Study protocol for the Treating Opioid Patients' Pain and Sadness (TOPPS) study - A randomized control trial to lower depression and chronic pain interference, and increase care retention among persons receiving buprenorphine.

BACKGROUND: Persons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. METHODS: This randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DISCUSSION: This RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. CLINICAL TRIAL: #NCT03698669.

Hitting them where it hurts: Pantothenate kinase targeting in pathogenic fungi.

In this issue of Structure, Gihaz and colleagues develop antifungal compounds targeting fungal pantothenate kinase (PanK). Through utilization of high-throughput chemical screening, along with biochemical and functional analyses and newly solved fungal PanK crystal structures, high-affinity inhibitors are produced, and invaluable insights into the mechanisms of fungal PanK are gained.

Pandemic Notes From a Maine Direct Primary Care Practice.

The effects of coronavirus disease-2019 (COVID-19) pandemic fear and its economic impact in rural primary care are still being felt, as they have affected demand for office visits and how we deliver care. Our finances and our ability to sustainably deliver this care, however, have not yet changed significantly due to the nature of our business model as a direct primary care practice.