically searched PubMed, EMBASE, and Web of Science in September 2023 for experimental or quasi-experimental studies of smoking cessation interventions among Indigenous adults in the U.S. The Cochrane guidelines assessed study bias. Outcomes included self-reported and bio-verified smoking abstinence.</div></div><div><h3>Results</h3><div>The review included eight studies, comprising 7 randomized control trials (RCTs) and 1 quasi-experimental trial evaluating multi-component interventions. The interventions included counseling, education, cultural tailoring, pharmacotherapy, mobile medical apps, and social media. The smoking abstinence outcomes varied. Four RCTs found no significant differences in self-reported or bio-verified abstinence between groups. Two RCTs showed significantly higher self-reported abstinence with culturally tailored interventions, while two postpartum RCTs found no difference between groups. The one-group quasi-experimental study showed a retention rate of 71 % and an abstinence rate of 31 % at 6-month follow-up. While results appear promising for tailored, multi-faceted approaches, abstinence differences between interventions and control groups overall remain inconsistent.</div></div><div><h3>Conclusions</h3><div>This review suggests that culturally tailored, technology-assisted smoking cessation interventions that strategically utilize pharmacotherapies may hold promise for U.S. Indigenous populations. However, the review emphasizes the need to test large-scale interventions that utilize more personalized strategies and community-based participatory approaches as well as the need for experimental trials that bio-verify abstinence.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209643"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic barriers and stigma: Healthcare provider perspectives on perinatal and neonatal care in the fentanyl crisis","authors":"Ekaterina Burduli ,&nbsp;Tullamora Landis ,&nbsp;Christina Brumley ,&nbsp;Leslie Kenefick ,&nbsp;Kaylee Paulsgrove ,&nbsp;Hendrée E. Jones ,&nbsp;Celestina Barbosa-Leiker ,&nbsp;Olivia Brooks ,&nbsp;Maria A. Gartstein ,&nbsp;Lisa Saldana","doi":"10.1016/j.josat.2025.209644","DOIUrl":"10.1016/j.josat.2025.209644","url":null,"abstract":"<div><h3>Introduction</h3><div>The rise in fentanyl use during pregnancy has created new challenges in caring for women with opioid use disorders (OUD) and their infants with neonatal abstinence syndrome or neonatal opioid withdrawal syndrome (NAS/NOWS). Despite complexities in treating opioid-affected dyads, little research exists on healthcare workers' perspectives regarding fentanyl's impact on perinatal and neonatal care.</div></div><div><h3>Objectives</h3><div>Explore dynamic challenges fentanyl has brought to the care of perinatal women with OUD and their infants experiencing NAS/NOWS from healthcare providers' perspectives.</div></div><div><h3>Methods</h3><div>Fifteen healthcare providers (neonatologists, OBGYNs, nurse practitioners, registered nurses, and pediatricians) from the Pacific Northwest completed an online qualitative survey with a mixture of Likert-type and open-ended questions. Reflexive thematic analysis was used to analyze open-ended responses.</div></div><div><h3>Results</h3><div>Three themes emerged from provider data that reflect systemic failures in addressing the complex needs of perinatal women and their families and highlight challenges in implementation of evidence-based care: 1) Systemic Barriers to Perinatal and Infant Care, 2) Impact of Increasing Polysubstance Use on Neonates and Mothers, and 3) Stigma and Judgment from Healthcare Providers toward Perinatal Women with Substance Use Disorders.</div></div><div><h3>Conclusions</h3><div>Themes reflected how broad and interconnected systemic issues contribute to inadequate care and support for mothers and newborns in the context of rising fentanyl and polysubstance use. Themes echoed the root of the problems lies in systemic failures—issues within the healthcare system, societal attitudes, and policy frameworks that collectively fail to meet the complex and evolving needs of families affected by the ever-changing landscape of substance use.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209644"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative inquiry into music consumption at drug treatment centers with and without music therapy sessions – challenges, dangers, and successes","authors":"Jeffrey Lozon,&nbsp;Moshe Bensimon","doi":"10.1016/j.josat.2025.209641","DOIUrl":"10.1016/j.josat.2025.209641","url":null,"abstract":"<div><h3>Introduction</h3><div>Music therapy supports individuals with substance use disorders (SUD) in their recovery. Although robust quantitative research exists on the topic, research on subjective experiences of people with SUD is scarce. This qualitative study offers a retrospective perspective on clients with SUD at treatment centers, exploring the impact of music consumption and music therapy on their recovery process, examining the varying experiences of participants from treatment centers providing music therapy and participants from treatment centers not providing music therapy.</div></div><div><h3>Methods</h3><div>This phenomenological study included semi-structured interviews with 23 clients with SUD from treatment centers in Israel. Six participants came from treatment centers providing music therapy. Participants from treatment centers without music therapy consisted of two groups: those from treatment centers with a policy prohibiting all music (<em>n</em> = 4), and those from treatment centers allowing all types of music (<em>n</em> = 13).</div></div><div><h3>Results</h3><div>Content analysis revealed that at treatment centers providing music therapy, participants completed a 4-stage process: 1) developing awareness of problematic music as a trigger to possible relapse; 2) avoiding problematic music; 3) finding alternative music genres to enjoy; 4) developing tolerance to problematic music. At treatment centers without music therapy and having a policy prohibiting all music, participants developed anxiety towards music, and consequently one person relapsed. At treatment centers not providing music therapy but allowing all types of music, some participants achieved stages 1 to 3, some did not, and two participants relapsed.</div></div><div><h3>Conclusions</h3><div>At treatment centers providing music therapy, participants completed a four-stage process in which they developed tolerance to problematic music. At treatment centers not providing music therapy, participants failed to develop tolerance and some relapsed. The ability to develop tolerance to musical triggers seems crucial for rehabilitation, as music is fundamental for human life and cannot be completely avoided outside treatment. The current study calls policy makers in the field of treating clients with SUD to incorporate music therapy in treatment programs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209641"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid expansion is not associated with prescription opioid and benzodiazepine misuse among people who inject drugs: A serial cross-sectional observational study using generalized difference-in-differences models","authors":"Danielle F. Haley ,&nbsp;Stephanie Beane ,&nbsp;Courtney R. Yarbrough ,&nbsp;Janet Cummings ,&nbsp;Sabriya Linton ,&nbsp;Umed Ibragimov ,&nbsp;Regine Haardörfer ,&nbsp;Catlainn Sionean ,&nbsp;Rashunda Lewis ,&nbsp;Hannah L.F. Cooper ,&nbsp;For the NHBS Study Group","doi":"10.1016/j.josat.2025.209639","DOIUrl":"10.1016/j.josat.2025.209639","url":null,"abstract":"<div><h3>Background</h3><div>While evidence suggests Medicaid expansion can reduce overdose, some expressed concern expansion fueled the US opioid overdose crisis by increasing access to low-cost prescription opioids diverted for non-prescribed use. Ecologic studies find a protective relationship or no relationship between expansion and area-level opioid prescribing. Little is known about the relationship between expansion and opioid use among people experiencing poverty who inject drugs (PWID), a population at heightened risk of overdose likely to benefit from Medicaid expansion. We examined whether expansion was associated with prescription opioid and benzodiazepine misuse among PWID experiencing poverty and whether associations varied by race/ethnicity and HIV status.</div></div><div><h3>Methods</h3><div>This serial cross-sectional observational study used generalized difference-in-differences models to analyze data (2012, 2015, 2018) from 19,728 PWID aged 18–64 with income ≤138 % of federal poverty line from 13 states in the CDC's National HIV Behavioral Surveillance. Outcomes included past 12-month non-injection and injection prescription opioid misuse and benzodiazepine misuse.</div></div><div><h3>Results</h3><div>The sample (<em>N</em> = 19,728) was 40 % non-Latinx Black persons and 22 % Latinx persons. Past 12-month non-injection prescription opioid misuse was 33 %, injection prescription opioid misuse was 16 %, and benzodiazepine use was 40 %. Across all models, there was no association between expansion and prescription opioid misuse (confidence intervals included 0) or prescription benzodiazepine misuse (confidence intervals included 0). Associations did not vary by race/ethnicity or HIV status.</div></div><div><h3>Conclusions</h3><div>We found no association between Medicaid expansion and opioid or benzodiazepine misuse overall, by race/ethnicity, or HIV status among a large, geographically diverse sample of PWID. These findings provide empirical evidence that expansion is not associated with prescription opioid or benzodiazepine misuse in a population likely to benefit from expansion.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209639"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the compulsive substance use questionnaire: Attending to substance use automaticity, craving, and continued use despite negative consequences","authors":"Nadine R. Taghian,&nbsp;E. Marie Parsons,&nbsp;Michael W. Otto","doi":"10.1016/j.josat.2025.209638","DOIUrl":"10.1016/j.josat.2025.209638","url":null,"abstract":"<div><h3>Background</h3><div>Compulsivity characterizes an important subtype of substance use disorders (SUDs), but there has been variability in how compulsive substance use is defined and measured. The current study was designed to (1) develop a new measure of substance use compulsivity, (2) validate this scale in a community sample of adults who drink alcohol, and (3) evaluate the association between this new measure of compulsivity and substance use severity. We hypothesize that compulsivity will be characterized by automaticity, craving and insensitivity to negative consequences, and greater substance use severity will be associated with higher levels of substance use compulsivity.</div></div><div><h3>Methods</h3><div>A preliminary set of items were generated for the novel Compulsive Substance Use Questionnaire (CSUQ) to reflect three conceptual aspects of substance use compulsivity: automaticity, craving, and disregarding negative consequences. The study recruited a total of 253 adults who drink alcohol, with a range of severity. Participants answered online surveys on compulsivity, frequency of alcohol use, craving, and negative consequences of alcohol use.</div></div><div><h3>Results</h3><div>We obtained a single-factor solution with 22 items that included 3 automaticity items, 10 craving items, and 9 disregarding negative consequences items. The resulting measure had excellent internal consistency (α = 0.96). The CSUQ was associated with substance use severity; specifically, greater compulsivity was associated with heavy alcohol use and higher frequency of negative consequences associated with alcohol use.</div></div><div><h3>Conclusions</h3><div>The current study supports the validity of a new measure of substance use compulsivity, composed of items that closely hew to the concept of substance use compulsivity. Future work investigating compulsivity in other substance use populations with varying levels of severity will further our understanding of compulsive substance use and SUD subtypes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209638"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The difference-making role of staff support in implementing nurse care management for opioid use disorder treatment: A configurational analysis","authors":"Theresa E. Matson ,&nbsp;Amy K. Lee ,&nbsp;Edward J. Miech ,&nbsp;Paige D. Wartko ,&nbsp;Rebecca C. Phillps ,&nbsp;Mary Shea ,&nbsp;Andrea Altschuler ,&nbsp;Aimee N.C. Campbell ,&nbsp;Colleen T. Labelle ,&nbsp;Julia H. Arnsten ,&nbsp;Jordan M. Braciszewski ,&nbsp;Joseph E. Glass ,&nbsp;Viviana E. Horigian ,&nbsp;Mark T. Murphy ,&nbsp;Mohammad Zare-Mehrjerdi ,&nbsp;Katharine A. Bradley","doi":"10.1016/j.josat.2025.209642","DOIUrl":"10.1016/j.josat.2025.209642","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding conditions in which interventions succeed or fail is critical. The PRimary care Opioid Use Disorders treatment (PROUD) trial, a cluster-randomized hybrid study, tested whether implementation of office-based addiction treatment supported by a nurse increased medication of OUD. Six health systems each provided two primary care (PC) clinics that were randomly assigned to implement the intervention or usual care. This secondary, exploratory study used an innovative mixed methods approach to understand contextual factors that consistently distinguished intervention clinics that increased OUD treatment from those that did not.</div></div><div><h3>Methods</h3><div>The study collected contextual information through field notes, health system debriefs, and nurse interviews. Rapid qualitative analysis using a template based on the Practical, Robust Implementation and Sustainability Model identified themes reflecting the external environment, recipients, and implementation infrastructure. The study used qualitative themes to create binary factors reflecting barriers and facilitators potentially critical to implementation success and assigned clinics a factor value of 1 if present and 0 if absent. Two clinic-level outcomes were defined: 1) significant increase in patient-years of OUD treatment from baseline to two-year follow-up; and 2) high rate of OUD treatment at two-year follow-up (≥20 per 10,000 patient-years). Coincidence analysis, a cross-case configurational method, identified difference-makers for both OUD outcomes across intervention clinics.</div></div><div><h3>Results</h3><div>Qualitative analysis yielded 11 themes which were dichotomized and consolidated into 9 factors. Two factor values perfectly distinguished between intervention clinics with and without increased OUD treatment (outcome #1): (a) presence of strong support from PC staff and providers and (b) lack of OUD treatment in the community. Intervention clinics increased OUD treatment when either factor value was present; when both were absent, clinics did not increase treatment. Strong support from PC staff and providers was independently sufficient to achieve high rates of OUD treatment (outcome #2) while the absence of support explained low rates of treatment. Importantly, strong support from leadership was not sufficient for either outcome.</div></div><div><h3>Conclusion</h3><div>Strong support from staff and providers consistently differentiated between clinics with increased OUD treatment across both outcomes in the PROUD trial from those without. OUD programs should consider increasing support across clinic roles.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"172 ","pages":"Article 209642"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the special issue on legislative-driven responses to the opioid crisis: Expanding research and implementation through federal and state funding","authors":"Dennis P. Watson ,&nbsp;Barbara Andraka-Christou","doi":"10.1016/j.josat.2025.209636","DOIUrl":"10.1016/j.josat.2025.209636","url":null,"abstract":"<div><div>This special issue focuses on legislative-driven responses to the opioid crisis in the United States, emphasizing the expansion of research and implementation through federal and state funding. Since 2017, federal, state, and local initiatives have allocated billions of dollars to combat the opioid epidemic. This issue comprises 10 articles that collectively demonstrate the critical role of federal and state funding in enhancing opioid-related prevention, treatment, and recovery services. They also bring to light ongoing challenges such as funding sustainability and equitable service access that can guide future funding initiatives.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"171 ","pages":"Article 209636"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}