Beyond the X — Next Steps in Policy Reforms to Address the Overdose Crisis
In this perspective, the authors consider the new 8-hour training requirement for prescribers of buprenorphine with the application or renewal of DEA registration. The authors find this requirement problematic, instead suggesting the provision of addiction medicine education in medical school and training programs so providers meet this requirement. There is the additional concern of certain state buprenorphine restrictions still in place and the treatment barriers these pose. Several suggested policy changes, including incentives for low-barrier treatment, could ensure patients seeking MOUD get the care that they need.
Trends in Buprenorphine Initiation and Retention in the United States, 2016-2022
This study used data from the Longitudinal Prescription Database, which includes 92% of retail prescriptions in the US, to calculate rates of initiation of buprenorphine treatment and treatment retention (180 days or more of continuous treatment). Researchers were looking for increased buprenorphine use because of relaxed waiver requirements in April 2021 and eased pandemic restrictions allowing better access to health care. Between 2016 and 2018 buprenorphine initiation rate increased from 12.5 to 15.9 per 100,000; however between 2018 and 2022 the initiation rate did not increase. This flattening occurred prior to the onset of the pandemic. Between 2016 and 2022 the retention rate remained unchanged at 22%. The authors conclude that efforts to increase buprenorphine use have been insufficient.
How the FDA Can Improve Public Health — Helping People Stop Smoking
There is a critical need for development and marketing of therapies for smoking cessation that are more effective than currently approved therapies. The FDA has approved only three types of drugs (nicotine-replacement therapy [NRT], bupropion, and varenicline) for helping people quit smoking, and there have been no substantial advances in FDA-approved smoking-cessation products in the past 17 years. Reviewing the Center for Drug Evaluation and Research (CDER) approval processes and requirements and the Center for Tobacco Products (CTP) parallel regulation of nicotine-containing products, including e-cigarettes, will be challenging. But encouraging the development and marketing of consumer-desirable, effective smoking-cessation aids could represent a profound contribution to public health.
Rapid Analysis of Drugs: A Pilot Surveillance System To Detect Changes in the Illicit Drug Supply To Guide Timely Harm Reduction Responses — Eight Syringe Services Programs, Maryland, November 2021–August 2022 🔓
The illicit drug supply can rapidly change, as demonstrated by fentanyl in the opioid supply, and timely identification of those changes are important to public health response. Between 2021 and 2022 at Maryland syringe service programs, the National Institute of Standards and Technology tested 496 samples, of which 74% were positive for opioids. Among the 367 samples that tested positive 98.9% tested positive for fentanyl or an analog while only 1.9% contained heroin and 80.5% contained xylazine. The authors note that being able to provide timely data to persons who use drugs about the drugs they use versus what they intend to use could reduce public health harms and guide interventions.