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.”

The article, “Regional Variation in Opioid-Related Emergency Medical Services Transfers During the COVID-19 Pandemic: An Interrupted Time Series Analysis,” has been published in SAj.

In this commentary, the authors state that the COVID-19 pandemic has impacted public infrastructure and healthcare utilization. However, regional variation in opioid-related harm secondary to COVID-19 remains poorly understood. This study aimed to measure the regional variation in the association between stay-at-home orders (SAHOs) and nonfatal opioid-related emergency medical services (EMS) transfers in the United States.

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

“Changes in the frequency and characteristics of EMS visits may be an advanced indicator of changes in opioid morbidity. Prior evidence demonstrated a nationwide increase in EMS transfers following state-level stay-at-home order (SAHO) implementation. Regional variation in this phenomenon, however, remains unmeasured. The United States is a vast country with significant sociodemographic variation at the regional level. Measuring regional differences in the trajectory of opioid-related morbidity in the wake of SAHO implementation can provide policymakers and public health authorities with useful information to focus future opioid response efforts. Therefore, this study aimed to measure regional variation in nonfatal opioid overdose-related EMS transfer activity before and after implementing the US COVID-19 SAHO.”

“This study highlights the need for a comprehensive and coordinated response to address the opioid overdose epidemic, including ensuring access to quality healthcare, mental health services, and addiction treatment. These changes will require collaboration among healthcare providers, public health agencies, and community organizations to address the root causes of the overdose crisis. Public health organizations and policymakers can also use these findings at a regional level to develop effective strategies and prevention programs to mitigate the impact of the opioid crisis.”

The article, “Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample,” has been published in SAj.

The authors state that the prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, they assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior.

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

“Despite the influence of social norms on tobacco use, there is limited research focused on older adults or differences across age groups. The current study among people who use CCs in Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study aims to determine whether the relationship between social norms and (1) past-year CC quit attempts and (2) past-month EC use varies as a function of age. We hypothesize that positive CC social norms will be negatively associated with quit attempts and vice versa, and the relationships will be stronger among older adults. We also hypothesize that positive EC social norms will be positively associated with EC use and vice versa, and that these relationships will likewise be stronger with older age.”

“Social norms about CCs and ECs differ by age, with older age generally associated with both positive and negative norms related to CCs and negative norms related to ECs. Socioenvironmental factors such as healthcare provider advice and home smoking bans are associated with both tobacco use behavior and age, suggesting that further emphasis on these factors can further improve clinical outcomes. Communication interventions would also be helpful to correct misperceptions and normative beliefs about tobacco products. A social norms communications campaign approach, for instance, could be developed to increase perceptions of approval of EC among adults ≥55 by their peers, making them more likely to consider switching from CCs. Social norms should continue to be evaluated and addressed, especially as the tobacco regulatory environment changes, leading to even larger disparities related to age, gender, socioeconomic status, disability, and more.”

The article, “High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants,” has been published in SAj.

The authors state that injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Their objective was to determine interest in iOAT-H among syringe services program (SSP) participants.

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

“In a sample of 108 SSP participants with OUD and a history of injecting opioids, we found that most were interested in receiving iOAT-H. More than 40% of participants reported that iOAT-H would be preferable to other forms of OUD treatment. Participants who were interested in iOAT-H injected heroin on more days per month, injected in public more frequently, and were more likely to participate in an illegal activity (other than drug possession) than participants who were not interested, suggesting that those who could most benefit from iOAT were also those who were most interested in the treatment. Though interest in iOAT-H was not universal, we identified a highly interested group of treatment-experienced PWID with severe OUD who were at high risk for OUD-related harms.”

“First-line MOUDs, such as methadone and buprenorphine, work well for many persons with OUD; however, even when these conventional treatments are available, important groups of PWID remain out of treatment and at high risk for opioid-related harms. iOAT-H provides a promising option to engage treatment-experienced individuals who continue to inject opioids after trying first-line OUD treatments. Our study demonstrates interest in iOAT-H, especially among persons at high risk for overdose—those with severe OUD who frequently use non-prescribed opioids and inject in public places. Broadening the spectrum of MOUDs available in the United States could help address the unacceptably high rates of opioid-involved overdose death.”