Substance Abuse Treatment Research Articles

Patterns of Pregabalin Users from Substance Abuse Treatment Facilities: Results from the French OPPIDUM Program from 2008 to 2022.

In recent years, pregabalin has received growing attention due to its abuse liability. The aim of this study was to further characterize patterns of pregabalin users from substance abuse treatment facilities and detect changes in users profile over the study period. The data source was the Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse (OPPIDUM) program, an annual, repeated, cross-sectional, nationwide, multicenter survey that collects consumption data from patients with substance use disorders. First, we described the characteristics of pregabalin users and their consumption patterns. We compared these data between 2008 and 2018 (P1) and 2019 and 2022 (P2). Second, we conducted a multiple correspondence analysis to identify profiles of users. From 2008 to 2022, 291 pregabalin users (0.37% of all users) from 116 substance abuse treatment facilities were identified. The number of pregabalin users was lower than 15 per year in P1 (n = 89) and between 40 and 60 per year in P2 (n = 202). The number of users who reported pregabalin as the first substance leading to dependence increased significantly in P2 compared with P1 (p < 0.005). When comparing P2 with P1, there was a significant increase in precarity (p < 0.001), users in prison (p = 0.002), withdrawal symptoms (p < 0.001), dependence (p < 0.001), use of higher dose of pregabalin (p = 0.029), and acquisition by deal/street market (p < 0.001). The multiple correspondence analysis allowed for the identification of distinct profiles of pregabalin users: (i) a cluster with mainly users from P1, who presented a simple use of pregabalin, and were older (> 45 years), were involved in opioid agonist treatment (OAT), and obtained pregabalin legally; and (ii) a cluster with mainly users from P2, who presented pregabalin dependence, and were younger (< 26 years), reported pregabalin as the first substance leading to dependence, used doses higher than the market authorization, were in severe precarity, and were in prison. These data showed that the profile of pregabalin users has changed in the last years. Pregabalin use disorders also affect users without history of addiction.

Telehealth Availability for Mental Health Care During and After the COVID-19 Public Health Emergency

Telehealth services expanded rapidly during the COVID-19 public health emergency (PHE). To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE. In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024. Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared. During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics. Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.

The Impact of Medicaid Institutions for Mental Disease Exclusion Waivers on the Availability of Substance Abuse Treatment Services and the Varying Effect by Ownership Type.

Access to integrated care for those with co-occurring mental health (MH) and substance use disorders (SUDs) has been limited because of an exclusion in Medicaid on paying for SUD care for those in institutions for mental disease (IMDs). Starting in 2015, the federal government encouraged states to pursue waivers of this exclusion, and by the end of 2020, 28 states had done so. It is unclear what impact these waivers have had on the availability of care for co-occurring disorders and the characteristics of any facilities that expanded care because of them. Using data from the National Survey of Substance Abuse Treatment Services, we estimate a two-stage residual inclusion model including time- and state-fixed effects to examine the effect of state IMD SUD waivers on the percentage of facilities offering co-occurring MH and SUD treatment, overall and for residential facilities specifically. Separate analyses are conducted by facility ownership type. Results show that the adoption of an IMD SUD waiver is associated with 1.068 greater odds of that state having facilities offering co-occurring MH and substance abuse (SA) treatment a year or more later. The adoption of a waiver increases the odds of a state's residential treatment facility offering co-occurring MH and SA treatment by 1.129 a year or more later. Additionally, the results suggest 1.163 higher odds of offering co-occurring MH/SA treatment in private for-profit SA facilities in states that adopt an IMD SUD waiver while suggesting no significant impact on offered services by private not-for-profit or public facilities. Our study findings suggest that Medicaid IMD waivers are at least somewhat effective at impacting the population targeted by the policy. Importantly, we find that there are differential responses to these IMD waivers based on facility ownership, providing new evidence for the literature on the role of ownership in the provision of health care.

Elevance Health Foundation awards additional $13.1 million for substance abuse treatment programs.

Elevance Health Foundation awards additional $13.1 million for substance abuse treatment programs.

Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health

There is much concern that substance use treatment programs are rarely integrated with smoking cessation programs. Here, the first national statistics are presented on the connection between heavy vs. light smoking and the opioid epidemic. Using the 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey, N=81,400 adults-years, logit regressions estimate the impact of heavy vs. light smoking on opioid use, chronic pain, work limitations due to pain, and poor mental health. Analyses were conducted from October 2023 to May 2024. Only 37 percent of the population has ever smoked, but they used 69% of the nation's annual prescription opioids. Adults who smoked more than 5 cigarettes a day composed 12% of the population but used about the same number of opioids as the 63% of the population who never smoked. Adults who formerly smoked used 16% fewer opioids than adults who currently smoke (p<0.01). The percent with chronic pain during the year varied from 12.2% for adults who never smoked to 14.2% for light smoking, to 16.5% for those smoking more than a pack a day (p<0.01). Severe work limitations due to pain varied from 7.3% for adults who never smoked to 16.9% for those smoking more than a pack a day (p<0.01). Adults smoking more than a pack a day were twice as likely to report fair or poor mental health compared to those who never smoked (29.2% vs 13.6%) (p<0.01). As nations deal with the opioid epidemic, integrating smoking cessation programs into substance abuse treatment programs appears prudent.

Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa.

The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.

Predictors of urine toxicology and other biologic specimen missingness in randomized trials of substance use disorders

BackgroundHigh levels of missing outcome data for biologically confirmed substance use (BCSU) threaten the validity of substance use disorder (SUD) clinical trials. Underlying attributes of clinical trials could explain BCSU missingness and identify targets for improved trial design. MethodsWe reviewed 21 clinical trials funded by the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) and published from 2005 to 2018 that examined pharmacologic and psychosocial interventions for SUD. We used configurational analysis—a Boolean algebra approach that identifies an attribute or combination of attributes predictive of an outcome—to identify trial design features and participant characteristics associated with high levels of BCSU missingness. Associations were identified by configuration complexity, consistency, coverage, and robustness. We limited results using a consistency threshold of 0.75 and summarized model fit using the product of consistency and coverage. ResultsFor trial design features, the final solution consisted of two pathways: psychosocial treatment as a trial intervention OR larger trial arm size (complexity=2, consistency=0.79, coverage=0.93, robustness score=0.71). For participant characteristics, the final solution consisted of two pathways: interventions targeting individuals with poly- or nonspecific substance use OR younger age (complexity=2, consistency=0.75, coverage=0.86, robustness score=1.00). ConclusionsPsychosocial treatments, larger trial arm size, interventions targeting individuals with poly- or nonspecific substance use, and younger age among trial participants were predictive of missing BCSU data in SUD clinical trials. Interventions to mitigate missing data that focus on these attributes may reduce threats to validity and improve utility of SUD clinical trials.

Access to treatment before and after Medicare coverage of opioid treatment programs

Abstract Since January 2020, Medicare has covered opioid use disorder (OUD) treatment services at opioid treatment programs (OTPs), the only outpatient settings allowed to dispense methadone for treating OUD. This study examined policy-associated changes in Medicare acceptance and the availability of four OUD treatment services (ongoing buprenorphine, HIV/AIDS education, employment services, and comprehensive mental health assessment), by for-profit status, and county-level changes in Medicare-accepting-OTPs access, by sociodemographic characteristics (racial composition, poverty rate, and rurality). Using data from the 2019-2022 National Directory of Drug and Alcohol Abuse Treatment Facilities, we found Medicare acceptance increased from 21.31% in 2018 to 80.76% in 2021. The availability of the four treatment services increased, but no increases were significantly associated with Medicare coverage. While county-level OTP access significantly improved, counties with higher rates of non-White residents experienced an additional average increase of 0.86 Medicare-accepting-OTPs (95% CI, 0.05–1.67) compared to those without higher rates of non-White populations. Overall, Medicare coverage was associated with improved OTP access, not ancillary services.

Intersecting Realities: Body Dysmorphic Disorder and Substance Abuse in Women – A Holistic Treatment Approach

The intersection of Body Dysmorphic Disorder (BDD) and substance abuse in women presents a clinical tableau rich with complexity and challenges. This review explores the intricate relationship between BDD—a disorder characterized by an obsessive preoccupation with perceived physical flaws—and substance abuse, where women may turn to drugs or alcohol as a maladaptive coping mechanism to alleviate the distress associated with BDD. A literature-focused methodology was employed in the study. In this context, databases such as PubMed, DergiPark, WoS, and ScienceDirect were utilized to explore the relevant literature. The analysis delves into the unique manifestation of BDD in women, influenced by societal, cultural, and psychological factors that often impose stringent beauty standards and exacerbate body image concerns. Patterns of substance abuse among women are discussed, highlighting the rapid progression from usage to dependency, known as telescoping, and the impact of societal stigma that compounds the struggles of women with addiction. Risk factors for both conditions are examined, with a focus on shared contributors such as trauma, mental health comorbidities, and societal pressures. Current treatment approaches are reviewed, advocating for an integrated model that combines psychotherapy, pharmacotherapy, and holistic or alternative interventions. The review emphasizes the importance of Cognitive Behavioral Therapy for BDD and Medication-Assisted Treatment for substance abuse, as well as the inclusion of mindfulness, meditation, and gender- The conclusion reinforces the imperative of a cohesive treatment strategy, underscoring the need for gender-specific, trauma-informed care that understands and addresses the complex interplay between BDD and substance abuse in women. This comprehensive approach promises more effective support and a hopeful pathway to recovery for women entangled in the web of these co-occurring disorders.

Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers.

Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.

Examining facilitative services for entry into substance use disorder treatment: A cluster analysis of treatment facilities.

We examined services to facilitate access to entering substance use disorder (SUD) treatment among a national sample of SUD treatment facilities. We analyzed data from the National Survey of Substance Abuse Treatment Services (N-SSATS) 2020. Facilities were included in the sample based on criteria such as SUD treatment provision and being in the U.S. Cluster analysis was conducted using variables including ownership, levels of care, and whether facilities provide services or accept payment options aimed at reducing treatment barriers. National and state-level data on the percentage of facilities in each cluster were presented. Among N = 15,788 SUD treatment facilities four distinct clusters were identified: Cluster 1 consisted of for-profit and government outpatient facilities with high proportions of services to reduce barriers (22.2%). Cluster 2, comprised of non-profit outpatient facilities, offered the most comprehensive array of services to minimize barriers to treatment among all four clusters (25.2%). Cluster 3 included facilities with diverse ownership and care levels and provided a moderate to high degree of services aimed at reducing entry barriers to treatment (26.0%). Cluster 4 was primarily for-profit outpatient facilities with a low proportion of these services (26.6%). This study revealed facility-level groupings with different services to reduce barriers to SUD treatment across various clusters of SUD treatment facilities. While some facilities offered extensive services, others provided fewer. Differences in cluster distributions point to possible facilitators to treatment access for some persons seeking admission to specific treatment facilities. Efforts should be made to ensure that individuals seeking SUD treatment can access these services, and facilities should be adequately equipped to meet their diverse needs.

EFFECTIVENESS OF CBT BASED RELAPSE PREVENTION THERAPY IN REDUCING RELAPSE RISK AND CRAVING AMONG INDIVIDUALS WITH SUBSTANCE USE DISORDER

Present study explored the effectiveness of Cognitive Behavioral Therapy with Relapse Prevention Techniques (CBT-BRPT) in reducing relapse risk and craving among individuals with substance use disorder (SUD). Drawing from a comprehensive literature review, the study addressed the pressing need for evidence-based interventions to combat SUD and its associated challenges. Present study employed a Pre-Experimental Research Design with a one-group pretest-posttest approach, utilized the purposive sampling to recruit a sample of 50 male participants seeking treatment for SUD. The instruments utilized include the Stimulant Relapse Risk Scale (SRRS), the Brief Substance Craving Scale (BSCS), and a Demographic Information Form. Results demonstrated significant reductions in both craving and relapse risk among participants who received CBT-BRPT intervention. These findings underscore the importance of CBT-BRPT as a viable treatment option for individuals with SUD, offering promising implications for clinical practice and substance abuse treatment programs. Despite limitations such as sample size and absence of a control group, the study's findings advocate for the integration of CBT approaches into existing treatment modalities and call for further research to validate the efficacy of CBT interventions in addressing substance use disorders comprehensively.

Effectiveness of School-based Substance abuse Prevention Programme (SSPP) on awareness, attitude, peer pressure, and life skills among adolescents in selected public schools of Pokhara, Nepal–A cluster randomized trial protocol

ObjectiveEarly substance use has been linked to various adverse outcomes and escalates quickly during adolescence. Delaying the onset of substance use among adolescents is a primary public priority as it is associated with severe effects. The objective of the study is to develop and determine the effectiveness of a School-based Substance Abuse Prevention Programme (SSPP) on awareness, attitude, peer pressure, and life skills towards preventing substance abuse among adolescents. MethodPhase I of the study is a qualitative approach, where a focus group discussion (FGD) will be conducted among different stakeholders to explore their perceptions regarding the prevention of substance use among adolescents. The anticipated sample size is 38. Thematic analysis will be done by using ATLAS.ti software. The inputs given by the stakeholders will be incorporated in developing the intervention (SSPP). Phase II is a cluster randomized controlled trial. A minimum of 210 adolescents (105 each in the intervention and control groups) between the age group of 13 to 15 years from 8th and 9th grade will be recruited for the study. In this study, the school will be the cluster and will be randomly assigned either to an intervention or control arm. The data will be collected at pre, post, 3-month, and 6-month intervals. The ethical approval was obtained from the Nepal Health Research Council Committee, Nepal (NHRC 276/2023). The trial was also registered under the Clinical Trial Registry of USA-Clinical Trials.gov (CTRI 06004726/2023/08/22/). Descriptive and inferential statistics will be used to analyze the data. Expected resultsImplementation of the SSPP module will improve the awareness, attitude, peer pressure, and life skills of adolescents toward preventing substance use behavior. Overall, the study aims to achieve Sustainable Development Goal (SDG) 3.5- ‘Good Health and Well-being; strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.’ ConclusionThe present study protocol will help to develop a unique training module (SSPP) focused on preventing substance use behaviour among adolescents in Nepal.

Contingency Management for Dually Diagnosed Inpatients with Psychosis.

Contingency management (CM) is an evidence-based treatment method in substance abuse treatment. However, little is known about its efficacy in dually diagnosed patients with psychosis and in inpatient settings. Therefore, the aim of this study is to investigate the efficacy of CM for dually diagnosed patients with psychosis in an inpatient setting. Furthermore, we investigate the effect of the nature of the reward used (cash vs. prize) on the efficacy of CM. We made use of an 8-week fish-bowl CM intervention by means of a within-subject reversal design with three treatment phases (baseline-intervention-follow-up). Sixty-seven patients were included in this study, of whom thirty-four completed the protocol. The results show no effect of CM on abstinence nor an interaction with clinical or demographic variables. Cash money is as effective as prizes. Future research should further investigate the effect of psychosis and treatment setting on the efficacy of CM, with special attention for Patient Report Experience and Outcome Measures (PREM/PROM).

마약류 치료기술 국내 도입 우선순위

Objectives: To determine Korean national priority for research and development planning for drug abuse and substance use disorder treatment. Methods: A Delphi survey methodology was employed, involving 19 experts in the field of addiction. Their potential priorities were assessed based on the size of the problem, urgency, effectiveness, budget size, and feasibility of research execution. Results: After three rounds, the expert consensus was reached for 13 research plans of universal therapeutic agenda and 7 plans for specific drugs. These included developing guidelines for children and adolescents on substance use, a community-based long-term management program, and the development of intervention programs and clinical guidelines for stimulant, cannabis, and opioid use disorders. However, consensus was not reached for research on therapeutic options such as digital therapeutics. Conclusion: This study highlights priority areas for systematic and effective development of treatment programs and research agenda against illicit use of drugs. By integrating insights from multidisciplinary experts, a comprehensive research and development blueprint is proposed to address drug use, which is on the rise and threatening public health and social security in the Republic of Korea.

A literature review addressing the relationship between mindfulness and stress-level

This review explores the effectiveness of mindfulness interventions, particularly Mindfulness-Based Stress Reduction (MBSR), in reducing stress. Existing research supports the positive impact of mindfulness-based therapy on stress, anxiety, and depression. Despite promising outcomes, the limited number of high-quality studies underscores the need for more comprehensive research. Highlighted studies include an 8-week mindfulness program for medical students, demonstrating significant reductions in stress and anxiety, and a pilot study investigating the impact of MBSR on individuals in substance abuse treatment. In the educational context, mindfulness interventions can improve students’ well-being and attention. A study in Granada, Spain, reports positive outcomes in health, school, and family variables post-intervention.In conclusion, while literature supports the positive impact of mindfulness on stress reduction, further robust research, especially in educational settings, is essential to establish effectiveness and guide future interventions.

Empirically contrasting urine drug screening-based opioid use disorder treatment outcome definitions.

A lack of consensus on the optimal outcome measures to assess opioid use disorder (OUD) treatment efficacy and their precise definition and computation has hampered the pooling of research data for evidence synthesis and meta-analyses. This study aimed to empirically contrast multiple clinical trial definitions of treatment success by applying them to the same dataset. Data analysis used a suite of functions, developed as a software package for the R language, to operationalize 61 treatment outcome definitions based on urine drug screening (UDS) results. Outcome definitions were derived from clinical trials that are among the most influential in the OUD treatment field. Outcome functions were applied to a harmonized dataset from three large-scale National Drug Abuse Treatment Clinical Trials Network (CTN) studies, which tested various medication for OUD (MOUD) options (n = 2492). Hierarchical clustering was employed to empirically contrast outcome definitions. The optimal number of clusters identified was three. Cluster 1, comprising eight definitions focused on detecting opioid-positive UDS, did not include missing UDS in outcome calculations, potentially resulting in inflated rates of treatment success. Cluster 2, with the highest variability, included 10 definitions characterized by strict criteria for treatment success, relying heavily on UDS results from either a brief period or a single study visit. The 43 definitions in Cluster 3 represented a diverse range of outcomes, conceptualized as measuring abstinence, use reduction and relapse. These definitions potentially offer more balanced measures of treatment success or failure, as they avoid the extreme methodologies characteristic of Clusters 1 and 2. Clinical trials using urine drug screening (UDS) for objective substance use assessment in outcome definitions should consider (1) incorporating missing UDS data in outcome computation and (2) avoiding over-reliance on UDS data confined to a short time frame or the occurrence of a single positive urine test following a period of abstinence.

ASAM features harm reduction, methadone, OTPs at conference

Not surprisingly, last week'k American Society of Addiction Medicine (ASAM) conference was sold out, with its big focus on moving methadone out of the opioid treatment program (OTP) system and into general office‐based care (preferably by only ASAM‐boarded physicians), and also considerable attention paid to the value of high‐quality treatment with methadone. A track called “Methadone in the Modern Era” included Ruth Potee, M.D., in an impassioned speech focused on the need for more access to methadone, and on the for‐profit OTPs that are out there. That track also featured Yngvild Olsen, M.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA) who talked about the other modern (aka, real world) era in which OTP regulations have been completely updated and revised. Aaron Ferguson, who said at a public conference last fall that he owed his life to diverted methadone (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33908) despite being a patient advocate, also presented at the conference, this time on harm reduction, which is beneficial to keeping people alive. Many OTPs, especially the large chain for‐profit OTPs, have been a target of ASAM members for years; most are also members of the American Association for the Treatment of Opioid Dependence, and some are members of the National Association for Behavioral Healthcare.

Rising substance use disorders in Malawi: analysis of hospital-based data (2010 to 2019)

Background Africa has a long history of substance abuse, mostly limited to alcohol, tobacco and cannabis, with the East African region being home to one of the world’s highest rates. There are reports of increasing substance abuse in Malawi but limited research evidence to provide details on the extent and nature of the issue. Despite indications of high prevalence, help seeking behaviour among the population is minimal. Mental health services are underfunded by government, and not a key health priority. Access to affordable psychosocial treatment for substance abuse is limited. This paper reports analysis of service utilisation patterns among those assessed at the St John of God (SJOG) Hospital and referred for psychosocial services for substance abuse treatment since its establishment in 2010. This is the first study in Malawi reporting routinely collected patient data related to substance abuse treatment from outpatient psychosocial services. Methods We descriptively analysed retrospective routinely collected data related to substance use disorders from two SJOG hospital sites that provide psychosocial or psychopharmacological treatment to service users at the mental health clinic from 2010 to 2019. Results Analysis of routinely collected data indicated increasing substance abuse treatment within SJOG psychosocial services between 2010 to 2019, with alcohol, chamba (cannabis) and tobacco related substance use disorders being predominant conditions among service users. Age-related data from 2018–2019 showed 22% of service users were under 18 years, indicating evidence of youth substance abuse. Conclusions These findings indicate growing service utilisation for substance use treatment in outpatient psychosocial services over the last decade in Malawi. Importantly, there is need for better electronic health data recording infrastructure to facilitate monitoring of incidents to inform extent of substance use issues and evidence-based solutions for treatment services in Malawi.

The effect of substance use Certificate‐of‐Need laws on access to substance use disorder treatment facilities

AbstractWe investigate how substance use Certificate‐of‐Need (CON) laws influence access to substance use disorder treatment facilities in the United States. We use the National Directory of Drug and Alcohol Abuse Treatment Facilities data set, which lists all federal, state, and local government facilities and private facilities that provide substance use treatment services in 2020. Based on the locations of these facilities, we develop a novel access index to substance use disorder treatment facilities that accounts for driving distance and duration to measure the ease of reaching these facilities for individuals living at the population‐weighted county centroids. We find that counties in states with CON laws that border counties without such laws have nearly 10% less spatial accessibility to substance use disorder treatment facilities at a 5% level of significance.