DNA methylation changes in young female adolescents with anorexia nervosa : focus on puberty related genes.

Opioid use disorder (OUD) has become increasingly prevalent in many countries, despite a recent slowdown in its spread in the US (Garnett & Miniño, ). One important aspect of OUD is its impact on treating comorbidities, including mental health disorders (MHD) (Pettit Bruns & Kraguljac, ). In particular, in the US, estimates from the 2023 National Survey on Drug Use and Health suggest that 54% of individuals with an OUD also had any mental illness, and 17% of them had a serious mental illness ((Substance Abuse and Mental Health Services Administration, ), author’s calculation). However, many people with both OUD and MHD receive no treatment for the MHD. During 2008–2014 in the US, among people with OUD, 47% of those with mild/moderate mental illness received no mental health treatment, while 21% of respondents with serious mental illness received no mental health treatment (Novak et al., ). One reason for this is that MHD expertise is often not available onsite at specialty addiction treatment programs (Pro et al., ), and patients in programs without it may not follow up on referrals to specialty mental health care elsewhere (Brooner et al., ). More generally, treatment of OUD and MHD are often siloed in separate programs, despite patient preferences (Tarn et al., ) and researchers’ frequent recommendations for integrated treatment approaches (National Academies of Sciences, ). A systematic international review in 2020 found 8 studies that reported an association between substance misuse and poorer medication adherence among psychiatric patients (Semahegn et al., ), confirming earlier US findings (Lacro et al., ; Magura et al., ). Some preliminary evidence suggests that receipt of medication treatment for OUD (MOUD) improves adherence to medications for the comorbid MHD, as reported in two studies of justice-involved populations who had both OUD and MHD. First, in British Columbia, among patients with both schizophrenia and OUD, the probability of antipsychotic adherence doubled in periods that were preceded by a period of adherence to methadone maintenance therapy (Rezansoff et al., ). Second, in Connecticut, among patients with OUD and at least one serious MHD, receipt of MOUD (methadone, buprenorphine, or oral naltrexone) was associated with improved adherence to antipsychotic medication, and this was true for each type of MOUD (Robertson et al., ). One possible explanation for these findings could be that successful concurrent OUD and MHD treatment reduces one barrier to MHD treatment adherence, allowing clinician and patient to pay greater attention than previously to the MHD. In addition, the OUD treatment may itself include components that directly address mental illness, e.g., psychosocial care or integrated treatment models (Moran et al., ). However, the British Columbia study reported that methadone was typically delivered in pharmacy settings with witnessed oral ingestion, with few integrated supports, while the Connecticut study did not describe or analyze the psychosocial supports provided. In recent years, experts have promoted the use of low-barrier care in settings that routinely treat patients with OUD, such as primary care and emergency departments (Jakubowski & Fox, ). A prominent example is the Hub and Spoke (HS) model. As originally envisioned, this model classifies some facilities as hubs, where MOUD treatment is initiated, and other programs as spokes, where patients can receive ongoing maintenance treatment once initiated (Brooklyn & Sigmon, ). Since its original emergence, states have modified the HS model to meet their individual needs (Snell-Rood et al., ). In this paper, we consider the HS model adopted in Washington state, in which MOUD-experienced providers – including primary care providers and addiction treatment programs – served as hubs, while community-based providers – such as mental health clinics, law enforcement, emergency departments, and jails – served as spokes (Reif et al., ; Stewart et al., ). In Washington, the six hubs served as experts and sources of knowledge, and MOUD could be initiated and maintained at either hubs or spokes. Prior research has assessed the impact of Washington’s HS initiative on MOUD continuity and other outcomes, with few significant findings (Reif et al., ), and demonstrated that outpatient psychosocial services received early in MOUD treatment increased MOUD continuity (Reif et al., ). Although these prior studies controlled for comorbid MHD, they did not examine MHD treatment as an outcome.