The article, “Recruiting and Retaining a Diverse and Skilled Addiction Treatment Workforce,” has been published in SAj.

The authors state that national drug overdose deaths have been rising for decades, with particularly significant increases in recent years among populations of color. There is an urgent need for timely, accessible substance use disorder treatment, but workforce shortages across roles and settings impede the ability of the treatment system to meet the rising and evolving demand. In this commentary, the authors discuss reasons for workforce shortages across roles, and offer recommendations for 8 areas of investment to grow and sustain a substance use and addiction care workforce prepared to address the overdose crisis in a racially equitable manner.

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

“As the overdose crisis has become more concentrated in historically marginalized and underserved populations, there is a growing need for staff who can bridge gaps, build trusting relationships, and make connections to care. Skills in trauma-informed and culturally responsive approaches are critical across roles, and research has also emphasized that people with SUD are most likely to trust and engage with staff who share their racial and cultural identities and/or elements of their lived experiences, including experiences with drug use, recovery, incarceration, and homelessness. However, people of color remain underrepresented in many healthcare occupations and many SUD treatment facilities do not employ peer support specialist staff.”

“To grow and sustain a diverse and skilled substance use and addiction workforce, systems must invest in comprehensive solutions that value and prioritize this field. This includes supporting the frontline staff who are critical points of engagement, while simultaneously developing a robust cadre of culturally responsive treatment providers to ensure that outreach and engagement efforts result in smooth connections to care rather than being bottlenecked by workforce shortages. Many of these changes will require financial resources, which organizations may not currently have, particularly community-based agencies. However, as states prepare to receive billions of dollars in opioid settlement funds, now is the time to consider bold investments.”

The article, “Advocacy for Equity Around Evidence-Based Treatments: Overview and Proceedings of the AMERSA 2023 Conference,” has been published in SAj.

This commentary provides an overview of the 2023 Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference: Advocacy for Equity Around Evidence-Based Treatments, held from November 1 to 4, 2023, in Washington, DC. The conference featured 9 interactive workshops, 106 oral abstract presentations, and 130 posters. From the pre-conference workshop to plenary sessions, paper, and poster presentations, there was a focus on addressing imbalanced social systems and structures underlying disparities. In the face of increasing drug overdose deaths, diminished access to prevention, intervention, treatment, and recovery supports for racial and ethnic minorities, there is a pressing need for advocacy for equity around evidence-based treatments.

Some conference info & highlights:

As the evidence base related to substance use prevention, intervention, treatment, and recovery supports grows, it is more important than ever to ensure that those resources are equitably distributed. For example, it is well established that drug overdose deaths disproportionately affect people of color, particularly non-Hispanic Black and American Indian/Alaska Native groups. Furthermore, there is evidence that racial and ethnic minorities had buprenorphine access at lower rates compared to White beneficiaries and Medicare recipients. Advocacy is a means of promoting policies that improve health equity, but doing so effectively requires expertise and credibility. Within that context, the theme of the 2023 Association of Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) annual conference was Advocacy for Equity Around Evidence-Based Treatments. This 47th Annual Meeting was held from November 1 to 4, 2023, in Washington, DC. The attendance was the largest to date, with more than 600 participants, over half of whom were first-time attendees.

To increase the representation of people with lived and living experience of substance use, a member-initiated peer recovery workforce special interest group (SIG) was launched at the conference. Most plenary sessions included a speaker with lived experience from peer recovery specialists working in rural Maryland to a mother affected by fetal alcohol spectrum disorder (FASD) to Native American researchers and healthcare professionals. For its annual networking run, AMERSA partnered for the first time with a local chapter of “Back on My Feet,” a running group that aims to empower persons experiencing homelessness, poverty, and/or addiction. “Back on My Feet” is a national organization that helps people overcome addiction and homelessness by offering resources and support through the “power of fitness, community support, and employment resources.

The pharmacist participation at the conference was the highest ever, with 27 pharmacists registered to attend. A pharmacist moderated the AMERSA Discourse, and pharmacists facilitated and delivered several oral presentations and presented posters. Sixteen pharmacists attended the inaugural pharmacists SIG. The mission of SIG is to advance and highlight pharmacist roles and leadership in interprofessional substance use disorder (SUD) care in teaching, scholarship, advocacy, and clinical service teams.

The article, “In Support of Community Drug Checking Programs: Position Statement of AMERSA, Inc. (Association for Multidisciplinary Education and Research in Substance use and Addiction),” has been published in SAj.

In this commentary, the authors state that this Position Statement, endorsed by the AMERSA Board of Directors on October 3, 2023, amplifies the position of the organization, guides their activities, and informs the public and policymakers on the organization’s stance on this issue.

In the AUTHORS’ OWN WORDS, they relate the importance of this issue:

“The unregulated drug supply in the United States evolves constantly, leaving those who use drugs potentially unaware of new adulterants in their drugs. Not knowing that information can leave people vulnerable to serious adverse events such as fatal overdoses, wounds, and other health consequences. Without real-time data on the composition of drugs available in a community, healthcare providers and public health practitioners are left with insufficient data, making it increasingly difficult to know how to best serve people who use drugs. In this context, community-based drug checking has become recognized as an important harm reduction strategy with the potential to provide those who use drugs with more information about their supply.”

“With the changing drug supply, it is crucial that we support and expand drug checking initiatives. To do so, we must increase access to and funding for all forms of drug checking technologies (ie, ITS, FDIR, GC-MS).”

“Moreover, it is imperative that we support the thoughtful and sustainable implementation of robust drug checking programs that are tailored to and driven by local community needs.”

“Finally, principles of equity and anti-racism must be at the forefront of these implementation plans to ensure that drug checking initiatives do not repeat inequities created by the War on Drugs or increased police surveillance in communities of color. In line with this, we must advocate for laws and policies that ensure that drug checking materials (eg, FTS) are not criminalized as paraphernalia and, ultimately, seek to establish a safe supply.”

The article, “Cocaine Use is Associated With Increased LVMI in Unstably Housed Women With Polysubstance Use,” has been published in SAj.

In this commentary, the authors state that while substance use is known to influence cardiovascular health, most prior studies only consider one substance at a time. The authors examined associations between the concurrent use of multiple substances and left ventricular mass index (LVMI) in unhoused and unstably housed women.

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

“Notably, these studies do not account for other substances, which is salient given rising trends of overdose death associated with polysubstance use. Furthermore, it has become clear that current CVD risk scores, often derived from study populations composed mostly of men, do not accurately predict CVD risk in women and that non-traditional risk factors are more common in women. Despite known sex differences in CVD risk factors, left ventricular (LV) remodeling, and a higher risk of death associated with LV hypertrophy in women, much of the existing evidence comes from predominantly male study populations. Sex-specific research that leads to sex-specific risk assessment models may improve risk prediction, particularly in women.”

“Our previous work showed that cocaine use is significantly associated with high-sensitivity cardiac troponin (hsTnI) in hospitalized patients. Similarly, we found that toxicology-confirmed substance use is associated with higher levels of hsTnI in non-hospitalized, unstably housed women,^18,26 suggesting potential ongoing cardiac injury in chronic users. The present study extends these findings to investigate structural evidence of end organ damage by examining the independent effects of stimulants and other substances on LVMI.”

The article, “Care Practices of Mental Health Clinical Pharmacist Practitioners Within an Interdisciplinary Primary Care Model for Patients With Substance Use Disorders,” has been published in SAj.

In this commentary, the authors state that clinical pharmacist practitioners (CPPs) play an increasingly important role in interdisciplinary care for patients with substance use disorders (SUDs). However, CPPs’ scope of practice varies substantially across clinics and settings. The authors sought to describe CPP practices and activities within an interdisciplinary, team-based primary care clinic dedicated to treat Veterans with histories of substance use disorders, experience of homelessness, high medical complexity, and other vulnerabilities.

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

“Nearly 1 in 7 primary care patients meet criteria for a substance use disorder (SUD), yet most patients with SUDs do not receive evidence-based treatment. Emergency department visits attributed to SUD-related causes increased by 45% from 2013 to 2018. With rising opioid-related overdoses and deaths, there have been calls for primary care to assume a greater role in providing treatment for SUDs, including opioid use disorder (OUD). However, system and provider barriers persist. Primary care providers (PCPs) often describe time constraints and lack of support staff as key barriers to prescribing medications for opioid use disorder (MOUD), even after receiving certified training to do so. Expanding the role of clinical pharmacist practitioners (CPPs) within primary care could address PCP staff shortages, mitigate time and resource barriers to medication treatment for SUDs, and prevent more costly hospital-based services.”

“Our study adds to the literature in several important ways. First, while other primary care-based studies that have utilized CPPs have shown effectiveness of CPPs for treating a single condition such as OUD alone, we found that mental health CPPs can successfully manage patients in a primary care setting when illness severity and medical complexity are high. Second, while previous studies have shown promise for CPPs in limited ways (eg, through small patient panels or restricted autonomy such as only following patients already stabilized on medications for SUDs), this study depicts successful CPP care management for a large patient panel where CPPs had autonomy to initiate medication treatment (ie, 5% of OUD interventions and 10% of AUD interventions performed by CPPs). The VA allows for CPPs to be co-located within primary care clinics and, in the present interdisciplinary clinic, the 2 CPPs collaborated closely with PCPs under their scope of practice. Thus, our results offer an example of how adding mental health CPPs to primary care settings can support PCPs in providing SUD care.”