Literature Collection

IMPORTANCE: The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION: The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE: There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.

BACKGROUND: Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time. METHODS: We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age = 45.2 years [SD = 8.1]; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence. RESULTS: Depressive symptomatology was not significantly related to neuropsychological change (p's > .05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r's = .52-60; p's < .05). CONCLUSIONS: Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD. TRIAL REGISTRATION: NCT01108679 . Registered 21 April 2010.

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.

PURPOSE: The New Mexico P5 (Physician-Pharmacist-Patient-Payor Partnerships) Summit, held May 13-15, 2024, in Albuquerque, NM, sought to bring physicians, pharmacists, patients, and payors together to address the state's healthcare access crisis by advancing integration of advanced practice pharmacists (APPh) into team-based care. The summit sought to identify gaps in healthcare delivery, optimize pharmacists' clinical roles, and develop sustainable collaborative care models to improve outcomes, particularly in rural and underserved areas. SUMMARY: New Mexico has a long history of progressive pharmacy practice legislation, including the Pharmacist Prescriptive Authority Act (1993) and reimbursement parity for pharmacist-provided services (2020). The New Mexico P5 Summit convened 119 stakeholders-healthcare providers, payors, policymakers, employers, and patient advocates-to address primary care shortages, workforce gaps, and socioeconomic determinants of health. Keynote and panel sessions examined APPh models in New Mexico and other states, payment reform initiatives, and expanded pharmacist roles in chronic disease management, preventive care, and point-of-care testing. Breakout sessions identified 5 priority areas: (1) legislative and regulatory reform, (2) pharmacy workforce development, (3) health information exchange, (4) reimbursement/business models for clinical services, and (5) employer-based pharmacist demonstration projects. Workgroups were formed and are working to address these priorities. CONCLUSION: The New Mexico P5 Summit underscored the potential of APPh to mitigate primary care shortages and improve healthcare quality, access, and equity. The collaborative strategies and workgroup initiatives developed provide a framework for legislative, workforce, and payment reforms that leverage pharmacists' expertise. Ongoing stakeholder engagement will be essential to achieving sustainable innovations and transforming New Mexico's healthcare delivery system.