Medicaid expansion was associated with reductions in total opioid overdose deaths, particularly deaths involving heroin and synthetic opioids other than methadone, but increases in methadone-related mortality. As states invest more resources in addressing the opioid overdose epidemic, attention should be paid to the role that Medicaid expansion may play in reducing opioid overdose mortality, in part through greater access to medications for opioid use disorder.

Source: JAMA Network Open
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758476

The opioid epidemic in the U.S. is driving a simultaneous epidemic of infectious diseases — including HIV, hepatitis C virus (HCV) and bacterial infections, and sexually transmitted infections — but workforce shortages, stigma, and financial and policy barriers are preventing the integration of opioid use disorder (OUD) and infectious disease services, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report recommends state and federal policy actions, including removing insurance requirements on prescribing medications for OUD (i.e., buprenorphine), expanding access to medications in criminal justice settings, and lifting state bans on syringe service programs.

Methadone clinics, primary care clinics, and jails and prisons see thousands of patients with concurrent OUD and infectious diseases annually, and should be leveraged as integrated care sites, the report says. However, some organizations are unable to provide integrated services because of restrictions on the types of services they can provide. For example, some state Medicaid laws do not allow billing for medical care and behavioral health services on the same day.

Source: National Academies of Sciences, Engineering, and Medicine
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25626

In this carefully conducted systematic review, the authors found that correctional facilities should scale up opioid agonist treatment (methadone and buprenorphine) among incarcerated persons with opioid use disorder. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release.

Source: PLOS Medicine
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003002

To optimize HIV prevention and treatment goals in Ukraine, opioid agonist treatment (OAT) must be substantially scaled up in all regions, the authors found. Increased medication procurement is needed, combined with optimization of OAT dosing.

Source: The Lancet
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30373-X/fulltext

Salt Lake County has a new strategy to combat the opioid crisis from inside the county’s jail. The new approach seeks to address the opioid epidemic by administering medication designed to treat addiction and providing patients with substance abuse counseling while they are in jail custody. “Not only is this intervention the compassionate thing to do, it’s the cost-effective thing to do,” said Salt Lake County Mayor Jenny Wilson, who hopes the expansion will curb recidivism rates for individuals struggling with substance abuse. According to Brent Kelsey, assistant director of the Utah Division of Substance Abuse and Mental Health, 75% of people released from jail with an opioid addiction relapse within 90 days, sometimes fatally. Roughly 400 Utahns will die from opioid overdoses this year.

Source: KSL.com
https://www.ksl.com/article/46708053/salt-lake-county-program-aims-to-combat-the-opioid-crisis-from-inside-jail

Salvador Ceniceros, a psychiatrist on the front lines of the opioid epidemic, took a break between seeing patients the other day to reflect. He’s finally gaining traction at Jordan Valley Community Health Center, which gives him a sense of urgency to speak his mind. Since July 2018, Jordan Valley, which has nine clinics in southwest Missouri that offer medical, dental and other services, has been doing something unheard of in Missouri. It has a walk-in clinic for people addicted to opioids. Even if they have an appointment, it’s OK to be days late. “If you don’t find a way to allow people to filter in when they need it, you are going to lose them,” Ceniceros said. “You are going to lose them to overdose. You are going to lose them to whatever.”

Source: St. Louis Post-Dispatch
https://www.stltoday.com/lifestyles/health-med-fit/a-different-way-walk-in-clinic-sees-success-treating-opioid/article_f1ace694-7ed5-52bf-a950-ab7d48a0322f.html

Local leaders got their first look at a new opioid treatment clinic in East Bremerton that could open by the end of the year. On a tour Monday, BAART clinic staff showed a group of Kitsap law enforcement officers, county officials and elected leaders the soon-to-be-open facility, which will provide medication-assisted treatment (MAT) for opioid addiction. The clinic’s three closet-sized dispensary rooms currently sit empty. But they will soon see a steady stream of patients coming to take their daily dosage of medication under the supervision of a nurse. 

Source: Kitsap Sun
https://www.kitsapsun.com/story/news/2019/12/17/inside-look-inside-kitsaps-first-methadone-clinic/2680629001/

Although the SAMHSA buprenorphine practitioner locator is used by patients and providers to locate treatment options, only a small portion of clinicians in the database ultimately offered initial appointments, implying that the database is only marginally useful for patients.

Source: Journal of Psychiatric Practice
https://journals.lww.com/practicalpsychiatry/Fulltext/2020/01000/Availability_of_Buprenorphine_Treatment_in_the_10.3.aspx

For older individuals with opioid use disorder (OUD) resulting from treatment of chronic pain, buprenorphine may be a safer pain management alternative, new research suggests.

Results of the review show that in general, there is evidence to support the use of buprenorphine in older patients. It is well tolerated, it has few side effects, and it can improve pain control, study investigator Dheepthi Arakonam Ravishankar, MBBS, told Medscape Medical News. “Some of these patients had poor pain control, poor quality of life, and these improved after buprenorphine was initiated,” she added. The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 30th Annual Meeting.

Source: Medscape
https://www.medscape.com/viewarticle/923754