The article, “Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder,” has been published in SAj.

In this commentary, the authors state that people living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). Their study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment.

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

“People living with both HIV and OUD are a highly prevalent, especially marginalized, high transmission-risk group with outsized implications for ending the HIV and OUD epidemics. Therefore, we investigated associations between 5 supportive SDOH and MOUD initiation, opioid use, and other substance use over a 6-month period in persons living with HIV enrolled in an OUD treatment randomized trial. We hypothesized that increased supportive SDOH would be associated with increased likelihood of MOUD initiation and reduced substance use over the trial period.

“Interventions targeting SDOH are increasingly recognized by the National Institute on Drug Abuse and others as vital to mitigating harms of the opioid epidemic and preventing future use disorders. Our study suggests that modifiable social determinants of health, including income, education, housing, criminal justice involvement, and engagement in SUD treatment may impact MOUD initiation and opioid use outcomes among people living with HIV and OUD. These findings, when added to the body of literature showing similar associations, provide possible intervention targets for future experimental studies. Especially following the steep rise in inequalities and overdose deaths during the COVID-19 pandemic, which disproportionately affected people of color, people experiencing homelessness, and those with co-occurring conditions including HIV, results highlight the need to address SDOH as part of OUD care.”

The article, “Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop,” has been published in SAj.

In this commentary, the authors state tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. Their project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop.

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

“One of the most common and significant barriers to discontinuing tobacco use reported by these communities is a lack of support from health professionals. The ability of health professionals to incorporate social and cultural influences into therapeutic interactions and treatment plans is now recognized as essential to high quality health care. In general, training to improve these competencies has shown promise, however the competencies and skills required for treating tobacco use among marginalized communities are unknown. We propose that increasing the proficiencies with which health professionals incorporate social and cultural influences on tobacco use into therapeutic interactions will improve the quality and effectiveness of tobacco treatment provided to marginalized communities, and contribute to addressing a well-established barrier to discontinuing tobacco use among these communities.”

“This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals, develop a virtual, self-paced workshop, and then pilot test the workshop via expert review. Because the approach required an intensive focus on improving these proficiencies, the approach was developed for learners who already had basic knowledge and skills for treating tobacco use with evidence-based approaches. Treatment of tobacco use is delivered in many contexts by health professionals from multiple disciplines. Thus, to achieve our aim the approach required that we accommodate differences in treatment settings and professional disciplines.”

The article, “Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care,” has been published in SAj.

In this commentary, the authors state that the lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care.

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

“Barriers to the uptake of this treatment in primary care settings includes stigmatizing views toward patients with OUD, concerns with diversion, perceived lack of staff to support clinic workflow, and provider lack of confidence in ability to provide the treatment. However, these barriers can be addressed by working with providers to give them access to comprehensive education/training and ongoing support as they initiate and expand treatment. In 2017, our team of providers and researchers, with expertise in treatment of OUD, buprenorphine prescribing and therapeutic approaches, developed an innovative curriculum to support rural primary care providers to start this treatment. Our curriculum, called MOUD ECHO, uses the Extensions for Community Healthcare Outcomes (ECHO©) model, an online telementoring approach providing didactics and interactive case-based learning with expert consultation.”

“Findings from this study help advance our understanding of the specific relationship between participating in MOUD ECHO sessions on expanding buprenorphine treatment in rural primary care. This study provides compelling evidence that participation can significantly increase the number of providers implementing this treatment and adding patients onto their panels.”

The article, “Impact of Mandated Case Review Policy on Opioid Discontinuation and Mortality Among High-Risk Long-Term Opioid Therapy Patients: The STORM Stepped-Wedge Cluster Randomized Controlled Trial,” has been published in SAj.

In this commentary, the authors state that the United States is facing a severe opioid crisis. Opioid overdose deaths rose from 47 600 in 2017 to 80 411 in 2021 and are the leading cause of injury deaths in the U.S. Veterans are at a greater risk of overdose-related adverse events due to higher rates of chronic pain, mental health disorders, and substance use disorders relative to the general U.S. population.

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

“Given the observed mortality benefits of the mandated case review policy and the potential challenges posed to LTOT patients who are discontinued from opioids, it is possible that the mandated case review policy could help clinicians consider unique factors such as duration of treatment, type of pain, and the physical and psychological attributes of the patient, and tailor their practice to cater for individual patient’s needs and concerns. Providers may change their prescribing patterns to ensure safe and effective opioid use for the patients, which could result in reduced mortality risk. Our study aimed to evaluate the impact of the mandated case review policy on discontinuation of VHA opioid prescriptions. We further tested the effect of the mandated case review policy on mortality among the subset of high-risk patients receiving LTOT. We hypothesized that the mandated case review policy would reduce the risk of prescription opioid discontinuation and mortality for LTOT patients.”

“This is the first national study suggesting that a predictive model-targeted prevention program had an impact on reducing likelihood of discontinuation for high-risk patients receiving LTOT. The findings also show a substantial decrease in the risk of mortality resulting from the mandated case review policy for this group of patients. Further investigation of interventions that maintain care engagement while optimizing pain management for high-risk patients may be beneficial for minimizing mortality and other risks.”

The article, “Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy,” has been published in SAj.

In this commentary, the authors state that in the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes

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

“This paper provides an innovative roadmap of necessary research to support increased access of MOUD in a community pharmacy setting. The collaboration of experts within the field to collectively define these areas of interest is important. However, other voices will be needed through this research to best highlight successful approaches to OUD care in alternative locations from opioid treatment programs.”

“Pharmacists are integral health professionals that stand to be useful providers within the continuum of OUD treatment, particularly in the community pharmacy arena, to increase access to services. More research is needed to best understand mechanisms for inclusion of services, payment and operational models, and professional education and development for evidence-based practice.”