BACKGROUND:Population-based screenings for substance use are highly recommended, but little is known about the screening status of substances in primary care settings (PCSs). This systematic review aims to understand what screening tools are used, the barriers that impact screenings, and the opportunities to improve screenings. METHODS:Articles focusing on the utilization of screening tools for substance use disorders (SUDs) within PCSs were considered for inclusion. Searches on PubMed and Embase databases were conducted from April 25, 2022, to July 22, 2022, which yielded 487 results; only 32 articles meeting the inclusion and exclusion criteria were included. RESULTS:Among all substances, alcohol was the most frequently screened substance at PCSs, with 20 studies included in this article. This was followed by opioids (n = 11), other illicit drugs (n = 8), cannabis (n = 6), and nicotine (n = 2). The Alcohol Use Disorders Identification Test was the most commonly used screening tool. Most studies utilized different screening tools to screen for the same substances. Identified barriers include no referral to treatment upon positive screenings, lack of training in providing interventions, and no recognition of the effectiveness of intervention services. CONCLUSION:Our search resulted in only 32 studies focusing on substance screening at PCSs, indicating that substance screening may not be conducted as recommended or formally. Integrating patient-centered SUD screening in PCSs is challenging but could be feasible via implementation strategies to address barriers. Future studies focusing on the feasibility, acceptability, and effectiveness of screening tools in PCSs may increase the screening rates for early identification and intervention for SUDs.

Background Hidradenitis suppurativa (HS) is an inflammatory skin condition caused by follicular occlusion and is associated with painful lesions in intertriginous areas of the skin. The primary objectives of this study were to investigate the relationship between HS severity and dietary factors and to explore which specific food groups, if any, are linked to an increase in HS severity. We also aimed to identify any potential disparities that may contribute to poor dietary habits. Methods This study employed a cross-sectional, survey-based approach to determine dietary habits of patients with and without HS at a university hospital in the Southern United States. A food frequency survey was utilized to assess dietary intake. Statistical analyses involved chi-squared and ANOVA tests to identify significant association. Results A total of 386 (195 with HS, 191 controls) participants took part in this study. Statistical analysis indicated significant differences in the consumption of high glycemic index (GI) foods, processed foods, fried items, and dairy products among patients with and without HS (p < 0.05). The HS group particularly reported decreased consumption of low GI foods than their counterparts (p < 0.05). Food insecurity and affordability played a significant role in access to nutrient dense foods for patients with HS. Conclusion Our findings indicate that greater consumption of inflammatory foods is associated with exacerbation of symptoms associated with HS. Implementing dietary modifications in HS treatment plans with greater awareness of social disparities could play a valuable role in reducing disease burden and improving patients’ quality of life.

Opioid-related overdose deaths have significantly increased in the USA and in Alabama. Despite this, medications for opioid use disorder (MOUD) remains significantly underutilized. Thus, this study aims to gain a better understanding of clinicians' viewpoints on potential barriers and opportunities that are likely to impact and improve the access to MOUD, especially buprenorphine prescribing. A cross-sectional survey study was conducted with Alabama's clinicians (n = 492). The survey containing a QR code was mailed to clinicians throughout the state and was asked about their viewpoints and thoughts on prescribing buprenorphine. Multivariable linear regression was used to examine associations between OUD self-efficacy, beliefs about the effectiveness of MOUD, attitudes regarding whether or not MOUD is addictive, and positive affect surrounding the treatment of OUD patients. A minority of respondents (39.8%) reported that they have an active X-waiver for MOUD. Results showed that beliefs that MOUD is addictive were significantly inversely correlated with beliefs about MOUD being effective. Furthermore, both self-efficacy and positive affect were significantly and positively associated with beliefs that MOUD is effective. Furthermore, nurse practitioners were more likely than physicians to have higher scores on the "MAT is Addictive" construct. Self-efficacy with OUD patients was positively associated with the "MOUD is Effective" construct. Finally, results showed that X-waivered providers expressed greater positive affect toward OUD patients than providers who were not X-waivered (b = 2.9, p < 0.001). Belief that MOUD is effective was also positively associated with higher scores on the positive affect construct (b = 0.5, p < 0.001). Several barriers and opportunities were identified in our survey data which could be used to explore MOUD expansion, especially buprenorphine prescribing. Strategic plans in expanding MOUD access may include educational trainings on MOUD, motivating clinicians to utilize their capacity by implementing incentive plans, increasing provider self-efficacy, reducing stigma around MOUD, and providing more financial support to uninsured patients.

Abstract Background Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020. Methods A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD. Results In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03). Conclusions Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.

Background Recent data suggest a disproportionate impact of opioid overdoses on Black Americans. The study aims to describe emergency department (ED) visits at a Southern, urban ED pertaining to opioid overdose and associated health disparities. Methods Patients presenting to the ED at the University of Alabama at Birmingham Hospital with opioid overdoses from January 1 to October 31, 2019, and from January 1 to October 31, 2020, were identified from electronic medical records. Results The total number of opioid overdose visits increased 9.7% (556 to 611) between January and October 2020 compared with 2019. Among patients who presented with opioid overdose, the mean ages were 50.3 years and 48.3 years, in 2019 and 2020, respectively. In both 2019 and 2020, more Blacks than whites were treated for opioid overdose in the ED (284 vs. 258 in 2019, and 306 vs. 271 in 2020) although 28 patients did not record their race in 2020. Consistently, more overdose deaths were observed in Blacks than in whites in 2020. More individuals seeking opioid overdose treatment were single in both years. Conclusions The study reported a greater number of visits for opioid overdoses from January to October of 2020 in an ED of a southeastern region, as well as higher overdose deaths in Blacks. Our findings highlight the importance of substance use treatment, harm reduction, and overdose prevention efforts that should be immediately present to reduce opioid overdose, especially for vulnerable populations in the South, i.e., Black community, and individuals experiencing singlehood.