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.”

The article, “Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce,” has been published in SAj.

In this commentary, the authors state that reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. They sought to characterize the program’s impact on the knowledge and attitudes of NE OBAT ECHO participants.

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

“To effectively care for patients with OUD, better training, including ongoing education, is needed for multidisciplinary care teams. The field of addiction medicine evolves rapidly as new regulations, medications, and protocols are introduced. The Extension for Community Healthcare Outcomes (ECHO) Model is a telementoring model shown to increase the capacity of care teams to manage chronic health conditions, including OUD.”

“We found that the NE OBAT ECHO, a tele-mentoring program linking community-based healthcare professionals to experts in addiction medicine, improved participants’ overall attitudes toward working with patients with SUD. In the face of an undereducated workforce with high rates of burnout, this is likely a valuable model for expanding and sustaining the SUD workforce.”

The article, “Evaluating a Video-Based Addiction Curriculum at a Safety Net Academic Medical Center,” has been published in SAj.

In this commentary, the authors state that since 2019, the United States has witnessed an unprecedented increase in drug overdose and alcohol-related deaths. Despite this rise in morbidity and mortality, treatment rates for substance use disorder remain inadequate. Insufficient training in addiction along with a dearth of addiction providers are key barriers to addressing the current addiction epidemic. Addiction-related clinical experiences can improve trainee knowledge, yet they remain dependent on practice sites and residency training environments. Asynchronous learning, in the form of video-based modules, may serve as a complement to formal, scheduled lectures and clinical experiences.

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

“The rising morbidity and mortality associated with SUD highlights the importance of making addiction education materials available to all medical providers. Asynchronous learning modalities such as brief addiction videos have the capacity to improve confidence in and knowledge around management of OUD and AUD among medical trainees.”

“While evidence demonstrates that brief addiction-related clinical experiences improve trainee knowledge, these clinical experiences are not always available or feasible. Further, formal or scheduled didactic lectures are often not adequate to reach large groups of residents or faculty who have varied practice schedules. Asynchronous learning—self-paced, efficient learning—is a potential solution for busy medical trainees and can complement clinical experiences. Asynchronous learning became more feasible during the COVID-19 pandemic when in-person lectures transitioned to interactive virtual platforms.”

The article, “Dispensary Staff Perceptions About the Benefits, Risks, and Safety of Cannabis for Medical Purposes,” has been published in SAj.

In this commentary, the authors state that therapeutic use of cannabis is common in the United States (up to 18.7% of Americans aged ≥12), and dispensaries in the US are proliferating rapidly. However, the efficacy profile of medical cannabis is unclear, and customers often rely on dispensary staff for purchasing decisions. The objective was to describe cannabis dispensary staff perceptions of medical cannabis benefits and risks, as well as its safety in high-risk populations.

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

“Not surprisingly, it follows that very few (<3%) dispensary customers use advice from a medical professional to guide their product choice, relying on dispensary staff. Other studies have documented dispensary staff roles in offering recommendations to treat a variety of medical conditions with cannabis products.

The purpose of this study was to conduct a descriptive study to better understand cannabis dispensary staff perceptions of medical cannabis benefits and risks for several medical conditions, as well as its safety in high-risk populations (pregnant individuals, older adults). This study is significant in that our findings provide new knowledge to help medical professionals provide anticipatory guidance to patients about how dispensary staff think about cannabis benefits and risks in the context of available medical evidence. This may have important implications for policy guidance on dispensary staff training, and lead to key next steps (e.g., training development) that improve customer safety and efficacy outcomes.”