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Exploring the Association of State Policies and the Trajectories of Buprenorphine Prescriber Patient Caseloads

Aug 23, 2023 by agalloway

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.”

Filed Under: SAj Blog, Uncategorized

Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions

Aug 16, 2023 by agalloway

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.”

Filed Under: SAj Blog, Uncategorized

Sociodemographic Differences in Menthol Cigarette Use in the United States

Aug 9, 2023 by agalloway

The article, “Sociodemographic Differences in Menthol Cigarette use in the United States,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that menthol cigarette use is associated with higher smoking initiation and reduced smoking cessation. The authors investigated sociodemographic differences in menthol and non-menthol cigarette use in the United States.

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

“The results from our study revealed that the likelihood of being an individual who currently smokes cigarettes is higher among individuals who used menthol cigarettes (ie, lower cessation rates) compared to individuals who used non-menthol cigarettes. The addictiveness and higher appeal of these cigarettes, as reported previously, may explain this difference.”

“Consistent with our findings, higher usage of menthol cigarettes in youth and young adult population has been reported. This is because, more so than adults, the adolescent brain is particularly vulnerable to the effects of nicotine, and menthol has been shown to increase the number of nicotinic receptors and the dopamine response, which increases the susceptibility even more. As previously reported, our study also confirmed the higher prevalence of menthol cigarette use in women.”

Filed Under: SAj Blog, Uncategorized

“I’m Clean and Sober, but not Necessarily Free”: Perceptions of Buprenorphine Among Patients in Long-Term Treatment

Aug 2, 2023 by agalloway

The article, “‘I’m Clean and Sober, but not Necessarily Free’: Perceptions of Buprenorphine Among Patients in Long-Term Treatment,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue.

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

“Findings from this study may help inform shared decision-making conversations between clinicians and patients regarding buprenorphine treatment duration and thereby contribute to patient-centered care. While most evidence indicates that longer treatment duration is better than shorter duration, continuing treatment long-term, or without a clear end point, may be contrary to patient wishes, desires, and/or concerns. Recognizing beliefs and medication perspectives that may underlie patients’ desires to discontinue treatment may help clinicians to anticipate such concerns and better address them within the context of shared decision-making conversations.”

“As patients stabilize in recovery, many may begin to consider tapering or discontinuing buprenorphine. Findings from this study may help clinicians anticipate patient concerns, and can be used to inform shared decision-making conversations between clinicians and patients regarding optimal buprenorphine treatment duration.”

Filed Under: SAj Blog, Uncategorized

The Association of Vaping With Social/Emotional Health and Attitudes Toward COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the COVID-19 Pandemic

Jul 26, 2023 by agalloway

The article, “The Association of Vaping With Social/Emotional Health and Attitudes Toward COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the COVID-19 Pandemic,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that vaping is a major health risk behavior which often occurs socially. Limited social activity during the COVID-19 pandemic contributed to worsening social and emotional health. The authors investigated associations among youth vaping, and reports of worsening mental health, loneliness, and relationships with friends and romantic partners (ie, social health), as well as perceived attitudes toward COVID-19 mitigation measures.

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

“We found that vaping among AYA was associated with larger perceived negative impacts from the COVID-19 pandemic on emotional wellbeing and greater levels of other substance use. We found no evidence that vaping was protective against experiencing loneliness or worsening social relationships during the COVID-19 pandemic. Further, we found that youth who vaped were less likely to adhere to non-pharmaceutical measures put in place to prevent the spread of COVID-19 compared to their non-vaping AYA peers.”

“Overall, vaping has been associated with a variety of health problems among AYA and while vaping may be a social activity, we found no evidence that it was protective of social/emotional health during the pandemic. On the contrary, while cross-sectional analyses cannot determine causation, vaping appears to be an indicator of increased risk for other substance use, mood, eating, and sleep disorders. Moreover, youth who vape may be more likely to forgo protective strategies such as social distancing and masking, even when they view those measures as being important. As such, health care providers involved in the care of AYA should screen for vaping and related co-occurring risk behaviors and health problems to take advantage of the opportunity to also identify and treat substance use and possible co-occurring disorders.”

Filed Under: SAj Blog, Uncategorized

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