Scott Alan Simpson

Patients with methamphetamine use disorder (MaUD) face social, financial, and systemic barriers to accessing evidence-based addiction treatment. We designed a care navigation intervention to better engage patients with MaUD in treatment after an acute care encounter. This intervention was modeled after linkage-to-care strategies for infectious diseases and emphasized rapport building, trauma-informed care, and practical assistance in overcoming barriers to treatment. We also added elements of contingency management given its treatment efficacy with MaUD. We describe the development of the care navigation model, characteristics and care needs of subjects receiving the intervention, and intervention engagement outcomes. Among 94 patients who received this intervention as part of a randomized controlled trial, 64% were considered engaged with at least 2 or more visits with the care navigator Patients had substantial barriers to care—85% of patients were not stably housed, 83% were unemployed, and 46% lacked access to a phone—and the most common domains of need were accessing addiction treatment, housing resources, or communication needs such as a phone or interpreter services. This intervention poses a model for connecting patients with MaUD to treatment after acute care encounters.

Aim: We define criteria for methamphetamine‐induced psychotic disorder (MIPD) to aid in accurate and reliable diagnosis.Method: An expert panel was recruited and engaged in an iterative consensus process. A literature search supported this work. The a priori level for consensus was considered ≥80% of voting panellists.Results: The final expert panel included 22 physicians from different backgrounds and practice environments. The panel produced two consensus diagnoses: (1) acute MIPD and (2) persisting MIPD, which is further separated into subacute and chronic timeframes. Although certain characteristics differentiate methamphetamine‐induced psychosis shortly after use, identification of persisting MIPD depends largely on a history of symptom onset. All respondents voted in the final round, and both criteria were fully endorsed by 91% (20/22) of respondents. Panellists further recommended next steps in validation and research on this topic.Conclusion: These diagnostic criteria aid clinicians in differentiating methamphetamine‐induced psychotic symptoms from psychosis because of other psychiatric disorders and can guide future studies. Future research might examine these criteria's prognostic significance, interrater reliability and acceptability including among persons in recovery. This work is a necessary and vital step in advancing the science of methamphetamine addiction treatment.

Introduction: The purpose of this study is to compare the prevalence of hospitalization after an emergency department (ED) visit at an urban safety net hospital for youth with and without a substance use disorder. Methods: This study used a retrospective cohort design of adolescents (aged 15–21 y; n = 14,852) treated in the ED and compared the risk of hospitalization within 90 days. Results: A substance use disorder diagnosis in the ED more than doubled the risk of 90-day hospitalization (5.4% vs 2.38%; P < 0.0001). Conclusions: Compared with youth without a substance use disorder, youth with substance use disorders are likely to require additional services after an ED visit.