In 2021, the Department of Health and Human Services released guidelines allowing waiver-eligible providers seeking to treat up to 30 patients to be exempt from waiver training (WT) and the counseling and other ancillary services (CAS) attestation. This study evaluates if states and the District of Columbia had more restrictive policies preventing adoption of the 2021 federal guidelines. First, the Westlaw database was searched for buprenorphine regulations. Second, state medical, osteopathic, physician assistant, nursing boards, and single state agencies (SSA) were surveyed to assess for the WT and CAS requirements and if they were discussing the 2021 guidelines. Results were recorded and compared by state and waiver-eligible provider types. The Westlaw search revealed seven states with regulations requiring the WT and ten states requiring CAS. Survey results showed ten state boards/SSAs required WT for at least one waiver-eligible practitioner type and eleven state boards/SSAs required CAS. In some states, the WT and CAS requirements only applied in special circumstances. Eleven states had discrepancies between the Westlaw and survey results among three waiver-eligible provider types. Despite the 2021 federal change intended to increase access to buprenorphine, several states had regulations and/or provider boards and SSAs that were not supportive. Now, the Mainstreaming Addiction Treatment (MAT) Act of 2022 eliminated the federal x-waiver requirement to prescribe buprenorphine. However, these states may continue to have barriers to treatment access despite the MAT Act. Strategies to engage states with these restrictive policies are needed to improve buprenorphine treatment capacity.

This paper outlines lessons learned from tailoring communication campaigns to increase demand for, and reduce stigma toward, evidence-based practices to reduce opioid overdose deaths in 66 communities participating in the HEALing (Helping to End Addiction Long-term^SM) Communities Study (HCS). We present nine lessons gathered about how to engage local communities in both virtual and in-person opioid messaging and distribution between February 2019 and June 2022. The research team created four communication campaigns and did extensive, tailored marketing and promotion to assist communities in implementing evidence-based clinical activities to reduce opioid overdose mortality. Various strategies and venues were used to amplify HCS messages, using free and paid outlets for message distribution, focusing primarily on social media due to the COVID-19 pandemic. Increasing the availability of medications for opioid use disorder and naloxone, as HCS attempted, is not enough; getting people to accept and use them depends on communication efforts. This paper focuses on the process of preparing communities for communication campaign activities, which we hope can help guide other communities preparing for opioid or substance-related campaigns in the future.

The opioid epidemic in the United States is a public health emergency that has triggered calls to action for policy reforms. However, variations exist between political parties and policymakers on how this issue is communicated to the public. With the substantial growth in the use of social media by policymakers as a tool for disseminating policy-related information affecting their constituents, examining their communication strategies on public health emergency issues is imperative. To better understand how U.S. Senate members use Twitter (now known as X) to communicate opioid-related issues, we conducted a quantitative content analysis of their opioid-related tweets (N = 697) from January 1 to August 25 2022. Findings reveal a significant political divide regarding how senators characterize the opioid crisis, influencing user engagement on Twitter. Guided by the moral foundation theory, the results suggest that Democratic senators were more likely to employ care/harm or fairness/cheating moral foundations, relative to Republican senators, who used more loyalty/betrayal or authority/subversion. Additionally, Democratic senators framed the opioid crisis as a health or policy issue, relative to Republican senators' immigration/border frame. For inclusion of information sources, Democratic senators included significantly more health sources compared to Republican senators' use of media or law enforcement sources. Issue frame and source type significantly influenced user engagement in the form of likes and retweets. These findings provide both practical and theoretical implications.

Background: The HEALing Communities Study (HCS) included health campaigns as part of a community-engaged intervention to reduce opioid-related overdose deaths in 67 highly impacted communities across Kentucky, Massachusetts, New York, and Ohio. Five campaigns were developed with community input to provide information on opioid use disorder (OUD) and overdose prevention, reduce stigma, and build demand for evidence-based practices (EBPs). An evaluation examined the recognition of campaign messages about naloxone and whether stigma and efficacy beliefs regarding OUD treatment and naloxone changed in HCS intervention communities. Methods: Data were collected through surveys offered on Facebook/Instagram to members of communities participating in the HCS intervention and wait-list control communities. Results: Participants in HCS intervention communities reported a reduction in stigma regarding OUD and increased efficacy beliefs regarding naloxone associated with recognition of campaign messages. However, this finding is cautiously interpreted as there was no clear evidence for recognition differences between the treatment/control conditions. Conclusion: Study findings indicate associations between campaign message recognition and positive outcomes. Results also highlight possible challenges concerning evaluations of social media campaigns using conventional evaluation techniques. Trial registration: ClinicalTrials.gov NCT04111939.