Harm Reduction: The Neglected Pillar of US Drug Policy.

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies.

Experiences of the changing illicit drug supply among racial and ethnic minoritized people in three US states: a qualitative study.

Background: Amidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply.

Methods: We conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically.

Associations Between State Policies Facilitating Telehealth and Buprenorphine Episode Initiation and Duration Early in the COVID Pandemic : State Telehealth Policies and Buprenorphine.

Importance: State policies facilitating telehealth implemented early in COVID may support buprenorphine treatment of opioid use disorder. However, little empirical information is available about those policies' effects.

Objective: Examine association between state policies that may facilitate telehealth use and buprenorphine treatment.

How emergency departments are responding to the opioid crisis: Results from a statewide survey in Kentucky.

Objective: There is a rising effort for hospital emergency departments (EDs) to offer and expand substance use disorder (SUD) services. This state-wide evaluation studies SUD services offered along the continuum of implementation across Kentucky's EDs to inform future state efforts to build ED bridge programs.

Methods: We conducted a mixed-methods study using an online survey of all Kentucky Emergency Department Directors between January and May of 2023.

Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data.

Background: Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD).

Methods: We linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021-June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix.

Implementation Of New Mexico's 'No Behavioral Health Cost Sharing' Law: A Qualitative Study.

Out-of-pocket spending is a long-standing challenge for privately insured people. New Mexico passed the first US law prohibiting private insurers from applying cost sharing to behavioral health treatment, effective January 1, 2022. We examined the perceptions of key informants, including clinicians, insurers, and state officials, about implementing the No Behavioral Health Cost Sharing law to explore how it might affect downstream outcomes such as spending and access.

Personal Experiences With Xylazine and Behavior Change: A Qualitative Content Analysis of Reddit Posts.

Objectives: Xylazine is a rapidly spreading adulterant in the United States' drug supply and is increasingly associated with overdoses and severe wounds, but there is a dearth of information about the clinical presentation or means of treatment for human xylazine exposure. The objective of this study was to explore personal attitudes about xylazine in the drug supply and experiences with xylazine-related use among people who reported using drugs and contributed content to social media site Reddit.

Methods: To conduct a retrospective qualitative content analysis, the study team extracted all posts and comments from Reddit, which mentioned the terms "xylazine" or "tranq.

Disparities in Medication Use for Criminal Justice System-Referred Opioid Use Disorder Treatment.

Importance: Individuals with opioid use disorder (OUD) and criminal justice system involvement experience high rates of overdose death. Historical data point to limited use of medications for opioid use disorder (MOUD) in criminal justice system-referred treatment for OUD as playing a role. However, how MOUD use among those referred to treatment by the criminal justice system has changed relative to other referral sources over time is still unclear, as well as how it varies across states.

Medications for Opioid Use Disorder after Entering Residential Treatment: Evidence from Louisiana Medicaid.

Objective: Policies have attempted to increase the use of medication for opioid use disorder (MOUD) during an admission to a residential treatment program, but little is known about the association of residential admission with subsequent MOUD use.

Methods: In a cohort study of Louisiana Medicaid beneficiaries age 18-64 with diagnosed opioid use disorder (OUD), weekly MOUD use and overdose for 20 weeks before and after an admission to residential treatment was analyzed using comparative interrupted time series regression. Participants with residential treatment admission between January 1, 2018, and December 31, 2020 (N = 12,222) were compared against a demographically similar group of people with OUD without residential treatment during the study period.

Harm Reduction and Treatment Among People at High Risk of Overdose.

Importance: Rates of overdose deaths involving synthetic opioids remain high, increasingly involve stimulants combined with opioids, and are increasing rapidly in racially and ethnically minoritized communities, yet little is known about access to harm reduction and treatment services in these groups.

Objective: To characterize access and barriers to harm reduction and treatment in a racially and ethnically diverse population of people who use drugs.

Design, Setting, And Participants: A cross-sectional telephone survey of people recruited from 39 treatment, harm reduction, and social service organizations in Milwaukee County, Wisconsin; Flint and Detroit, Michigan; and statewide in New Jersey was conducted from January 30 to July 28, 2023.

A content analysis of legal policy responses to xylazine in the illicit drug supply in the United States.

Background: Xylazine is a veterinary sedative that is quickly spreading in the U.S. illicit drug supply and is increasingly associated with fatal overdoses and severe wounds.

Racial and Ethnic Disparities in Geographic Availability of Buprenorphine.

Objectives: Overdose mortality has risen most rapidly among racial and ethnic minority groups while buprenorphine prescribing has increased disproportionately in predominantly non-Hispanic White urban areas. To identify whether buprenorphine availability equitably meets the needs of diverse populations, we examined the differential geographic availability of buprenorphine in areas with greater concentrations of racial and ethnic minority groups.

Methods: Using IQVIA longitudinal prescription data, IQVIA OneKey data, and Microsoft Bing Maps, we calculated 2 outcome measures across the continental United States: the number of buprenorphine prescribers per 1000 residents within a 30-minute drive of a ZIP code, and the number of buprenorphine prescriptions dispensed per capita at retail pharmacies among nearby buprenorphine prescribers.

Piloting racial bias training for hospital emergency department providers treating patients with opioid use disorder.

Racial disparities in opioid overdose have increased in recent years. Several studies have linked these disparities to health care providers' inequitable delivery of opioid use disorder (OUD) services. In response, health care policymakers and systems have designed new programs to improve equitable OUD care delivery.

US payment policy for medications to treat opioid use disorder: landscape and opportunities.

Offering patients medications for opioid use disorder (MOUD) is the standard of care for opioid use disorder (OUD), but an estimated 75%-90% of people with OUD who could benefit from MOUD do not receive medication. Payment policy, defined as public and private payers' approaches to covering and reimbursing providers for MOUD, is 1 contributor to this treatment gap. We conducted a policy analysis and qualitative interviews ( = 21) and surveys ( = 31) with US MOUD payment policy experts to characterize MOUD insurance coverage across major categories of US insurers and identify opportunities for reform and innovation.

How policymakers innovate around behavioral health: adoption of the New Mexico "No Behavioral Health Cost-Sharing" law.

State policymakers have long sought to improve access to mental health and substance use disorder (MH/SUD) treatment through insurance market reforms. Examining decisions made by innovative policymakers ("policy entrepreneurs") can inform the potential scope and limits of legislative reform. Beginning in 2022, New Mexico became the first state to eliminate cost-sharing for MH/SUD treatment in private insurance plans subject to state regulation.

Allocating health care resources in jails and prisons during COVID-19: a qualitative study of carceral decision-makers.

COVID-19 created acute demands on health resources in jails and prisons, burdening health care providers and straining capacity. However, little is known about how carceral decision-makers balanced the allocation of scarce resources to optimize access to and quality of care for incarcerated individuals. This study analyzes a national sample of semi-structured interviews with health care and custody officials ( = 32) with decision-making authority in 1 or more carceral facilities during the COVID-19 pandemic.

Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment.

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies.

Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009-2018.

Background: We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018.

Methods: In this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009-2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined.

Association of buprenorphine retention and subsequent adverse outcomes following non-fatal overdose: An analysis using statewide linked Maryland databases.

Introduction: Patients receiving buprenorphine after a non-fatal overdose have lower risk of future nonfatal or fatal overdose, but less is known about the relationship between buprenorphine retention and the risk of adverse outcomes in the post-overdose year.

Objective: To examine the relationship between the total number of months with an active buprenorphine prescription (retention) and the odds of an adverse outcome within the 12 months following an index non-fatal overdose.

Materials And Methods: We studied a cohort of people with an index non-fatal opioid overdose in Maryland between July 2016 and December 2020 and at least one filled buprenorphine prescription in the 12-month post-overdose observation period.

Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law.

Importance: On January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier to treatment for MH/SUDs among the commercially insured; however, the outcomes of the law are unknown.

Objective: To assess the association of implementation of the NCS with out-of-pocket spending for prescription for drugs primarily used to treat MH/SUDs and monthly volume of dispensed drugs.

Design, Settings, And Participants: This retrospective cohort study used a difference-in-differences research design to examine trends in outcomes for New Mexico state employees, a population affected by the NCS, compared with federal employees in New Mexico who were unaffected by NCS.