enCompass: evaluation of a community-based substance use disorder stigma intervention.

Introduction: Stigma within communities is pervasive and a barrier to substance use disorder (SUD) treatment. The current proof-of-concept study evaluated , a community-based SUD knowledge and stigma intervention.

Methods: In 2021, 22 trainings were offered to community members in partnership with the Ohio Governor's RecoveryOhio initiative to 22 Ohio counties with high numbers of overdose deaths.

Lessons from Maternal Mortality Reviews. How Addiction Care Providers can help improve Outcomes for Pregnant, Postpartum, and Parenting people.

Background: Drug-related deaths, including accidental and intentional overdose and other drug-related causes, are among the leading causes of maternal mortality in the United States.

Analysis: Addiction care providers can contribute to efforts to decrease maternal mortality related to substance use disorder. In this report, we review current research to inform the care of pregnant and parenting people with substance use disorder (SUD) to address rising drug-related deaths.

A conceptual framework for assessing implementation strategy integrity.

Background: The outcomes of planned implementation efforts have been mixed, with some applications failing to achieve the desired change or impact. While reasons for mixed findings in implementation research are multifaceted (e.g.

Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People.

Introduction: As perinatal drug overdoses continue to rise, reliable approaches are needed to monitor overdose trends during pregnancy and postpartum. This analysis aimed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-9/10-CM codes for drug overdose events among people in the MATernaL and Infant clinical NetworK (MAT-LINK) with medication for opioid use disorder (MOUD) during pregnancy.

Methods: People included in this analysis had electronic health record (EHR) documentation of MOUD and a known pregnancy outcome from January 1, 2014 through August 31, 2021.

Examining the Severity and Progression of Illicitly Manufactured Fentanyl Withdrawal: A Quasi-Experimental Comparison.

Objective: Illicitly manufactured fentanyl has largely replaced heroin throughout the United States. Characteristics of fentanyl-specific withdrawal are not well understood compared to traditional opioid withdrawal. This study examines opioid withdrawal severity among 2 cohorts of study participants who underwent identical morphine stabilization procedures before and after fentanyl was introduced to the local drug market.

Treatment and decriminalization of the mother-infant dyad in perinatal opioid use disorder.

Treatment of perinatal opioid use disorder should center the mother-infant dyad, the needs of both entities, and preservation of the relationship. The criminalization of pregnancy and substance use in pregnancy through punitive policies and legislation and the involvement of the family policing system are in direct opposition to compassionate, person-centered care and lead to worse maternal and neonatal outcomes. In this chapter, we review the history and ongoing criminalization of pregnancy and perinatal substance use disorder, explore carcerality as a barrier to dyadic care that disproportionately targets Black, Brown, and Indigenous birthing individuals, and propose solutions to decriminalize care based in abolition medicine and reproductive justice frameworks.

Protocol for a randomized controlled trial with a stepped care approach, utilizing PrEP navigation with and without contingency management, for transgender women and sexual minority men with a substance use disorder: Assistance Services Knowledge-PrEP (A.S.K.-PrEP).

Background: In the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use.

Exposure to Bupropion-SR vs. Placebo is associated with reductions in smoking among persons receiving methadone with no stated interest in smoking cessation.

Smoking is prevalent among individuals receiving methadone treatment. Reducing smoking among this population is needed as smoking is a leading cause of morbidity and preventable death. Smoking cessation interventions for persons receiving medication for opioid use disorder have yielded small changes in abstinence.

Consensus Statement on Pain Management for Pregnant Patients with Opioid-Use Disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine.

Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care providers in obstetrics and anesthesiology.

Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment.

Background: Overdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.

Methods: We conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023.

Revisiting Preaddiction.

The directors of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism have proposed new efforts to enable earlier identification and intervention for harmful substance use and its consequences. As editors of The ASAM Principles of Addiction Medicine, we fully support this goal. The word "preaddiction" has been suggested as a diagnostic label to describe individuals who would be targeted for early intervention.

"We're Checking a Box and, You Know, Covering Our Own": Health Professionals' Descriptions of Hospital-Policy Making Regarding Child Welfare Reporting Related to Birthing People's Drug Use.

Background: Hospital policies play a role in healthcare providers' decision-making about reporting birthing people who use drugs to child welfare. This study sought to understand how these specific hospital policies are made.

Methods: We conducted semi-structured interviews with healthcare professionals involved in developing or revising hospital policies related to child welfare reporting for birthing people who use drugs.

Adverse Events at 1 Month Following Medication Initiation for Opioid Use Disorder Among Adolescents and Young Adults.

Background: We assess adverse events (AEs) following medication initiation for adolescents and young adults with opioid use disorder (OUD).

Methods: This is a secondary analysis of a clinical trial of long-acting injectable naltrexone (LAI-naltrexone) among youth with OUD aged 15 to 21 years. Participants were recruited from residential treatment and placed into 1 of 3 treatment groups based on medication receipt at time of discharge (no medication, sublingual buprenorphine-naloxone [buprenorphine], or LAI-naltrexone).

Technology-Based Interventions, with a Stepped Care Approach, for Reducing Sexual Risk Behaviors and Increasing PrEP Initiation Among Transgender and Gender Expansive Youth and Young Adults.

TechStep was a technology-based trial, with a stepped care approach, to reduce sexual risks and increase PrEP uptake among transgender and gender expansive youth and young adults (15-24 years old). From October 2019 to September 2021, 254 participants were randomized into: 1) Text (n = 82), or 2) Webapp (n = 87), or 3) Control (n = 85). At the 3-month follow-up assessment, those randomized to Text and Webapp and did not demonstrate improvement on primary outcomes were re-randomized to receive virtual eCoaching (Text + or Webapp +), or to remain in their initial condition without eCoaching.

Maternal Perception of Infant Sleep and Bonding in Opioid Use Disorder.

Objective: Infant sleep problems are common in early infancy and can negatively influence maternal-infant bonding. As opioid-exposed neonates are at increased risk of sleep difficulties, we examined the association between maternal perception of infant sleep difficulties and maternal-infant bonding among dyads affected by maternal opioid use disorder (OUD), from birth through 6 months.

Methods: We enrolled 100 birthing people (participants) between 6 months and 2 years postpartum who had received medications for OUD during their pregnancy.

Medications for Alcohol Use Disorder among Birthing People with an Alcohol-related Diagnosis.

Objectives: Although safety and effectiveness of medications for alcohol use disorder (AUD) are well established for adults, literature on these medications in pregnancy is limited. Given known adverse effects of untreated AUD during pregnancy, clinicians and researchers have recently begun to call for reconsidering use of medications for AUD in pregnancy. Thus, we sought to estimate the proportion of birthing people with an alcohol-related diagnosis who received a prescription for medication related to AUD treatment.

Reasons pregnant people use cannabis to self-treat health conditions during pregnancy: Results from a US population-based survey.

Introduction: Little is known about reasons pregnant people self-treat health conditions and pregnancy-related symptoms with cannabis.

Methods: We administered a cross-sectional survey to 3571 pregnant and recently pregnant people from US population-based panels. Participants who used cannabis at some point during pregnancy were asked which health conditions or symptoms they used cannabis to treat and reasons they used cannabis for self-treatment.

Perinatal substance use treatment and criminal legal system referral trends.

Introduction: To guide improvements in treatment for pregnant persons with substance use disorders within the criminal legal system, treatment programs must first determine the primary substances of concern for this population. The objective of this study is to compare trends in specific substance use upon admission to treatment in pregnancy, based upon whether referrals originated from the criminal legal system or from another referral source.

Methods: This research accessed data on perinatal substance use (1995-2021) and referral sources from the Treatment Episode Data Set-Admissions (TEDS-A).

Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone.

Importance: Buprenorphine combined with naloxone is commonly used to treat opioid use disorders outside of pregnancy. In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product.

Objective: To compare perinatal outcomes following prenatal exposure to buprenorphine with naloxone vs buprenorphine alone.

Experience Starting an Addiction Medicine Practice-based Research Network.

Objectives: This paper outlines the experience developing Addiction Medicine Practice-Based Research Network (AMNet), which promotes the adoption of patient-reported outcome measures (PROMs) and measurement-based care in outpatient addiction treatment practices and creates a platform for quality improvement and research.

Methods: From August 2019 to July 2023, the AMNet team selected patient-reported outcome measures for implementation in the American Psychiatric Association's clinical data registry (PsychPRO), recruited addiction medicine providers, and collected PROMs data.

Results: AMNet selected 12 PROMs for implementation in PsychPRO.

Efficacy and Safety of Esmethadone (REL-1017) in Patients With Major Depressive Disorder and Inadequate Response to Standard Antidepressants: A Phase 3 Randomized Controlled Trial.

To test esmethadone (REL-1017) as adjunctive treatment in patients with major depressive disorder (MDD) and inadequate response to standard antidepressants. In this phase 3, double-blind, placebo-controlled trial, outpatients with MDD () were randomized to daily oral esmethadone (75 mg on day 1, followed by 25 mg daily on days 2 through 28) or placebo between December 2020 and December 2022. The primary efficacy measure was change from baseline (CFB) to day 28 in the Montgomery-Asberg Depression Rating Scale (MADRS) score.

Naloxone Use During Pregnancy-Data From 26 US Jurisdictions, 2019-2020.

Objectives: We aimed to determine the prevalence of self-reported naloxone use during pregnancy among people in the United States with a recent live birth. A secondary objective was to characterize people at increased risk of overdose who did and did not use naloxone.

Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System from 26 US jurisdictions that conducted an opioid supplement survey from 2019 to 2020.

Assessing the impact of jail-initiated medication for opioid use disorder: A multisite analysis of the SOMATICS collaborative.

The objective of this study was to estimate the associations of jail-initiated medication for opioid use disorder (MOUD) and patient navigation (PN) with opioid use disorder (OUD) at 6 months post-release. Three randomized trials (combined N = 330) were combined to assess whether MOUD (extended-release naltrexone or interim methadone) initiated prior to release from jail with or without PN would reduce the likelihood of a DSM-5 diagnosis of OUD 6 months post-release relative to enhanced treatment-as-usual (ETAU). Across the three studies, assignment to MOUD compared to ETAU was not associated with an OUD diagnosis at 6 months post-release (69% vs.