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Background/Aims: In people with opioid use disorder (OUD), buprenorphine is a vital treatment to decrease opioid use and overdose. The US Food and Drug Administration's prescribing information for buprenorphine advises dosing up to 24 mg/day; however, doses of buprenorphine up to 32 mg have been shown to be safe and effective. We compared outcomes associated increased dosing from 24 to 32 mg/day. Design: Prospective cohort investigation. Setting: Low‐barrier buprenorphine clinic in Washington, District of Columbia, USA. Participants: Participants in the ANCHOR study (people with hepatitis C virus (HCV), OUD, and active opioid misuse who were treated for HCV and offered buprenorphine) who received buprenorphine at doses of 24 and/or 32 mg/day. 72 participants were included in the analysis: 24 (33%) patients stabilized on 24 mg, and 48 (67%) patients stabilized on 32 mg. Patients were predominantly male (78%), Black (96%), unstably housed (57%), and used opioids by injection (93%). Measurements: Patient‐reported drug use, use frequency, triggers for use, and urine drug screens were collected at each visit. For analysis, the cohort was divided into individuals stabilized on 24 mg (24 mg cohort) or 32 mg (32 mg cohort). Drug use outcomes were assessed between cohorts at 24 mg dosing and at respective maximum dosing. Within the 32 mg cohort, outcomes were compared at 24 mg versus 32 mg dosing. Findings Within the 32 mg cohort, increased dosing from 24 to 32 mg was associated with a decline in opioid use (68.5% [5.2%] at 24 mg vs 59.5% [5.6%] at 32 mg; P = 0.02), frequency of use per week (1.58 [0.19] at 24 mg vs. 1.15 [0.16] at 32 mg; P = 0.0002) and physiologic triggers for use (38.2% [6.0%] at 24 mg vs 7.0% [1.9%] at 32 mg; P < 0.0001). At the end of the study period, there were significantly more patients retained in the 32 mg cohort (78.7%) compared with the 24 mg cohort (50.0%, P = 0.02). Conclusion: Higher buprenorphine dosing (32 mg/day) appears to improve outcomes in people with opioid use disorder, even in the absence of abstinence. [ABSTRACT FROM AUTHOR]

Background and Aims: Accurate case discovery is critical for disease surveillance, resource allocation and research. International Classification of Disease (ICD) diagnosis codes are commonly used for this purpose. We aimed to determine the sensitivity, specificity and positive predictive value (PPV) of ICD‐10 codes for opioid misuse case discovery in the emergency department (ED) setting. Design and Setting: Retrospective cohort study of ED encounters from January 2018 to December 2020 at an urban academic hospital in the United States. A sample of ED encounters enriched for opioid misuse was developed by oversampling ED encounters with positive urine opiate screens or pre‐existing opioid‐related diagnosis codes in addition to other opioid misuse risk factors. Cases: A total of 1200 randomly selected encounters were annotated by research staff for the presence of opioid misuse within health record documentation using a 5‐point scale for likelihood of opioid misuse and dichotomized into cohorts of opioid misuse and no opioid misuse. Measurements Using manual annotation as ground truth, the sensitivity and specificity of ICD‐10 codes entered during the encounter were determined with PPV adjusted for oversampled data. Metrics were also determined by disposition subgroup: discharged home or admitted. Findings There were 541 encounters annotated as opioid misuse and 617 with no opioid misuse. The majority were males (54.4%), average age was 47 years and 68.5% were discharged directly from the ED. The sensitivity of ICD‐10 codes was 0.56 (95% confidence interval [CI], 0.51–0.60), specificity 0.99 (95% CI, 0.97–0.99) and adjusted PPV 0.78 (95% CI, 0.65–0.92). The sensitivity was higher for patients discharged from the ED (0.65; 95% CI, 0.60–0.69) than those admitted (0.31; 95% CI, 0.24–0.39). Conclusions: International Classification of Disease‐10 codes appear to have low sensitivity but high specificity and positive predictive value in detecting opioid misuse among emergency department patients in the United States. [ABSTRACT FROM AUTHOR]

The article addresses the emergence of nitazenes on the Irish heroin market and urges for national preparation for possible future outbreaks. It provides a background on the pattern of opioid overdoses in Ireland. It suggests the development of emergency protocols and preparation work to establish communication channels, tailor messaging and adapt safety measures. Emphasis is given on the need for political prioritization and increased budget allocation to reduce harms of nitazene outbreaks.

Aims: To create a novel emergency medical service (EMS) opioid‐related incident (ORI) tiering framework to describe more accurately the opioid epidemic in Massachusetts. By classifying the data, we could more accurately detail differing trends among the new categories. Design: Free‐text fields of Massachusetts EMS reports, from 2013 through 2020, were analyzed to identify ORIs and then categorized into a five‐tier severity cascade based on symptom presentation: 'dead on arrival,' 'acute overdose,' 'intoxication,' 'withdrawal' and 'other ORI.' As a validation of the new classification, an emergency medical technician, paramedic and emergency medical physician reviewed clinical reports and assigned a severity category to 100 randomly selected cases. The algorithm then assessed the same 100 cases to determine if it could accurately identify the severity category for each case. Findings Validation of the algorithm by clinical review indicated a substantial level of agreement between the algorithm and the reviewers. Over half of all ORIs were acute overdose (55%), 21% were intoxication, 20% were other ORI, 3% were withdrawal, and 1% were dead on arrival. Overall ORIs decreased in 2020, but the number of 'dead on arrival' increased 32% from 2019. Administration of naloxone also differed between the categories, with 95% of acute overdose and 29% of intoxication receiving naloxone. Conclusions: This novel categorization of emergency medical service opioid‐related incidents in Massachusetts, United States, reveals new trend details and strains on the emergency medical service system. Using these categories also improves dataset linkage within the state and interstate rate comparisons. [ABSTRACT FROM AUTHOR]

Background and Aims: The current opioid epidemic in the United States began 20 years ago and has become the leading cause of accidental deaths in the country. This crisis prompted us to explore trends in opioid abuse and dependence worldwide. We sought to identify other countries at high‐risk of opioid use disorders, using the World Health Organization's (WHO) pharmacovigilance database. Methods: We performed a disproportionality analysis using VigiBase, the WHO Global Individual Case Safety Report (ICSR) database. Five opioids used worldwide were included: oxycodone, fentanyl, morphine, tramadol, and codeine. We extracted all ICSRs associated with the drugs of interest, considered as suspect medication and recorded up until 5 June 2021, using the narrow Standardised MedDRA Query (SMQ) for drug abuse and dependence. Countries with at least one ICSR for each of the five opioids were retained. The relationship between the use of a drug (i.e. an opioid) and the occurrence of an adverse drug reaction (i.e. drug abuse and dependence) for each country was assessed by calculating the information component (IC) and its 99.9% CI [IC0005; IC9995], using a quasi‐Bayesian confidence propagation neural network (BCPNN). A hierarchical cluster analysis (Ward's method) of the IC0005 value for each of the five opioids was performed to identify subgroups of countries with similar reported risks of opioid abuse and dependence. Results: Among 21 countries, the optimal number of clusters was calculated to be four, each with a Jaccard index >0.5 (0.95, 0.78, 0.65 and 0.75, respectively). Six countries with the highest signals of drug abuse and dependence were identified in cluster 1, with significant CIs for the five opioids of interest (IC0005 > 0), ranging from 0.9 to 5.8 for the lower endpoint. Conclusions: There appear to be four distinct clusters of countries with similar opioid abuse and dependence profiles. The group with the highest reported risk for the opioids oxycodone, fentanyl, morphine, tramadol and codeine includes Australia, Canada, France, Germans, the United Kingdom and the United States. [ABSTRACT FROM AUTHOR]

The author asserts that drug interactions is a disadvantage of phenobarbital (PB) that is overlooked when used as a treatment for alcohol withdrawal syndrome in patients with concurrent opioid use disorder. They note that PB overuse could lower the effectiveness of methadone and buprenorphine which increases the risk of opioid withdrawal symptoms and relapse. They suggest the need for alternative treatment protocols that omit phenobarbital should be in place when risks overweigh its benefits.

Background and aim: Opioid agonist medications for treatment of opioid use disorder (OUD) can improve human immunodeficiency virus (HIV) outcomes and reduce opioid use. We tested whether outpatient antagonist treatment with naltrexone could achieve similar results. Design Open‐label, non‐inferiority randomized trial. Setting: Six US HIV primary care clinics. Participants: A total of 114 participants with untreated HIV and OUD (62% male; 56% black, 12% Hispanic; positive for fentanyl (62%), other opioids (47%) and cocaine (60%) at baseline). Enrollment halted early due to slow recruitment. Intervention: HIV clinic‐based extended‐release naltrexone (XR‐NTX; n = 55) versus treatment as usual (TAU) with buprenorphine or methadone (TAU; n = 59). Measurements Treatment group differences were compared for the primary outcome of viral suppression (HIV RNA ≤ 200 copies/ml) at 24 weeks and secondary outcomes included past 30‐day use of opioids at 24 weeks. Findings Fewer XR‐NTX participants initiated medication compared with TAU participants (47 versus 73%). The primary outcome of viral suppression was comparable for XR‐NTX (52.7%) and TAU (49.2%) [risk ratio (RR) = 1.064; 95% confidence interval (CI) = 0.748, 1.514] at 24 weeks. Non‐inferiority could not be demonstrated, as the lower confidence limit of the RR did not exceed the pre‐specified margin of 0.75 in intention‐to‐treat (ITT) analysis. The main secondary outcome of past 30‐day opioid use was comparable for XR‐NTX versus TAU (11.7 versus 14.8 days; mean difference = −3.1; 95% CI = –8.7, 1.1) in ITT analysis. Among those initiating medication, XR‐NTX resulted in fewer days of opioid use compared with TAU in the past 30 days (6.0 versus 13.6, mean difference = −7.6; 95% CI = –13.8, −0.2). Conclusions: A randomized controlled trial found supportive, but not conclusive, evidence that human immunodeficiency virus clinic‐based extended‐release naltrexone is not inferior to treatment as usual for facilitating human immunodeficiency virus viral suppression. Participants who initiated extended‐release naltrexone used fewer opioids than those who received treatment as usual. [ABSTRACT FROM AUTHOR]

Background and Aims: During the past decades, people who inject drugs (PWID) have been impacted by the development of combination antiretroviral therapy (cART) to combat HIV/AIDS, the prescription opioid crisis and increased use of lethal synthetic opioids. We measured how these dynamics have impacted mortality among PWID in an urban US city. Design: Prospective cohort study using data from the AIDS Linked to the Intravenous Experience (ALIVE). Setting: Baltimore, MD, USA from 1988 to 2018. Participants: A total of 5506 adult PWIDs (median age at baseline 37 years). Measurements: Mortality was identified by linkage to National Death Index-Plus (NDI-Plus) and categorized into HIV/infectious disease (HIV/ID) deaths, overdose and violence-related (drug-related) deaths and chronic disease deaths. Person-time at risk accrued from baseline and ended at the earliest of death or study period. All-cause and cause-specific mortality were calculated annually. The Fine & Gray method was used to estimate the subdistribution hazards of cause-specific deaths accounting for competing risks. Findings: Among 5506 participants with 84 226 person-years of follow-up, 43.9% were deceased by 2018. Among all deaths, 30.5% were HIV/ID deaths, 24.4% drug-related deaths and 33.3% chronic disease deaths. Age-standardized all-cause mortality increased from 23 to 45 per 1000 person-years from 1988 to 1996, declined from 1996 to 2014, then trended upward to 2018. HIV/ID deaths peaked in 1996 coincident with the availability of cART, then continuously declined. Chronic disease deaths increased continuously as the cohort aged. Drug-related deaths declined until 2011, but increased more than fourfold by 2018. HIV/HCV infection and active injecting were independently associated with HIV/ID and drug-related deaths. Female and black participants had a higher risk of dying from HIV/ID deaths and a lower risk of dying from drug-related deaths than male and non-black participants. Conclusions: Deaths in Baltimore, MD, USA attributable to HIV/ID appear to have declined following the widespread use of combination antiretroviral therapy. Increases in the rates of drug-related deaths in Baltimore were observed prior to and continue in conjunction with national mortality rates associated with the opiate crisis. [ABSTRACT FROM AUTHOR]

Background and aims: Prescription drug‐seeking (PDS) from multiple prescribers is a primary means of obtaining prescription opioids; however, PDS behavior has probably evolved in response to policy shifts, and there is little agreement about how to operationalize it. We systematically compared the performance of traditional and novel PDS indicators. Design Longitudinal study using a de‐identified commercial claims database. Setting: United States, 2009–18. Participants: A total of 318 million provider visits from 21.5 million opioid‐prescribed patients. Measurements We applied binary classification and generalized linear models to compare predictive accuracy and average marginal effect size predicting future opioid use disorder (OUD), overdose and high morphine milligram equivalents (MME). We compared traditional indicators of PDS to a network centrality measure, PageRank, that reflects the prominence of patients in a co‐prescribing network. Analyses used the same data and adjusted for patient demographics, region, SES, diagnoses and health services. Findings The predictive accuracy of a widely used traditional measure (N + unique doctors and N + unique pharmacies in 90 days) on OUD, overdose and MME decreased between 2009 and 2018, and performed no better than chance (50% accuracy) after 2015. Binarized PageRank measures however exhibited higher predictive accuracy than the traditional binary measures throughout 2009‐2018. Continuous indicators of PDS performed better than binary thresholds, with days of Rx performing best overall with 77–93% predictive accuracy. For example, days of Rx had the highest average marginal effects on overdose and OUD: a 1 standard deviation increase in days of Rx was associated with a 6–8% [confidence intervals (CIs) = 0.058–0.061 and 0.078–0.082] increase in the probability of overdose and a 4–5% (CIs = 0.038–0.043 and 0.047–0.053) increase in the probability of OUD. PageRank performed nearly as well or better than traditional indicators of PDS, with predictive performance increasing after 2016. Conclusions: In the United States, network‐based measures appear to have increasing promise for identifying prescription opioid drug‐seeking behavior, while indicators based on quantity of providers or pharmacies appear to have decreasing utility. [ABSTRACT FROM AUTHOR]

Background and Aims: It is widely believed that the 2018 decline in overdose deaths in the United States was attributable to a range of public health interventions, however, this decline also coincided with the regulation and decline in use of potent fentanyl analogs, especially carfentanil. The aim of this study was to investigate the association between overdose deaths and carfentanil availability in the United States. Design Secondary analysis of drug overdose deaths from the Center for Disease Control and Prevention (CDC) and carfentanil exhibit data from drug seizures submitted to drug crime labs and published by the Drug Enforcement Administration (DEA). Trends in overdose deaths were compared in states with high carfentanil exhibits with states with low or no carfentanil exhibits. Setting: United States. Participants: A total of 1 035 923 drug overdose death records in the United States from 1979 through 2019 were studied. Measurements The outcomes studied were number of overdose deaths and mortality rates by state. Findings Drug overdose deaths have been closely tracked along an exponential curve. The years 2016 and 2017 witnessed a hyper‐exponential surge with increases in overdose deaths of 11 228 (+21.4%) and 6605 (+10.4%), respectively. Subsequently in 2018, drug overdose deaths declined by −2870 (−4.1%). This rise and then fall coincided with a surge and then decline in carfentanil drug seizure exhibits during these same years: 0 (2015), 1292 (2016), 5857 (2017) and 804 (2018). The majority of carfentanil exhibits were localized to a few states. The 2018 decline in overdose deaths in the top five states with the greatest spike in carfentanil exhibits in 2017 (Ohio, Florida, Pennsylvania, Kentucky and Michigan) was 2848, which accounted for nearly all of the total US decline. Conclusions: The 2016–2017 acceleration and then 2018 decline in drug overdose deaths in the United States was associated with the sudden rise and then fall of carfentanil availability. Given the regional variation, carfentanil's decreased availability may have contributed to the reduction in overdose deaths in 2018. [ABSTRACT FROM AUTHOR]

The authors stress the need for comprehensive and timely data to address the opioid overdose epidemic. They talk about the problem regarding access to real-time data on drug overdose deaths, the need for innovation in data collection, which should include timely information on emerging drugs of abuse and data from nontraditional settings, and how some states in the U.S. have successfully enhanced their drug overdose surveillance.

Background and Aims Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non‐medical opioids. Design Prospective cohort study. Setting The greater New York area and a suburban inpatient addiction program. Participants Adults with problem substance use who use non‐medical opioids, recruited from May 2016–June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years). Measurements Participants completed interviewer‐ and self‐administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: 'Did you use Cannabis yesterday?' and endorsing moderate or severe pain at baseline, respectively. The main outcome, non‐medical or illicit opioid use during 90‐day follow‐up, was defined as responding affirmatively to IVR question: 'Did you use heroin yesterday?' or 'Did you use prescription opioids more than prescribed or without a prescription yesterday?'. Findings The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same‐day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54–2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44–2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate‐to‐severe pain and less‐than‐moderate pain was inconclusive. Conclusions: Among US adults with problem substance use who use non‐medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids. [ABSTRACT FROM AUTHOR]

The article explores what addiction specialists in the United States might learn from Sweden regarding their response to problems relating to drug addiction and overdose. Particular focus is given to Sweden's use of methadone programs. Other topics discussed include methodologies for harm reduction, fentanyl use and abuse and the opioid overdose epidemic in the U.S.

The article explores the exponential growth in drug overdose deaths as of 2022, noting opportunities for intervention. Topics discussed include long-term and short-term overdose death trends in the U.S., how the COVID-19 pandemic may have impacted drug overdose trends because of social isolation and restrictions, and a chart that examines drug overdose deaths since 1979.

Background and aims: Although opioid agonist treatment (OAT) for opioid use disorder (OUD) is cost‐effective in settings where the HIV epidemic is concentrated among people who inject drugs, OAT coverage in Ukraine remains far below internationally recommended targets. Scale‐up is limited by both OAT availability and demand. This study aimed to evaluate the cost‐effectiveness of a range of plausible OAT scale‐up strategies in Ukraine incorporating the potential impact of treatment spillover and the real‐world demand for addiction treatment. Design, setting and participants: Ten‐year horizon (2016–25) modeling study of opioid addiction epidemic and treatment that accommodated potential peer effects in opioid use initiation and supply‐induced treatment demand in three Ukrainian cities: Kyiv, Mykolaiv and Lviv, comprising a simulated population of people at risk of and with OUD. Measurements Incremental cost per quality‐adjusted life‐year gained in the simulated population. Findings An estimated 12.2‐, 2.4‐ and 13.4‐fold OAT capacity increase over 2016 baseline capacity in Kyiv, Mykolaiv and Lviv, respectively, would be cost‐effective at a willingness‐to‐pay of one per‐capita gross domestic product (GDP) per quality‐adjusted life‐year gained. This result is robust to parametric and structural uncertainty. Even under the most ambitious capacity increase, OAT coverage (i.e. the proportion of people with OUD receiving OAT) over a 10‐year modeling horizon would be 20, 11 and 17% in Kyiv, Mykolaiv and Lviv, respectively, owing to limited demand. Conclusions: It is estimated that a substantial increase in opioid agonist treatment (OAT) capacity in three Ukrainian cities would be cost‐effective for a wide range of willingness‐to‐pay thresholds. Even a very ambitious capacity increase, however, is unlikely to reach internationally recommended coverage levels. Further increases in coverage may be limited by demand and would require addressing existing structural barriers to OAT access. [ABSTRACT FROM AUTHOR]

The authors comment on an article by K. Jones et al. on emergency medical service (EMS) opioid-related incidents (ORI) in Massachusetts. They note the effort of the researchers to review all available data despite the fact that multiple EMS documentation platforms are used by the state which are then aggregated via the National EMS Informatuin System. They view that the authors' multi-tiered approach to ORI is a step towards advancing public health and public policy.

Aims: To determine whether, in the United States, higher opioid overdose‐related mortality rates (OOMR) in Affordable Care Act (ACA) Medicaid expansion states relative to mortality rates in non‐expansion states have been mediated by increased prescription opioid availability. Design Separate mixed‐effect regression models examined difference‐in‐difference effects of time and expansion status on Medicaid‐reimbursed opioids measured in morphine milligram (mg) equivalents on all OOMR and on prescription OOMR. We used generalized structural equation models to test whether increases in Medicaid‐reimbursed prescription opioid availability mediated OOMR post‐Medicaid expansion. Setting and participants: This study used national, serial, cross‐sectional data for Medicaid‐reimbursed prescription opioids, Medicaid enrollment information and annual OOMR for any opioids and for prescription opioids from 49 states and the DC pre‐ (2008–13) and post‐ACA Medicaid expansion (2014–16). Measurements The outcome measures were OOOMR and Medicaid‐reimbursed prescription opioid availability. The main input variables were time and ACA Medicaid expansion status. Findings Medicaid expansion states had larger increases in prescription opioid availability (b = 480, 357.8, P = 0.001) compared with non‐expansion states. However, the largest increases in prescription opioid availability in expansion states were between 2009 and 2011, well before the ACA Medicaid expansion. Whereas expansion states also had higher any OOMR compared with non‐expansion states (b = 3.6, P = 0.011), significant differences in prescription OOMR between expansion and non‐expansion states did not emerge until 2015 (b = 1.4, P = 0.014) and 2016 (b = 4.0, P = 0.004), and Medicaid‐reimbursed prescription opioid availability was not a significant mediator. Conclusions: Increases in Medicaid‐reimbursed prescription opioid availability in Affordable Care Act Medicaid expansion states in the United States do not appear to have mediated post‐Affordable Care Act Medicaid expansion mortality rate differences, but there is still a possibility of lagged effects. [ABSTRACT FROM AUTHOR]

Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication‐assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design Cross‐sectional study using inverse‐propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12‐month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements Any opioid‐dispensed, chronic (> 90‐days) and high‐dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re‐enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication‐assisted treatment for opioid use disorder. [ABSTRACT FROM AUTHOR]

The author comments on a study published within the issue which examined the concurrent use of prescription opioids and benzodiazepines through group based multi-trajectory modeling to identify patterns of medication co-prescribing based on dosage and duration. Topics covered include the value of group-based trajectory modeling (GBTM) as a tool to improve understanding of treatment characteristics and outcomes, and the barriers created by prescribing interventions for patients.

An introduction to a series of articles that attempt to synthesize advice given to the United States from other nations that have experienced drug epidemics is presented.

The article explores what addiction specialists in the United States might learn from France regarding their response to problems relating to drug addiction and overdose. Particular focus is given to the use of pain medicine, which has been a major contributor to the overdose death epidemic in the United States. Other topics discussed include methodologies for harm reduction used in France, public drug policy and neoliberal health-care reform.

A response is provided to the article "New means, new measures: assessing prescription drug-seeking indicators over 10 years of the opioid epidemic" by B.L Perry, M. Odabaş, K. Yang, and others which appears in the same issue of the journal. According to the article, multi-dimensional analyses of data sources are a key factor in examinations of issues such as prescription drug abuse. The monitoring of prescription drug-seeking (PDS) is assessed.

A response is provided to the article "Trends in opioid use disorder and overdose among opioid-naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014" by L.G. Burke and others which appears in the same issue of the journal, and it mentions how opioid prescribing in America is becoming safer. The use of opioids by chronic pain patients is addressed, along with U.S. public health and the per-capita rate of opioid prescribing for dental patients.

The author discusses a study by Irving et al. which discusses barriers to the broad implementation of several evidence-based interventions that reduce opioid-related overdose deaths, which include take-home naloxone, opioid agonist therapy, and overdose prevention sites.