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.”

The article, “More Effective Communication During Inpatient Addiction Treatment” has been
published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors argue that historical approaches to inpatient addiction treatment favoring more confrontational, expert-centric, or paternalistic undercurrents continue to permeate the hidden curriculum in medical training. These older approaches unfortunately continue to inform how many trainees learn to approach inpatient addiction treatment. The authors go on to provide several examples of how clinical challenges specific to inpatient addiction treatment can be addressed by employing principles of motivational interviewing, harm reduction, and psychodynamic thought.

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

“Gaps in medical education—including limited exposure to evidence-based approaches to patient engagement using motivational interviewing and harm reduction principles—leave some medical providers without clear guidance on how to effectively work with this vulnerable population.”

“Here we address several common clinical challenges encountered by medical providers on inpatient psychiatric services caring for patients with substance-related and addictive disorders. Though our observations certainly will apply to other clinical services (eg, inpatient general medicine and ambulatory psychiatry), we have developed this commentary with a focus on the inpatient addiction care setting both because it is where we have made these observations most frequently, and because of the intense biopsychosocial instability that we believe demands heightened attention to effective communication from us as providers.”

AMERSA is pleased to announce that we have partnered with Sage Publishing as the new publisher of the Substance Abuse journal (SAj.) Sage is a global academic publisher of books, journals, and a growing suite of library products and services. 

The new website for the journal is journals.sagepub.com/home/saj. AMERSA members can access the journal for free via amersa.org/journal-home. All members will receive an email with instructions on how to access our new members portal where member access for the journal is housed. Please contact Adrienne Galloway at adrienne@amersa.org if you have any questions.

Journal Title Change! The AMERSA Board of Directors and the SAj Editorial Team has long recognized that the title of the journal (Substance Abuse) includes pejorative language which can negatively impact the way society perceives persons with substance use and substance use disorder treatments. Thus, we have secured the name Substance Use & Addiction Journal (SAj) with the goal of formally implementing the change with the first issue of 2024.

The 2022 Annual Conference commentary and the presented abstracts are now available here.