The 에볼루션 바카라 Weekly for April 15th, 2025

This Week in the 에볼루션 바카라 Weekly

Medical experts like to use acronyms, likely because they are an efficient use of language. 

For example, the START (Substance Use Treatment and Recovery Team) Addiction Consultative Service (ACS) is a hospital-based model of care that can improve initiation rates of MOUD as well as successfully transition individuals to community-based care. It’s also a translational model, with the potential to address SUD’s beyond OUD ().

The SCOUTT (Stepped Care for Opioid Use Disorder Train the Trainer) initiative is brought to us by the VHA (Veterans Health Administration) and is a program that expands MOUD to primary care, mental health, and pain care settings, yet its impact on downstream utilization is not well understood. A new study found that SCOUTT did not significantly reduce hospitalizations or ED utilization among patients with OUD, but there are positive insights deserving further analysis ().

One of the most efficient acronyms is AI — it’s only two letters and excels at processing language. An NIH-funded study demonstrates this well with an AI-driven screening tool that seamlessly integrates into a hospital's EHR (electronic health record), identifies patients at risk of OUD, and recommends them for an addiction consultation service (ACS). This AI screener helped improve workflows and saved over $100,000 in estimated health care costs over the study period (). Does this mean that AI + START = START+? What about AI + SCOUTT?

Either way, there will be hidden costs from incorporating AI, in healthcare or more broadly. Its ability to seamlessly integrate into systems and find efficiencies is a plus, but its ability to deliver human companionship — more efficiently than humans — will come at a cost ().

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DF에볼루션 바카라
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, F에볼루션 바카라; John A. Fromson, MD; Jack Woodside, MD

Lead Story 

🔓

JAMA Internal Medicine

While medication for opioid use disorder (MOUD) is effective, many patients with OUD do not receive it, particularly in hospitalized settings. In this randomized trial, researchers evaluated the Substance Use Treatment and Recovery Team (START) model, including a team of an addiction medicine provider and a care manager who provided motivational interviewing, discharge planning, and telephone follow-up for one month. Patients who received the START intervention were more likely to receive MOUD (aRR=2.10) and connect to OUD care after discharge (aRR=1.49). In addition, these patients were more likely to have an OUD-focused discharge plan (aRR=1.8), initiate or continue MOUD post discharge (aRR=1.71), and see a clinician for OUD post discharge (aRR=1.89). These findings support the use of hospital-based addiction consult services to address this health care gap. 

Research and Science 

International Journal of Drug Policy

This study used claims data from commercially-insured patients to compare treatment retention for extended-release buprenorphine (XR-BUP) and sublingual buprenorphine (SL-BUP). Retention for SL-BUP was higher throughout the first year, and at 6 months was 50% v. 14% for XR-BUP. Many patients dropping out of treatment with XR-BUP switched to SL-BUP so the rate of permanent dropout from buprenorphine treatment was similar for the two groups (6-month dropout 39% vs. 41%). Researchers also found that dropout rates were improved by higher buprenorphine doses and longer prescription duration. Patients receiving 16 mg and 28-day supply had a 12-month dropout rate of 48%, similar to the 6-month dropout rate of 46% for those receiving <16 mg and <28-day supply. The authors conclude that retention is greater for SL-BUP than XR-BUP, and is improved by higher doses and extended supplies. 

 🔓

BMC Psychiatry

The Veterans Health Administration implemented a program to increase MOUD utilization. This study used medical record data to determine if this intervention affected hospital and emergency department utilization. During the year prior to implementation, hospital utilization increased from 3.7% to 5.4% of patients and ED utilization also increased from 9.3% to 11.2% of patients. During the year after implementation, hospital utilization decreased from 5.3% to 5.1% of patients and ED utilization also decreased from 11.1% to 10.5% of patients. In comparison clinics without the program, both hospital and ED utilization increased before implementation and remained stable after. There was no substantial difference in utilization between clinics with and without the program. The program did increase MOUD implementation but also decreased retention in treatment which may have had opposing effects on the outcome 

Nature Medicine

This group previously developed an artificial intelligence (AI)-based screener to assess hospitalized patients for OUD. In this study the AI screener was embedded in the EHR and assessed patient data in real time, issuing an alert to clinicians when it detected opioid risk. The number of addiction medicine consultations completed before and after the implementation of the AI tool did not significantly change (1.35% before to 1.51% after), demonstrating that the AI tool was just as effective as a manual screen by health care personnel. Patients receiving addiction medicine consultation as the result of the AI screener had a significantly reduced rehospitalization rate (aOR 0.53, p=0.02), making the AI screener cost-effective. This AI screener is feasible and could free up human resources required for manual screening. 

 🔓

Annals of Internal Medicine

The American College of Physicians (ACP) reviewed the available evidence for efficacy of cannabis and cannabinoids for chronic noncancer pain and potential harms to develop guidelines for clinicians when counseling patients. Overall, the ACP found the benefits to be small and long-term efficacy is unknown. For the general population, the ACP recommends counseling patients about the potential benefits and harms of cannabis and cannabinoids, while the subpopulations of young adults, adolescents, and patients with substance use disorder, serious mental illness, or at risk of falls should be advised that risks likely outweigh benefits. Pregnant, seeking to become pregnant, or breastfeeding patients should be advised against use. In addition, all patients should be advised against inhaled cannabis for chronic noncancer pain.   

Learn More 

 🔓 

JAMA Network Open

This cross-sectional study of all psilocybin dispensaries operating in Canada examined the level of access to unregulated psilocybin dispensaries in Canada and what kind of health claims and warnings are made by dispensaries. The study identified 57 dispensaries; 15 of Canada’s 42 major urban cities contained 1 or more psilocybin dispensaries. Most dispensaries had a website that offered online sales while making unsubstantiated health claims and important omissions of risk. These results suggest that further regulatory action may be warranted in response to growing access to unlicensed psilocybin dispensaries and product promotion. 

 🔓 

JAMA Network Open

This cross-sectional study assessed how the packaging of cannabis edibles is associated with ability to recall health warnings as well as perceptions among young adults. The study included 4,500 young adults and found that plain packaging was significantly associated with increased odds of correct warning recall, decreased product appeal, and increased perceived harm, and that youth-appealing packaging was associated with increased product appeal. Health claims were significantly associated with increased product appeal. Policymakers may require plain packaging, prohibit youth-appealing features, and regulate unsubstantiated health claims to improve warning recall and perceptions of cannabis edible products among young adults. 

Nature Mental Health

In this commentary emphasizing the need for evidence-based clinical practice in the community, the author highlights Mindfulness-Oriented Recovery Enhancement (MORE), a treatment that can alleviate pain and emotional stress and reshuffle the salience of drug and non-drug rewards and is beneficial in conjunction with medications for opioid use disorder (MOUD) to improve outcomes. The author notes there can be a disconnect between scientific research on interventions and clinical practice in the community, partially due to the lack of forums to bring researcher and community-based providers together, but also the funding for training, fidelity, and supervision needed to adopt new interventions. The author supports the use of opioid-settlement funds to address some of these limitations. 

Learn More 

 🔓

Psychology Today

 🔓

The Conversation

 🔓

Medical Xpress 

 🔓

MIT Technology Review

 🔓

The Hill

STAT

 🔓

Reuters