Considerations for Opioid Use Disorder Treatment From Policy Makers' Experiences With COVID-19 Policy Flexibilities.

OBJECTIVE: This qualitative study aimed to examine how states implemented COVID-19 public health emergency-related federal policy flexibilities for opioid use disorder treatment from the perspective of state-level behavioral health policy makers. Recommendations are given for applying lessons learned to improve the long-term impact of these flexibilities on opioid use disorder treatment. METHODS: Eleven semistructured interviews were conducted with 13 stakeholders from six state governments, and transcripts were qualitatively coded. Data were analyzed by grouping findings according to state-, institution-, and provider-level barriers and facilitators and were then compared to identify overarching themes. RESULTS: Policy makers expressed positive opinions about the opioid use disorder treatment flexibilities and described benefits regarding treatment access, continuity of care, and quality of care. No interviewees reported evidence of increased adverse events associated with the relaxed medication protocols. Challenges to state-level implementation included gaps in the federal flexibilities, competing state policies, facility and provider liability concerns, and persistent systemic stigma. CONCLUSIONS: As the federal government considers permanent adoption of COVID-19-related flexibilities regarding opioid use disorder treatment policies, the lessons learned from this study are crucial to consider in order to avoid continuing challenges with policy implementation and to effectively remove opioid use disorder treatment barriers.

Remote detection of a lunar granitic batholith at Compton-Belkovich.

Granites are nearly absent in the Solar System outside of Earth. Achieving granitic compositions in magmatic systems requires multi-stage melting and fractionation, which also increases the concentration of radiogenic elements1. Abundant water and plate tectonics facilitate these processes on Earth, aiding in remelting. Although these drivers are absent on the Moon, small granite samples have been found, but details of their origin and the scale of systems they represent are unknown2. Here we report microwave-wavelength measurements of an anomalously hot geothermal source that is best explained by the presence of an approximately 50-kilometre-diameter granitic system below the thorium-rich farside feature known as Compton-Belkovich. Passive microwave radiometry is sensitive to the integrated thermal gradient to several wavelengths depth. The 3-37-gigahertz antenna temperatures of the Chang'e-1 and Chang'e-2 microwave instruments allow us to measure a peak heat flux of about 180 milliwatts per square metre, which is about 20 times higher than that of the average lunar highlands3,4. The surprising magnitude and geographic extent of this feature imply an Earth-like, evolved granitic system larger than believed possible on the Moon, especially outside of the Procellarum region5. Furthermore, these methods are generalizable: similar uses of passive radiometric data could vastly expand our knowledge of geothermal processes on the Moon and other planetary bodies.

The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study.

BACKGROUND: In March 2020, Veterans Health Administration (VHA) enacted policies to expand treatment for Veterans with opioid use disorder (OUD) during COVID-19. In this study, we evaluate whether COVID-19 and subsequent OUD treatment policies impacted receipt of therapy/counseling and medication for OUD (MOUD). METHODS: Using VHA's nationwide electronic health record data, we compared outcomes between a comparison cohort derived using data from prior to COVID-19 (October 2017-December 2019) and a pandemic-exposed cohort (January 2019-March 2021). Primary outcomes included receipt of therapy/counseling or any MOUD (any/none); secondary outcomes included the number of therapy/counseling sessions attended, and the average percentage of days covered (PDC) by, and months prescribed, each MOUD in a year. RESULTS: Veterans were less likely to receive therapy/counseling over time, especially post-pandemic onset, and despite substantial increases in teletherapy. The likelihood of receiving buprenorphine, methadone, and naltrexone was reduced post-pandemic onset. PDC on MOUD generally decreased over time, especially methadone PDC post-pandemic onset, whereas buprenorphine PDC was less impacted during COVID-19. The number of months prescribed methadone and buprenorphine represented relative improvements compared to prior years. We observed important disparities across Veteran demographics. CONCLUSION: Receipt of treatment was negatively impacted during the pandemic. However, there was some evidence that coverage on methadone and buprenorphine may have improved among some veterans who received them. These medication effects are consistent with expected COVID-19 treatment disruptions, while improvements regarding access to therapy/counseling via telehealth, as well as coverage on MOUD during the pandemic, are consistent with the aims of MOUD policy exemptions.

Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field.

Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

Nursing Care for the Initial Resuscitation of Severe Sepsis Patients.

Sepsis is recognized as a major health care problem worldwide. In the United States, mortality from severe sepsis and septic shock remains a serious health problem; yet, the early recognition of sepsis by nurses reduces can reduce mortality, morbidity, and long-term consequences of sepsis for patients. Improving the knowledge of nurses to first recognize the early signs of sepsis and then how to apply the most up-to-date evidence-based treatments can improve outcomes. Enhanced monitoring includes the use of computerized early warning systems to alert nurses of worrisome clinical patterns and promote the early recognition of sepsis.

Nursing Care for the Initial Resuscitation of Burn Patients.

Serious burn injuries may have lifelong impacts for individuals that experience them and require timely medical treatment in order to reduce associated morbidity and mortality. Initial management of a burn is nursing intensive and focuses primarily on stopping the burning process, maintaining homeostasis by keeping the patient warm, and replacing lost fluid and electrolytes. As healing progresses, nurses meet the critical needs of the patient and must skillfully manage pain levels, perform burn care, prevent infection, help the patient meet increased nutrient requirements, and address psychological concerns with the goal to restore health and function to the highest possible level.