The article, “Cannabis Use Differences Among Sexual Minority Versus Heterosexual Females and Males in Oklahoma: The Roles of Mental Health, Cannabis Perceptions, and Cannabis Marketing Exposure,” has been published in SAj.

In this commentary, the authors state that despite the high cannabis use rates among sexual minority (SM) individuals, less research has examined factors related to cannabis use among SM (vs. heterosexual) individuals, especially in places with legal medical cannabis retail markets and high structural stigma, like Oklahoma.

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

“Although elevated rates of cannabis use among SM individuals are evident, less is known about the range of factors that may be associated with cannabis use and use severity among SM, relative to heterosexual adults. Moreover, research on SM cannabis use is lacking in places with legal cannabis retail markets, high structural stigma, and pronounced SM substance use, like Oklahoma. This work is critical to inform public health efforts aimed at reducing cannabis use among this vulnerable population, particularly as further cannabis legalization across the United States is likely. To identify factors associated with differences in cannabis use among SM versus heterosexual individuals, the current study examined associations between sexual identity and potential cannabis-related factors (i.e., perceived harm to health, positive cannabis perceptions, cannabis marketing exposure, depressive symptoms, anxiety symptoms). We then examined associations of sexual identity and these cannabis-related factors with cannabis use and use severity (i.e., any past 30-day use, daily/near-daily use, CUD symptoms). Based on the aforementioned literature, we hypothesized that SM (vs. heterosexual) individuals would display greater odds for current cannabis use, daily/near-daily cannabis use, and CUD symptoms. Moreover, SM (vs. heterosexual) individuals were expected to report lower cannabis-related harm perceptions and greater positive attitudes toward cannabis; a greater proportion of SM individuals was expected to report cannabis marketing exposure, depressive symptoms, and anxiety symptoms. Lower harm perceptions, greater positive attitudes, marketing exposure, and depressive and anxiety symptoms were hypothesized to predict greater odds of each cannabis-related outcome.”

“The current study examined differences in a range of potential cannabis-related factors and behaviors among SM and heterosexual adults in Oklahoma. SM (vs. heterosexual) females reported higher rates of cannabis use, whereas SM (vs. heterosexual) females and males reported higher rates of daily/near-daily cannabis use. Among females, findings may be related to cannabis marketing exposure (for past 30-day and daily/near-daily use) and harm perceptions (past 30-day use), whereas past 30-day cannabis use among males may be related to depressive symptoms. With future replication, findings highlight important potential targets for reducing cannabis-related disparities among SM, relative to heterosexual females and males, respectively, living in places with legal medical cannabis retail markets, high structural stigma, and pronounced substance use. Public health campaigns aimed at correcting misinterpretations of harm that could emanate from marketing efforts by the cannabis industry may help reduce cannabis use among SM females, whereas SM males may be better reached by intervention efforts targeting mental health symptoms, as well as large-scale interventions that attend to the unjust social conditions that perpetuate stigma and discrimination related to sexual identity.”

The article, “Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults,” has been published in SAj.

In this commentary, the authors state that people in Canada and the United States (US) have seen expanding access to cannabis following the legalization of both medicinal and recreational use. Canadians have been able to access cannabis for medical purposes since 2001, but the Cannabis Act legalized recreational use at the federal level as of October 2018. As of May 2023, recreational use is legal in 23 US states and the District of Columbia, and medicinal use is legal in 38 states and the District of Columbia. With expanded access, there is increasing emphasis on understanding potential harms to individuals and public health, including driving after cannabis use (DACU).

Their study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months.

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

“Relative to studies of people who DACU and driving-related cognitions in the US, data on these same measures in people from Canada are notably lacking. In the study by Goodman et. al. Canadian younger adults who rated DACU as less risky reported higher frequency of engagement in DACU. Despite these initial findings, understanding the risk perceptions of Canadians who DACU remains a priority area for research, and no studies have directly compared US and Canadian samples. Comparing US and Canadian samples is scientifically important, given the rapidly shifting legal landscape concerning cannabis use in both countries. Differences in legalization also result in variability in public messaging, psychoeducation, and other prevention campaigns concerning cannabis risks and harms, including DACU. To further expand the US literature on DACU among community adults and add new data from Canadian community adults, the current study examined perceptions, driving behavior, and cannabis use among Canadian and US adults who reported recent cannabis use in the past six months”

“The findings of the present study affirm previous research that suggests that when people endorse favorable perceptions of DACU, they are more likely to engage in DACU. While this association has been studied in the US, this study expands on this subject by providing novel insights into DACU cognitions and behaviors of Canadians, although updated research with contemporary samples is needed to determine if these perceptions and attitudes have changed with expanded access to cannabis following federal legalization. Informed by an understanding of the perceptions and attitudes of people who DACU, tailored prevention and treatment efforts aimed at the people most likely to engage in this behavior can be made to promote safe decision-making concerning driving.”

The article, “High Seroprevalence of Hepatitis C Virus Among Cisgender Women Who Exchange Sex in the Seattle, Washington Area,” has been published in SAj.

The authors state that injection drug use (IDU) is a risk factor for hepatitis C virus (HCV) acquisition and occurs disproportionately among women who exchange sex (WES). However, little is known about HCV epidemiology in this population. We estimated HCV seroprevalence, identified correlates of HCV seropositivity, and characterized social networks by HCV serostatus and IDU history among WES in the Seattle, Washington, area.

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

“Previous studies among PWID have found peer referral to be an effective means of linking PWID with HCV care, but most of this research has been conducted outside of the United States, and to our knowledge, none has focused on WES.

To address these knowledge gaps, we used data from a cross-sectional survey of WES in the Seattle, Washington area to (1) estimate the prevalence of HCV seropositivity, (2) identify correlates of HCV seropositivity, and (3) characterize social networks among WES by analyzing participant recruitment trees and measuring whether and to what extent individuals were likely to recruit others with the same HCV serostatus or IDU history.”

“The high prevalence of lifetime IDU in our sample of WES highlights the need for targeted HCV services and interventions for this population. WES—as well as other women who have HCV—are likely to encounter barriers and stigma when accessing health care. One strategy for reaching stigmatized communities is through peer referral. For example, a team from the University of British Columbia found that peer referrals to drug treatment were effective for WES. Based on this and other work among populations with a high HCV burden, we hypothesized that HCV treatment interventions involving peer referral of networks may be beneficial to WES.”

The article, “Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone,” has been published in SAj.

In this commentary, the authors state that West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia’s nine opioid treatment programs (OTPs) for the first time.

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

“Understanding utilization of methadone among enrollees who received Medicaid-covered methadone for the first time following implementation of West Virginia’s policy change is important to inform future policy decisions addressing disparities in access to MOUD. In West Virginia, Medicaid represented the first major source of public funding for OTP services—federal block grants had previously not covered OTP services. Thus, many people covered by Medicaid would likely have either been new to methadone treatment or have been self-paying for methadone treatment prior to the waiver, given there was no coverage of OTP services through Medicaid or Medicare prior to 2018 and 2020, respectively, though this has not been explored. It is also unknown whether Medicaid coverage of OTP services would have different impacts for those already recognized as needing treatment (e.g., enrolled with an OUD diagnosis) compared to those without. Additionally, while expanding Medicaid coverage of OTP services removed the cost barrier, prior studies have identified that distance from an OTP reduces methadone use and treatment duration, and there are wide disparities in access to OTPs across the United States, particularly in nonmetropolitan areas. To that end, we also examine whether these known barriers (i.e., travel distance and residing in a nonmetropolitan area) impacted methadone initiation and treatment duration following Medicaid coverage of methadone treatment.”

“The implementation of the IMD waiver may have been associated with an influx of enrollees. Many individuals who initiated treatment with Medicaid-covered methadone had no prior diagnosis of OUD or prior Medicaid enrollment in our observation period and potentially were existing uninsured OTP patients, underscoring that Medicaid coverage of methadone may bring underserved populations to the program. At minimum, Medicaid coverage of methadone reduces affordability barriers to OTP services for patients who otherwise were not receiving MOUD. Still, methadone patients in West Virginia Medicaid frequently traveled over 20 miles to an OTP, suggesting that the state needs greater methadone availability.”

The article, “Why Substance Use Screening Frequency Matters in Adult Primary Care,” has been published in SAj.

The authors state that evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time.

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

“The USPSTF lacks explicit guidance regarding screening frequency, stating that there is little or inadequate evidence around the optimal screening interval. Studies reviewing screening implementation to evaluation are plentiful, but also lack guidance around screening frequency. In lieu of strong evidence to guide policies, healthcare sites may generate policies based on how heavily they weigh convenience versus perceived risk about how quickly substance use can escalate to hazardous levels. Providers who weighed convenience tended to prefer annual screenings bundled with general health screening visits; providers who were concerned about how quickly substance use can escalate were more likely to advocate for more frequent screenings, as annual screenings alone could miss opportunities for early intervention. Additionally, universal screening integrated within the workflow may reduce biases in screening and identification of individuals using substances. Given the inquiries from the healthcare sites, lack of explicit guidance from the USPSTF, and PERU’s positionality with the robust data set, PERU conducted a secondary analysis from the PA SBIRT screening data to examine patterns and direction of change in substance use risk category among patients being screened on multiple occasions. The results generated initial insights into the applicability of frequent screening policies.”

“Screening in adult primary care settings is recommended to reduce substance use. The results from this analysis function as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection to care. This analysis points to potential benefits of frequent screening policies. Evidence-based screening tools, along with policies that implement frequent screening, may further support providers to identify patients at risk of SUD and connect them to appropriate care. Healthcare professionals should consider these findings supporting frequent, universal screening when determining policies on screening frequency for substance use identification.”