Literature Collection

OBJECTIVE: The aim is to assess the impact of long-acting buprenorphine (LAI-BNP) on frequency of methamphetamine (MA) use. METHODS: We undertook an observational, descriptive, retrospective cohort study of patients of a public, tertiary, community-based Alcohol and Other Drug Service (AODS) with opioid use disorder (OUD) treated with LAI-BNP who are current or past users of MA. We assessed the changes of frequency of use in their MA use at start (baseline), 3 and 6 months of LAI-BNP. RESULTS: Study included 59 participants. Based on their MA use at the commencement of LAI-BNP, the sample was further sub-grouped as active users (n = 30) and past users (n = 29). At 6 months of LAI-BNP, all the past users remained abstinent from MA use. 70% (n = 21) of participants with active MA use had reduced or ceased their MA use while 17% (n = 5) increased their MA use at 6 months. CONCLUSIONS: The results favour the use of LAI-BNP as a potential treatment for MA use.

OBJECTIVES: The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver training requirement on primary care buprenorphine prescribing remains unclear. We aimed to investigate the impact of the policy change on primary care providers' likelihood of applying for a waiver and the current attitudes, practices, and barriers to buprenorphine prescribing in primary care. METHODS: We used a cross-sectional survey with embedded educational resources disseminated to primary care providers in a southern US academic health system. We used descriptive statistics to aggregate survey data, logistic regression models to evaluate whether buprenorphine interest and familiarity correlate with clinical characteristics, and a χ(2) test to evaluate the effect of the educational intervention on screening. RESULTS: Of the 54 respondents, 70.4% reported seeing patients with opioid use disorder, but only 11.1% had a waiver to prescribe buprenorphine. Few nonwaivered providers were interested in prescribing, but perceiving buprenorphine to be beneficial to the patient population was associated with interest (adjusted odds ratio 34.7, P < 0.001). Two-thirds of nonwaivered respondents reported the policy change having no impact on their decision to obtain a waiver; however, among interested providers, it increased their likelihood of obtaining a waiver. Barriers to buprenorphine prescribing included lack of clinical experience, clinical capacity, and referral resources. Screening for opioid use disorder did not increase significantly after the survey. CONCLUSIONS: Although most primary care providers reported seeing patients with opioid use disorder, interest in prescribing buprenorphine was low and structural barriers remained the dominant obstacles. Providers with a preexisting interest in buprenorphine prescribing reported that removing the training requirement was helpful.

Primary care-based mental health management has been proposed as a strategy to reduce preventable psychiatric crises and lessen reliance on emergency departments, yet its impact remains uncertain across different populations and health systems. This review synthesized evidence from observational and quasi-experimental studies evaluating integrated, collaborative, or behavioral health home interventions within primary care and their association with emergency psychiatric utilization. Nine eligible studies were identified from a comprehensive search, most involving co-located or integrated behavioral health services aimed at improving continuity and outpatient engagement. Overall, interventions demonstrated consistent trends toward fewer psychiatric emergency visits, enhanced follow-up care, and better support for individuals with serious mental illness, although effect sizes varied and several studies were limited by methodological weaknesses such as confounding and selection bias. Two higher-quality studies showed moderate reductions in all-cause and psychiatric emergency use, while others reported mixed or modest effects. Collectively, the findings suggest that integrated primary care mental health approaches hold promise for reducing emergency presentations, but stronger, well-controlled research is needed to clarify which models yield the most meaningful and sustained reductions in acute care utilization.

OBJECTIVE: Receiving mental health services as part of primary care in the Veterans Health Administration (VHA) might increase engagement in specialty mental health care. The authors reexamined the association between primary care-mental health integration (PCMHI) and continued engagement in specialty mental health care for VHA patients and assessed differences by race and ethnicity. METHODS: The study included 437,051 primary care patients with a first in-person specialty mental health encounter in 2015-2016 (no specialty mental health encounters in prior 12 months), including 46,417 patients with new PCMHI encounters in the year before the first specialty mental health encounter. Multivariable logistic regression assessed odds of follow-up specialty mental health care within 3 months of the first specialty mental health encounter. The dependent variable was care engagement (attending a second specialty mental health appointment); independent variables were whether patients were seen by PCMHI on the same day as the primary care appointment ("same-day access"), the time between PCMHI and first specialty mental health appointments, and race and ethnicity. RESULTS: PCMHI was associated with increased engagement in specialty mental health care for all patients, with a greater likelihood of engagement among non-Hispanic White patients. Same-day access to PCMHI was positively associated with care engagement, with no significant differences by race or ethnicity. PCMHI care within 3 months before a first specialty mental health encounter was associated with greater care engagement. CONCLUSIONS: PCMHI, especially same-day access to PCMHI care, may boost engagement in mental health care, although the study design precluded conclusions regarding causal relationships.