Opioid Use Disorder (OUD) has emerged as a critical public health issue among pregnant and postpartum individuals. To address this concern, it is of utmost importance that healthcare institutions, community-based programs, and other agencies collaborate to improve the support offered to the concerned population in their OUD recovery journey. A social network analysis was conducted to understand collaborations among multisectoral agencies serving or having potential to serve pregnant and postpartum individuals with OUD. Collaborations among agencies (n = 79), including three Continuous And Data-drivEN CarE (CADENCE) program clinics, in a large Florida county were mapped. A cross-sectional web-based survey was distributed to these agencies to capture inter-agency collaborations, including services provided (e.g., housing, transportation, etc.), interaction frequency, and perceptions of partner agency confidence, dependence, and value. Open-ended questions identified champion agencies and needs of agencies to better serve the population. Network maps of the agencies were generated to characterize the nature of existing collaborations and identify opportunities for strengthening interagency coordination. Twenty-six out of 79 enlisted agencies (33%) responded, describing connections with 72 enlisted agencies. The social network analysis of total 376 ties among these agencies demonstrated low density (0.108) but high clustering (0.637), indicating a connected core with tightly knit subgroups and cross-sector bridges especially through social services. CADENCE clinics were inter-linked; CADENCE Co-located pediatric/ psychiatric/Maternal-Fetal Medicine clinic was most connected (38 ties), followed by CADENCE Outpatient Prenatal Care clinic (16 ties), and CADENCE Addiction Medicine (9 ties). Collaboration frequency varied, with 34% of referral ties used only once a year or less, 13% used daily, and 17% never used. Agencies reported having confidence in 82% of collaborations, yet more than half (56%) were considered non-essential (no or little dependency) to achieving patient care goals. Qualitative insights emphasized integrated, trauma-informed care, standardized referral pathways and shared data; destigmatization, and harm reduction; simpler resource navigation and supports for housing and transportation. Overall, the county possesses a multisector perinatal OUD network that is yet underutilized. Strengthening structured referrals, interoperability, and wraparound, stigma-free services leveraging CADENCE could reduce fragmentation and improve maternal-infant outcomes. ClinicalTrails.gov (NCT05609669). November 02, 2022.

The Road to Recovery (R2R) initiative represents an innovative approach to substance use care in British Columbia, Canada, that is designed to provide timely, comprehensive, and culturally safe services for individuals with a substance use disorder (SUD). This survey sought to understand patient experiences with this new care model. Adults (≥ 18 years) with a SUD who accessed R2R's new hospital-based withdrawal management unit in Vancouver, Canada between May 2024 and April 2025 were invited to participate in a cross-sectional survey that captured their individual experiences. Descriptive statistics were used to summarize responses. 87 participants completed the survey. The mean age was 41 years (Standard Deviation [SD] = 15); 57% (n = 50) identified as male, and 49% (n = 43) as Indigenous. The majority (n = 58, 67%) of respondents reported access to withdrawal management services in ≤ 48h. A total of 91% (n = 79) of participants felt the quality of care was 'good' or 'excellent', 90% (n = 78) reported positive interactions with staff, 88% (n = 68) of respondents felt their withdrawal symptoms were adequately managed, 91% (n = 71) believed the program helped them achieve their treatment goals. Among participants visited by Indigenous Wellness Liaisons (IWLs) (n = 56), 77% (n = 43) completely trusted IWLs, and 52% (n = 17) reported that their cultural and spiritual needs were completely met by IWLs. Peer support was valued by 85% of respondents for providing empathy and motivation. One-third (n = 29, 33%) of participants contemplated leaving during their admission, most commonly because of the absence of engaging activities (n = 12, 41%,). Overall, 95% said they would recommend the program to others. Findings highlight that the R2R model delivers timely, high-quality, and culturally safe withdrawal management care. Patients emphasized the value of respectful staff, effective medical management, and integration of Indigenous and peer supports. Enhancing structured programming and expanding access to psychosocial and cultural services may further improve engagement and reduce early discharge. Embedding trauma-informed, interdisciplinary, and culturally grounded approaches within hospital-based withdrawal management may improve patient experience and retention, informing future models of addiction care in Canada.

Buprenorphine (Bup) is a first-line medication for opioid use disorder (OUD) that carries risk of precipitated withdrawal (PW) with ongoing need for rapid and effective initiation strategies. We report a novel approach to low-dose initiation using transdermal Bup patches (TD-Bup) and characterize the efficacy and tolerability of 24 h and 48 h TD-Bup initiation protocols for Bup as a medication for OUD (MOUD). We conducted a retrospective chart review using data extracted from paper and electronic medical records of adult inpatients with OUD admitted to Vancouver General Hospital between January 2022 and October 2023. Eligible patients were started on low-dose transdermal buprenorphine (TD-Bup) initiation protocols. The intervention involved sequenced application of TD-Bup patches reaching a total of 12 patches (240 µg/h) over 24 to 48 hours, with continuation of full opioid agonists. Protocol variants included: 6 patches q24h for 48 hours, 6 patches q12h for 24 hours, and 4 patches q8h for 24 hours. Primary outcomes were the rate of successful initiation onto therapeutic doses of sublingual or extended-release depot Bup, and the incidence of opioid withdrawal. Seventy five patients were identified. Fifty five (73%) were successfully initiated and discharged on Bup and the most common reasons for unsuccessful initiation were preference to switch to another medication for OUD (n = 11) and withdrawal (n = 6). There was no significant difference between the protocol variants for successful initiation (p = 0.191). Adverse events (agitation, increased pain, insomnia, pruritus) were reported in 5 dropouts. Only 28 patients had sufficient Clinical Opioid Withdrawal Scale (COWS) scores to allow for objective assessment of withdrawal, with the remainder evaluated from full chart review. Nineteen patients had COWS score elevation > 6 and/or any narrative documentation of withdrawal. Three patients were felt to represent probable PW. No relationships were found between withdrawals and protocol variant (p = 0.621) or successful initiation (p = 0.082). All-cause withdrawals were associated with self-directed discharges (p = 0.042). Rapid low-dose buprenorphine initiation with TD-Bup appears feasible with relatively low risk of withdrawals and PW, although a weakness is the vulnerability to underdosing patients with full opioid agonists resulting in opioid deficit withdrawal. Further prospective evaluation of d rapid low-dose buprenorphine initiation with TD-Bup against other evidence-based contemporary Bup MOUD initiations is warranted.

Despite the high prevalence of tobacco use among people with substance use disorder (SUD), tobacco cessation is not a routine part of SUD treatment in South Africa. No studies have explored how people receiving SUD treatment view the effects of tobacco use on SUD treatment or their barriers to tobacco cessation. Clinicians need this information to develop locally relevant, person-centred tobacco cessation interventions. To address this gap, this study aimed to explore perceptions of tobacco use and its impact on SUD recovery among people receiving SUD treatment in South Africa. In-depth interviews were conducted with 20 participants (14 males, 6 females) recruited from five outpatient SUD treatment programmes in Cape Town, South Africa. On average, participants were 34.6 years old (SD = 10.1) and began smoking tobacco when 13.4 years old (SD = 2.6). At the time of the study, 40.0% (n = 8) had quit tobacco. Interviews explored experiences of tobacco use and its impact on SUD recovery. Data were analysed using reflexive thematic analysis. The analysis generated four themes: (1) tobacco interconnects with other substance use; (2) psychosocial functions of tobacco: identity, connection and coping; (3) detrimental impact on SUD recovery; and (4) ambivalence about tobacco cessation, despite acknowledged benefits. Participants reported that their tobacco use intertwined with and reinforced their substance use, heightening cravings and impacting efforts to remain abstinent. Participants identified barriers to cessation that included using tobacco as a coping mechanism and as a tool for social connection, difficulties managing physiological withdrawal symptoms, and limited cessation support within SUD treatment and their social environments. Findings highlight the need for tobacco cessation interventions within South Africa's SUD services. To overcome psychosocial and physiological barriers, SUD services should consider providing pharmacological interventions, psychosocial and behavioural counselling, and social support for tobacco cessation. Integrating these interventions into SUD treatment services could improve tobacco cessation rates and recovery outcomes for South Africans with SUDs.

Specialty drug treatment programs should be a key setting to treat opioid use disorder (OUD), but most programs continue to not treat OUD patients with evidence-based medications for opioid use disorder (MOUD). COVID-19 introduced some flexibilities that could improve uptake of MOUD but ongoing barriers have not been examined. We examined barriers and facilitators to integrating MOUD post-COVID among specialty treatment programs in New Jersey. Between March-July 2023, we conducted 14 semi-structured qualitative interviews with leadership and clinical staff of New Jersey specialty outpatient drug treatment programs, with varying levels of client MOUD uptake. Thematic analysis examined barriers and facilitators to providing MOUD in specialty treatment programs in the post-COVID-19 era. Treatment providers revealed that financial barriers, including gaps in insurance coverage after COVID Medicaid expansions were terminated, continue to prevent MOUD use. Second, despite new buprenorphine telehealth flexibilities, a shortage of buprenorphine providers continues to limit ability to offer MOUD. Third, stigma against MOUD among clients, families, providers, and ancillary service providers such as housing programs continues to prevent MOUD initiation. Successful facilitators include expanding educational efforts on effectiveness of MOUD and harm reduction for clients and community members, forming specialized partnerships with pharmacies, and expanding care coordination efforts for those on MOUD. Despite efforts by federal and state governments, MOUD continues to be underutilized in specialty treatment settings, introducing significant risks for patients. Efforts should focus on reducing gaps in insurance coverage, improving provider knowledge of regulatory changes around MOUD, and supporting anti-stigma campaigns.

BackgroundLonger duration of treatment with medication for opioid use disorder (MOUD) is associated with improved outcomes, but long-term retention remains a challenge. Research is needed to identify psychosocial interventions that support MOUD retention. To address this gap, we examined associations between a wide range of psychosocial services and buprenorphine treatment discontinuation across 18 months among a large cohort of Veterans initiating buprenorphine nationwide.MethodsWe identified a cohort of patients with new buprenorphine initiation in 2017–2018 in Veterans Health Administration electronic health record data (N = 11,704). We examined prescription fills for up to 18 months after initiation. The primary outcome was first discontinuation of buprenorphine. We examined a variety of services, including psychotherapy in specialty substance use disorder (SUD) and mental health clinics, other healthcare services, and residential programs. To examine time-varying associations between psychosocial services and risk of discontinuation, we fit extended Cox regression models for each service separately and simultaneously.ResultsOverall, 80.5% of patients discontinued buprenorphine at least once within 18 months. Risk of discontinuation was 18% (HR: 0.82, 95% CI: 0.77, 0.87) relatively lower following SUD psychotherapy and 26% (HR: 1.26, 95% CI: 1.15,1.39) higher following residential treatment.ConclusionsSeveral services, including residential treatment, were associated with greater risk of subsequent buprenorphine discontinuation, whereas only SUD psychotherapy was consistently associated with lower risk of later discontinuation. These findings emphasize the need for future studies to increase understandings of beneficial and disruptive components of psychosocial services to improve treatment retention among patients receiving MOUD.

IntroductionBuprenorphine is an effective first-line treatment for opioid use disorder (OUD) that substantially reduces morbidity and mortality. For patients using illicitly-manufactured fentanyl (IMF), however, transitioning to buprenorphine can be challenging. Evidence is lacking for how best to make this transition in the outpatient setting. A shared decision-making (SDM) approach has been found to benefit patients with OUD but has not been studied for buprenorphine initiation. We sought to explore participants’ experiences with a SDM approach to buprenorphine initiation.MethodsParticipants were seeking care at a low barrier, telehealth buprenorphine clinic. Clinicians implemented a standardized SDM approach whereby they offered patients using IMF three options for buprenorphine initiation (traditional, low-dose, and QuickStart). They elicited patient goals and preferences and discussed the pros and cons of each method to come to a shared decision. Patients meeting study criteria were invited to participate in semi-structured qualitative interviews 1–2 weeks after the initial visit. Interviews focused on experiences with the clinical visit, suggestions for enhancing the treatment experience, and patient factors affecting the method they chose. Interviews were coded and analyzed using reflexive thematic analysis.ResultsTwenty participants completed interviews. Participants’ mean age was 33, they were 50% female, predominantly white (16 [80%]), and most had Medicaid insurance (19 [95%]). We identified three important themes. First, participants found SDM acceptable and a positive addition to their OUD treatment. They felt their opinion mattered and reported that SDM gave them important control over their care plan. Second, patient goals, preferences, and past experiences with buprenorphine-associated withdrawal impacted what type of buprenorphine initiation method they chose. Finally, participants had advice for clinicians to improve SDM counseling. Participant recommendations included ensuring patients are informed that withdrawal (or “feeling sick”) can occur with any initiation method, that buprenorphine will eventually “block” fentanyl effects once at a high enough dose, and that clinicians provide specific advice for tapering off fentanyl during a low dose initiation.ConclusionsFor patients with OUD using IMF, shared decision-making is an acceptable approach to buprenorphine initiation in the outpatient setting. It can enhance patient autonomy and lead to an individualized approach to OUD care.

BackgroundDeaths from opioid overdose have increased dramatically in the past decade. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients’ access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings.MethodsQualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we conducted semi-structured interviews with 25 patients and 16 clinicians (including prescribers and non-prescribers). We coded all interview data and used a thematic analysis approach to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward.ResultsFive themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: (1) telemedicine integration precipitated openness to more flexibility in care practices, (2) concerns regarding telemedicine-related adaptations centered around safety and accountability, (3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, (4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and (5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care which integrate both in-person and virtual visits.ConclusionsTelemedicine implementation within office-based buprenorphine treatment has the potential to improve patients’ engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.