The article, “Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care,” has been published in SAj.

In this commentary, the authors state that the lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care.

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

“Barriers to the uptake of this treatment in primary care settings includes stigmatizing views toward patients with OUD, concerns with diversion, perceived lack of staff to support clinic workflow, and provider lack of confidence in ability to provide the treatment. However, these barriers can be addressed by working with providers to give them access to comprehensive education/training and ongoing support as they initiate and expand treatment. In 2017, our team of providers and researchers, with expertise in treatment of OUD, buprenorphine prescribing and therapeutic approaches, developed an innovative curriculum to support rural primary care providers to start this treatment. Our curriculum, called MOUD ECHO, uses the Extensions for Community Healthcare Outcomes (ECHO©) model, an online telementoring approach providing didactics and interactive case-based learning with expert consultation.”

“Findings from this study help advance our understanding of the specific relationship between participating in MOUD ECHO sessions on expanding buprenorphine treatment in rural primary care. This study provides compelling evidence that participation can significantly increase the number of providers implementing this treatment and adding patients onto their panels.”

The article, “Impact of Mandated Case Review Policy on Opioid Discontinuation and Mortality Among High-Risk Long-Term Opioid Therapy Patients: The STORM Stepped-Wedge Cluster Randomized Controlled Trial,” has been published in SAj.

In this commentary, the authors state that the United States is facing a severe opioid crisis. Opioid overdose deaths rose from 47 600 in 2017 to 80 411 in 2021 and are the leading cause of injury deaths in the U.S. Veterans are at a greater risk of overdose-related adverse events due to higher rates of chronic pain, mental health disorders, and substance use disorders relative to the general U.S. population.

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

“Given the observed mortality benefits of the mandated case review policy and the potential challenges posed to LTOT patients who are discontinued from opioids, it is possible that the mandated case review policy could help clinicians consider unique factors such as duration of treatment, type of pain, and the physical and psychological attributes of the patient, and tailor their practice to cater for individual patient’s needs and concerns. Providers may change their prescribing patterns to ensure safe and effective opioid use for the patients, which could result in reduced mortality risk. Our study aimed to evaluate the impact of the mandated case review policy on discontinuation of VHA opioid prescriptions. We further tested the effect of the mandated case review policy on mortality among the subset of high-risk patients receiving LTOT. We hypothesized that the mandated case review policy would reduce the risk of prescription opioid discontinuation and mortality for LTOT patients.”

“This is the first national study suggesting that a predictive model-targeted prevention program had an impact on reducing likelihood of discontinuation for high-risk patients receiving LTOT. The findings also show a substantial decrease in the risk of mortality resulting from the mandated case review policy for this group of patients. Further investigation of interventions that maintain care engagement while optimizing pain management for high-risk patients may be beneficial for minimizing mortality and other risks.”

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, “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, “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.”