“No Excuses Anymore”: Substance Use Screening and Treatment for Justice-involved Youth
Journal of Addiction Medicine
This study concerned provision of substance use screening and treatment for youth in the criminal justice system. Semistructured interviews were conducted with 14 medical and behavioral health providers from 11 institutions. Several themes were identified. All team members should have substance use training. Screening for and treatment of substance use needs to be automatic. Other needs identified include resources, such as staffing and funding, and provisions to continue substance care after detention. Barriers include staff beliefs about substance use, such as distrust of MOUD, and youth ambivalence, believing substance use is normal with few consequences. The authors conclude there is a critical need for improved substance use care for justice-involved youth.
Drug Overdose Prevention: An Exercise in Optimism 🔓
The American Journal of Psychiatry
This editorial starts by discussing a recent study of factors associated with overdose in people receiving MOUD. Three risk factors for overdose were failure to initiate MOUD (particularly for naltrexone), early discontinuation, and benzodiazepine use. The authors note that elimination of the X waiver has improved access to MOUD, but addressing the overdose rate will also require improving initiation and retention rates. Barriers to initiation include criminalization of drug use, stigma, pessimism about recovery, and fear of a continued yearning to get high. The most common reasons for discontinuing MOUD are ineffectiveness in stopping opioid use and leaving a person unable to get high. Reducing overdose deaths will involve addressing such factors.
‘Safe Supply’ initiatives: Are they a recipe for harm through reduced healthcare input and supply induced toxicity and overdose?
Journal of Studies on Alcohol and Drugs
In this perspective, the authors discuss initiatives to provide people who use drugs with access to ‘safe supply’ medications as a harm reduction. While deregulatory changes to naloxone have had significant impact on negative outcomes for opioid use disorder, the authors note such an approach for ‘safer supply’ should not be considered in the same way. Motivations to decrease barriers to access are understandable, but ‘safer supply’ medications do have potential bad outcomes, both among people who use drugs and others who may intentionally or unintentionally access these medications. Further, if the need to see a provider for evaluation and to receive the medication were eliminated in efforts to reduce barriers, we lose opportunities for engagement in the healthcare system and potential for other interventions including treatments.
Structure-based discovery of conformationally selective inhibitors of the serotonin transporter
The serotonin transporter (SERT) removes synaptic serotonin and is the target of anti-depressant drugs. SERT adopts three conformations: outward-open, occluded, and inward-open. All known inhibitors target the outward-open state except ibogaine, which has unusual anti-depressant and substance-withdrawal effects and stabilizes the inward-open conformation. Unfortunately, ibogaine’s promiscuity and cardiotoxicity limit the understanding of inward-open state ligands. This study docked over 200 million small molecules against the inward-open state of the SERT. Two potent (low nanomolar) inhibitors stabilized an outward-closed state of the SERT with little activity against common off-targets. In mouse behavioral assays, both compounds had anxiolytic- and anti-depressant-like activity, with potencies up to 200-fold better than fluoxetine (Prozac), and one substantially reversed morphine withdrawal effects.