The article, “Effects of Smoking Marijuana on the Respiratory System: A Systematic Review,” has been published in SAj.

In this commentary, the authors state that the prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease.

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

“Despite existing research, significant knowledge gaps remain. Few studies have isolated the effects of individual components of marijuana smoke on lung tissue, meaning our understanding of how marijuana smoke impacts the lungs and how these effects compare to tobacco smoke remains limited. Additionally, the long-term effects of marijuana use on lung health are inadequately understood, making it difficult to develop effective risk minimization strategies. Further complicating matters, varying legal statuses and stigma attached to marijuana use impede large-scale, longitudinal studies, contributing to these knowledge gaps.

There is an undeniable need for more research to shed light on the unknowns, particularly given the increasing usage and changing legal landscape. This study aims to consolidate available information on the immediate and long-term effects of marijuana on the respiratory system and underscore areas requiring further investigation.”

The article, “Leveraging National Data and Regional Innovations to Right-Size Tobacco Treatment Policy for Behavioral Health in a Midwestern State,” has been published in SAj.

In this commentary, the authors state that 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.

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

“Tobacco use remains the leading preventable cause of death worldwide, estimated to cause more than 7 million deaths per year. People with mental health or substance use disorders (MH/SUD) are disproportionately affected by high smoking prevalence, being 2 to 4 times more likely to smoke cigarettes than the general population. They also die 5 or more years earlier from smoking-related diseases compared to people with MH/SUD who do not smoke.”

“The purpose of our study was to summarize data on tobacco services in MH/SUD facilities in states similar to our own, identify policies these states that were associated with high rates of tobacco treatment, and present these data to state leaders to encourage them to adopt similar policies to potentially increase support for tobacco recovery in behavioral health facilities. This descriptive ecologic study may serve as a model for how other states can leverage readily available data to help their states identify locally feasible policies to reduce tobacco-related illnesses and deaths among people with MH/SUD.”

The article, “Will the End of the X-Waiver Expand Access to Buprenorphine Treatment? Achieving the Full Potential of the 2023 Consolidated Appropriations Act,” has been published in SAj.

In this commentary, the authors state that the expansive Consolidated Appropriations Act of 2023 was the last major law passed by the 117th Congress, and for opioid use disorder (OUD), it may prove its most consequential. The Act repeals the requirement that clinicians who prescribe buprenorphine, a life-saving medication for OUD, obtain a special license (the “X-waiver”) from the Drug Enforcement Administration (DEA). The repeal of the waiver was long sought by advocates and had bipartisan support. The Drug Addiction Treatment Act of 2000 (DATA), which created the waiver requirement, was a Congressional compromise allowing office-based prescribing of opioids to treat OUD; but the law was constrained by decades of arcane federal controlled substances law.

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

“The repeal of the X-waiver sets the stage for the expansion of buprenorphine treatment, but this potential can only be fully achieved by eliminating the bottlenecks that often cause patients to miss the chance to receive life-changing treatment. The difficult task that lies ahead is ensuring that the greater flexibility in the federal law is met by an educated workforce, empowered by state regulations, with the capacity to get patients into treatment when they need it the most.”

The article, “Exploring the Association of State Policies and the Trajectories of Buprenorphine Prescriber Patient Caseloads,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that increasing buprenorphine access is critical to facilitating effective opioid use disorder treatment. Buprenorphine prescriber numbers have increased substantially, but most clinicians who start prescribing buprenorphine stop within a year, and most active prescribers treat very few individuals. Little research has examined state policies’ association with the evolution of buprenorphine prescribing clinicians’ patient caseloads.

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

“Many clinicians approved to prescribe buprenorphine historically have not actively prescribed, and many active prescribers have treated very few individuals. One potential way to increase buprenorphine treatment capacity is to identify state policies associated with increasing the percentage of authorized prescribers who actively prescribe it to more patients for longer periods.⁴⁵ However, our analysis of 3 state policies thought to be associated with buprenorphine prescribing behavior—Medicaid coverage for buprenorphine, prior authorization, and mandated counseling—were not associated with an increase in the percentage of persistent buprenorphine prescribers.”

“Policies that expand the buprenorphine prescriber workforce have been intended to increase treatment access, but these policies may not be sufficient on their own. Because buprenorphine treatment is highly concentrated among a small group of clinicians, it is imperative to increase the size of the clinician workforce who can and will provide care to larger numbers of patients for longer periods of time. Our analysis indicates that several policies that could influence buprenorphine prescribing are not accomplishing this goal. Greater attention should be given to identifying the characteristics of successful high-volume practices (eg, staffing models, referral practices, and care coordination), and policies should focus specifically on creating incentives or supports to replicate these practices.”

The article, “Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions.

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

“Our study extends upon previous OUD research, incorporating physician and other participants (i.e., participants who were not physicians, e.g., nurse practitioner, licensed practical nurse, physician assistant, mental health specialist, non-clinical administrative staff, and other) in monthly OUD learning sessions. These sessions were based on the Extension for Community Healthcare Outcomes^® (ECHO^®) Model. Project ECHO has shown to impact primary care clinicians’ knowledge, confidence, and/or self-efficacy on several topics, including OUD.”

“This study demonstrated all participants’ participation in OUD learning sessions increased confidence and knowledge across curriculum topics. All may benefit from increased knowledge and confidence in diagnosing, treating, prescribing, and educating patients with OUD. These team-based interactive sessions have the potential to inform and educate all practice staff, fueling better insight and awareness of medications for opioid use disorder (MOUD), other team member roles, structural barriers for OUD care, and patients with OUD.”