The article, “Cannabis Use Differences Among Sexual Minority Versus Heterosexual Females and Males in Oklahoma: The Roles of Mental Health, Cannabis Perceptions, and Cannabis Marketing Exposure,” has been published in SAj.

In this commentary, the authors state that despite the high cannabis use rates among sexual minority (SM) individuals, less research has examined factors related to cannabis use among SM (vs. heterosexual) individuals, especially in places with legal medical cannabis retail markets and high structural stigma, like Oklahoma.

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

“Although elevated rates of cannabis use among SM individuals are evident, less is known about the range of factors that may be associated with cannabis use and use severity among SM, relative to heterosexual adults. Moreover, research on SM cannabis use is lacking in places with legal cannabis retail markets, high structural stigma, and pronounced SM substance use, like Oklahoma. This work is critical to inform public health efforts aimed at reducing cannabis use among this vulnerable population, particularly as further cannabis legalization across the United States is likely. To identify factors associated with differences in cannabis use among SM versus heterosexual individuals, the current study examined associations between sexual identity and potential cannabis-related factors (i.e., perceived harm to health, positive cannabis perceptions, cannabis marketing exposure, depressive symptoms, anxiety symptoms). We then examined associations of sexual identity and these cannabis-related factors with cannabis use and use severity (i.e., any past 30-day use, daily/near-daily use, CUD symptoms). Based on the aforementioned literature, we hypothesized that SM (vs. heterosexual) individuals would display greater odds for current cannabis use, daily/near-daily cannabis use, and CUD symptoms. Moreover, SM (vs. heterosexual) individuals were expected to report lower cannabis-related harm perceptions and greater positive attitudes toward cannabis; a greater proportion of SM individuals was expected to report cannabis marketing exposure, depressive symptoms, and anxiety symptoms. Lower harm perceptions, greater positive attitudes, marketing exposure, and depressive and anxiety symptoms were hypothesized to predict greater odds of each cannabis-related outcome.”

“The current study examined differences in a range of potential cannabis-related factors and behaviors among SM and heterosexual adults in Oklahoma. SM (vs. heterosexual) females reported higher rates of cannabis use, whereas SM (vs. heterosexual) females and males reported higher rates of daily/near-daily cannabis use. Among females, findings may be related to cannabis marketing exposure (for past 30-day and daily/near-daily use) and harm perceptions (past 30-day use), whereas past 30-day cannabis use among males may be related to depressive symptoms. With future replication, findings highlight important potential targets for reducing cannabis-related disparities among SM, relative to heterosexual females and males, respectively, living in places with legal medical cannabis retail markets, high structural stigma, and pronounced substance use. Public health campaigns aimed at correcting misinterpretations of harm that could emanate from marketing efforts by the cannabis industry may help reduce cannabis use among SM females, whereas SM males may be better reached by intervention efforts targeting mental health symptoms, as well as large-scale interventions that attend to the unjust social conditions that perpetuate stigma and discrimination related to sexual identity.”

The article, “High Seroprevalence of Hepatitis C Virus Among Cisgender Women Who Exchange Sex in the Seattle, Washington Area,” has been published in SAj.

The authors state that injection drug use (IDU) is a risk factor for hepatitis C virus (HCV) acquisition and occurs disproportionately among women who exchange sex (WES). However, little is known about HCV epidemiology in this population. We estimated HCV seroprevalence, identified correlates of HCV seropositivity, and characterized social networks by HCV serostatus and IDU history among WES in the Seattle, Washington, area.

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

“Previous studies among PWID have found peer referral to be an effective means of linking PWID with HCV care, but most of this research has been conducted outside of the United States, and to our knowledge, none has focused on WES.

To address these knowledge gaps, we used data from a cross-sectional survey of WES in the Seattle, Washington area to (1) estimate the prevalence of HCV seropositivity, (2) identify correlates of HCV seropositivity, and (3) characterize social networks among WES by analyzing participant recruitment trees and measuring whether and to what extent individuals were likely to recruit others with the same HCV serostatus or IDU history.”

“The high prevalence of lifetime IDU in our sample of WES highlights the need for targeted HCV services and interventions for this population. WES—as well as other women who have HCV—are likely to encounter barriers and stigma when accessing health care. One strategy for reaching stigmatized communities is through peer referral. For example, a team from the University of British Columbia found that peer referrals to drug treatment were effective for WES. Based on this and other work among populations with a high HCV burden, we hypothesized that HCV treatment interventions involving peer referral of networks may be beneficial to WES.”

The article, “Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone,” has been published in SAj.

In this commentary, the authors state that West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia’s nine opioid treatment programs (OTPs) for the first time.

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

“Understanding utilization of methadone among enrollees who received Medicaid-covered methadone for the first time following implementation of West Virginia’s policy change is important to inform future policy decisions addressing disparities in access to MOUD. In West Virginia, Medicaid represented the first major source of public funding for OTP services—federal block grants had previously not covered OTP services. Thus, many people covered by Medicaid would likely have either been new to methadone treatment or have been self-paying for methadone treatment prior to the waiver, given there was no coverage of OTP services through Medicaid or Medicare prior to 2018 and 2020, respectively, though this has not been explored. It is also unknown whether Medicaid coverage of OTP services would have different impacts for those already recognized as needing treatment (e.g., enrolled with an OUD diagnosis) compared to those without. Additionally, while expanding Medicaid coverage of OTP services removed the cost barrier, prior studies have identified that distance from an OTP reduces methadone use and treatment duration, and there are wide disparities in access to OTPs across the United States, particularly in nonmetropolitan areas. To that end, we also examine whether these known barriers (i.e., travel distance and residing in a nonmetropolitan area) impacted methadone initiation and treatment duration following Medicaid coverage of methadone treatment.”

“The implementation of the IMD waiver may have been associated with an influx of enrollees. Many individuals who initiated treatment with Medicaid-covered methadone had no prior diagnosis of OUD or prior Medicaid enrollment in our observation period and potentially were existing uninsured OTP patients, underscoring that Medicaid coverage of methadone may bring underserved populations to the program. At minimum, Medicaid coverage of methadone reduces affordability barriers to OTP services for patients who otherwise were not receiving MOUD. Still, methadone patients in West Virginia Medicaid frequently traveled over 20 miles to an OTP, suggesting that the state needs greater methadone availability.”

The article, “Why Substance Use Screening Frequency Matters in Adult Primary Care,” has been published in SAj.

The authors state that evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time.

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

“The USPSTF lacks explicit guidance regarding screening frequency, stating that there is little or inadequate evidence around the optimal screening interval. Studies reviewing screening implementation to evaluation are plentiful, but also lack guidance around screening frequency. In lieu of strong evidence to guide policies, healthcare sites may generate policies based on how heavily they weigh convenience versus perceived risk about how quickly substance use can escalate to hazardous levels. Providers who weighed convenience tended to prefer annual screenings bundled with general health screening visits; providers who were concerned about how quickly substance use can escalate were more likely to advocate for more frequent screenings, as annual screenings alone could miss opportunities for early intervention. Additionally, universal screening integrated within the workflow may reduce biases in screening and identification of individuals using substances. Given the inquiries from the healthcare sites, lack of explicit guidance from the USPSTF, and PERU’s positionality with the robust data set, PERU conducted a secondary analysis from the PA SBIRT screening data to examine patterns and direction of change in substance use risk category among patients being screened on multiple occasions. The results generated initial insights into the applicability of frequent screening policies.”

“Screening in adult primary care settings is recommended to reduce substance use. The results from this analysis function as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection to care. This analysis points to potential benefits of frequent screening policies. Evidence-based screening tools, along with policies that implement frequent screening, may further support providers to identify patients at risk of SUD and connect them to appropriate care. Healthcare professionals should consider these findings supporting frequent, universal screening when determining policies on screening frequency for substance use identification.”

The article, “Regional Variation in Opioid-Related Emergency Medical Services Transfers During the COVID-19 Pandemic: An Interrupted Time Series Analysis,” has been published in SAj.

In this commentary, the authors state that the COVID-19 pandemic has impacted public infrastructure and healthcare utilization. However, regional variation in opioid-related harm secondary to COVID-19 remains poorly understood. This study aimed to measure the regional variation in the association between stay-at-home orders (SAHOs) and nonfatal opioid-related emergency medical services (EMS) transfers in the United States.

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

“Changes in the frequency and characteristics of EMS visits may be an advanced indicator of changes in opioid morbidity. Prior evidence demonstrated a nationwide increase in EMS transfers following state-level stay-at-home order (SAHO) implementation. Regional variation in this phenomenon, however, remains unmeasured. The United States is a vast country with significant sociodemographic variation at the regional level. Measuring regional differences in the trajectory of opioid-related morbidity in the wake of SAHO implementation can provide policymakers and public health authorities with useful information to focus future opioid response efforts. Therefore, this study aimed to measure regional variation in nonfatal opioid overdose-related EMS transfer activity before and after implementing the US COVID-19 SAHO.”

“This study highlights the need for a comprehensive and coordinated response to address the opioid overdose epidemic, including ensuring access to quality healthcare, mental health services, and addiction treatment. These changes will require collaboration among healthcare providers, public health agencies, and community organizations to address the root causes of the overdose crisis. Public health organizations and policymakers can also use these findings at a regional level to develop effective strategies and prevention programs to mitigate the impact of the opioid crisis.”