Association between high-threshold practices and buprenorphine treatment termination.

BACKGROUND: Regular counseling and frequent drug testing are common requirements for patients with opioid use disorder in buprenorphine treatment. State policies throughout the United States often reinforce these high-threshold practices, as was the case with Michigan, USA. METHODS: We sought to explore the association between counseling requirements, drug testing practices, and buprenorphine treatment termination rates through administering a survey to buprenorphine prescribers in Michigan. RESULTS: In our sample of 377 prescribers, we found associations between high-threshold practices like drug testing at every clinical visit and requiring counseling and buprenorphine treatment termination rates. Relative to prescribers who randomly drug tested, drug tested at fixed intervals, or did not require any drug testing, prescribers who drug-tested patients at every visit were 38% more likely to terminate treatment. Prescribers who required counseling were 33% more likely to terminate treatment than those who did not require counseling. CONCLUSION: With the elimination of the USA Drug Enforcement Administration X-waiver in December 2022, state policies need to minimize high-threshold practices that reduce buprenorphine treatment continuity and undermine an effective response to the overdose crisis.

Attitudes and behaviors of international air travelers toward pandemic influenza.

BACKGROUND: Air travelers play a significant role in the spread of novel strains of influenza viruses; however, little is understood about the knowledge, attitudes, and practices of international air travelers toward pandemic influenza in relation to public health interventions and personal protective behaviors at overseas destinations. METHODS: Prior to the 2009 H1N1 influenza pandemic, we surveyed a convenience sample of 404 departing international travelers at Detroit Metropolitan Wayne County Airport. Presented with a hypothetical pandemic influenza scenario occurring overseas, the participants predicted their anticipated protective behaviors while abroad and recorded their attitudes toward potential screening measures at US ports of entry (POE). The survey also qualitatively explored factors that would influence compliance with health entry screening at POE. RESULTS: Those who perceived pandemic influenza to be serious were more likely to state that they would be comfortable with screening (p = 0.006), and if they had influenza-like illness (ILI) overseas, would be more willing to see a physician and delay return travel (p = 0.006 and 0.002, respectively). Other demographic variables, including age and race, were associated with protective behaviors in response to ILI. Travelers also identified diverse information requirements which would influence their behavior in response to entry screening, including characteristics of the pandemic, severity of illness, and screening operations. CONCLUSIONS: Demographic characteristics and perceived severity of illness are important factors that may influence the protective behaviors of travelers overseas. Our results indicate that educational material and advice directed to international travelers could be differentially tailored to traveler subpopulations.