| Even though evidence-based treatment for opioid use disorders (OUD) is eff ective, almost four in fi ve Americans with OUD do not receive any form of treatment. The gap in access to evidencebased care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and fi nancial barriers. Action from a number of actors is urgently needed to address this crisis.

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Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System

New psychoactive substances have drastically modified the world drug a scene. An increasingly popular class comprises synthetic or substituted a cathinones (legal highs, research chemicals, bath salts). Among the most a common psychoactive constituents of bath salts are mephedrone and a methylone. Recent reports on the abuse of novel synthetic cathinone a derivatives call attention to the serious physical and psychological a risks resulting from their consumption, thereby emphasizing the growing a use of these drugs might constitute an important public health issue. a In this paper, we will review the available data regarding the use and a effects of mephedrone and methylone in humans in order to highlight a their impact on public health. To reach this objective, a literature a search was performed on two representative databases (Pubmed, Google a Scholar), the Erowid Center website (a US non-profit educational a organization that provides information about psychoactive plants and a chemicals), and various governmental websites. The terms used for the a database search were ``mephedrone'', ``methylone'', ``new a psychoactive substances'', ``synthetic cathinones'', ``substituted a cathinones'', ``substance abuse'', ``substance use disorder'', a ``adverse effects'', ``fatalities''. The literature search was a limited to years 2005-2015 and led to the identification of 71 a potentially relevant articles. a To date, the actual prevalence rates of their use remains difficult to a estimate. Important health-related issues have emerged in relation to a the somatic, psychiatric, and addictive consequences of their use. The a potential chronic health effects of their prolonged use remain to date a unknown (e.g., reproductive toxicity, genotoxicity and carcinogenic a potential). Treatment for patients with prolonged exposure to synthetic a cathinones should ideally include a drug management plan coupled with a psychotherapy taking place in a structured program of care. (C) 2016 a Elsevier Inc. All rights reserved.

The effects and risks associated to mephedrone and methylone in humans: ă A review of the preliminary evidences

Background and aims Evidence from randomized controlled trials establishes that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention. However, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among US patient populations receiving treatment in usual care settings. This study compared overdose mortality among those in medication versus non-medication treatments in specialty care settings. Design Retrospective cohort study using state-wide treatment data linked to death records. Survival analysis was used to analyze data in a time-to-event framework. Setting Services delivered by 757 providers in publicly funded out-patient specialty treatment programs in Maryland, USA between 1 January 2015 and 31 December 2016. Participants A total of 48 274 adults admitted to out-patient specialty treatment programs in 2015-16 for primary diagnosis of opioid use disorder. Measurements Main exposure was time in medication treatment (methadone/buprenorphine), time following medication treatment, time exposed to non-medication treatments and time following non-medication treatment. Main outcome was opioid overdose death during and after treatment. Hazard ratios were calculated using Cox proportional hazard regression. Propensity score weights were adjusted for patient information on sex, age, race, region of residence, marital and veteran status, employment, homelessness, primary opioid, mental health treatment, arrests and criminal justice referral. Findings The study population experienced 371 opioid overdose deaths. Periods in medication treatment were associated with substantially reduced hazard of opioid overdose death compared with periods in non-medication treatment [adjusted hazard ratio (aHR) = 0.18, 95% confidence interval (CI) = 0.08-0.40]. Periods after discharge from non-medication treatment (aHR = 5.45, 95% CI = 2.80-9.53) and medication treatment (aHR = 5.85, 95% CI = 3.10-11.02) had similar and substantially elevated risks compared with periods in non-medication treatments. Conclusions Among Maryland patients in specialty opioid treatment, periods in treatment are protective against overdose compared with periods out of care. Methadone and buprenorphine are associated with significantly lower overdose death compared with non-medication treatments during care but not after treatment is discontinued.

Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services.

Background: A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of ...

Mobile Technologies and Geographic Information Systems to Improve Health Care Systems: A Literature Review

Insights into biased signaling at cannabinoid receptors: synthetic cannabinoid receptor agonists.

Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap.

New and Emerging Illicit Psychoactive Substances.

Introduction Use of the unregulated herbal supplement kratom is on the rise in the United States. We present a case series of 2 patients who developed kratom dependence and withdrawal who were successfully transitioned to buprenorphine-naloxone maintenance. Case summary Two patients using kratom to self-treat chronic pain after prescription opioids were discontinued presenting to our clinic with evidence of kratom dependence and withdrawal. On examination, both patients showed signs of mild opioid withdrawal. Both patients were successfully transitioned to buprenorphine-naloxone maintenance via home initiation with control of both their opioid withdrawal and chronic pain. Conclusions Kratom use is on the rise and with increasing evidence of developing opioid-type dependence due to chronic kratom use. This case series shows that buprenorphine can be used to treat kratom dependence and underlying chronic pain that drives it use.

Treatment of Kratom Dependence With Buprenorphine-Naloxone Maintenance

Latinos in the US are disproportionately affected by HIV and are at risk for late presentation to care. Between June 2011 and January 2012, we conducted a cross-sectional survey of 209 Baltimore Latinos at community-based venues to evaluate the feasibility of using information communication technology-based interventions to improve access to HIV testing and education within the Spanish-speaking community in Baltimore. Participants had a median age of 33 years interquartile range (IQR) (IQR 28–42), 51.7 % were male, and 95.7 % were foreign-born. Approximately two-thirds (63.2 %) had been in the US less than 10 years and 70.1 % had been previously tested for HIV. Cell phone (92.3 %) and text messaging (74.2 %) was used more than Internet (52.2 %) or e-mail (42.8 %) (p < 0.01). In multivariate analysis, older age and lower education were associated with less utilization of Internet, e-mail and text messaging, but not cell phones. Interest was high for receiving health education (73.1 %), HIV education (70.2 %), and test results (68.8 %) via text messaging. Innovative cell phone-based communication interventions have the potential to link Latino migrants to HIV prevention, testing and treatment services.

Cell Phone Utilization Among Foreign-Born Latinos: A Promising Tool for Dissemination of Health and HIV Information

OBJECTIVES: To examine patient characteristics and outcomes among opioid use disorder patients enrolled in low-threshold buprenorphine treatment during the COVID-19 pandemic. METHODS: This paper describes the adaptation of the Project Connections (PC) program, a low-threshold buprenorphine program in Baltimore, in response to the COVID-19 pandemic. This paper examines patient characteristics and initial outcomes of patients served during a rapid protocol shift to telehealth that allowed buprenorphine initiation without an in-person encounter following a state-mandated stay-at-home order. Patient characteristics were compared to a subsample of patients enrolled in the program before the COVID-19 pandemic. RESULTS: In March 2020, there was a sharp increase in new enrollments to the PC program. A total of 143 patients completed an intake assessment between March and May 2020 and 140 began treatment with buprenorphine/naloxone. Those who completed an intake assessment were primarily male (68.5%), Black (83.2%), had a mean age of 43.2 years (SDâ=â11.7), and reported a mean of 17.0 years of opioid use (SDâ=â12.9). The majority of patients were unemployed (72.7%) and reported previous criminal justice involvement (69.2%). Of those who completed an intake assessment, 96.5% returned for a second visit. Among those for whom 30-day retention data was available (nâ=â113), 63.7% were engaged for 30 days or longer. CONCLUSIONS: The PC program illustrates that offering on-demand, flexible treatment is an opportunity to increase opioid use disorder treatment access, even during a public health emergency that disrupted access to services. Relaxation of buprenorphine telehealth regulations allowed for flexibility in treatment and benefits vulnerable populations.

Megan Buresh

Papers

Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap.

New and Emerging Illicit Psychoactive Substances.

Treatment of Kratom Dependence With Buprenorphine-Naloxone Maintenance

Cell Phone Utilization Among Foreign-Born Latinos: A Promising Tool for Dissemination of Health and HIV Information

Adapting a Low-threshold Buprenorphine Program for Vulnerable Populations During the COVID-19 Pandemic.