Dennis McCarty

Introduction: Residential treatment is part of the care continuum for opioid use disorder (OUD). However, use of OUD medications (MOUD) has been historically low in this setting. The goal of this study was to assess changes in MOUD during residential treatment stays and the 12-month period surrounding them. Methods: We used national Medicaid claims data for the year 2017-2021 and descriptive as well as regression analyses. Results: Between 2017 and 2021, the rate of MOUD treatment in residential settings increased from 30.4 to 58.5 percentage points. By contrast, the rate of MOUD treatment 6 months before residential treatment stays and 5 months following residential treatment stays was low in 2017 and increased only slightly. Changes were similar in states that implemented a substance use disorder waiver compared to non-waiver states. Most states exhibited similar changes. New York was the only state where MOUD rates before and after residential treatment stays increased markedly. Conclusions: Our study suggests that use of MOUD during residential treatment stays increased substantially 2017-2021, but that this increase was not sustained during the months following stays. Improving retention in MOUD treatment following residential treatment stays could be an important future policy goal.

New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon's early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023. Data collection included a review of public listings, contact with training programs, and facilitator survey. Results indicated that in the 16 active training programs, the mean tuition was $9,359 and half offered diversity scholarships. Survey respondents (n = 106) were relatively diverse; many had an existing healthcare license. The majority reported that training expenses were a moderate-to-severe financial strain. Most were satisfied with training. The mean planned price for a session was $1,388 and the most common areas of specialization were trauma, mental disorders, consciousness exploration, and spirituality. Facilitators requested ongoing training opportunities. In conclusion, Oregon's emerging psilocybin facilitator workforce and training programs are in early development. These findings are crucial for informing future policy and training program development to support a diverse and effective workforce.

A long-standing policy prohibits the use of federal funds for Medicaid services in Institutions for Mental Diseases (facilities with more than sixteen beds that specialize in mental health or substance use disorder treatment). Beginning in 2015, states could apply for Section 1115 Medicaid waivers, which permit federal funding for Institutions for Mental Diseases services and require improvements in opioid use disorder (OUD) treatment. Using 2016-20 Medicaid data, we compared changes in the use of medications for OUD and nonfatal overdoses in seventeen states with waivers approved during 2017-19 to changes in eighteen states without waivers. Waiver implementation was not associated with improvements in overall medication treatment, buprenorphine and naltrexone prescribing, or rates of nonfatal overdoses among Medicaid enrollees with OUD. Waiver implementation was associated with a 2.3-percentage-point increase in the use of methadone with waiver implementation, as a result of coverage changes, and a 3.7-percentage-point increase in any medication treatment among Medicaid enrollees diagnosed with severe OUD who had an inpatient or residential stay. Our findings suggest that such waivers adopted by states during 2017-19 were not associated with significant improvements in medication treatment or reductions in nonfatal opioid-related overdoses among Medicaid enrollees with OUD. However, they may have moderately improved the use of medication treatment for those with severe OUD.

Background and aims: Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all‐cause, alcohol‐, polydrug‐ and psychiatric‐related repeated hospitalizations among older people with problematic alcohol use.Design: A linked register‐based cohort study with discontinuous multiple‐failure (time‐to‐repeated‐event) data. Hospitalization and mortality were considered as failure.Setting: Sweden, March 2003–November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register.Participants: Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment.Measurements: Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: ‘late onset with fewer consequences (LO:FC; reference group)’; ‘early onset/prevalent multi‐dimensional problems (EO:MD)’; ‘late onset with co‐occurring anxiety and depression (LO:AD)’; ‘early onset with co‐occurring psychiatric problems (EO:PP)’; and ‘early onset with major alcohol problem (EO:AP)’. Covariates included socio‐demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all‐cause, (b) alcohol‐related disorders and diseases (c) polydrug use and (d) other psychiatric disorders.Findings: During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol‐related, 8.5% with polydrug use and 18.5% with psychiatric‐related diagnoses. Compared with LO:FC, EO:PP had higher risk for all‐cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02–1.59] and alcohol‐related (aHR = 1.34, 95% CI = 1.02–1.75) hospitalizations. Adjusted risks for polydrug‐related hospitalization were 2.55, 95% CI = 1.04–6.27 for EO:MD and 2.62, 95% CI = 1.07–6.40 for EO:PP. Adjusted risk for psychiatric‐related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16–2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22–3.38).Conclusions: Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

Objective: A scoping review assessed access to medications for opioid use disorder (MOUD) and treatment outcomes among adolescents (12 – 17 years) and young adults (18 – 25 years). Methods: Studies addressing adolescent and young adult opioid use disorder and treatment with MOUD on patient outcomes (eg, retention in care) were included. Randomized trials and controlled observational studies were prioritized. Investigators extracted key information, summarized findings, noted methodological weaknesses, and tabled the details. Results: The search identified 4 randomized trials (N = 241), 1 systematic review with 52 studies (total N = 125,994), and 5 retrospective analyses of health insurance claims. The trials reported buprenorphine and extended-release naltrexone reduced opioid use. Return to use was observed when pharmacotherapy ceased. A systematic review concluded that adolescents and young adults had lower retention in care than older adults. The observational studies found that adolescents were unlikely to receive MOUD. There was some evidence that non-Hispanic Black adolescents and young adults were less likely than non-Hispanic Whites to receive MOUD. Conclusions: MOUD therapies reduce opioid use among adolescent and young adults but few receive MOUD. MOUD services for adolescents and young adults should be developed and tested. Randomized clinical trials are necessary to develop appropriate clinical guidelines for using MOUD with adolescents and young adults.

Guided by communication accommodation theory (CAT), this study examined whether young adults’ perceptions of similarity in their religious and political beliefs with a parent and grandparent were associated with young adults’ relationship satisfaction, as well as how identity accommodation from the older family member moderated these associations. Perceived similarity was not associated with relationship satisfaction at the main-effects level. However, perceptions of parent religious accommodation, parent political accommodation, and grandparent political accommodation moderated the associations between perceived similarity and relationship satisfaction. The study contributes to CAT by delineating the contingencies under which perceived similarity may be associated with relational health.

Background and aim: Opioid agonist medications for treatment of opioid use disorder (OUD) can improve human immunodeficiency virus (HIV) outcomes and reduce opioid use. We tested whether outpatient antagonist treatment with naltrexone could achieve similar results.Design: Open‐label, non‐inferiority randomized trial.Setting: Six US HIV primary care clinics.Participants: A total of 114 participants with untreated HIV and OUD (62% male; 56% black, 12% Hispanic; positive for fentanyl (62%), other opioids (47%) and cocaine (60%) at baseline). Enrollment halted early due to slow recruitment.Intervention: HIV clinic‐based extended‐release naltrexone (XR‐NTX; n = 55) versus treatment as usual (TAU) with buprenorphine or methadone (TAU; n = 59).Measurements: Treatment group differences were compared for the primary outcome of viral suppression (HIV RNA ≤ 200 copies/ml) at 24 weeks and secondary outcomes included past 30‐day use of opioids at 24 weeks.Findings: Fewer XR‐NTX participants initiated medication compared with TAU participants (47 versus 73%). The primary outcome of viral suppression was comparable for XR‐NTX (52.7%) and TAU (49.2%) [risk ratio (RR) = 1.064; 95% confidence interval (CI) = 0.748, 1.514] at 24 weeks. Non‐inferiority could not be demonstrated, as the lower confidence limit of the RR did not exceed the pre‐specified margin of 0.75 in intention‐to‐treat (ITT) analysis. The main secondary outcome of past 30‐day opioid use was comparable for XR‐NTX versus TAU (11.7 versus 14.8 days; mean difference = −3.1; 95% CI = –8.7, 1.1) in ITT analysis. Among those initiating medication, XR‐NTX resulted in fewer days of opioid use compared with TAU in the past 30 days (6.0 versus 13.6, mean difference = −7.6; 95% CI = –13.8, −0.2).Conclusions: A randomized controlled trial found supportive, but not conclusive, evidence that human immunodeficiency virus clinic‐based extended‐release naltrexone is not inferior to treatment as usual for facilitating human immunodeficiency virus viral suppression. Participants who initiated extended‐release naltrexone used fewer opioids than those who received treatment as usual.