The fourth wave of the overdose crisis: Examining the prominent role of psychomotor stimulants with and without fentanyl
This article describes the fourth wave of the overdose crisis being fueled by fentanyl combined with stimulants. The preceding waves involved (1) prescription opioids, (2) heroin, and (3) fentanyl. In 2021, 32% of overdose deaths involved both fentanyl and stimulants, similar to the 34% from fentanyl alone. In addition, 18% of overdose deaths involved stimulants alone. In the Midwest, West, and South, methamphetamine was most prevalent, while in the Northeast and Great Lakes, cocaine was most common. Although there are no FDA approved medications for stimulant use disorder, contingency management (CM) has considerable evidence of efficacy. A meta-analysis has demonstrated long-term efficacy superior to established treatments such as CBT. Among the barriers discussed is a SAMHSA limit of rewards to $75/pt/year, well below the amount used in research studies. The authors conclude that expanding CM is a priority in addressing this fourth wave of the overdose crisis.
Psychedelics as Therapeutics—Potential and Challenges
In the context of the history of marijuana use as medicine and its rapid legalization, the authors discuss the potential future of psychedelics for treatment of psychiatric and substance use disorders. Authors note there is limited evidence to suggest that psychedelics may offer benefit, but there are essential research questions to be answered. First, if the subjective experiences that occur with psychedelics are intrinsic to or separate from their potential benefits. Second, currently there are not standardized protocols and research needs to establish therapeutic thresholds, including dosing, timing and what if any contextual components are needed. In addition, improved understanding about the mechanisms of action that produce benefit could lead to alternate treatments modalities that could provide similar benefits.
Achieving integrated treatment: a realist synthesis of service models and systems for co-existing serious mental health and substance use conditions
The Lancet Psychiatry
Integrating care for persons with co-occurring mental health disorders is complex. In the UK, uncertainty exists on how to best employ systems of care for persons with these conditions. This article discusses theories that could increase understanding of how these services might work in the UK, for whom, and in what circumstances. This realist synthesis highlights that comprehensive workforce training, supervision, and policy change are needed to provide integrated care. This will require committed leadership and clear expectations, as well as solid care-coordination to be successful.