The article, “Why Substance Use Screening Frequency Matters in Adult Primary Care,” has been published in SAj.

The authors state that evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time.

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

“The USPSTF lacks explicit guidance regarding screening frequency, stating that there is little or inadequate evidence around the optimal screening interval. Studies reviewing screening implementation to evaluation are plentiful, but also lack guidance around screening frequency. In lieu of strong evidence to guide policies, healthcare sites may generate policies based on how heavily they weigh convenience versus perceived risk about how quickly substance use can escalate to hazardous levels. Providers who weighed convenience tended to prefer annual screenings bundled with general health screening visits; providers who were concerned about how quickly substance use can escalate were more likely to advocate for more frequent screenings, as annual screenings alone could miss opportunities for early intervention. Additionally, universal screening integrated within the workflow may reduce biases in screening and identification of individuals using substances. Given the inquiries from the healthcare sites, lack of explicit guidance from the USPSTF, and PERU’s positionality with the robust data set, PERU conducted a secondary analysis from the PA SBIRT screening data to examine patterns and direction of change in substance use risk category among patients being screened on multiple occasions. The results generated initial insights into the applicability of frequent screening policies.”

“Screening in adult primary care settings is recommended to reduce substance use. The results from this analysis function as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection to care. This analysis points to potential benefits of frequent screening policies. Evidence-based screening tools, along with policies that implement frequent screening, may further support providers to identify patients at risk of SUD and connect them to appropriate care. Healthcare professionals should consider these findings supporting frequent, universal screening when determining policies on screening frequency for substance use identification.”

The article, “Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample,” has been published in SAj.

The authors state that the prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, they assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior.

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

“Despite the influence of social norms on tobacco use, there is limited research focused on older adults or differences across age groups. The current study among people who use CCs in Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study aims to determine whether the relationship between social norms and (1) past-year CC quit attempts and (2) past-month EC use varies as a function of age. We hypothesize that positive CC social norms will be negatively associated with quit attempts and vice versa, and the relationships will be stronger among older adults. We also hypothesize that positive EC social norms will be positively associated with EC use and vice versa, and that these relationships will likewise be stronger with older age.”

“Social norms about CCs and ECs differ by age, with older age generally associated with both positive and negative norms related to CCs and negative norms related to ECs. Socioenvironmental factors such as healthcare provider advice and home smoking bans are associated with both tobacco use behavior and age, suggesting that further emphasis on these factors can further improve clinical outcomes. Communication interventions would also be helpful to correct misperceptions and normative beliefs about tobacco products. A social norms communications campaign approach, for instance, could be developed to increase perceptions of approval of EC among adults ≥55 by their peers, making them more likely to consider switching from CCs. Social norms should continue to be evaluated and addressed, especially as the tobacco regulatory environment changes, leading to even larger disparities related to age, gender, socioeconomic status, disability, and more.”

The article, “High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants,” has been published in SAj.

The authors state that injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Their objective was to determine interest in iOAT-H among syringe services program (SSP) participants.

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

“In a sample of 108 SSP participants with OUD and a history of injecting opioids, we found that most were interested in receiving iOAT-H. More than 40% of participants reported that iOAT-H would be preferable to other forms of OUD treatment. Participants who were interested in iOAT-H injected heroin on more days per month, injected in public more frequently, and were more likely to participate in an illegal activity (other than drug possession) than participants who were not interested, suggesting that those who could most benefit from iOAT were also those who were most interested in the treatment. Though interest in iOAT-H was not universal, we identified a highly interested group of treatment-experienced PWID with severe OUD who were at high risk for OUD-related harms.”

“First-line MOUDs, such as methadone and buprenorphine, work well for many persons with OUD; however, even when these conventional treatments are available, important groups of PWID remain out of treatment and at high risk for opioid-related harms. iOAT-H provides a promising option to engage treatment-experienced individuals who continue to inject opioids after trying first-line OUD treatments. Our study demonstrates interest in iOAT-H, especially among persons at high risk for overdose—those with severe OUD who frequently use non-prescribed opioids and inject in public places. Broadening the spectrum of MOUDs available in the United States could help address the unacceptably high rates of opioid-involved overdose death.”

The article, “Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic,” has been published in SAj.

In this commentary, the authors state youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

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

“Given limited data on youth with acute psychiatric needs, the investigators sought to examine substance use in CA patients that were psychiatrically hospitalized. We aimed to determine if the COVID-19 pandemic led to an increased prevalence of positive urine drug screening (UDS) among the CA psychiatric population. The study also aimed to determine if certain sociodemographic or clinical factors increased the likelihood of having a positive UDS. Specific substances tested on routine UDS were examined, including cannabis, opiates, benzodiazepines, and stimulants. We sought to evaluate if any of these factors might independently predict substance use in this population, and, in addition, to examine outcomes, such as length of stay or need for emergency medications for agitation, in patients with positive UDS as compared to those without positive UDS. The study also aimed to compare previously reported substance use with current UDS results.”

“Multiple sociodemographic and psychiatric factors may predispose CA patients to substance use, which can have long-term negative, medical, and psychiatric effects. This study, despite some limitations, is unique in that it compares UDS results to previously reported substance use as well as examines the impact of COVID-19 on substance use among youths in the inpatient psychiatric setting. While our analyses found no impact of the COVID-19 pandemic on UDS results among inpatients, further and more long-term studies are needed. It is crucial to identify and address substance use in the CA population, to prevent future SUDs, improve mental health and psychiatric stability, and to minimize negative structural effects on the brain from substance use.”

The article, “An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention,” has been published in SAj.

The authors state that screening and brief interventions (SBI) can help identify opioid safety risks and healthcare professionals can accordingly intervene without a significant increase in workload. Pharmacists, one of the most accessible healthcare professionals, are uniquely positioned to offer SBI. To design an effective intervention with high potential for implementation, we explored pharmacist needs and barriers regarding SBI for opioid use disorders.

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

“Prescription-opioid-involved death rates increased by 16% in 2020, despite the declining trend in opioid prescribing rates observed since 2012. While stricter opioid prescribing guidelines have not sufficiently addressed opioid safety concerns, they have also led to opioid access issues. Prevention interventions such as screening, education, prescription monitoring programs, and naloxone dispensing can reduce risky opioid use and promote opioid safety, while ensuring appropriate medication access. Community pharmacists are uniquely positioned to offer opioid use disorder (OUD) prevention interventions due to their high accessibility and medication expertise. Pharmacists can aid in primary prevention of OUD by counseling patients regarding safe medication use and be involved in secondary (screening) and tertiary (harm reduction) prevention. However, in the United States, the role of the community pharmacist in OUD prevention has been limited.”

“The development of a pharmacy-based SBI must incorporate pharmacist views in initial design. This will lead to the development of an intervention that is more feasible for pharmacists to deliver, with greater chance of successful implementation. To design an effective SBI with high potential for implementation, we explored such needs and barriers regarding SBI among community pharmacists dispensing opioid prescriptions. We expected to identify needs such as training to deliver intervention and barriers such as managing time and balancing responsibilities.”