Alcohol Use Disorder Treatment Availability at Mental Health Treatment Facilities

This recently study published in JAMA Network Open, based on the 2023 National Substance Use and Mental Health Services Survey, highlights a significant gap in the treatment of alcohol use disorder (AUD) within mental health facilities. Of the 2,640 facilities that primarily provided mental health services, 73.6% provided SUD treatment, but only 9.9% offered medications for alcohol use disorder (MAUD). Facilities that accepted insurance and those that had a prescribing clinician were more likely to offer MAUD. This study reveals that while some facilities provide AUD services, a substantial portion do not, highlighting a missed opportunity within the mental health system.



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Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial



In a study conducted at an inpatient drug treatment center in India, researchers compared oral methadone to sublingual buprenorphine for managing acute opioid withdrawal. Patients were randomly assigned to receive either medication, with doses titrated over days 1-3 to control withdrawal symptoms. Over days 4-10, the medications were tapered and stopped by day 11. Completion of treatment was similar in both groups (83% methadone, 82% buprenorphine). The study found that while both medications successfully reduced subjective (SOWS) and objective (COWS) withdrawal symptoms, the buprenorphine group experienced significantly greater withdrawal symptoms than the methadone group at the end of treatment on day 10 (p = 0.009). Opioid craving decreased in both groups, without significant differences. The authors concluded that methadone is a safe and effective alternative to buprenorphine for the management of opioid withdrawal.

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Implementation of a Statewide Fentanyl Possession Law and Opioid-Related Overdose Deaths

In an effort to combat the rise in opioid-related overdose deaths (OODs) from high-potency synthetic opioids like fentanyl, many states have classified fentanyl possession – even small amounts – as a felony. Colorado, for example, passed a 2022 law making possession of more than 1 gram of a substance containing any amount of fentanyl a felony punishable by up to 180 days in jail. Researchers conducted a cross-sectional study of adults in Colorado who experienced an OOD from January 2018 to November 2023 to evaluate the law's impact. The study found that while the overall OOD rate increased from 11.99 per 100,000 in 2018 to 25.0 per 100,000 in 2023, the total number of deaths did not significantly differ from the number predicted without the law. However, among the non-Hispanic Black population, OOD rates were significantly higher than predicted. The authors conclude that increasing criminal penalties for drug possession may not only fail to decrease OODs but could also worsen them.

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Feasibility and acceptability of a contingency management program for stimulant use disorder in a pallet shelter community for homeless-experienced veterans

Contingency management (CM) is the most effective psychosocial treatment for stimulant use disorder, but it is often underutilized. To test its feasibility and acceptability, a 12-week CM program based on the standard VA protocol was implemented at a pallet shelter community for homeless-experienced veterans in Los Angeles. The study used a mixed-methods approach, analyzing attendance and stimulant abstinence rates, and conducting interviews with both participants (n = 10) and staff (n = 6). The findings showed that the program had an average attendance rate of 32% and, based on urine drug screens, a stimulant abstinence rate of 49%. While participants found the program accessible and helpful for meeting immediate needs and engaging with health services, they also expressed concerns about privacy, stigma and the perceived insufficiency of the rewards. The authors suggest that these findings should be taken into consideration when developing CM programs for other community-based settings.

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