The article, “Buprenorphine Prescribing and Dosing Limits: Evidence and Policy Goals,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that the opioid misuse epidemic is a serious public health crisis. Opioid-involved deaths continue to rise and the potency of illicitly manufactured synthetic opioids has increased, creating challenges for the healthcare system to provide multifaceted specialized care. Elements of the regulation around buprenorphine, 1 of 3 drugs approved to treat opioid use disorder (OUD), constrain treatment options for patients and providers alike. Updates to this regulatory framework, particularly around dosing and access to care, would enable providers to better treat the changing landscape of opioid misuse. The authors state specific actions to this end are to: (1) Increase buprenorphine dosing flexibility based on FDA labeling which drives payor policies; (2) Restrict local government and institutional impositions of arbitrary access and dosing limits for buprenorphine; and (3) Liberalize buprenorphine initiation and maintenance via telemedicine for OUD.

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

“Reducing barriers to accessing care is a key step that can create lasting change. Among the 2 approved opioid agonist MOUD, buprenorphine is more easily modified from a regulatory perspective. Although advocacy for extended access to methadone has been well articulated and available data show relaxed regulation during the pandemic did not necessarily lead to increased safety concerns, this manuscript focuses on buprenorphine alone. This is because the safety of methadone expansion appears significantly more complex due to its full agonist properties, prolonged half-life, additional physiological effects (eg, QTc prolongation and drug-drug interactions), and regulatory framework. Methadone’s regulatory constraints, justified or not, further support broader use of and easier access to buprenorphine products.”

The article, “A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.

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

“To our knowledge, this study is one of the first investigations of differences in U.S. national MOUD treatment outcomes and social determinants of health based specifically on housing status. There were several main findings.”

“Our findings highlight the potentially additive or intersectional nature of social determinants of health for people experiencing homelessness and how they might potentially compound to worsen outcomes in MOUD treatment. Examples from the present study include how, compared to episodes among those who were housed, we found the group of episodes among PEH had significantly higher rates of unemployment, no income, receipt of public assistance, lacking health insurance, and arrests in the 30 days prior to admission and discharge.”

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.”