The article, “Relationships Between Stigma, Risk Tolerance, and Buprenorphine Dispensing Intentions Among Community-Based Pharmacists: Results From a National Sample,” has been published in SAj.

In this commentary, the authors state that concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists’ endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, the authors assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions.

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

“In the context of existing stigma and knowledge deficits, the concept of risk aversion related to controlled substance dispensing has been identified among pharmacists. Risk aversion, defined as a preference for certain outcomes over uncertain outcomes, is a pervasive cognitive bias, at times leading to disadvantageous decision-making to avoid uncertainty around potential negative outcomes.

In the present research, we explore 2 factors that may influence pharmacists’ dispensing behavior—stigma toward patients taking buprenorphine for OUD and risk tolerance in the domain of pharmacy practice. In addition to measuring levels of stigma toward buprenorphine patients and risk avoidance, the present research explored how these key variables relate to (1) general intentions to dispense buprenorphine and (2) decision-making in buprenorphine dispensing vignettes. Specifically, we hypothesized that stigma and risk tolerance would impact more proximal cognitions like behavioral intentions and comfort with dispensing a specific prescription to influence decision-making. We tested our hypotheses using a variety of statistical methods, including mediation models.”

“Buprenorphine is an effective treatment for OUD with the potential to reduce mortality, but patients may encounter barriers to access in pharmacy settings. Our data suggest that stigmatizing beliefs and concerns about risk among community pharmacists may contribute to these barriers. Education and training efforts and regulatory reform should incorporate attempts to reduce stigma and broaden the scope of risks considered in pharmacy practice to include negative outcomes of choosing not to fill a valid prescription.”

The article, “The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping,” has been published in SAj.

In this commentary, the authors state that although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. The authors examined the consistency of syringe pricing as another possible barrier.

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

“Pharmacists are among the most accessible healthcare providers and therefore are uniquely positioned to provide harm-reduction services. Pharmacies can contribute to community infection prevention by stocking and dispensing medications for opioid use disorder and NPS, as well as providing universal, on-site, and portable syringe disposal services. Pharmacies can also act as critical sources of the opioid antagonist, naloxone, which is a medication proven to reduce opioid overdose mortality. At the same time, pharmacies can only provide effective harm-reduction services if syringes are consistently stocked and distributed at low- or no-cost. The purpose of this study is to examine the variability of syringe prices across 2 retail chain pharmacy businesses and 4 states—Massachusetts, New Hampshire, Oregon, and Washington—and to explore the determinants of syringe prices.”

“Inconsistency in syringe price is yet another barrier to accessing sterile syringe equipment from community pharmacies. While professional education is needed to reduce stigma at pharmacy counter interactions, system-level changes are critically needed to improve transparency, streamline syringe purchases, eliminate the taxation of exempt syringes, and reduce the variation in syringe prices if equitable, consistent access to these essential public health tools is to be realized for consumers.”

The article, “Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults,” has been published in SAj.

In this commentary, the authors state that adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Adverse childhood experiences (ACEs) are defined as stressful and/or traumatic experiences that occur before the age of 18 years and consist of abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (parental incarceration, divorce, substance use, abuse toward mother). ACEs are a common occurrence, with nearly two-thirds of US adults reporting having experienced at least 1 ACE, and most individuals who experience ACEs experience more than one type. Unfortunately, ACEs are associated with a range of problematic health outcomes, including substance use (eg, tobacco, cannabis, alcohol) and mental health conditions (eg, depression, anxiety) during adulthood.

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

“Because lifelong patterns of health behaviors are commonly initiated during young adulthood, understanding unique associations between specific ACE profiles and a range of adverse health outcomes is essential to informing health behavior interventions to offset the risk of negative health patterns throughout the life course. Thus, the twofold aims of the current study were to: (1) identify classes of young adults based on their exposure to ACEs assessed via the widely accepted 10 ACEs items developed by Kaiser Permanente and (2) examine associations between ACEs classes and a range of health outcomes, including substance use (ie, tobacco use and number of products used; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, symptoms of depression and anxiety).”

“Taken together, young adults displayed 4 unique patterns of ACEs, including Low ACEs, Parental abuse, Poor family health and divorce, and High ACEs. All combinations of ACEs were associated with reporting current use of tobacco and cannabis, as well as current depression and anxiety. However, specific combinations of ACEs uniquely predicted more problematic patterns of tobacco and cannabis use, with Parental abuse potentially driving patterns of polytobacco use, Poor family health and divorce driving patterns of hazardous cannabis use, and the combination of Parental abuse and Poor family health and divorce driving binge drinking behaviors. Findings highlight that all combinations of ACEs are associated with problematic health behaviors among young adults, but that young adults may seek out specific substances to cope with their unique experiences of childhood maltreatment. Findings underscore the need for substance use and mental health interventions for young adults to assess the specific types of ACEs experienced during childhood and to tailor treatment for such experiences.”

The article, “Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults,” has been published in SAj.

In this commentary, the authors state that e-cigarettes are the most commonly used tobacco product among youth in the United States. While overall normal cigarette smoking rates have declined over the last decade, the rising popularity of e-cigarettes has led to concern regarding the perpetuation of nicotine use, particularly in younger populations. E-cigarettes are not subject to the same restrictions historically placed on the tobacco industry, allowing for a variety of e-cigarette device types, flavors, and practices to proliferate in the United States. E-cigarettes are often marketed as a smoking cessation tool or harm reduction product, yet young adults rarely use e-cigarettes for these purposes. Rather, e-cigarettes appeal to young adults for a number of reasons, including: sleek design, user-friendly functions, less aversive experiences of taste, smell, and throat irritation compared to cigarettes, appealing flavors (eg, candy, fruit, or chocolate), accessibility to purchase while underage, and convenience and ability to discreetly use in places where cigarette smoking is not permitted. The consequences of e-cigarette use are well-established and include development of nicotine addiction, transition to combustible cigarette use, and adverse respiratory health effects. Despite these known risks, young people often are unaware of the negative consequences associated with e-cigarettes. Studies have shown that young people often believe that e-cigarettes are harmless and are a healthier alternative to cigarettes, and that they cannot become addicted to them. Furthermore, young people often believe that the mid- to long-term effects of e-cigarette use are not yet known, despite evidence to the contrary. Skepticism about e-cigarette harms and safety among young adults is particularly concerning, given the known consequences of e-cigarette use, and thus warrants continued consideration as a significant public health concern. Using one-on-one interviews with young adults who self-reported having recently used e-cigarettes on a regular basis, the authors examined young adult perceptions of e-cigarette use safety and harms.

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

“While several young adults in our study denied that e-cigarettes were unsafe, others accepted that e-cigarettes were harmful and that they were the “guinea pigs” or early test subjects in proving these harms. Some acknowledged the existence of e-cigarette myths and marketing schemes targeting youth, yet they still continued to use e-cigarettes despite the adverse consequences to their health. Young adults’ denial or defiance of being the e-cigarette “guinea pigs” combined with increased access and exposure to e-cigarettes through peers and online vendors with little self-awareness of their vaping consumption is a deadly combination that can result in higher nicotine exposure and dependence. Given the addictiveness of e-cigarettes and the harm it can cause to a developing brain during adolescence, it is critical for future studies and public health interventions targeting young adults to debunk myths claiming that e-cigarettes are safer than cigarettes and thus not safe to use.”

“The current study describes accounts from young adults who vape regarding their perceptions of e-cigarette harm and safety. Many of their reasons were grounded in misperceptions rather than empirical studies in the literature, and addressing this misinformation should be a top public health priority to encourage and prevent young people from using e-cigarettes. It is unclear what young adults deem to be definitive and informative research and where they are obtaining their information from, which should be a subject for future research. Future public health interventions could target this discrepancy and better translate and disseminate emerging research to a young adult audience, promote anti-vaping campaigns that are youth-centered, and approach young adults as health-conscious consumers.”

The article, “The FASTER-BUP Study, Extended-Release Injectable Buprenorphine for the Treatment of Opioid Use Disorder Among Individuals at High Risk of Overdose: Protocol for an Observational Prospective Study,” has been published in SAj.

In this commentary, the authors state that North America is facing an unprecedented public health emergency of opioid-related morbidity and mortality. The mortality benefits of oral medication treatment for opioid use disorder (MOUD), such as methadone or buprenorphine, are well documented. However, barriers to access and long-term engagement have prevented maximizing their benefits. Long-acting injectable buprenorphine formulations were developed to address some of the challenges associated with oral MOUD. The “Pilot study to assess the feasibility, efficacy, and safety of extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose” (FASTER-BUP) was developed to explore this treatment option in populations at high risk of overdose in a real-world Canadian setting. FASTER-BUP is a 24-week observational prospective study evaluating the feasibility and clinical utility of extended-release injectable buprenorphine (XR-BUP) for the treatment of opioid use disorder (OUD) among 40 adults at high risk of overdose (ie, lifetime history of overdose or a positive urine drug test (UDT) for fentanyl within 30 days prior to screening) in Vancouver, BC. The primary outcome is retention in treatment and secondary outcomes include: use of unregulated opioids, safety, overdose events, treatment satisfaction, changes in drug-related problems, changes in quality of life, opioid cravings, health service utilization, and criminal activity. FASTER-BUP is the first study to explore XR-BUP among individuals at high risk of overdose in a real-world Canadian setting. This commentary provides a brief narrative about the study thus far and presents insights on key adaptations to the study protocol, including those adopted to mitigate recruitment challenges.

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

“Despite its demonstrable efficacy, XR-BUP remains an understudied and underutilized tool with limited programs existing in Canada. In 2018, Health Canada approved one formulation of XR-BUP (ie, Sublocade^TM). The approval of this medication expanded treatment options for individuals with OUD, particularly those for whom medication adherence may pose a challenge. However, there remains a lack of research exploring XR-BUP in real-world Canadian settings and in populations, such as individuals at high risk of overdose, who may benefit most from this treatment. The FASTER-BUP study aims to address this research gap and this narrative provides insight into key adaptations to the study protocol in the hope that it informs future studies.”

“FASTER-BUP is among the first to explore XR-BUP among individuals at high risk of overdose in the Canadian context. Adaptable study materials and partnering with AMCT permitted critical shifts to the study protocol, thus resulting in increased recruitment efforts and study enrollment. This study will generate important preliminary data which will support the development of a larger effectiveness clinical trial evaluating XR-BUP in real-world settings. Ultimately, findings from this study will inform interventions to address Canada’s worsening opioid epidemic.”