The article, “Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy,” has been published in SAj.

In this commentary, the authors state that in the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes

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

“This paper provides an innovative roadmap of necessary research to support increased access of MOUD in a community pharmacy setting. The collaboration of experts within the field to collectively define these areas of interest is important. However, other voices will be needed through this research to best highlight successful approaches to OUD care in alternative locations from opioid treatment programs.”

“Pharmacists are integral health professionals that stand to be useful providers within the continuum of OUD treatment, particularly in the community pharmacy arena, to increase access to services. More research is needed to best understand mechanisms for inclusion of services, payment and operational models, and professional education and development for evidence-based practice.”

The article, “Improving DEIB in Addiction Medicine Training Through Interdisciplinary Collaboration and Program Evaluation,” has been published in SAj.

In this commentary, the authors state that developing a diverse Addiction Medicine (AM) workforce will improve medical and public health responses to the increasing health risks created by substance use disorders (SUDs). A workforce that embraces diversity, equity, inclusion, and belonging (DEIB) principles may foster novel responses to address the disparities in treatment and outcomes experienced by Black, Indigenous, and People of Color (BIPOC) who are impacted by SUDs. However, experiences of bias and discrimination in the workplace and a lack of exposure to addiction-related content in educational settings limit opportunities to develop and retain a diverse workforce.

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

“Boston Medical Center (BMC) and Boston University Aram V. Chobanian & Edward Avedisian School of Medicine (BUCASM) are among the leading institutions in the field of addiction with nationally recognized addiction training programs, clinical care models, and innovative research programs. These addiction medicine training programs include the Grayken Fellowship in Addiction Medicine (AMF), the Chief Resident Immersion Training (CRIT) Program in Addiction Medicine, the Fellow Immersion Training (FIT) Program, and the Research in Addiction Medicine Scholars (RAMS) Program

In this robust training environment, we describe the creation of a program at BMC/BUCASM which aims to improve and foster diversity, equity, inclusion, and belonging (DEIB) within AM training programs.”

“Widening disparities in access to SUD care and increasing opioid overdose rates observed during the COVID-19 pandemic further demonstrate the demand for innovative approaches to recruit and train the future AM workforce. The IDEAAA program is an example of a multidisciplinary multi-pronged approach connecting different age learners in the community with faculty at an academic institution in order to increase knowledge, reduce stigma, and train and mentor future innovators and leaders in addiction medicine.”

The article, “Associations Between Patient-Reported Experiences with Opioid Use Disorder Treatment and Unmet Treatment Needs and Discontinuation Among Virginia Medicaid Members,” has been published in SAj.

In this commentary, the authors state many payers, including Medicaid, the largest payer of opioid use disorder (OUD) treatment, are pursuing treatment-related quality improvement initiatives. Yet, how patient-reported experiences with OUD treatment relate to patient-centered outcomes remains poorly understood. The authors aim to examine associations between Medicaid members’ OUD treatment experiences, outpatient treatment settings, demographic and social factors, and members’ self-report of unmet needs during treatment and treatment discontinuation.

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

” Medication for opioid use disorder (MOUD) such as buprenorphine, methadone, and naltrexone are proven to reduce opioid use and overdose deaths as well as improve other treatment outcomes. Treatment with MOUD is the only type of treatment that has been shown to reduce the risk of overdose death as well as opioid-related acute care use. For any treatment, including MOUD, to be effective, patients must feel that they can access appropriate care where they are treated with dignity and respect. Reports of unmet needs during treatment represent important information about both the accessibility of treatment types and potential inequities, and patients’ identification of unmet needs may reflect poorer care for specific groups. Importantly, these unmet needs during treatment are associated with an increased risk of opioid overdose. Similarly, retention in treatment is an important quality measure in the treatment cascade. While MOUD is known to be highly efficacious, continued successful retention in treatment is critical: findings from a multi-state sample of Medicaid members from 2013 to 2017 showed that MOUD treatment discontinuation increased overdose risk, prescription opioid fills, as well as emergency department use and inpatient hospitalizations.”

“To inform and improve the OUD treatment delivery systems in Virginia Medicaid and beyond, we used a first-of-its-kind survey to characterize the relationship between patient-reported treatment experiences, type of outpatient treatment received, and patient-reported unmet treatment needs and discontinuation.”

The article, “Association Between Opioid Dose Reduction Rates and Overdose Among Patients Prescribed Long-Term Opioid Therapy,” has been published in SAj.

In this commentary, the authors state that tapering long-term opioid therapy is an increasingly common practice, yet rapid opioid dose reductions may increase the risk of overdose. The objective of their study was to compare overdose risk following opioid dose reduction rates of ≤10%, 11% to 20%, 21% to 30%, and >30% per month to stable dosing.

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

“In response to the opioid crisis, the Centers for Disease Control and Prevention (CDC) and other organizations issued guidelines to encourage safer opioid prescribing practices. The CDC Guidelines recommend that clinicians closely monitor patients prescribed opioids to re-evaluate whether the benefits of opioid therapy outweigh the harms, which may include opioid use disorder and overdose. When harms exceed benefits, guidelines encourage clinicians to consider slowly tapering the patient’s opioid dose, beginning with a 10% dose reduction per month for patients taking opioids for years, and 10% per week for shorter opioid therapy durations. These tapering rate recommendations, however, were based on limited evidence, and it has been suggested that inappropriately rapid tapers increase the risk for heroin use, suicide, and, paradoxically, overdose.”

“Using electronic health record (EHR) data from three diverse health systems, we identified patients prescribed LTOT and applied a scan statistic methodology to identify opioid dose patterns across the follow-up, including stable doses and dose reduction rates of ≤10%, 11 to 20%, 21 to 30%, and >30% per month. We conducted a retrospective cohort study to examine the effect of the different dose reduction rates on the incidence of overdoses occurring at 1, 3, 6, 9, and 12 months after initiation of a dose reduction. We hypothesized that faster dose reductions would be associated with higher overdose risks.”

The article, “Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis,” has been published in SAj.

In this commentary, the authors state that outpatient methadone guidelines recommend starting at a low dose and titrating slowly. As fentanyl prevalence and opioid-related mortality increases, there is a need for individuals to rapidly achieve a therapeutic methadone dose. Hospitalization offers a monitored setting for methadone initiation, however dosing practices and safety are not well described.

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

“In this retrospective analysis of hospitalized patients with OUD who were newly initiated on methadone by an inpatient addiction consult team, patients were titrated more rapidly than traditional OTP initiation dosing with only 3.5% of patients experiencing a safety event probably or definitely related to methadone. In all cases the safety event was oversedation not requiring naloxone. Patients who experienced an oversedation event that was possibly related to methadone had higher final methadone doses than those who did not experience any sedation events. More than three-quarters (76%) of patients were successfully connected to an OTP prior to discharge.”

“These findings suggest that hospitalization may offer an opportunity to safely initiate methadone with a more rapid dosing titration than what is currently utilized in outpatient settings.”