Oesterle, Tyler

Background Long-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is underutilized. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting opioid use disorder (OUD) treatment. Methods Secondary analysis of a national, cross-sectional survey of U.S. physicians prescribing buprenorphine for OUD. Respondents reported OUD caseload, LAI-BUP use, and importance of medication attributes (eg, efficacy, safety, ease of prescribing, administrative requirements). Providers were categorized as no LAI-BUP use or, among LAI-BUP prescribers, Low vs High use by a median split. Group comparisons used chi-square (or Fisher’s exact) tests for categorical variables and Jonckheere–Terpstra tests for ordinal responses. Results Among 125 respondents, 39 (31.2%) reported no LAI-BUP use. The remaining 86 (68.8%) were split evenly into Low and High use groups (n’s = 43). LAI-BUP use did not differ meaningfully by specialty, region, or practice setting. Greater LAI-BUP use was reported by providers with larger OUD panels. Ratings of medication attributes were uniformly high. Conclusions LAI-BUP remains underused, with uptake highest among clinicians managing larger OUD caseloads. Measured attitudes toward medication attributes did not explain these differences. Future work should assess clinic workflow, staffing, reimbursement, and REMS burden, testing targeted implementation strategies using mixed-methods trials.

Introduction The integration of telehealth into clinical care has increased access to substance use disorder (SUD) treatment. However, drug screen monitoring has largely remained tied to in-person visits, preventing a fully virtual workflow. We evaluated the acceptability, appropriateness, feasibility, and usability of video-observed oral fluid (VOOF) self-collection as an approach to address this implementation gap. Methods Participants receiving SUD treatment in outpatient ( n = 13) or residential ( n = 15) settings completed a video-recorded oral fluid self-collection protocol, followed by the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, and System Usability Scale. Results Most participants had multiple SUDs ( n = 23, 82.1%), and nearly all had co-occurring mental illness ( n = 27, 96.4%). The majority completed study measures ( n = 23, 82.1%) and returned collection kits ( n = 25, 89.2%). Acceptability, appropriateness, and feasibility all exceeded established thresholds (>3), with respective means of 3.5 (SD 1.1), 3.8 (SD 1.1), and 3.4 (SD 1.3). Usability scores were below average and more variable (mean = 51.8, SD 20.4). Scores did not significantly differ by care setting. Discussion This early-stage pilot found that VOOF self-collection was generally acceptable, appropriate, and feasible among individuals with SUD in real-world care settings. Usability scores were below average, with technical challenges related to video recording and upload likely contributing. Integrating VOOF within digital treatment platforms may streamline the user experience and improve usability while better aligning drug screen monitoring with the growth of telehealth in SUD treatment. This approach may benefit individuals experiencing transportation barriers and those in rural areas who live significant distances from testing sites.

Substance use disorders (SUD) remain a significant source of morbidity and mortality in the United States, and access to treatment continues to be inadequate. Primary Care Clinicians (PCCs) are well-positioned to provide long-term SUD care for patients. However, multiple provider-level barriers exist. Collaborative Care Management (CoCM) has proven successful in supporting PCCs in treating psychiatric conditions, such as depression. Our group proposes an addiction-focused modified CoCM that leverages telemedicine and an electronic platform (Senyo) into primary care. This study assesses PCCs’ attitudes toward this proposed model and their likelihood (with support) of prescribing medications for alcohol and opioid use disorder. To achieve this, an anonymized and confidential electronic survey was deployed to all 489 of our institutions’ PCCs. Eighty-five completed the survey (17.4% response); the majority (94%) agreed that digital CoCM for SUD will be helpful for their practice, and 85% expressed agreement that such a model will increase their confidence and likelihood to prescribe anti-craving medications. Additionally, we found that PCCs’ comfort level in addressing SUD with patients is not associated with years in practice, clinician type (attending physicians, resident/fellow physicians, nurse practitioner or physician assistant), or their perception of currently available SUD treatment resources. Future work to evaluate practice changes, including rates of anti-craving medication prescribing and SUD-treatment outcomes after implementation of our digital CoCM will prove useful in determining the effectiveness of this model.

Abstract Background Long-acting injectable buprenorphine (LAIB) has been positioned as a potentially transformative option for opioid use disorder (OUD), in part because patient experiences reported in qualitative studies emphasize reduced daily burden, increased “freedom,” reduced stigma, and fewer pressures related to diversion—while also noting barriers such as insufficient information, early adverse experiences, and concerns about coercion. Methods We conducted a cross-sectional online survey of adults recruited from the Behavioral Health Research Panel (BHRP). Eligibility included age ≥18, English literacy, and OUD diagnosis or problematic opioid use within the past 5 years. Survey content assessed buprenorphine experience, knowledge and attitudes toward LAIB, attribute preferences, and open-text feedback. Descriptive statistics were generated; analyses were stratified by buprenorphine experience (experienced vs naïve). Results Among 105 participants, 82.9% reported prior buprenorphine use, and 17.1% were buprenorphine-naïve. Overall, 53.3% preferred a long-acting injection regimen (weekly/monthly/3-monthly) versus 46.7% preferring a daily oral tablet/film. Convenience and adherence-related themes (e.g., not missing doses, fewer visits) drove LAIB preference, while oral-route preference and concerns about side effects and safety were prominent among those favoring oral formulations. Conclusions In this national convenience sample, preferences were nearly evenly split between daily oral and long-acting injectable buprenorphine regimens, with a slight overall preference for LAIB. Findings align with the qualitative literature, emphasizing the practical and psychosocial benefits of LAIB, alongside persistent needs for improved education, shared decision-making, and attention to tolerability, safety perceptions, and cost/coverage barriers.

Abstract Background Long-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is dramatically underutilized in comparison to oral formulations. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting treatment for opioid use disorder (OUD). Methods A secondary analysis of a national, cross-sectional online survey of U.S. physicians who prescribe buprenorphine for OUD was conducted. Respondents reported OUD caseload, LAI-BUP use, and the importance of medication attributes relevant to treatment selection (e.g., efficacy, safety, ease of administration, ease of prescribing, and administrative requirements). Providers were categorized as no LAI-BUP use or, among LAI-BUP prescribers, Low vs High use based on a median split. Group comparisons used chi-square (or Fisher’s exact) tests for categorical variables and Jonckheere–Terpstra tests for ordinal responses. Results Among 125 respondents, 39 (31.2%) reported no patients receiving LAI-BUP. The remaining 86 (68.8%) were LAI-BUP prescribers, split evenly into Low and High (n’s=43; 34.4%) groups using a median cut of 23.2%. LAI-BUP use did not differ meaningfully by specialty, region, or practice setting. Greater LAI-BUP use was reported by providers with larger OUD panels. Ratings of key medication attributes were uniformly high. Conclusions LAI-BUP remains underused, with uptake highest among clinicians managing larger OUD caseloads. Measured attitudes toward medication attributes did not explain these differences. Future work should assess clinic workflow, staffing, reimbursement, and REMS burden, testing targeted implementation strategies using mixed-methods trials. Identifying what shifts clinicians from no use to low and high use may guide scalable implementation interventions.

Abstract Background and Objectives Implementation of screening, brief intervention, and referral to treatment (SBIRT) for substance use in primary care remains challenging. Care coordination (CC) may strengthen SBIRT by supporting brief interventions, improving referral follow‐through, and enhancing continuity. CC models and outcomes vary, however, and no prior scoping review has synthesized these. Methods A comprehensive search of 10 resources, including Embase, MEDLINE, and PsycINFO, was conducted on 4/15/2025. Eligible studies described outpatient SBIRT models adding CC for any age group. Articles were excluded if they lacked CC, presented no original data, or were not in English. Relevant implementation and patient‐level outcomes were extracted to describe CC models and their impact. Results Of 737 abstracts and 50 full texts reviewed, 15 met the inclusion criteria. Studies spanned primary care, specialty care, and age ranges. CC models included embedded behavioral health providers, centralized linkage managers, and remote coordinators using phone or digital platforms. CC was associated with higher screening completion, brief intervention delivery, referral initiation, and treatment engagement. Successful integration incorporated structured communication, follow‐up protocols, and accessible technology. Barriers included limited billing infrastructure, weak electronic record integration, and unclear roles. Discussion and Conclusions CC appears to enhance SBIRT implementation and treatment engagement across outpatient settings. Embedded approaches offer relational benefits, while remote and digital strategies show promise for scalability. Comparative studies are needed to assess effectiveness, cost, and contextual fit. Scientific Significance Provides the first review of CC models within SBIRT, highlighting their implementation impact and guiding future optimization.

Background: Substance use disorders (SUDs) are highly prevalent, affecting over 48.5 million Americans. Available treatments for SUD remain insufficient, and many patients do not respond to existing interventions despite adequate adherence to treatments. While novel therapies for SUD are urgently needed, the use of psychedelic drugs for the treatment of SUDs has shown promise. Objectives: This overview of systematic reviews summarizes existing evidence on hallucinogens—serotonergic psychedelics and ketamine—for the treatment of SUD. Methods: A comprehensive search of the literature was conducted to identify relevant evidence for using serotonergic and non-serotonergic psychedelics for the treatment of SUDs. After initial screening (n = 468 studies), 62 studies were retrieved and assessed for eligibility, and a total of 16 systematic reviews were included. Conclusions: Although preliminary, evidence suggests that the use of serotonergic and non-serotonergic psychedelics for the treatment of SUD may provide advantages over traditional therapeutics, and these compounds may eventually become part of the next generation of treatments for SUD under specific circumstances. Research with these drugs has faced significant challenges, though, and caution when interpreting results is warranted, given high risk of bias and several other methodological limitations from the studies to date. Furthermore, risks associated with these drugs are not negligible. For now, the use of psychedelic drugs for the treatment of SUDs remains experimental, and existing evidence is insufficient to support its use in clinical practice.

Background: Invasive and non-invasive neuromodulation in psychiatry represents a burgeoning field that leverages advanced neuromodulation techniques to address substance use disorders (SUDs). Aims: This narrative review synthesizes findings from multiple reviews to evaluate the efficacy of neuromodulation in treating SUDs. Methods: A comprehensive literature search was conducted between December 2024 and April 2025, focusing on systematic reviews and meta-analyses that examined various neuromodulation modalities, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The selected reviews were analyzed to identify common themes, outcomes, and gaps in the current understanding of these treatments for SUDs. Results: 11 reviews met the final inclusion criteria; 5 focused on non-invasive neuromodulation (rTMS, tDCS) and 6 on invasive neuromodulation (DBS). Non-invasive neurostimulation was associated with modest improvements in craving and cognitive dysfunction in individuals with SUDs. Similarly, invasive neuromodulation (DBS), through high-frequency stimulation of the bilateral nucleus accumbens, appeared to reduce cravings and improve comorbid psychiatric symptoms in both preclinical and human studies. Importantly, small sample sizes, heterogeneity in targets and stimulation protocols, and short follow-up periods significantly limit the generalizability of current findings from both non-invasive and invasive neuromodulation studies. Conclusions: As novel and more effective therapies for the treatment of SUD are desperately needed, procedural interventional psychiatry holds promise. However, despite encouraging results, existing evidence is still preliminary, and larger, rigorously designed studies are warranted to further establish the safety and efficacy of neuromodulatory interventions for SUD treatment.