The article, “In Support of Community Drug Checking Programs: Position Statement of AMERSA, Inc. (Association for Multidisciplinary Education and Research in Substance use and Addiction),” has been published in SAj.

In this commentary, the authors state that this Position Statement, endorsed by the AMERSA Board of Directors on October 3, 2023, amplifies the position of the organization, guides their activities, and informs the public and policymakers on the organization’s stance on this issue.

In the AUTHORS’ OWN WORDS, they relate the importance of this issue:

“The unregulated drug supply in the United States evolves constantly, leaving those who use drugs potentially unaware of new adulterants in their drugs. Not knowing that information can leave people vulnerable to serious adverse events such as fatal overdoses, wounds, and other health consequences. Without real-time data on the composition of drugs available in a community, healthcare providers and public health practitioners are left with insufficient data, making it increasingly difficult to know how to best serve people who use drugs. In this context, community-based drug checking has become recognized as an important harm reduction strategy with the potential to provide those who use drugs with more information about their supply.”

“With the changing drug supply, it is crucial that we support and expand drug checking initiatives. To do so, we must increase access to and funding for all forms of drug checking technologies (ie, ITS, FDIR, GC-MS).”

“Moreover, it is imperative that we support the thoughtful and sustainable implementation of robust drug checking programs that are tailored to and driven by local community needs.”

“Finally, principles of equity and anti-racism must be at the forefront of these implementation plans to ensure that drug checking initiatives do not repeat inequities created by the War on Drugs or increased police surveillance in communities of color. In line with this, we must advocate for laws and policies that ensure that drug checking materials (eg, FTS) are not criminalized as paraphernalia and, ultimately, seek to establish a safe supply.”

The article, “Cocaine Use is Associated With Increased LVMI in Unstably Housed Women With Polysubstance Use,” has been published in SAj.

In this commentary, the authors state that while substance use is known to influence cardiovascular health, most prior studies only consider one substance at a time. The authors examined associations between the concurrent use of multiple substances and left ventricular mass index (LVMI) in unhoused and unstably housed women.

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

“Notably, these studies do not account for other substances, which is salient given rising trends of overdose death associated with polysubstance use. Furthermore, it has become clear that current CVD risk scores, often derived from study populations composed mostly of men, do not accurately predict CVD risk in women and that non-traditional risk factors are more common in women. Despite known sex differences in CVD risk factors, left ventricular (LV) remodeling, and a higher risk of death associated with LV hypertrophy in women, much of the existing evidence comes from predominantly male study populations. Sex-specific research that leads to sex-specific risk assessment models may improve risk prediction, particularly in women.”

“Our previous work showed that cocaine use is significantly associated with high-sensitivity cardiac troponin (hsTnI) in hospitalized patients. Similarly, we found that toxicology-confirmed substance use is associated with higher levels of hsTnI in non-hospitalized, unstably housed women,^18,26 suggesting potential ongoing cardiac injury in chronic users. The present study extends these findings to investigate structural evidence of end organ damage by examining the independent effects of stimulants and other substances on LVMI.”

The article, “Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders,” has been published in SAj.

In this commentary, the authors state that clinical pharmacist practitioners (CPPs) play an increasingly important role in interdisciplinary care for patients with substance use disorders (SUDs). However, CPPs’ scope of practice varies substantially across clinics and settings. The authors sought to describe CPP practices and activities within an interdisciplinary, team-based primary care clinic dedicated to treat Veterans with histories of substance use disorders, experience of homelessness, high medical complexity, and other vulnerabilities.

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

“Nearly 1 in 7 primary care patients meet criteria for a substance use disorder (SUD), yet most patients with SUDs do not receive evidence-based treatment. Emergency department visits attributed to SUD-related causes increased by 45% from 2013 to 2018. With rising opioid-related overdoses and deaths, there have been calls for primary care to assume a greater role in providing treatment for SUDs, including opioid use disorder (OUD). However, system and provider barriers persist. Primary care providers (PCPs) often describe time constraints and lack of support staff as key barriers to prescribing medications for opioid use disorder (MOUD), even after receiving certified training to do so. Expanding the role of clinical pharmacist practitioners (CPPs) within primary care could address PCP staff shortages, mitigate time and resource barriers to medication treatment for SUDs, and prevent more costly hospital-based services.”

“Our study adds to the literature in several important ways. First, while other primary care-based studies that have utilized CPPs have shown effectiveness of CPPs for treating a single condition such as OUD alone, we found that mental health CPPs can successfully manage patients in a primary care setting when illness severity and medical complexity are high. Second, while previous studies have shown promise for CPPs in limited ways (eg, through small patient panels or restricted autonomy such as only following patients already stabilized on medications for SUDs), this study depicts successful CPP care management for a large patient panel where CPPs had autonomy to initiate medication treatment (ie, 5% of OUD interventions and 10% of AUD interventions performed by CPPs). The VA allows for CPPs to be co-located within primary care clinics and, in the present interdisciplinary clinic, the 2 CPPs collaborated closely with PCPs under their scope of practice. Thus, our results offer an example of how adding mental health CPPs to primary care settings can support PCPs in providing SUD care.”

The article, “Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder,” has been published in SAj.

In this commentary, the authors state that people living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). Their study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment.

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

“People living with both HIV and OUD are a highly prevalent, especially marginalized, high transmission-risk group with outsized implications for ending the HIV and OUD epidemics. Therefore, we investigated associations between 5 supportive SDOH and MOUD initiation, opioid use, and other substance use over a 6-month period in persons living with HIV enrolled in an OUD treatment randomized trial. We hypothesized that increased supportive SDOH would be associated with increased likelihood of MOUD initiation and reduced substance use over the trial period.

“Interventions targeting SDOH are increasingly recognized by the National Institute on Drug Abuse and others as vital to mitigating harms of the opioid epidemic and preventing future use disorders. Our study suggests that modifiable social determinants of health, including income, education, housing, criminal justice involvement, and engagement in SUD treatment may impact MOUD initiation and opioid use outcomes among people living with HIV and OUD. These findings, when added to the body of literature showing similar associations, provide possible intervention targets for future experimental studies. Especially following the steep rise in inequalities and overdose deaths during the COVID-19 pandemic, which disproportionately affected people of color, people experiencing homelessness, and those with co-occurring conditions including HIV, results highlight the need to address SDOH as part of OUD care.”

The article, “Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop,” has been published in SAj.

In this commentary, the authors state tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. Their project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop.

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

“One of the most common and significant barriers to discontinuing tobacco use reported by these communities is a lack of support from health professionals. The ability of health professionals to incorporate social and cultural influences into therapeutic interactions and treatment plans is now recognized as essential to high quality health care. In general, training to improve these competencies has shown promise, however the competencies and skills required for treating tobacco use among marginalized communities are unknown. We propose that increasing the proficiencies with which health professionals incorporate social and cultural influences on tobacco use into therapeutic interactions will improve the quality and effectiveness of tobacco treatment provided to marginalized communities, and contribute to addressing a well-established barrier to discontinuing tobacco use among these communities.”

“This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals, develop a virtual, self-paced workshop, and then pilot test the workshop via expert review. Because the approach required an intensive focus on improving these proficiencies, the approach was developed for learners who already had basic knowledge and skills for treating tobacco use with evidence-based approaches. Treatment of tobacco use is delivered in many contexts by health professionals from multiple disciplines. Thus, to achieve our aim the approach required that we accommodate differences in treatment settings and professional disciplines.”