Addiction [JOURNAL]
Sun
200 papers
A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial.
Schuler MS, Weir R, McCullough CM … +5 more , Hindmarch GM, Griffin BA, Becker K, Meredith LS, Watkins KE
Addiction · 2026 Jun · PMID 42286436 · Publisher ↗
BACKGROUND AND AIMS: Individuals with opioid use disorder (OUD) frequently present with co-occurring mental health conditions such as depression and posttraumatic stress disorder (PTSD), along with other mental health su...
BACKGROUND AND AIMS: Individuals with opioid use disorder (OUD) frequently present with co-occurring mental health conditions such as depression and posttraumatic stress disorder (PTSD), along with other mental health substance use disorders, physical health conditions and social determinants that together comprise 'clinical complexity.' Collaborative care (CC), a primary care-based behavioral health integration model, aims to improve outcomes through coordinated, patient-centered treatment. This study examined heterogeneity in baseline clinical complexity among participants in the CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) trial and assessed whether the effects of CC versus enhanced usual care (EUC) differed across clinical complexity groups. METHODS: Secondary analysis of CLARO, a pragmatic randomized clinical trial (n = 797) of CC versus EUC for adults with OUD and depression and/or PTSD, conducted in 18 low-resourced primary care clinics in New Mexico and California, USA. Latent class analysis of baseline data identified subgroups defined by mental health and substance use as the main characteristics along with physical health and social challenges. Six-month treatment effects were estimated using one-step models that jointly estimated latent class membership and class-specific outcomes, incorporating class × treatment interactions. Outcomes included depression symptom severity, PTSD symptom severity, and buprenorphine utilization and prescribing duration. RESULTS: Three subgroups were identified: (1) low complexity (43%), with relative clinical and social stability; (2) mental health complexity (34%), with high psychiatric symptoms but lower substance use and moderate social adversity; and (3) high dual complexity (23%). Compared with EUC, CC was associated with lower depression severity at follow-up for the low-complexity class, but not for other classes. CC and EUC did not differ statistically significantly with respect to PTSD outcomes in any class. Buprenorphine utilization and prescribing duration outcomes were similar across CC and EUC treatment arms. CONCLUSIONS: The effects of collaborative care may vary according to patients' baseline clinical complexity. Collaborative care appears to be associated with more favorable depression outcomes than enhanced usual care among participants with lower clinical complexity but not among those with higher clinical complexity.
Prevalence and risk perceptions of nicotine pouch use: A systematic review of population-based studies.
Mahmoodianfard S, Shahen S, Heshmati J … +5 more , Bates E, Quirouette E, Gelibo T, Visintini S, Mir H
Addiction · 2026 Jun · PMID 42286419 · Publisher ↗
BACKGROUND AND AIMS: Oral nicotine pouches (NPs) are a new class of non-combustible nicotine products that have gained rapid popularity. Despite rising sales and marketing, evidence of their prevalence and risk perceptio...
BACKGROUND AND AIMS: Oral nicotine pouches (NPs) are a new class of non-combustible nicotine products that have gained rapid popularity. Despite rising sales and marketing, evidence of their prevalence and risk perceptions remains limited. This systematic review aimed to synthesize the available global evidence on the prevalence and patterns of nicotine pouch use and to summarize reported risk perceptions from population-based studies. METHODS: Four electronic databases (Scopus, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched in March 2024 and searches were updated in September 2025. Observational studies reporting the prevalence of NPs use among general populations were selected. Study quality was assessed using an adapted Newcastle-Ottawa Scale, and findings were synthesized narratively. RESULTS: From 6752 records, 16 studies met the inclusion criteria and were included in this systematic review. The studies conducted surveys on NPs use in the United States, United Kingdom, Canada, Switzerland, the Netherlands, Finland, Poland, and Saudi Arabia (overall sample size = 184 497). Reported ever (defined as lifetime use) and current use (defined as use within the past 30 days) varied by country and demographic group. In the US, ever use ranged from 0.6% to 17.9%, while current use ranged from 0.8% to 12.0%; most studies were conducted among youth (<18 years) and young adults (18-29 years). In Europe, current use ranged from 0.06% in a population aged ≥13 years in the Netherlands to 3.7% among adults in Finland and 4.3% among adults in Poland, while lower rates were observed among adults in the United Kingdom and youth in Switzerland with 0.2% and 3.0%, respectively. In Canada, current use among secondary-school students was 2.6%, and in Saudi Arabia, 11.9% of medical university students reported ever use. Across studies, use was higher among adults aged 18-40 years compared with youth and older age adults and was also higher among males than females. NPs were frequently used concurrently with cigarettes, e-cigarettes, and smokeless tobacco. Perceptions generally indicated lower harm, lower addictiveness, and greater social acceptability than cigarettes. Marketing emphasizing flavors or cessation benefits increased appeal and intentions to use, particularly among youth perceiving low risk. CONCLUSION: Current global prevalence of oral nicotine pouch use remains low but varies by country and population group, with higher use reported among younger adults and males. Nicotine pouches are commonly used concurrently with other nicotine products and are generally perceived as less harmful and more socially acceptable than cigarettes.
The association between naloxone distribution, buprenorphine treatment and retention and incident high-risk opioid prescribing with opioid overdose death in Kentucky, Massachusetts, New York and Ohio, United States: An exploratory community-level cohort study of data from the HEALing Communities Study.
Walley AY, Cheng DM, Vandergrift N … +17 more , Larochelle M, Holloway J, Brown JL, Chandler R, Fanucchi LC, Feaster DJ, Freeman PR, Hunt T, Lofwall MR, Knudsen HK, Nunes EV, Oga E, Oyler DR, Samet JH, Villani J, Walsh SL, Winhusen TJ
Addiction · 2026 Jun · PMID 42283399 · Publisher ↗
AIM: We evaluated whether community-level naloxone distribution, medication for opioid use disorder treatment and retention and incident high-risk opioid prescribing rates were associated with opioid overdose death rates...
AIM: We evaluated whether community-level naloxone distribution, medication for opioid use disorder treatment and retention and incident high-risk opioid prescribing rates were associated with opioid overdose death rates. DESIGN: Observational cohort conducted using 2019 to 2023 community-level data as an exploratory analysis of the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS). Exposures included: (1) community-level naloxone distribution, past 12-months, categorized as ≤1000 units per 100 000 population vs. 1001-3000 units per 100 000 population vs. >3000 units per 100 000 population; (2) individuals treated with buprenorphine per 100 000 adult population in the current quarter; (3) individuals retained on buprenorphine for ≥ 180 days per 100 000 adult population in the current quarter; and (4) incident high-risk opioid prescribing per 100 000 adult population in the current quarter. SETTING AND PARTICIPANTS: Population-based study of 67 communities with 8.2 million adults in Kentucky, Massachusetts, New York and Ohio, USA, with required annual opioid overdose death rates of > 25 per 100 000 adult population and at least 30% rural. Across the 67 communities participating in the HCS, the adult population was 31% 18-34 years, 31% 35-54 years, 38% 55 years and over, 52% female, 73% non-Hispanic White, 15% non-Hispanic Black and 7.4% Hispanic. MEASUREMENTS: Quarterly community-level opioid overdose death rates from 2020 through 2023. FINDINGS: The 2019 annual rates were 40.4 opioid overdose deaths, 1287 naloxone rescue units distributed, 977.7 people received buprenorphine treatment, 546.3 people retained for more than 180 days on buprenorphine and 1266.7 high-risk opioid prescribing incidents per 100 000 population. In models adjusted for state, community age, sex, race/ethnicity, rurality, HCS intervention group assignment, 2019 rates of opioid overdose death, naloxone distribution, buprenorphine and high-risk opioid prescribing, and the ratio of opioid overdose deaths involving fentanyl, an increase in 100 people treated with buprenorphine per 100 000 population was associated with a decrease of 0.92 [95% confidence interval (CI) = -1.30 to -0.55] in the quarterly opioid overdose death rate, while an increase of 100 people retained on buprenorphine for more than 180 days per 100 000 population was associated with a decrease of 1.3 (95% CI = -1.8 to -0. 76). There were no statistically significant associations between naloxone distribution or incident high-risk opioid prescribing with change in quarterly opioid overdose death rates. CONCLUSIONS: In this exploratory analysis, increases in both buprenorphine treatment and retention were statistically significantly associated with decreases in opioid overdose death rates, after adjusting for baseline rates of buprenorphine treatment and retention.
Commentary on Comstock et al.: Here we go again-Kratom and the failure to learn from the opioid crisis.
Kolodny A
Addiction · 2026 Jun · PMID 42274132 · Publisher ↗
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The role of perceived access to cannabis in the association between friends who use cannabis and adolescent initiation: A longitudinal analysis from the Canadian COMPASS study.
Sylvestre MP, Boulanger L, Pelekanakis A … +6 more , Naja M, Dubé G, Doré I, Bélanger RE, Haddad S, Leatherdale ST
Addiction · 2026 Jun · PMID 42271491 · Publisher ↗
BACKGROUND AND AIMS: Early initiation to cannabis use in adolescence is linked to cognitive and mental health risks. Having friends who use cannabis is a strong risk factor for initiation, but the mechanisms underlying t...
BACKGROUND AND AIMS: Early initiation to cannabis use in adolescence is linked to cognitive and mental health risks. Having friends who use cannabis is a strong risk factor for initiation, but the mechanisms underlying this relationship are unclear. This study examined the role of perceived ease of access to cannabis in the association between close friends' cannabis use and cannabis initiation. DESIGN: Observational longitudinal investigation using data from the COMPASS study. SETTING: A convenience sample of 11 high schools in Québec, Canada, from 2017 to 2019. PARTICIPANTS: 1768 students who had not initiated cannabis use before 2019. MEASUREMENTS: Having ≥1 close friend who uses cannabis and perceived ease of access to cannabis were measured in 2018, while cannabis initiation in the past 12 months was assessed in 2019. Covariates measured in 2017 included sociodemographic factors, substance use history, lifestyle behaviors and school-related variables. We compared the risk of cannabis initiation across groups defined jointly by friends' cannabis use and perceived access. Generalised estimating equations with bootstrap resampling, inverse probability weighting for attrition and multiple imputation for missing data were used to estimate these associations. Natural effect models were then applied to estimate total, direct and indirect effects with initiation as the outcome and perceived access as the mediator. FINDINGS: Within the COMPASS cohort, 14% of cannabis-naive adolescents in 2018 initiated use in 2019. Using students with no close friends who use cannabis and who perceive access as difficult as the reference group, the risk difference (RD) for having at least one friend who uses cannabis while still perceiving access as difficult was 3.2 [95% confidence interval (CI) = -3.8 to 10.2]. Perceiving access as easy but having no friends who use cannabis yielded an RD of 8.4 (95% CI = 3.0-13.7). Friends' cannabis use combined with easy access acted synergistically, producing an RD of 21.6 (95% CI = 15.5-27.7). According to the natural effect models, perceived ease of access mediated about 39% of the association between having ≥1 close friend who uses cannabis and subsequent initiation, suggesting a possible explanatory pathway. CONCLUSIONS: In Canada, cannabis initiation risk appears to be highest among adolescents with both exposure to close friends who use cannabis and perceived easy access. Perceived access may help explain part of this association. Preventive strategies should address the influence of friends and accessibility through school policies, public education and stricter enforcement of access restrictions to delay adolescent cannabis use.
Pioglitazone for the treatment of alcohol use disorder: A randomized controlled trial.
Dieperink E, Anderson K, Dockter K … +3 more , Evenson M, Thuras P, Hauser P
Addiction · 2026 Jun · PMID 42271154 · Publisher ↗
BACKGROUND AND AIMS: Current medications for alcohol use disorders (AUD) are under-used and of moderate benefit; new or improved treatments are much needed. Preclinical and small clinical studies indicate that pioglitazo...
BACKGROUND AND AIMS: Current medications for alcohol use disorders (AUD) are under-used and of moderate benefit; new or improved treatments are much needed. Preclinical and small clinical studies indicate that pioglitazone, a thiazolidinedione agonist of the peroxisome proliferator-activated receptor gamma, may reduce alcohol use. The primary purpose of this study was to evaluate, in a randomized trial, the effect of pioglitazone on alcohol use and craving in adults with AUD. DESIGN: A double-blind, placebo-controlled randomized trial. SETTING: Enrollment occurred in the United States at two Veterans Affairs Health Care Centers (VAHCS) from July 2019 to March 2024. PARTICIPANTS: One hundred eighty-five Veteran men and women older than 18 years with at least a moderate AUD and current alcohol use. INTERVENTION AND COMPARATOR: Oral pioglitazone was given at dosages of 0 (placebo) (n = 92), or 45 mg (n = 93) over 14 weeks. All participants received Brief Behavioral Compliance Enhancement Treatment at each visit. MEASUREMENTS: The primary outcome measure was the number of heavy drinking days during week 14 as measured by the Timeline Follow Back (TLFB). Secondary measurements included the number of standard drinks consumed per week, the rate of no heavy drinking days over the last 8 weeks of the study, alcohol craving, anxiety, depression and post-traumatic stress disorder symptoms. Exploratory outcome included change in alcohol use based on inflammation (C-reactive protein) at baseline. FINDINGS: There was no difference between groups on the primary outcome (pioglitazone mean = 2.43, placebo mean = 2.01, difference = 0.43, 95% confidence interval = -0.25 to 1.10, P = 0.22). No differences were found between groups in secondary alcohol use measures or a measure of craving. Participants with elevated inflammation at baseline treated with pioglitazone had a greater decrease in heavy drinking days over time compared with placebo (z = 2.21, P = 0.03). Pioglitazone was safe and well tolerated. CONCLUSIONS: Pioglitazone administered to people with alcohol use disorder at a dose of 45 mg per day appears to be safe although there is no evidence that it is efficacious in reducing alcohol use, alcohol craving or any psychiatric measures.
Online prize draws and competitions: Gambling products outside the United Kingdom regulatory framework.
McGarrigle J, Torrance J, Quigley M … +1 more , Dymond S
Addiction · 2026 Jun · PMID 42267900 · Publisher ↗
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Brain reward function in young people with cannabis use disorder: A functional magnetic resonance imaging study.
Skumlien M, Greenwood LM, Arun AH … +13 more , Goodwin I, Paloubis A, Rana TT, Valera MQ, McTavish E, Abbott G, Dunsford S, Verdejo-Garcia A, Ramamurthy J, Schira MM, Solowij N, Suo C, Lorenzetti V
Addiction · 2026 Jun · PMID 42266038 · Publisher ↗
BACKGROUND AND AIMS: Cannabis use disorder (CUD) affects ~50 million people globally. Neuroscientific theories suggest that a blunted neural response to non-drug rewards is a hallmark of substance use disorders; however,...
BACKGROUND AND AIMS: Cannabis use disorder (CUD) affects ~50 million people globally. Neuroscientific theories suggest that a blunted neural response to non-drug rewards is a hallmark of substance use disorders; however, this remains untested in CUD. The current study tested whether brain reward system responses to the anticipation and feedback of monetary rewards differed in people with CUD and controls. DESIGN: Observational study using functional magnetic resonance imaging (fMRI). SETTING: Participants were recruited from universities and the community in Wollongong, Australia. PARTICIPANTS: Sixty-four individuals with CUD (20 female) and 28 controls (9 female), aged 18-32 years. MEASUREMENTS: Participants completed a monetary incentive delay task during fMRI. We compared blood-oxygen-level-dependent responses during reward anticipation and reward feedback between the CUD and control groups using hypothesis-driven region of interest analyses in brain areas implicated in reward pathways (i.e., orbitofrontal cortex, cingulum, insula, putamen, dorsal caudate, ventral striatum) and data-driven whole-brain analyses, controlling for age, sex, alcohol use, and depressive symptoms. Correlations tested associations between beta values from regions showing statistically significant group differences and severity of cannabis use measured with the Cannabis Use Disorder Identification Test (CUDIT), as well as other cannabis use and mental health measures. FINDINGS: In whole-brain analyses, the CUD group showed statistically significantly greater left medial/superior frontal activity during reward anticipation compared with the control group (p < 0.001). Activity in this region was not associated with CUDIT scores or any other cannabis use or mental health variables. All region of interest analyses were statistically non-significant (all p > 0.05). CONCLUSIONS: People with cannabis use disorder do not appear to show evidence of a hypoactive reward system on the Monetary Incentive Delay task compared with controls. There may be differences in non-reward regions, but these appear unrelated to cannabis use severity.
Discontinuation of medications for alcohol use disorder in the United States: Patient, prescriber and medication predictors.
Busch AB, Hodgkin D, Kennedy-Hendricks A … +4 more , Ritter GA, Uscher-Pines L, Horgan CM, Huskamp HA
Addiction · 2026 Jun · PMID 42266032 · Publisher ↗
BACKGROUND AND AIMS: Little is known about medication for alcohol use disorder (MAUD) adherence. The goal of this study was to examine patient, prescriber and medication characteristics associated with time to discontinu...
BACKGROUND AND AIMS: Little is known about medication for alcohol use disorder (MAUD) adherence. The goal of this study was to examine patient, prescriber and medication characteristics associated with time to discontinuation of MAUD. DESIGN, SETTING AND PARTICIPANTS: Observational cohort study from Optum Labs de-identified administrative claims data of a United States national sample of commercial and Medicare Advantage enrollees with alcohol use disorder (AUD) who initiated MAUD (naltrexone, acamprosate, disulfiram, topiramate) January 2017-June 2024 (n = 51 915). Using an accelerated failure time (AFT) log logistic survival model, we examined MAUD discontinuation, adjusting for patient demographic and clinical characteristics established within 6 months prior to or on date of initiation, specific MAUD initiated with, MAUD prescriber type and study year. We defined effect size of at least 10% change in AFT survival (i.e. AFT estimates > +/- 0.100) as being of clinical significance. MEASUREMENTS: Time-to-discontinuation of MAUD, defined as a gap in pharmacy fills or medication administrations of MAUD days-supply >7 days. FINDINGS: In unadjusted analyses, the median time to MAUD discontinuation was 30 days; median days-supply prior to discontinuation varied by medication (e.g. 30 days for acamprosate and naltrexone, 56 for disulfiram, 60 for topiramate). Adjusted analyses showed that among the patient characteristics, longer MAUD duration was associated with older age [e.g. AFT duration estimate (95% confidence interval) for age ≥65 vs. 18-30 = 0.164 (0.088-0.240)], while lower county median household income was associated with shorter duration [e.g. <$40 000 vs. ≥$200 000: -0.106 (-0.136 to -0.076)]. MAUD initiations via topiramate (vs. naltrexone) were associated with longer duration [0.339 (0.311-0.366)], as were initiations via disulfiram [0.103 (0.076-0.131)]. MAUD duration increased in recent study years, except 2024 [(e.g. 2023 vs. 2017 = 0.116 0.087-0.144)]. CONCLUSIONS: Among the few individuals in the United States who receive medication for alcohol use disorder (MAUD), early discontinuation is common, minimizing the opportunity for MAUD to support patients' recovery goals. While MAUD duration has increased in recent years, the improvements are small.
Optimizing outpatient pharmacologic treatment for veterans with alcohol use disorder using an academic detailing approach for primary care providers in the United States Department of Veterans Affairs: A retrospective quasi-experimental study.
Bounthavong M, Lau MK, Popish SJ … +8 more , Gray J, Chen A, Graham R, Jubran N, Stout MP, Schultz E, Kay CL, Christopher MLD
Addiction · 2026 Jun · PMID 42248693 · Publisher ↗
BACKGROUND AND AIMS: Although evidence-based medications for alcohol use disorder (AUD) exist, they are alarmingly under-prescribed, particularly for United States (US) veterans. Only 9.5% of veterans who had an alcohol-...
BACKGROUND AND AIMS: Although evidence-based medications for alcohol use disorder (AUD) exist, they are alarmingly under-prescribed, particularly for United States (US) veterans. Only 9.5% of veterans who had an alcohol-related overdose death were prescribed a medication for alcohol use disorder (MAUD) in the year prior. Academic detailing (AD), an educational outreach targeting primary care providers (physicians, nurse practitioners and physician assistants), was implemented at the US Department of Veterans Affairs (VA) to improve MAUD prescribing rates among veterans with AUD. This study evaluated the effectiveness of AD outreach to VA primary care providers (PCPs) on MAUD prescribing rates among US veterans with AUD. DESIGN: We conducted a retrospective, quasi-experimental study using a staggered difference-in-differences approach to evaluate the difference in MAUD prescribing between VA PCPs who received and did not receive an AD outreach at VA between 1 January 2023 and 31 December 2023. SETTING: US Department of Veterans Affairs, the largest integrated national healthcare system in the United States. PARTICIPANTS: A total of 5153 VA PCPs; 3436 (66.7%) physicians, 1385 (26.9%) nurse practitioners and 332 (6.4%) physician assistants. MEASUREMENTS: Clinician-level outpatient MAUD prescribing rates (number of prescriptions per 100 veterans with AUD), which included prescriptions of acamprosate, disulfiram, naltrexone and topiramate. Mean differences in MAUD prescribing rates between PCPs were reported alongside their 95% confidence interval (CI). FINDINGS: VA PCPs who received an AD encounter were associated with a statistically significant mean increase of 8.10 outpatient MAUD prescriptions per 100 veterans with AUD (95% CI = 5.20-11.01) compared with those who did not receive an AD encounter after adjusting for clinician-level characteristics. This was driven mainly by outpatient prescriptions of topiramate (+4.89; 95% CI = 3.18-6.60), naltrexone (+2.65; 95% CI = 0.90-4.40) and disulfiram (+0.43; 95% CI = 0.03-0.83). In the unadjusted model, there was a statistically significant increase in MAUD prescribing (+1.96; 95% CI = 0.25-3.68), but no statistically significant differences were reported for individual medications. CONCLUSIONS: Between 01 January 2023 and 31 December 2023, primary care providers at the United States Department of Veterans Affairs who received academic detailing outreach were associated with increased medication for alcohol use disorder prescribing rates compared with those who did not receive academic detailing outreach. Academic detailing outreach appears to improve prescribing rates of medication for alcohol use disorder within the US Department of Veterans Affairs for veterans with alcohol use disorder, but careful adjustments of clinician-level characteristics are needed to mitigate potential bias.
Performance-enhancing drugs and the urgent need for data.
Kutscher E
Addiction · 2026 Jun · PMID 42237740 · Publisher ↗
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Impact of bariatric surgery on alcohol-use disorder and alcohol-related liver disease: A retrospective study.
Williams TJ, Palmer AJ, Connor JP … +2 more , Holtmann G, Clark PJ
Addiction · 2026 Jun · PMID 42233260 · Publisher ↗
BACKGROUND AND AIMS: Increased risk of alcohol dependence is recognised following bariatric surgery. Modified gastrointestinal anatomy and neurohormonal profiles lead to altered alcohol metabolism, peak blood alcohol con...
BACKGROUND AND AIMS: Increased risk of alcohol dependence is recognised following bariatric surgery. Modified gastrointestinal anatomy and neurohormonal profiles lead to altered alcohol metabolism, peak blood alcohol concentrations and enhanced reward circuits and cravings. For patients with metabolic associated fatty liver disease, bariatric surgery has been shown to reduce liver fibrosis; however, the impact of bariatric surgery on alcohol consumption and consequent liver fibrosis has not been well-characterised using validated measures. This study examined the changes in alcohol consumption patterns, alcohol dependence and validated liver fibrosis measures before and after bariatric surgery. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study assessing patients seeking treatment for alcohol problems with a history of gastric sleeve (GS) or Roux-en-Y Gastric Bypass (RYGB) in a quaternary hospital in Brisbane, Australia. MEASUREMENTS: Validated measures of alcohol dependence [Alcohol Use Disorders Identification Test (AUDIT) and brief Michigan Alcohol Screening Test (bMAST)] and non-invasive liver fibrosis (FIB4 and APRI) were compared pre- and post-surgery. FINDINGS: Twenty patients were identified with prior GS and 10 patients with RYGB. Following bariatric surgery, body mass index was reduced by 14.5 (±9.39) kg/m. Metabolic co-morbidities were less frequent post-surgery. Pre-surgery, the mean AUDIT score was 10.2 ± 8.9, with 9 patients having scores indicative of alcohol dependence. Mean AUDIT increased statistically significantly post-surgery (18.1, standard deviation ±11.4; P < 0.001) with 29 patients meeting criteria for alcohol dependence. AUDIT components relating to both consumption (volume, frequency) and harmful consequences of alcohol increased following surgery. Despite surgery lowering metabolic liver fibrosis risk, worsened liver fibrosis was observed [mean FIB4 (0.98 ± 1.8) and APRI (0.41 ± 0.83) increased; P < 0.05]. CONCLUSION: Within a cohort of adults seeking treatment for alcohol problems, increases in alcohol consumption and alcohol-related harm were observed following bariatric surgery. Despite improvement in risk factors for metabolic-associated fatty liver disease after surgery, non-invasive markers for hepatic fibrosis worsened, likely in the setting of harmful alcohol intake and associated liver injury. This supports the role of bariatric surgery pre-operative assessment and post-operative follow-up to identify and manage alcohol-related problems and associated liver disease risk.
Keeping stimulant-induced psychosis in sight.
Arunogiri S
Addiction · 2026 Jun · PMID 42227317 · Publisher ↗
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Comparative effectiveness of alternative times to opioid agonist treatment taper initiation on taper completion and all-cause mortality among people with opioid use disorder: A retrospective population-based target trial emulation study in British Columbia, Canada, 2010-2020.
Yan R, Min JE, Kurz M … +11 more , Seaman SR, Bach P, Greenland S, Gustafson P, Karim ME, McCandless L, Platt RW, Siebert U, Socías ME, Xie H, Nosyk B
Addiction · 2026 Jun · PMID 42227316 · Publisher ↗
BACKGROUND AND AIMS: Opioid use disorder (OUD) treatment guidelines worldwide recommend opioid agonist treatment (OAT) as a long-term, potentially indefinite treatment for managing OUD. However, many individuals express...
BACKGROUND AND AIMS: Opioid use disorder (OUD) treatment guidelines worldwide recommend opioid agonist treatment (OAT) as a long-term, potentially indefinite treatment for managing OUD. However, many individuals express a strong interest in eventually tapering fully off treatment. Current clinical practice guidelines offer relatively limited guidance or evidence on the appropriate timing to initiate a taper. We aimed to determine the safety and comparative effectiveness of different times from completion of OAT induction at which tapering could be considered to maximize the likelihood of taper completion and minimize the risk of mortality. DESIGN: Population-based retrospective observational study and target trial emulation based on nine linked administrative health databases. SETTING: British Columbia, Canada, from 1 January 2010 to 17 March 2020. PARTICIPANTS: Individuals (identified via linkage of nine provincial health administrative databases) completing OAT induction with methadone or buprenorphine/naloxone who were ≥18 years of age with no known pregnancy, no history of cancer or palliative care and not currently incarcerated. We executed both incident-user (no OAT experiences) and prevalent-new-user (no OAT within the past month) analyses. INTERVENTION AND COMPARATOR: The time between completed OAT induction and taper initiation: <3 months, 3-6 months, 6-12 months, compared with 12-48 months. MEASUREMENTS: The primary outcomes were completed taper (reaching a final daily dose of ≤5 mg/day for methadone, or ≤2 mg/0.5 mg/day for buprenorphine/naloxone) and all-cause mortality. A clone-censor-weight approach was used to adjust for informative censoring and balance baseline characteristics between the groups. Logistic regression and pooled logistic regression models were used to estimate odds ratios (ORs) for completed taper and hazard ratios (HRs) for all-cause mortality, respectively, each with 95% compatibility ('confidence') intervals. FINDINGS: We included 17 726 incident users (buprenorphine/naloxone: 36.9%) and 49 515 treatment episodes (buprenorphine/naloxone: 31.2%) from 31 231 prevalent new users who completed induction in the analyses. Among prevalent new users, beginning tapering within 3 months, between 3 and 6 months and between 6 and 12 months of completing induction was associated with an increased likelihood of completed taper [methadone: <3 months: adjusted odds ratio (aOR) = 3.09, 95% compatibility interval (95% CI) = 2.58-3.68; buprenorphine/naloxone: <3 months: aOR = 6.90, 95% CI = 5.19-9.16] but a higher risk of mortality [methadone: <3 months: adjusted hazard ratio (aHR) = 1.18, 95% CI = 1.12-1.25; buprenorphine/naloxone: <3 months: aHR = 1.12, 95% CI = 1.05-1.19], compared with initiating a taper between 12 and 48 months. Similar results were found among incident users. CONCLUSIONS: Although initiating early tapering off opioid agonist treatment may be associated with a greater likelihood of taper completion, this practice also increases the risk of mortality.
Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement.
Friedman JR, Palamar JJ, Ciccarone D … +4 more , Gaines TL, Borquez A, Shover CL, Strathdee SA
Addiction · 2026 Jun · PMID 42227062 · Publisher ↗
AIMS: To characterize decreases in overdose death rates in the United States (US) between 2023 and 2024 by race/ethnicity, and substance involvement. DESIGN: Population-based study of national death records accessed via...
AIMS: To characterize decreases in overdose death rates in the United States (US) between 2023 and 2024 by race/ethnicity, and substance involvement. DESIGN: Population-based study of national death records accessed via the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) platform using an underlying cause of death approach. SETTING: US. PARTICIPANTS/CASES: All individuals who died from drug overdose between January 1999 and December 2024. MEASUREMENTS: Annual overdose deaths per 100 000 population. Year of occurrence of overdose death, substance involvement, race/ethnicity of decedents. FINDINGS: After many years of increases, the US overdose death rate dropped 24.4% between 2023 and 2024. Decreases reflected declining illicit fentanyl-involved deaths (with and without stimulant involvement). The fourth wave of the US overdose crisis-defined by deaths involving fentanyl together with stimulants-declined for the first time in 2024. Despite overall decreases, deaths involving stimulants without fentanyl and deaths involving xylazine continued to represent a growing fraction of overdose fatalities. Non-Hispanic Black and African Americans had the largest decrease in death rates in 2023-2024, falling by 29.3% but remaining elevated at 36.0 per 100 000, 1.51 times higher than the national average of 23.7 per 100 000. Non-Hispanic American Indian and Alaska Native individuals had the highest overdose death rates rate in 2024, at 50.8 per 100 000, 2.15 times the national average rate, and experienced a below-average relative decrease of 20.1%. CONCLUSIONS: All four previously defined waves of the US overdose crisis appear to be in decline, as deaths involving illicit fentanyl, with and without stimulants, dropped sharply between 2023 and 2024. Concurrently, the fraction of overdose deaths involving stimulants without fentanyl and those involving xylazine continued to increase. While racial disparities in drug overdose death rates narrowed slightly during this period, large gaps remain, with the highest overdose death rates among American Indian, Alaska Native, and Black individuals.
Tobacco and cannabis use in the young 'Not in Employment, Education or Training' population: A systematic review and meta-analysis.
Eyraud C, Collin C, Martin P … +4 more , Alberti C, Minary L, Dumas A, Le Roux E
Addiction · 2026 Jun · PMID 42225563 · Publisher ↗
BACKGROUND AND AIMS: NEET (Not in Employment, Education or Training) youth represent a vulnerable population from a public health perspective, facing multiple health challenges, including elevated substance use. Tobacco...
BACKGROUND AND AIMS: NEET (Not in Employment, Education or Training) youth represent a vulnerable population from a public health perspective, facing multiple health challenges, including elevated substance use. Tobacco and cannabis are the most commonly used psychoactive substances among young people, with early initiation associated with long-term health and social consequences. While evidence suggests associations between NEET status and substance use, data remain limited regarding patterns of use and potential variations across different NEET profiles. This study aimed to characterise tobacco and cannabis use within the NEET population, taking into account the diversity of profiles, and to compare it with that of the general population, including employed youth and students, in order to inform targeted prevention strategies. METHODS: A systematic review and meta-analysis included observational studies examining tobacco and cannabis use among NEET youth aged 15-29 years. A search was conducted for observational studies available on PubMed, PsycINFO, Cairn and Web of Science databases and published between 1999 and 2025. Analyses studied the variations in use among NEET profiles and compared NEET against employed youth, student and general population controls. Random-effects models generated pooled crude odds ratios. Sensitivity and subgroup analyses were conducted based on study quality, gender and type of comparison population. RESULTS: Twenty-five studies were included and analysed, including a total of 91 085 individuals. A statistically significant association between NEET status and both tobacco use [odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.46-2.53] and current cannabis use (OR = 2.14, 95% CI = 1.68-2.71) was found. Current smoking was statistically significantly more prevalent among NEET than among students (OR = 3.05, 95% CI = 2.31-4.03), but not statistically significantly different compared with young workers (OR = 1.10, 95% CI = 0.91-1.34). NEET demonstrated statistically significantly higher cannabis use compared with both students (OR = 1.81, 95% CI = 1.34-2.44) and workers (OR = 1.67, 95% CI = 1.21-2.31). A higher prevalence of cannabis use disorder among young people with NEET status (31.93%) was observed compared with their non-NEET peers (12.12%), but no statistically significant association was found. CONCLUSIONS: Youth Not in Employment, Education or Training (NEET) appear to show higher tobacco and cannabis use compared with their peers. Given these findings, targeted prevention strategies addressing substance use in NEET populations are essential to reduce social health inequities.
Can Thailand replace a commercialised cannabis market for adult use with a medical prescription model?
Kalayasiri R, Ratta-Apha W, Wilson J … +2 more , Hall W, Freeman TP
Addiction · 2026 Jun · PMID 42220013 · Publisher ↗
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#NoIDVape: A content analysis of illicit vape messaging in young people's information sources.
Bray E, Gentry S, Varley A … +3 more , Notley C, Webb S, Ward E
Addiction · 2026 May · PMID 42218916 · Publisher ↗
BACKGROUND AND AIMS: In recent years, the increased prevalence of youth vaping in the United Kingdom (UK) may have coincided with a proliferation in the use of 'illicit' (unregulated) vapes. Media or educational content...
BACKGROUND AND AIMS: In recent years, the increased prevalence of youth vaping in the United Kingdom (UK) may have coincided with a proliferation in the use of 'illicit' (unregulated) vapes. Media or educational content about illicit vaping aimed at young people is scarce and poorly understood. This study aimed to systematically assess the content of both TikTok videos and educational resources relating to illicit vaping. METHODS: A systematically conducted analysis of educational and social media resources. Manual searches were conducted in the UK to collect URLs and metadata for publicly available TikTok videos using eight illicit vaping-related hashtags. Video content was coded across inductively derived thematic domains. Educational resources were collected via relevant search terms on Google; illicit vape content was appraised across five domains and the quality of each resource was assessed. RESULTS: A total of 58 TikTok videos were categorised across nine thematic domains. The most prevalent themes were 'Apathy Towards Law' (57%), 'Entertain/Humour' (50%) and 'Sub-culture and Shared Experience' (50%), generating a combined total of 21 million likes. Educational resources were rated as 'good' quality overall (56%) but underperformed in domains related to 'Illicit Vapes Health Risk Depiction' and 'Relevance and Appeal to Youth'. In contrast to the 'homemade', 'entertaining' and sometimes 'glamourising' presentation of the TikTok videos, educational resources adopted a serious tone and were often disengaging. CONCLUSIONS: Illicit vaping content differs between TikTok videos and educational resources, exhibiting differences in sentiment, information and youth appeal. TikTok videos typically receive high engagement and frequently depict themes of apathy towards the law, entertainment and shared experience. Educational resources are generally of good quality but contain limited information on illicit vape health risks and lack youth relevance.
Beyond treatment response: Injection-site reactions as part of the extended-release buprenorphine experience.
Cabé J, Brousse G
Addiction · 2026 May · PMID 42216518 · Publisher ↗
Abstract loading — click title to view on PubMed.
Commentary on Norström and Leifman: A welcome contribution and an invitation to further research.
Rossow I
Addiction · 2026 Jul · PMID 42216512 · Publisher ↗
Abstract loading — click title to view on PubMed.
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