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Lead Story 

Productivity Losses From Substance Use Disorder in the US in 2023🔓

American Journal of Preventive Medicine

Information on morbidity-related productivity losses attributable to substance use disorder (SUD) is limited. This study estimates such losses among US adults in 2023. Researchers found that total morbidity-related productivity losses attributable to SUD in the US are substantial, amounting to $92.65 billion in 2023. Inability to work cost accounted for $45.25 billion, followed by absenteeism cost of $25.65 billion, presenteeism cost of $12.06 billion, and cost of household productivity loss of $9.68 billion. Given that these estimates depend on the prevalence of SUD and the amount of lost productive time, evidence-based prevention efforts and policies addressing them can help reduce these losses. 

Research and Science

Variations in US county-level trends in buprenorphine use, 2018–2022

Addiction

Medications for opioid use disorder (MOUD), including buprenorphine, are a cornerstone of treatment, but buprenorphine prescribing on a national level has plateaued. Researchers looked at county-level retail pharmacy dispensing to better understand trends in prescribing. Counties with decreasing trends in prescribing had higher opioid overdose death rates, higher proportion of Black or African Americans, and higher unemployment. Counties with increasing trends in prescribing had more prescribing by nurse practitioners, and residents living in rural areas. Improved understanding of trends in buprenorphine prescribing can inform interventions to increase access.

Buprenorphine Treatment Duration and Adherence Among Youth and Subsequent Health Outcomes

Pediatrics

Researchers utilized retrospective cohort data to evaluate buprenorphine prescribing patterns among youth (13–26 years old) between 2014 and 2022. Four patterns were identified: 1) high adherence for 12 months; 2) low adherence for 12 months; 3) discontinuation between 3 and 9 months; and 4) discontinuation before 3 months. High adherence was associated with lower opioid overdose risks and inpatient hospitalization, compared with the other patterns. High adherence was also associated with lower risk of fatal overdose than the pattern of discontinuation between 3 and 9 months. Emergency department visits were also higher among those with low adherence and discontinuation before 3 months. These findings support the importance of longer duration and higher adherence use of buprenorphine in youths.

Integrating Methadone Services Into Primary Care in Ukraine: Two-Year Outcomes From a Randomized Trial

Annals of Internal Medicine

Opioid use disorder (OUD) drives high morbidity and mortality, but access to opioid agonist therapy (OAT) is limited in low- and middle-income countries. Integrating OAT into primary care may expand access and improve comorbidity management, although provider discomfort remains a barrier. This two-group randomized controlled trial compared health care use among persons with OUD receiving methadone in specialty clinics versus primary care centers in Ukraine (January 2018 to December 2023).  Researchers found that participants in primary care settings achieved higher composite quality health indicator (QHI) scores than those in specialty clinics. Results were similar for primary care QHI and specialty care QHI. Methadone retention among new patients at 24 months was 67.2% in primary care versus 64.7% in specialty clinics. Integrating methadone treatment into primary care settings improves adherence to guideline-concordant health care without compromising methadone retention and treatment quality. 

Breaking barriers: evaluating access models for harm reduction vending machines🔓

International Journal of Drug Policy

This article explores the impact of harm reduction vending machine (HRVM) models on harm reduction product utilization, based on the experiences of Project Hope in California. Project Hope operates an outdoor, temperature-controlled HRVM which is free to the community and available 24/7. Initially, the Project Hope HRVM required registration and imposed product limits; these restrictions were removed in August 2023. The authors completed an interrupted time series of data from June to October 2023 to examine the impact of these changes. After the removal of registration requirements and product limits, there was a significant increase in product utilization including naloxone kits, safer injection kits, wound care kits, and other basic supplies. Study results suggest that removing restrictions could increase uptake and utilization of HRVM. 

Learn More

Opioid overdose associated with concomitant use of hydrocodone and selective serotonin reuptake inhibitors🔓

BMC Medicine

SSRIs inhibit the enzyme CYP2D6 which metabolizes hydrocodone. This study investigated the overdose risk of combining opioids with SSRI antidepressants. Health care databases were used to identify 1.5 million patients who initiated an SSRI while receiving hydrocodone. A total of 1,500 opioid overdoses occurred during the following
13–48 days. The overdose risk for sertraline (6.1 per 1,000 person-years) was lower than with four other SSRIs (7.2 to 7.9 per 1,000 person-years). Compared to sertraline the odds of overdose was 1.2 for citalopram, 1.3 for escitalopram, 1.3 for fluoxetine, and 1.2 for paroxetine. The risk of overdose was higher (2–5 fold) for patients using multiple opioids or other CNS depressants, and those with substance use disorder. The authors conclude that sertraline may be a safer option, although the overall risk of overdose is low. 

Telehealth Delivery of Peer Support Services for Medicaid Beneficiaries with Substance Use Disorders

Journal of General Internal Medicine

This study used Medicaid data from 2021 to examine peer support services (PSS) for an SUD, in 32 states where Medicaid covers telehealth services.  Thirty percent of PSS users had at least one telehealth-delivered PSS. The median number of PSS days was 11 and telehealth-delivered PSS days was 3. Telehealth-delivered PSS was more likely in those who were female, had rural residence, had a mental health diagnosis, and had more than one SUD diagnosis. The authors conclude that telehealth may improve access to PSS for rural patients and those requiring more mental health and SUD services. 

Expedited referrals from community health center to opioid treatment program: innovative approaches to improving access to methadone treatment for patients who use opioids and experience homelessness🔓

Addiction Science and Clinical Practice

This paper describes the development of an expedited referral process to engage patients with OUD and unstable housing in methadone treatment in Lawrence, Massachusetts as part of the HEALing Communities Study, as well as descriptive outcomes of the program. The program seeks to remove access barriers to methadone treatment, highlighting that access barriers disproportionately affect people experiencing homelessness. To do so, the program developed a linkage between a Federally Qualified Health Center (FQHC) with a focus on OUD treatment (including a syringe service program) and an opioid treatment program (OTP) located within walking distance, allowing for same-day or next-day OTP enrollment. Both the FQHC and OTP expanded access hours to create a bridge clinic, facilitated by two recovery coaches. In a six-month period from July to December 2023, 87 individuals were linked to the OTP to begin treatment, with 67 ultimately being admitted and dosed with methadone. This intervention serves as a model for expedited referral to OUD treatment, and highlights the impact of removing access barriers on treatment engagement. 

In the News

Schedule III Cannabis: Rearranging Prohibition🔓

Cato Institute 

Children seeking candy are finding adults’ weed-infused edibles

The Washington Post

‘Intoxicated’ raccoon gets its own cocktails, T-shirts after ransacking Virginia liquor store🔓

The Hill

Will blockbuster obesity drugs revolutionize addiction treatment?🔓

Nature

Drive Sober This December — and Every Month🔓

National Highway Traffic Safety Administration (NHTSA)

How Online Crypto Casinos Use Celebrities and Livestreamers to Recruit Gamblers

The New York Times

Time to legalize psychedelics? Campus debate weighs therapeutic need vs. safety questions🔓

Medical Xpress/Harvard University