The article, “Co-use of Opioid Medications and Alcohol Prevention Study (COAPS),” has been published in SAj.

In this commentary, the authors state that while there is limited research in the field regarding the various dimensions of co-use of alcohol and opioid medication, particularly related to co-use and levels of severity, their research has shown 20% to 30% of community pharmacy patients receiving opioid pain medications are engaged in co-use. Co-use of alcohol and opioid medications is a significant risk factor for opioid-related overdose. Community pharmacy is a valuable yet underutilized resource and setting for addressing the US opioid epidemic, with an untapped potential for identification of and intervention for risks associated with co-use of alcohol and opioids

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

“Notwithstanding the clear need for intervention services for co-use of opioids and alcohol and the potential impact of engaging community pharmacies, no current models exist for deployment in these settings. Therefore, our team has targeted adaptation of an intervention we previously developed for opioid medication misuse (called Brief Intervention-Medication Therapy Management [BI-MTM]). This adapted intervention would therefore be prepared to address co-use of opioid medications and alcohol.”

“Among the highest-risk behaviors for those taking opioid medications is co-use with alcohol. Conducting this study is critical to the field given that, to our knowledge, there are no existing pharmacist-led intervention to specifically target co-use of alcohol and opioid medications. Further, a study aiming to develop and test an intervention while gleaning an understanding of the organizational context of implementation of such an intervention has not heretofore been conducted. Results of this study will create an opportunity to leverage community pharmacists’ unique expertise in medication management, including medication interactions and safety. These results will further address a significant gap in the literature regarding the untapped potential for community pharmacist interventions that build on their trusting relationships with patients.”

The article, “Starting the Discussion: A Call to Enhance Care for People with Stimulant Use Disorder,” has been published in SAj.

In this commentary, the authors state stimulant use disorder (StUD) significantly contributes to substance-related morbidity and mortality in the United States. Overshadowed by the country’s focus on opioid-related overdose deaths, stimulant and stimulant/opioid overdose deaths have increased dramatically over the last decade. Many individuals who use stimulants illicitly or have StUD have multiple, intersecting stigmatized characteristics which exacerbate existing barriers and create new obstacles to attaining addiction treatment. Illicit stimulant use, StUD, and stimulant-related overdose disproportionately impact minoritized racial and gender, and sexuality diverse groups.

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

“As with anything in medicine, we strive for progress, not perfection. Improving the care of people with StUD will require a multilevel response, and society, institutions, and individuals must all be open to change. Societally we must address stigma about people who use drugs, specifically those who use stimulants, and change the narrative in the media and public discourse that leads to fear and discrimination. Institutionally, we must commit to changing existing harmful and long-held practices and protocols that do not adequately meet the needs or serve people most likely to have a StUD. Healthcare providers must also commit to adopting evidence-based methods to care for people with StUD to move beyond creating a non-stigmatizing environment to one that is also engaging and responsive. Individually, all of us must re-examine our personal beliefs and stigmas about people with StUD and actively change our thoughts and behaviors. Words matter, but so do actions. Building a more inclusive and responsive addiction treatment environment for people with a StUD will not be easy, but it is necessary and long overdue.”

The article, “Harms Versus Harms: Rethinking Treatment for Patients on Long-Term Opioids,“ has been published in SAj.

In this commentary, the authors state that in 2022, the CDC began encouraging clinicians to weight the risks versus harms of continued therapy and empathetically engage patients in patient-centered discussions around continued therapy while avoiding patient abandonment. This commentary discusses how the emphasis on “benefit” will almost always lead to discordance between the patient and provider since many clinicians find little benefit in opioid therapy for chronic pain with evidence questioning its efficacy for chronic pain. The authors believe this disagreement between patients and providers has the potential to lead to unilateral tapers or patient abandonment and further increase patient harm. Considering this dilemma, they propose a revised framework that emphasizes weighing the harms of continuation of therapy against the harms of discontinuation of therapy when caring for patients on long-term opioid therapy. The authors state that this revised harm-reductive decisional framework has the potential to retain patient-provider trust and increase opportunities for engagement in evidence-based multi-modal pain treatment, including non-opioid based treatment options.

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

“In patient care, physicians are counseled to weigh each treatment’s risks against its benefits. But what happens when patients and doctors don’t agree on the benefits of continuing opioid therapy when the risks are almost never negligible and are difficult to predict? A physician-initiated opioid taper without patient buy-in may seem inevitable, despite its potential to precipitate harm. To prevent such harm, we propose a revision to the risk-benefit framework that could help both clinicians and patients approach this fraught decision in a more thoughtful way.”

The article, “Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician,” has been published in SAj.

In this commentary, the authors state that no literature exists directly comparing traditional buprenorphine initiation to low dose buprenorphine initiation (LDBI). Until information on long-term outcomes is available, these dosing strategies should be reserved for patients unable to tolerate traditional buprenorphine initiation. Available published research suggests LDBI strategies will allow some patients to successfully transition to buprenorphine with minimal or no symptoms of withdrawal. Ensuring access to pharmacotherapy during hospital admission is a crucial time for potential intervention and should be considered when appropriate. This narrative review discusses the background of LDBI strategies as well as practical clinical and operational considerations for the inpatient clinician.

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

“While vast, evidence surrounding LDBI is limited to case series, feasibility studies, single-arm retrospective cohort studies, and comparative studies using historical controls. There are no prospective, randomized studies directly comparing clinical outcomes of varying buprenorphine dosing strategies.”

“Due to lack of high-quality evidence supporting LDBI, these strategies should be reserved for patients who cannot tolerate traditional buprenorphine initiation and would otherwise be precluded from receiving buprenorphine. Patients with concomitant pain, high distress, medically fragile, or those with concurrent illicit fentanyl use may prove the best candidates for these strategies.”

The article, “Effects of Smoking Marijuana on the Respiratory System: A Systematic Review,” has been published in SAj.

In this commentary, the authors state that the prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease.

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

“Despite existing research, significant knowledge gaps remain. Few studies have isolated the effects of individual components of marijuana smoke on lung tissue, meaning our understanding of how marijuana smoke impacts the lungs and how these effects compare to tobacco smoke remains limited. Additionally, the long-term effects of marijuana use on lung health are inadequately understood, making it difficult to develop effective risk minimization strategies. Further complicating matters, varying legal statuses and stigma attached to marijuana use impede large-scale, longitudinal studies, contributing to these knowledge gaps.

There is an undeniable need for more research to shed light on the unknowns, particularly given the increasing usage and changing legal landscape. This study aims to consolidate available information on the immediate and long-term effects of marijuana on the respiratory system and underscore areas requiring further investigation.”