Expanding Access to Buprenorphine and Methadone: Global Perspectives and Policy Recommendations

Substance Use and Addiction Journal

This is a narrative review of methadone and buprenorphine regulations, prescriber eligibility, dispensing models, and coverage across eight countries: the United States, Canada, the United Kingdom, Russia, France, Iran, Australia, and Portugal. The study identified several key barriers to MOUD: requirements for daily supervised dosing, restricted community prescribing, and stigmatizing drug scheduling. The authors highlight policies that improved MOUD access without compromising safety such as: 1) community pharmacy dispensing supports in the U.K. and Australia, 2) liberal buprenorphine prescribing in primary care in France, and 3) decriminalization and expansion of low-threshold public health models in Portugal and Iran.

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Very Low Nicotine Content Cigarettes for Smoking Cessation: Examining a Facilitated Extinction Approach and Dosing Schedule

Drug and Alcohol Dependence

Very low nicotine cigarettes (VLNC, 0.4 mg nicotine/g tobacco) have been shown to reduce smoking behavior when compared to normal nicotine cigarettes (NNC,17 mg nicotine/g tobacco). Participants (n=208) were randomly assigned to 4 experimental groups, immediate versus gradual (over 5 weeks) transition to VLNC, and standard counseling versus facilitated extinction counseling (weekly for 5 weeks). Facilitated extinction had participants smoke only in relevant contexts (e.g., places, affects, triggers). The immediate nicotine reduction group reported less smoking satisfaction and lower completion rates (72% immediate reduction versus 88% gradual reduction, p=.02). Abstinence (biochemically verified) at 2 months post study was 29%. There were no significant differences between the 4 study groups. VLNC were beneficial in smoking cessation.

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Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism🔓

JAMA Health Forum

This cross-sectional study of 796 census tracts prior to the COVID-19 pandemic (2017-2019) and 792 census tracts during the COVID-19 pandemic (2020-2022) in Chicago, Illinois, assessed the extent to which there is a spatial association between neighborhood-level structural racism and opioid-involved overdose deaths. Researchers found that neighborhoods exposed to high levels of structural racism in the past (historical redlining) and present (contemporary segregation) had the highest fatal overdose incidence rates before the COVID-19 pandemic (2017-2019). Neighborhoods that experienced high levels of contemporary racism had the highest fatal overdose incidence rates during the pandemic (2020-2022).

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