The article, “The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that in 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses’ knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, that to their knowledge, is the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Substance use disorder is widespread across the lifespan, underscoring the need for nurses in all disciplines and settings to have the expertise and skills to help to manage the global burden of substance use disorder. To address this, all nurses must have the education and clinical training necessary to care for individuals with substance use disorder. Nurses with education on addiction and possessing well-developed clinical skills in the management of patients with SUD can play a major role in improving the care of this marginalized patient population and reducing negative attitudes toward them. Thus, there is a clear need to establish additional addiction nursing fellowships across the country. This description of BMC’s addiction nursing fellowship may provide a useful model for replication.”

The article, “National Trends in Buprenorphine Treatment for Opioid Use Disorder From 2007 to 2018,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that 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.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Overall, our findings demonstrate that the U.S. experienced clear growth in buprenorphine treatment, with a doubling of treatment episodes occurring from 2007-2009 to 2016-2018 as well as increases in treatment episode duration. Yet, this growth in buprenorphine utilization should be viewed in context of an evolving opioid epidemic. Given that the prevalence of OUD and fatal overdose rate have also approximately doubled during this period,^12,13 the observed growth in buprenorphine treatment did not demonstrably impact the pronounced treatment gap. This has also been observed in previous studies among Medicaid beneficiaries¹⁴ and in the Veterans Health Administration (VHA)¹⁵ that concluded that growth in buprenorphine waivered clinicians and prescribing did not notably increase the overall proportion of OUD patients who received buprenorphine.”

The article, “Training Providers of People Who Use Drugs to Offer Hepatitis C Treatment: A Washington State Initiative,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that to address hepatitis C infection (HCV) treatment gaps among people who use drugs (PWUD), a statewide initiative trained buprenorphine waiver trainers to offer an optional HCV treatment module to waiver trainees. Five of twelve trained buprenorphine trainers went on to conduct HCV sessions at waiver trainings, reaching 57 trainees. Word-of-mouth led to multiple additional presentations by the project team, suggesting an unmet need for more education about treating HCV among PWUD. A post-session survey suggested that participant views on the importance of treating HCV among PWUD changed and that almost all felt confident to treat uncomplicated HCV.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Greater than 60% of new hepatitis C (HCV) infections in the United States now occur among people who inject drugs (PWID), with young people and those who use opioids most affected.¹ Meanwhile, direct-acting antiviral (DAA) medications have dramatically improved the landscape of HCV treatment such that cure is expected with 8 to 12 weeks of well-tolerated oral medications.² Targeting treatment to PWID is an important step to reduce forward transmission. Modeling studies of a “treatment as prevention” approach demonstrate that even modest increases in HCV treatment will reduce new infections and lower prevalence over time.^3–5“

“A Washington State initiative to train buprenorphine waiver trainers to offer HCV treatment modules to waiver trainees trained 12 waiver trainers; 5 went on to conduct HCV trainings during the initial months of the program. Word-of-mouth invitations led to an additional 5 presentations by the project team. While a minority of those who attended these HCV trainings and presentations completed a post-session survey, most respondents reported their views were changed by the session, nearly all agreed that treating HCV among PWUD is important and nearly all reported confidence treating uncomplicated HCV.”

“We describe a statewide initiative to train and inspire buprenorphine waiver trainers to also conduct modules on treating HCV among PWUD. An unanticipated outcome was multiple invitations to disseminate the material more widely, suggesting an unmet need for education and support around HCV treatment among addiction-related audiences. Participants of HCV training sessions subsequently reported near universal belief in the importance of treating HCV and confidence in treating uncomplicated HCV. This work suggests that among providers who care for PWUD, limited HCV training may be adequate to change views about treating HCV among PWUD, although research specifically designed to evaluate efficacy would be helpful. Future studies could also evaluate models of care that would better support providers to treat PWUD for what is most often an easily curable disease.”

The article, “Patients’ Perceptions of Physical Therapists Addressing Opioid Misuse” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state in the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients’ perceptions of PTs addressing opioid misuse.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Over 61% of outpatient physical therapy practice is comprised of patients with musculoskeletal pain, and about 16% of physician visits for musculoskeletal pain are associated with referral to physical therapists (PTs). In the US, over 2 million adults are annually referred to physical therapy just for low back pain and knee osteoarthritis. About 1 in 3 patients treated for musculoskeletal pain by PTs in outpatient clinics take prescription opioids.”

“The US Preventive Services Task Force has called for all healthcare providers to be trained to screen and address (treat or refer to treatment) opioid misuse among patients. PTs, primary care providers (PCPs), addiction treatment leaders and scholars advocate that PTs should play a greater role screening and addressing patients with opioid misuse.”

“While PTs are well-positioned to address opioid misuse and seemingly are willing to do it, what remains unknown are the perceptions of patients regarding PTs’ role in addressing opioid misuse. Patients may not appreciate or want PTs—providers not typically engaged in opioid risk assessment and mitigation—to address this potentially sensitive subject.”

The article, “Perioperative Management of Extended-Release Buprenorphine: A Narrative Review and Case Series” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state perioperative management of formulations of buprenorphine used for the treatment of opioid use disorder and/or pain are common clinical challenges. Care strategies are increasingly recommending continuation of buprenorphine while administering multimodal analgesia including full agonist opioids. While this “simultaneous strategy” is relatively simple for the shorter-acting sublingual buprenorphine formulation, best practices are needed for the increasingly prescribed extended-release buprenorphine (ER-buprenorphine). The authors state that, to their knowledge, there are no prospective data to guide perioperative management of patients on ER-buprenorphine. They provide a narrative review, report on the perioperative experiences of a series of patients maintained on ER-buprenorphine, and propose recommendations for perioperative ER-buprenorphine management based on best evidence, clinical experience, and their judgments.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“There is a paucity of literature and guidance on how to address patients on ER-buprenorphine who require either acute pain treatment or elective/urgent operative care. We identified only 1 published case report describing the perioperative management of a patient on ER-buprenorphine undergoing elective surgery; in that case the patient successfully underwent major surgeries utilizing a strategy of performing the surgeries at the time of the next scheduled dose.”

“This evidence void lends itself to large variations in practice. Even in the case of sublingual buprenorphine, where perioperative continuation has become the consensus strategy, two-thirds of patients in a large healthcare system had their buprenorphine doses withheld preoperatively as recently as 2018.”

“Here we have described several management strategies which are unsurprisingly quite diverse and met with varying degrees of success. These cases clearly do not support any particular strategy; more so they illustrate the lack of an established uniform approach. Recognizing the absence of strong supporting data and extrapolating from clinical experience and the limited data described herein, we propose the following general overarching principles to guide clinicians of perioperative patients with steady state levels of ER-buprenorphine. These are applicable to both elective and emergent surgeries.”