The article, “The FASTER-BUP Study, Extended-Release Injectable Buprenorphine for the Treatment of Opioid Use Disorder Among Individuals at High Risk of Overdose: Protocol for an Observational Prospective Study,” has been published in SAj.

In this commentary, the authors state that North America is facing an unprecedented public health emergency of opioid-related morbidity and mortality. The mortality benefits of oral medication treatment for opioid use disorder (MOUD), such as methadone or buprenorphine, are well documented. However, barriers to access and long-term engagement have prevented maximizing their benefits. Long-acting injectable buprenorphine formulations were developed to address some of the challenges associated with oral MOUD. The “Pilot study to assess the feasibility, efficacy, and safety of extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose” (FASTER-BUP) was developed to explore this treatment option in populations at high risk of overdose in a real-world Canadian setting. FASTER-BUP is a 24-week observational prospective study evaluating the feasibility and clinical utility of extended-release injectable buprenorphine (XR-BUP) for the treatment of opioid use disorder (OUD) among 40 adults at high risk of overdose (ie, lifetime history of overdose or a positive urine drug test (UDT) for fentanyl within 30 days prior to screening) in Vancouver, BC. The primary outcome is retention in treatment and secondary outcomes include: use of unregulated opioids, safety, overdose events, treatment satisfaction, changes in drug-related problems, changes in quality of life, opioid cravings, health service utilization, and criminal activity. FASTER-BUP is the first study to explore XR-BUP among individuals at high risk of overdose in a real-world Canadian setting. This commentary provides a brief narrative about the study thus far and presents insights on key adaptations to the study protocol, including those adopted to mitigate recruitment challenges.

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

“Despite its demonstrable efficacy, XR-BUP remains an understudied and underutilized tool with limited programs existing in Canada. In 2018, Health Canada approved one formulation of XR-BUP (ie, Sublocade^TM). The approval of this medication expanded treatment options for individuals with OUD, particularly those for whom medication adherence may pose a challenge. However, there remains a lack of research exploring XR-BUP in real-world Canadian settings and in populations, such as individuals at high risk of overdose, who may benefit most from this treatment. The FASTER-BUP study aims to address this research gap and this narrative provides insight into key adaptations to the study protocol in the hope that it informs future studies.”

“FASTER-BUP is among the first to explore XR-BUP among individuals at high risk of overdose in the Canadian context. Adaptable study materials and partnering with AMCT permitted critical shifts to the study protocol, thus resulting in increased recruitment efforts and study enrollment. This study will generate important preliminary data which will support the development of a larger effectiveness clinical trial evaluating XR-BUP in real-world settings. Ultimately, findings from this study will inform interventions to address Canada’s worsening opioid epidemic.”

The article, “Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models,” has been published in SAj.

In this commentary, the authors state that novel adulterants and synthetic substances are rapidly infiltrating the US and international drug supply. Efforts to reduce the overprescription of opioids, compounded by increased pressure from law enforcement, have led to shifts in the US drug market and forced people to seek illicit sources which are at risk of adulteration. This shifting drug landscape has resulted in an increasingly dangerous and unregulated supply. Initially an adulterant to heroin, fentanyl, a potent synthetic opioid, has now largely replaced heroin as the dominant illicit opioid in the US. This shift has resulted in an exponential rise in fatal overdoses and other drug-related harms. As the addiction care community continues to navigate the challenges posed by fentanyl, the nation must now adapt to yet another emerging substance, xylazine, contaminating the illicit drug supply.

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

“Public health threats significantly affect population health, and early effective distribution of information is critical to enhance clinical response capabilities. In the context of the evolving supply to date, avenues for timely continuing and interprofessional dissemination of information for those in practice have been limited. Providers can seek opportunities for collaborative learning during annual national conferences that require membership or payment; or self-directed learning using emerging literature that requires practical and contextual translation; or rely on freestanding online resources, webinars, or courses, which may exclude the voice of the harm reduction community. Brief, interactive, didactic-based trainings have been effective and are valuable mechanisms to distribute information and implement practices in this field. In the rapidly evolving space of new psychoactive substances, peer-reviewed statistical and clinical evidence takes time to accrue. A significant body of current working knowledge from those with lived experience and professional exposure is communicated through professional and informal networks, including social media, and can be used to address urgent and novel substance-related harms. We describe our experience and lessons learned leveraging a robust existing training and technical assistance (TTA) model to disseminate education and information about xylazine as an emerging threat in the absence of robust clinical guidelines and a peer-reviewed evidence base.”

“Our responsive educational training on xylazine had broad reach and impact allowing for timely dissemination of information. By leveraging a flexible TTA model, our team was able to provide accessible education with free CEC to a diverse group of professionals and community members. Post-training participant feedback was critical to facilitate adaptation of content and aid development of needed resources for the field. By pairing information gathered from literature and nontraditional sources with established clinical protocols and harm reduction strategies from the field, we were able to provide tangible education. The added benefit of working with a robust TTA team allowed us to proactively update information in real time that participants could consider implementing in their own practices—all before literature and official public health guidance became accessible.”

The article, “Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions,” has been published in SAj.

In this commentary, the authors state that an alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention.

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

“Building on prior analyses demonstrating the effectiveness of alcohol text message interventions versus control condition in reducing HED at three month follow-up, this exploratory study examined baseline participant characteristics that predicted HED at three months using PRE. To our knowledge, this is the first use of PRE to identify prediction rules for a digital alcohol intervention. Identifying prediction rules can increase understanding of “for whom” the intervention has effects, and indicate features important to predicting the main intervention outcome. The PRE model included treatment assignment as a confirmatory rule known to predict outcome, and generated information on the baseline characteristics most important to predicting HED at three months to aid model interpretation. This data-driven approach maximized predictive accuracy while minimizing complex rule structure, to generate a set of rules that could be readily understood by clinicians to support young adult HED intervention.”

“This exploratory study identified 12 rules based on a small set of six baseline variables and intervention status (seven total features) that predict HED days at three month follow-up. Future possible clinical application might involve computerized assessment of key baseline predictors of intervention effects on HED days, which include drinking pattern, negative urgency, perceived number of friends who get drunk weekly, and perceived risk of possible HED-related consequences. The rules balance prediction performance and ease of interpretation to estimate short-term HED outcome among young adults exposed to a text message intervention.”

The article, “Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception,” has been published in SAj.

In this commentary, the authors state that concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of their study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations.

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

“There is a need in the adolescent substance use literature to further understand Latent class (LC) group membership characteristics of concurrent substance use among adolescents living in under-served urban communities. Primary aims for this study were to: 1. Use LCA to identify and investigate patterns of concurrent substance use among adolescents from an under-served urban community in the northeastern United States. 2. Examine corollary clinical features of substance use with LCA patterns of concurrent substance use among adolescents of color.”

“Concurrent substance use during adolescence has innumerable unfavorable developmental outcomes. Our findings have important implications for both prevention and practice, and provide a step in understanding concurrent substance use and associations with mental health and other corollary clinical features. Recognizing patterns of alcohol and substance use in under-served communities can support interventions targeted to such groups without disregard for other environmental factors that promote the likelihood of access to substances.”

The article, “Recovery Support and Capacity Assessment Using the Calculating an Adequate System Tool: Two Case Studies,” has been published in SAj.

In this commentary, the authors state that there are multiple, reliable, and authoritative federally managed data sources for understanding the incidence and prevalence of substance use disorder (SUD) and its sequela. However, there remains a gap in metrics representing the need and capacity for treatment and related supports within local communities. To address this challenge, Calculating an Adequate System Tool (CAST) was developed in 2016 by an interdisciplinary group of researchers at the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality to assess the capacity of the SUD care system within a defined geographic area. It allows for risk assessment of local social and community determinants of substance abuse, as well as an assessment of local service needs across the continuum of SUD care.

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

“CAST is designed to assist with short- and long-term planning for improving the behavioral health of communities. Program saturation, estimated with CAST algorithms, should be interpreted as a guide for decision-making and not a rigid boundary for program activity levels. CAST is predicated on the assumption that resources are finite and decisions need to be made about how financial and human capital are allocated within a given community. It is important to note that CAST estimates are based upon data that were provided by community organizations and not all organizations that responded to the survey provided detailed program activity information. In both the Ohio and Montana projects presented in this research brief, the logic of CAST and the quantification of need were able to elucidate community-level needs and differences in a manner that allowed for meaningful action among the coalitions that commissioned the studies.”

“Throughout the projects identified in this research brief, it has become clear that there is a need for further expansion and refinement of quantitative methods for assessing the capacity of the substance use care systems. One of the distinctive elements of CAST, as highlighted in the Missoula County case study, is quantification of prevention programming. Future research and additional efforts should be made to offer mathematical models of demand and program saturation, leveraging the progress made with CAST to improve the ability of community needs assessments to inform resource allocation.”