The article, “‘I’m Clean and Sober, but not Necessarily Free’: Perceptions of Buprenorphine Among Patients in Long-Term Treatment,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue.

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

“Findings from this study may help inform shared decision-making conversations between clinicians and patients regarding buprenorphine treatment duration and thereby contribute to patient-centered care. While most evidence indicates that longer treatment duration is better than shorter duration, continuing treatment long-term, or without a clear end point, may be contrary to patient wishes, desires, and/or concerns. Recognizing beliefs and medication perspectives that may underlie patients’ desires to discontinue treatment may help clinicians to anticipate such concerns and better address them within the context of shared decision-making conversations.”

“As patients stabilize in recovery, many may begin to consider tapering or discontinuing buprenorphine. Findings from this study may help clinicians anticipate patient concerns, and can be used to inform shared decision-making conversations between clinicians and patients regarding optimal buprenorphine treatment duration.”

The article, “The Association of Vaping With Social/Emotional Health and Attitudes Toward COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the COVID-19 Pandemic,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that vaping is a major health risk behavior which often occurs socially. Limited social activity during the COVID-19 pandemic contributed to worsening social and emotional health. The authors investigated associations among youth vaping, and reports of worsening mental health, loneliness, and relationships with friends and romantic partners (ie, social health), as well as perceived attitudes toward COVID-19 mitigation measures.

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

“We found that vaping among AYA was associated with larger perceived negative impacts from the COVID-19 pandemic on emotional wellbeing and greater levels of other substance use. We found no evidence that vaping was protective against experiencing loneliness or worsening social relationships during the COVID-19 pandemic. Further, we found that youth who vaped were less likely to adhere to non-pharmaceutical measures put in place to prevent the spread of COVID-19 compared to their non-vaping AYA peers.”

“Overall, vaping has been associated with a variety of health problems among AYA and while vaping may be a social activity, we found no evidence that it was protective of social/emotional health during the pandemic. On the contrary, while cross-sectional analyses cannot determine causation, vaping appears to be an indicator of increased risk for other substance use, mood, eating, and sleep disorders. Moreover, youth who vape may be more likely to forgo protective strategies such as social distancing and masking, even when they view those measures as being important. As such, health care providers involved in the care of AYA should screen for vaping and related co-occurring risk behaviors and health problems to take advantage of the opportunity to also identify and treat substance use and possible co-occurring disorders.”

The article, “Buprenorphine Prescribing and Dosing Limits: Evidence and Policy Goals,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that the opioid misuse epidemic is a serious public health crisis. Opioid-involved deaths continue to rise and the potency of illicitly manufactured synthetic opioids has increased, creating challenges for the healthcare system to provide multifaceted specialized care. Elements of the regulation around buprenorphine, 1 of 3 drugs approved to treat opioid use disorder (OUD), constrain treatment options for patients and providers alike. Updates to this regulatory framework, particularly around dosing and access to care, would enable providers to better treat the changing landscape of opioid misuse. The authors state specific actions to this end are to: (1) Increase buprenorphine dosing flexibility based on FDA labeling which drives payor policies; (2) Restrict local government and institutional impositions of arbitrary access and dosing limits for buprenorphine; and (3) Liberalize buprenorphine initiation and maintenance via telemedicine for OUD.

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

“Reducing barriers to accessing care is a key step that can create lasting change. Among the 2 approved opioid agonist MOUD, buprenorphine is more easily modified from a regulatory perspective. Although advocacy for extended access to methadone has been well articulated and available data show relaxed regulation during the pandemic did not necessarily lead to increased safety concerns, this manuscript focuses on buprenorphine alone. This is because the safety of methadone expansion appears significantly more complex due to its full agonist properties, prolonged half-life, additional physiological effects (eg, QTc prolongation and drug-drug interactions), and regulatory framework. Methadone’s regulatory constraints, justified or not, further support broader use of and easier access to buprenorphine products.”

The article, “A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.

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

“To our knowledge, this study is one of the first investigations of differences in U.S. national MOUD treatment outcomes and social determinants of health based specifically on housing status. There were several main findings.”

“Our findings highlight the potentially additive or intersectional nature of social determinants of health for people experiencing homelessness and how they might potentially compound to worsen outcomes in MOUD treatment. Examples from the present study include how, compared to episodes among those who were housed, we found the group of episodes among PEH had significantly higher rates of unemployment, no income, receipt of public assistance, lacking health insurance, and arrests in the 30 days prior to admission and discharge.”

The article, “The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce,” has been published in SAj in Volume 44 Issue 1-2.

In this commentary, the authors state that in 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses’ knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, that to their knowledge, is the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

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

“Substance use disorder is widespread across the lifespan, underscoring the need for nurses in all disciplines and settings to have the expertise and skills to help to manage the global burden of substance use disorder. To address this, all nurses must have the education and clinical training necessary to care for individuals with substance use disorder. Nurses with education on addiction and possessing well-developed clinical skills in the management of patients with SUD can play a major role in improving the care of this marginalized patient population and reducing negative attitudes toward them. Thus, there is a clear need to establish additional addiction nursing fellowships across the country. This description of BMC’s addiction nursing fellowship may provide a useful model for replication.”