Drug And Alcohol Dependence[JOURNAL]
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200 papers
Beneficial effects of the rapid vs. standard procedure for injection naltrexone initiation operate through increased adjunctive medication use.
Rudolph KE, Inose S, Williams NT … +4 more , Díaz I, Nunes EV, Shulman M, Bisaga A
Drug Alcohol Depend · 2026 Jul · PMID 42090840 · Full text
OBJECTIVE: To estimate the extent to which increased use of clonidine and benzodiazepines is associated with the beneficial effect of the rapid versus standard procedure for induction onto extended-release injectable nal...
OBJECTIVE: To estimate the extent to which increased use of clonidine and benzodiazepines is associated with the beneficial effect of the rapid versus standard procedure for induction onto extended-release injectable naltrexone (XR-NTX). METHODS: We conducted two mediation analyses using a doubly robust nonparametric estimation approach. First, we estimated the extent to which the difference in XR-NTX initiation rates comparing the rapid vs. standard induction operated through: (1) differences in categorized daily doses of clonidine and benzodiazepines averaged over the first 3 days of the study, and (2) differences in categorized clonidine and benzodiazepine usage during each of the first 5 days, treated as time-varying mediators, and accounting for time-varying confounders and competing events. RESULTS: Rapid vs. standard induction increased the probability of initiating XR-NTX by day 14 by an estimated 42.4 percentage points (95% CI: 34.6, 50.2), and the natural indirect effect (i.e., mediated effect) through clonidine and benzodiazepine use was associated with a 24.2 percentage point (95% CI: 10.3, 38.0) increased the initiation probability, explaining 57.1% of the total effect. Estimates were similar in the longitudinal mediation analysis. CONCLUSIONS: Use of clonidine and benzodiazepines proactively and at higher dosages during the initial days of inpatient medically managed withdrawal, in conjunction with attentive safety monitoring, could improve XR-NTX initiation rates as part of a rapid induction procedure.
GHSR antagonist LEAP2 concentrations negatively correlate with alcohol craving and are modulated by alcohol exposure: Evidence from human and rat studies.
Leko AH, Farokhnia M, Tressler EH … +10 more , Vendruscolo JCM, Kryszak LA, Jackson SN, Farinelli LA, Jennings O, Yang Z, Haass-Koffler CL, Vendruscolo LF, Liangpunsakul S, Leggio L
Drug Alcohol Depend · 2026 Jul · PMID 42090839 · Publisher ↗
BACKGROUND: Despite its clinical significance, pharmacological treatment options for alcohol use disorder (AUD) remained limited, which highlights the need for novel therapeutic targets. The ghrelin system has emerged as...
BACKGROUND: Despite its clinical significance, pharmacological treatment options for alcohol use disorder (AUD) remained limited, which highlights the need for novel therapeutic targets. The ghrelin system has emerged as an important regulator of alcohol craving and intake. Liver-expressed antimicrobial peptide 2 (LEAP2) has recently been identified as an endogenous ghrelin receptor (GHSR) antagonist that influences metabolic and reward-related pathways. METHODS: As a secondary analysis of five different clinical trials, we measured LEAP2 concentrations in the collected blood samples and examined their association with alcohol craving and the effects of both acute and chronic alcohol use on LEAP2. In addition, we complemented these clinical trial analyses by conducting preclinical experiments in wild-type and GHSR-KO Wistar rats to investigate the effects of alcohol and ghrelin on LEAP2 concentrations. RESULTS: In humans, LEAP2 concentrations negatively correlated with both priming- and cue-induced alcohol craving. Acute alcohol administration reduced LEAP2 concentrations 90min after oral alcohol intake, a response that was attenuated by co-administration of the GHSR inverse agonist PF-5190457. An intraperitoneal alcohol administration after a pre-treatment with ghrelin reduced LEAP2 concentrations in wild-type but not GHSR-KO Wistar rats. In contrast to acute alcohol administration, LEAP2 concentrations did not differ between people with alcohol use disorder and healthy controls and were unaffected by evidence of hepatocyte injury and alcohol abstinence. CONCLUSIONS: These results enhance our understanding of the ghrelin system, particularly LEAP2, with regard to alcohol craving and consumption. This work may inform the development of novel interventions for alcohol use disorder.
Incidence of substance use disorders and comorbidities in the All of Us Research Program.
Parker MA, Ahmedani BK, Yeh HH
Drug Alcohol Depend · 2026 Jul · PMID 42068725 · Full text
BACKGROUND: Substance use disorders (SUDs) are highly associated with other mental health conditions and disparities exist across sociodemographic characteristics. We aimed to estimate the incidence of specific SUDs and...
BACKGROUND: Substance use disorders (SUDs) are highly associated with other mental health conditions and disparities exist across sociodemographic characteristics. We aimed to estimate the incidence of specific SUDs and comorbidities with United States electronic health record data. METHODS: We harnessed data from the All of Us Research Program cohort from Jan 1, 2017 to Jun 30, 2022 (N = 266,472). We identified newly documented SUDs after a two-year washout period, along with related mental health diagnoses. Multivariate logistic regression models estimated associations between incident SUDs and comorbidities. RESULTS: Participants included 160,792 females (60.3%) aged 51.6 years on average [SD= 16.7]. The incidence of any SUD was 4.8%; among these, 74.4% had at least one mental health comorbidity. Alcohol (1.6%) and cannabis use (1.6%) disorders were the most common. Individuals with newly documented SUDs (vs. non-SUD) were more often male, Black, socioeconomically disadvantaged, and unmarried (all p < 0.001). Overall, anxiety (25.3%) and depression (23.1%) were the most frequent comorbidities, though the prevalence of comorbid mental health conditions ranged from 48% to 77% across SUD subtypes. Most other mental health conditions were associated with elevated odds of newly documented SUDs (AOR range=4.6-9.7, p < 0.001), particularly for stimulant, cocaine, and opioid use disorders. CONCLUSIONS: Newly documented SUDs in this diverse cohort frequently co-occurred with other mental health conditions, with diagnostic patterns varying across sociodemographic groups. Findings underscore the importance of integrated behavioral health screening and interventions that account for comorbidity. These patterns further highlight the need for strategies that enhance equitable access to prevention and treatment for individuals with SUDs.
Care trajectories among people with opioid use disorder after release from New York City jails: A state sequence analysis approach.
Cherian T, Bórquez I, Krawczyk N … +13 more , Katyal M, Goldfeld KS, Wiewel E, Khan M, Braunstein SL, Murphy SM, Jalali A, Oyemakinde B, Jeng PJ, Rosner Z, MacDonald R, Lee JD, Lim S
Drug Alcohol Depend · 2026 Jul · PMID 42066528 · Publisher ↗
BACKGROUND: Individuals with opioid use disorder (OUD) may experience fewer barriers to treatment following incarceration if offered in-jail medications for OUD (MOUD). We aimed to identify care trajectories of community...
BACKGROUND: Individuals with opioid use disorder (OUD) may experience fewer barriers to treatment following incarceration if offered in-jail medications for OUD (MOUD). We aimed to identify care trajectories of community OUD treatment after incarceration and examine the association between receiving in-jail MOUD and experiencing specific community treatment trajectories. METHODS: This retrospective cohort study using matched New York City (NYC) health care administrative data included adults with OUD incarcerated on or after May 2011 and discharged during 2014-2017. We defined states of community OUD treatment at the weekly level over one year following index jail discharge and performed state sequence analysis (SSA) to identify trajectories of treatment after jail and assessed the influence of receiving in-jail MOUD on treatment trajectories. RESULTS: Of 14,923 eligible individuals, 26.2% received in-jail MOUD. SSA identified eight clusters of community care trajectories: continuous methadone treatment (9.7%), methadone treatment discontinuation (3.7%), methadone treatment and reincarceration (6.7%), methadone treatment initiation (4.8%), continuous reincarceration (3.5%), short reincarceration with little community treatment (20.3%), long reincarceration with little community treatment (7.0%), and no community OUD treatment or reincarceration (44.5%). Receiving in-jail MOUD was associated with belonging to the continuous methadone treatment cluster compared to the no community OUD treatment or reincarceration cluster (adjusted OR: 12.5, 95% CI: 9.9-15.7). CONCLUSION: We identified eight unique patterns of community OUD treatment after jail release. Receipt of in-jail MOUD was associated with belonging to the continuous methadone treatment cluster. These findings suggest that provision of in-jail MOUD could improve methadone uptake in the community.
HIV pre-exposure prophylaxis among people initiating buprenorphine for opioid use disorder in the ambulatory setting: A retrospective cohort study.
Tilhou AS, Wang J, George ST … +2 more , White L, Assoumou SA
Drug Alcohol Depend · 2026 Jul · PMID 42066527 · Publisher ↗
INTRODUCTION: Buprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD. HIV prevention, particularly pre-expo...
INTRODUCTION: Buprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD. HIV prevention, particularly pre-exposure prophylaxis (PrEP), represents a vital service for persons with OUD due to HIV risk associated with injection drug use and condomless sex. Evaluating the integration of BUP treatment and HIV prevention is an important step to further optimize care for patients with OUD. METHODS: This retrospective cohort study used pharmacy claims from the Merative™ MarketScan® Research Databases, 2014-2022, to examine use of PrEP among new BUP treatment episodes over the first nine weeks of treatment. We excluded BUP episodes from individuals with probable HIV based on diagnosis or medications indicated for HIV in the past 365 days. Clinical indications for PrEP were identified based on past 365-day diagnosis of sexually transmitted infections or serious injection-related infections. RESULTS: Of 119,863 BUP episodes representing 76,377 individuals, 102 (0.1%) involved PrEP during BUP treatment. Most of these episodes (71%) involved PrEP in the 30 days prior to BUP initiation. Only 6% of the sample exhibited diagnoses indicating risk for HIV. Of these, only 0.2% involved PrEP during the BUP episode. CONCLUSIONS: Findings from this retrospective cohort study identify a major gap in PrEP use for individuals with OUD and documented HIV risk. Aligning HIV prevention and BUP treatment is an important opportunity to enhance health for patients with OUD.
Association between state cannabis laws and opioid outcomes: A systematic review.
Fink DS, Gorfinkel L, Gutkind S … +12 more , Bachowski D, Mannes ZL, Livne O, Malte C, Bruzelius E, Olfson M, Martins SS, Cerdá M, Keyhani S, Saxon AJ, Wall M, Hasin DS
Drug Alcohol Depend · 2026 Jul · PMID 42061001 · Full text
BACKGROUND: Through increasing cannabis availability, state cannabis legalization has been posited as one potential solution to the opioid crisis by providing an alternative to long-term opioid use for treating chronic p...
BACKGROUND: Through increasing cannabis availability, state cannabis legalization has been posited as one potential solution to the opioid crisis by providing an alternative to long-term opioid use for treating chronic pain. Forty U.S. states have legalized cannabis for medical use and 25 for recreational use. We systematically reviewed the literature to investigate the relationship of state medical and recreational cannabis legalization (MCL and RCL, respectively) to rates of opioid prescriptions, nonmedical use, opioid use disorder (OUD), opioid-related hospitalizations and emergency department visits, and overdose deaths. METHODS: We searched EconLit, EMBASE, MEDLINE, and Web of Science Core Collection for English-language studies published through 10/21/25 that estimated MCL or RCL enactment effects on opioid outcomes compared to states that did not enact such laws. This study is registered with PROSPERO, CRD42023416119. FINDINGS: Of 43 eligible studies, 18 investigated MCL, 11 investigated RCL, and 14 investigated both. Findings on MCL, RCL and opioid prescribing were mixed. No study found decreases in non-medical opioid use after MCL enactment; only one study found decreased non-medical use after RCL enactment. No studies found that MCL or RCL decreased OUD. MCL enactment was associated with lower opioid overdose mortality rates in earlier but not more recent studies; studies of RCL and opioid overdose fatalities had inconsistent results. INTERPRETATIONS: The mixed study findings suggest that MCL and RCL are just two factors in a complex set of influences on opioid outcomes that require further study. Meanwhile, cannabis legalization should not be considered an effective policy for curbing the opioid epidemic.
Implementation of addiction consult services and bridge clinics in the HEALing communities study in Massachusetts.
Weinstein ZM, Jadovich E, Drainoni ML … +7 more , LaRochelle M, Yan S, Lee J, Bettano A, Beers D, Walley AY, Samet JH
Drug Alcohol Depend · 2026 Jul · PMID 42033894 · Publisher ↗
INTRODUCTION: Addiction Consult Services (ACS) and bridge clinics are hospital-based intervention strategies to expand access to medication for opioid use disorder (MOUD) which many Massachusetts communities adopted duri...
INTRODUCTION: Addiction Consult Services (ACS) and bridge clinics are hospital-based intervention strategies to expand access to medication for opioid use disorder (MOUD) which many Massachusetts communities adopted during the HEALing Communities Study (HCS). This study describes the implementation of HCS hospital-based MOUD intervention strategies using the RE-AIM framework. METHODS: Post-hoc analysis of community ACS and bridge clinic implementation as part of a waitlist cluster randomized controlled trial of sixteen Massachusetts HCS communities across Wave 1 (randomized to receive intervention first) and Wave 2 (wait-list controls received the intervention second). The intervention was ACS and/or bridge clinics. Main measures include Adoption (planned to implement); Implementation (served at least one patient); Reach (median number of patients served per month); Effectiveness (receipt of MOUD within 14 days of opioid-related emergency or hospital encounter using Massachusetts Public Health Data Warehouse) and Maintenance (serving patients in the year post-study intervention). RESULTS: Eleven communities adopted 17 ACS and bridge clinics. Among the 17 adopted, 14 (7 ACS and 7 bridge clinics) were implemented. ACS reached a median of 16 patients/month and bridge clinics a median of 51 patients/month. Hospitals that implemented ACS and bridge clinics first did not have significantly higher 14-day post hospital MOUD rates compared to waitlisted hospitals. All 14 implemented ACS and bridge clinics were maintained post-intervention. CONCLUSIONS: ACS and bridge clinics were widely adopted intervention strategies, and the majority of programs were implemented and sustained, demonstrating the perceived value of these services to their communities.
Addressing diagnostic code variability in intimate partner violence surveillance through natural language processing: Evidence from substance use disorder populations.
Harris DR, Clements BP, Anthony N … +3 more , Bhullar M, Quesinberry D, Delcher C
Drug Alcohol Depend · 2026 Jul · PMID 42033893 · Publisher ↗
BACKGROUND: Intimate partner violence (IPV) and substance use disorders (SUDs) represent major public health challenges, yet identifying IPV cases in electronic health records (EHR) remains difficult due to inconsistent...
BACKGROUND: Intimate partner violence (IPV) and substance use disorders (SUDs) represent major public health challenges, yet identifying IPV cases in electronic health records (EHR) remains difficult due to inconsistent documentation practices and variable billing procedures. METHODS: We constructed three patient cohorts based on SUDs or overdoses involving stimulants, opioids, or both from the EHR. Using the Open Health Natural Language Processing (OHNLP) toolkit, we developed a rule-based classifier to identify IPV in clinical notes. We validated classifier performance through manual chart review and linked cohorts to Kentucky's fatal overdose surveillance system to examine the relationship between IPV and fatal overdose risk. RESULTS: We analyzed 15,557,678 clinical notes from 29,447 patients with SUDs (2017-2023). Our classifier demonstrated strong performance: recall 0.91, precision 0.85, F1-score 0.89. IPV was detected in 5.6% of patients via NLP compared to 0.2-2.5% using various ICD-10-CM diagnostic code definitions; this variation reflected different levels of code specificity across published definitions. Notably, 90% of NLP-detected cases lacked corresponding diagnostic codes. The cohort with both stimulant and opioid disorders showed the highest IPV prevalence (7.5%), followed by opioid-only (5.2%) and stimulant-only (4.8%). Among fatal overdose cases, IPV documentation rates (4.4% via NLP, 5.1% via diagnostic codes) were similar to the overall cohort, suggesting missed intervention opportunities. CONCLUSION: NLP-based analysis of EHR clinical notes identified substantially more IPV cases than diagnostic codes alone. The elevated IPV prevalence among people with polysubstance use highlights a particularly vulnerable population requiring integrated screening and intervention strategies. Routine NLP surveillance could significantly improve IPV case identification in populations with SUDs.
A geospatial analysis of access to syringe services programs in the United States, 2023.
Humphrey JL, Patel SV, Strack CN … +5 more , Lindstrom M, Saunders ME, LaKosky P, Kral AH, Lambdin BH
Drug Alcohol Depend · 2026 Jul · PMID 42033892 · Publisher ↗
BACKGROUND: Syringe services programs (SSPs) deliver essential services to people who use drugs, including safer drug use supplies, infectious disease testing, and naloxone distribution. Geographic proximity influences S...
BACKGROUND: Syringe services programs (SSPs) deliver essential services to people who use drugs, including safer drug use supplies, infectious disease testing, and naloxone distribution. Geographic proximity influences SSP utilization and health outcomes, yet no national measures of travel-time access exist. We estimated geographic access to SSPs across the United States and assessed alignment with factors related to need. METHODS: We conducted a cross-sectional analysis of 701 SSPs operating in 2023 and listed in the Syringe Services Programs in the U.S. DATASET: SSP addresses were geocoded; 30-minute driving and 20-minute walking isochrones were generated and spatially intersected with Census division, state, county-level centers of population, adult population, rurality, and lagged drug overdose mortality rates RESULTS: Overall, 63% of U.S. adults lived within a 30-minute drive of an SSP, but only 2.5% within a 20-minute walk. Drive-time access varied by rurality (urban: 93%, suburban: 62%, rural: 18%) and overdose mortality level (high: 70%, moderate: 61%, low: 62%). Walk-time access was extremely limited across all strata, ranging from 0.7% in rural counties to 9.6% in urban counties. Only seven states achieved > 67% drive-time coverage across all mortality levels. Access was generally higher in counties with greater need, though 30% and 92% of adults in high-mortality counties remained beyond 30-minute drive or 20-minute walk, respectively. CONCLUSIONS: Substantial geographic barriers limit SSP access, particularly for walking and in rural areas. Expanding SSP implementation and alternative delivery models (mobile units, mail-based distribution, vending machines) are needed to ensure equitable access to harm reduction services.
Plasma cannabinoid pharmacokinetics following the inhalation of vaporised cannabis with and without cannabidiol.
Hall D, Chesney E, Mokrysz C … +7 more , Caldwell A, Halket J, Petrilli K, Wall MB, Curran HV, Freeman TP, Lawn W
Drug Alcohol Depend · 2026 Jul · PMID 42033891 · Publisher ↗
BACKGROUND: The presence of cannabidiol (CBD) in cannabis may alter cannabinoid pharmacokinetics, however previous research has produced mixed results. Furthermore, no prior research has explored how cannabinoid pharmaco...
BACKGROUND: The presence of cannabidiol (CBD) in cannabis may alter cannabinoid pharmacokinetics, however previous research has produced mixed results. Furthermore, no prior research has explored how cannabinoid pharmacokinetics are moderated by age. AIM: Using vaporised and inhaled cannabis, we aimed to (1) examine the effect of CBD on the plasma concentration of delta-9-tetrahydrocannabinol (THC) and its metabolites, and (2) compare cannabinoid plasma pharmacokinetics in adolescents and adults. METHODOLOGY: We conducted a randomised, double-blind, placebo-controlled, cross-over study. We compared the effects of three vaporized, weight-adjusted cannabis preparations: 'THC-alone' (8mg THC/75kg), 'THC+CBD' (8mg THC and 24mg CBD/75kg) and placebo, in 48 participants, aged 16-17-years and 26-29-years. Blood samples were taken prior to inhalation, then 20, 30, and 160min after inhalation began. Thirty-five participants had complete pharmacokinetic datasets, which were analysed. Plasma was analysed for concentrations of THC, 11-hydroxy-THC (OH-THC) and 11-Nor-9-carboxy-THC (COOH-THC), CBD, 7-hydroxy-cannabidiol (OH-CBD) and 7-carboxy-cannabidiol (COOH-CBD). RESULTS: The 'THC+CBD' condition produced significantly greater THC, OH-THC, and COOH-THC plasma levels than the 'THC-alone' condition, in terms of natural-log-transformed area-under-the-curve (AUC) and peak concentration (C) values, with the exception of C for OH-THC. Geometric mean ratios showed the 'THC+CBD' condition led to higher THC plasma levels. There was no strong evidence of age-related differences. CONCLUSION: The presence of CBD in vaporised cannabis increased circulating levels of THC and THC-metabolites. However, further research is needed to understand discrepancies across studies regarding the impact of CBD on THC pharmacokinetics.
Opioid use disorder and medication for opioid use disorder among pregnant women with commercial insurance in the United States, 2016-2020.
Martins SS, Huang Y, Fan W … +5 more , Segura LE, Bruzelius E, Marziali ME, Khan A, Philbin MM
Drug Alcohol Depend · 2026 Jun · PMID 42025510 · Publisher ↗
OBJECTIVE: To examine the prevalence of opioid use disorder (OUD) diagnosis and medications for OUD (MOUD), which includes methadone, buprenorphine, and naltrexone, during pregnancy, and examine pre-pregnancy clinical fa...
OBJECTIVE: To examine the prevalence of opioid use disorder (OUD) diagnosis and medications for OUD (MOUD), which includes methadone, buprenorphine, and naltrexone, during pregnancy, and examine pre-pregnancy clinical factors associated with MOUD receipt in a nationwide commercial insurance database. STUDY DESIGN: We utilized data from Marketscan to identify pregnancies among women aged 15-54 years from 2016 to 2020. Individuals were included if they had consecutive enrollment from 90 days before the estimated last menstrual period (LMP) through 90 days postpartum. OUD and MOUD were identified using International Classification of Diseases (ICD) codes and pharmaceutical claims or Healthcare Common Procedure Coding System (HCPCS) codes. Multivariable Poisson regression was used to examine demographic and pre-pregnancy clinical factors associated with MOUD. RESULTS: We identified 909,241 total pregnancies, among which 2926 (0.3%) individuals had an OUD diagnosis during pregnancy or postpartum. Among women diagnosed pre- or during pregnancy with OUD (n = 2346), 1014 (40.2%) received MOUD. Demographic and clinical factors positively associated with an OUD diagnosis included younger age and non-metropolitan statistical area (MSA) residence. Factors negatively associated with MOUD receipt during pregnancy included co-occurring chronic pain or concurrent substance use disorder diagnosis other than OUD. Having two or more mental health disorders was positively associated with MOUD receipt. CONCLUSION: Less than half of pregnant women with OUD received MOUD, the gold standard for treatment. Our results demonstrate substantial missed opportunities for MOUD treatment during pregnancy, highlighting the need for targeted interventions to improve evidence-based perinatal OUD care.
Real-time discrepancies between simultaneous alcohol and cannabis expectancies and subjective responses.
Moran DK, Tolbert RC, Waddell JT
Drug Alcohol Depend · 2026 Jul · PMID 42019097 · Publisher ↗
BACKGROUND: Simultaneous alcohol and cannabis use is common, prevalent, and risky. Ecological momentary assessment (EMA) research suggests that simultaneous use is associated with increased positive subjective responses....
BACKGROUND: Simultaneous alcohol and cannabis use is common, prevalent, and risky. Ecological momentary assessment (EMA) research suggests that simultaneous use is associated with increased positive subjective responses. However, research has yet to examine how often, and what happens when, subjective responses to simultaneous use are discrepant from one's expectations. METHODS: Young adults who reported simultaneous use during acute drinking reports (N = 71) completed 21 days of ecological momentary assessment. Individuals reported their simultaneous use expectancies at baseline and their subjective stimulation and relaxation during acute use episodes - for this study, moments when an individual reported simultaneous use were retained. Two-level multilevel models tested (1) the extent to which one's simultaneous use expectancies aligned with their acute stimulation/relaxation during simultaneous use moments and (2) whether feeling higher stimulation/relaxation than expected were associated with alcohol and cannabis use cravings. RESULTS: Individuals with higher stimulant simultaneous use expectancies experienced higher levels of stimulant subjective effects during simultaneous use moments. Similarly, individuals with higher relaxation simultaneous use expectancies experienced higher levels of subjective relaxation during simultaneous use moments. Experiencing more stimulant subjective effects than expected from simultaneous use was associated with both increased alcohol craving and cannabis craving. However, greater-than-expected stimulant subjective effects from simultaneous use had a stronger impact on alcohol versus cannabis craving. CONCLUSIONS: Simultaneous use expectancies were modestly associated with subjective responses during simultaneous use moments, and experiencing greater-than-expected stimulation motivated continued use, particularly for alcohol. When assessing subjective response to simultaneous use, it is important to take expectancies into consideration.
Impact of a stimulant-inclusive post-overdose outreach toolkit on engagement of overdose survivors who use stimulants: An interrupted time series analysis.
Xuan Z, Walley AY, Formica SW … +9 more , Wang J, Gamble MC, Kosakowski S, Murray S, Wiggins M, Cogan AG, Haley DF, Hyde J, Bagley SM
Drug Alcohol Depend · 2026 Jun · PMID 42014260 · Publisher ↗
BACKGROUND: Stimulant (cocaine or methamphetamine)-involved overdoses have increased significantly. Post-overdose outreach programs seek to reduce future overdose by engaging overdose survivors. We evaluated the change i...
BACKGROUND: Stimulant (cocaine or methamphetamine)-involved overdoses have increased significantly. Post-overdose outreach programs seek to reduce future overdose by engaging overdose survivors. We evaluated the change in successful outreach after the implementation of a stimulant-inclusive post-overdose outreach toolkit in March 2023. METHODS: We conducted a comparative interrupted time-series analysis over a 31-month period (March 2022-September 2024) using individual-level survivor outreach and contact data collected from 11 post-overdose outreach programs in Massachusetts. The primary outcome was the monthly proportion of successful outreach contacts based on all outreach attempts each month. We also analyzed a binary outcome indicating whether individual outreach contacts were successful. The comparative ITS analysis examined differences in outreach success among outreach attempts to survivors who use stimulants compared to attempts to survivors who did not use stimulants. RESULTS: The proportions of successful contacts among survivors who used stimulants were 37.5% before toolkit implementation and 52.1% after implementation (Chi-squared=18.91, p < 0.001). The toolkit was associated with an immediate 15.2 %age points increase (level) of the proportion of successful contacts (marginally significant at p = 0.06) and a statistically significant 2.3 %age point (p = 0.03) monthly increase (slope) of the proportions of successful contacts after implementation, compared to non-stimulant-involved outreach contacts. Adjusted logistic regression results on the binary outcome of successful contact found positive level and slope increases. CONCLUSIONS: Implementation of a stimulant-inclusive outreach toolkit was associated with improved engagement among survivors who used stimulants. These findings warrant more evaluation of tailored outreach strategies engaging individuals who use stimulants.
Non-fatal GHB overdose among sexual and gender minorities: A syndemic perspective.
Chavez JV, Guo Y, Larson ME … +7 more , Westmoreland DA, D'Angelo AB, Tsai AC, Bartholomew TS, Nash D, Grov C, Carrico AW
Drug Alcohol Depend · 2026 Jun · PMID 42013580 · Full text
AIMS: This study examined prevalence and correlates of non-fatal gamma-hydroxybutyrate (GHB) overdose in sexual and gender minority (SGM) people. METHODS: Cross sectional analyses leveraged baseline data from a subset of...
AIMS: This study examined prevalence and correlates of non-fatal gamma-hydroxybutyrate (GHB) overdose in sexual and gender minority (SGM) people. METHODS: Cross sectional analyses leveraged baseline data from a subset of 1815 participants from US cohort of SGM people that reported recent GHB use. The outcome was any self-reported nonfatal GHB overdose in the past year. The exposure was a syndemic burden score (0-4), based on the presence of depressive symptoms and hypersexual disorder, childhood sexual assault, and intimate partner violence. Multivariable logistic regression was used to examine correlates of overdose. Sensitivity analyses assessed interactions between syndemic conditions using the relative excess risk due to interaction to assess associations beyond an additive model. RESULTS: Among the 1815 participants who used GHB, 244 (13%) reported a past year overdose. Compared to those with 0-1 syndemic conditions, those with two (aOR = 3.02; 95% CI: 1.89, 5.05; p < 0.001), three (aOR = 3.19; 95% CI: 1.96, 5.41; p < 0.001) and four conditions (aOR = 5.63; 95% CI: 3.02,10.70; p < 0.001) had higher odds of reporting a GHB overdose. Hazardous alcohol use and residing in an Ending the HIV Epidemic (EHE) jurisdiction had higher odds of syndemic factors. No significant interaction effects between syndemic factors were found in sensitivity analyses. CONCLUSIONS: More than one-in-ten SGM people who use GHB report at least one overdose in the past year. Interventions are needed especially for those reporting hazardous alcohol use and residing in EHE regions.
Patterns in methods, timing, and sequence of nicotine and cannabis co-use among adolescents.
Ouellette RR, Kong G, Davis DR … +5 more , Bold KW, Li W, Sharma A, Krishnan-Sarin S, Morean ME
Drug Alcohol Depend · 2026 Jun · PMID 42013579 · Publisher ↗
SIGNIFICANCE: Adolescent co-use of nicotine and cannabis increases their negative health risks. Much is still unknown about what products adolescents co-use, when, and how. METHODS: We collected a cross-sectional, self-r...
SIGNIFICANCE: Adolescent co-use of nicotine and cannabis increases their negative health risks. Much is still unknown about what products adolescents co-use, when, and how. METHODS: We collected a cross-sectional, self-report survey (N = 4760) in Spring 2024 across eight Connecticut high schools (M=15.86 years, 51% female, 60% White, 38% Hispanic, 22% Black, 81% straight, 10% bisexual, 4% gay/lesbian). We assessed co-use timing (i.e., same-occasion, same-day, different-day); same-occasion sequence (i.e., simultaneous, cannabis/nicotine first); nicotine and cannabis products used for same-month co-use; and methods of simultaneous co-use (e.g., blunts, spliffs). We used Chi-squared tests to examine differences in same-month, same-occasion, and simultaneous co-use rates by race, ethnicity, sex, and orientation. RESULTS: Youth who ever used nicotine and cannabis (n = 885) reported same-occasion co-use (83%), different-day co-use (45%), and same-day different-occasion co-use (41%). Same-month co-use differed by race, ethnicity and sexual orientation. Same-occasion co-use differed by race. Among youth reporting lifetime same-occasion co-use (n = 731), 34% used cannabis before nicotine, 31% nicotine before cannabis, and 96% both substances simultaneously. Simultaneous co-use differed by race and ethnicity. Among adolescents with same-month co-use (n = 397), the most endorsed nicotine products were e-cigarettes (74%), nicotine pouches (16%), and cigarettes (13%), with cannabis use by smoking (35%) or vaping (15%) flower and vaping concentrates (25%). The most common methods for simultaneous co-use were blunts, using two products simultaneously, and spliffs. CONCLUSION: Results indicate a range of co-use behaviors, with elevated risk based on race, ethnicity, and sexual orientation. Identified co-use patterns should be examined for impacts on addiction risk and health harms.
Daily motivation for and perceived accessibility of nondrug reward among people in long-term recovery from opioid use disorder.
Stull SW, Epstein DH, Gersz M … +2 more , Mondry L, Lanza ST
Drug Alcohol Depend · 2026 Jun · PMID 42001567 · Publisher ↗
BACKGROUND: Enjoyment from experiences not involving drugs (nondrug rewards) can support recovery from addiction. Elegant experiments have shown that alternative reinforcers reduce drug use. However, investigations outsi...
BACKGROUND: Enjoyment from experiences not involving drugs (nondrug rewards) can support recovery from addiction. Elegant experiments have shown that alternative reinforcers reduce drug use. However, investigations outside a laboratory may offer insight into the "real-world" complexities of nondrug reward. We used ecological daily assessment (daily electronic diaries) to examine how motivation for, and perceived accessibility of, nondrug rewards were associated with likelihood of experiencing same-day nondrug rewards. METHODS: 130 adults in recovery from OUD (M=3.8 years in recovery) receiving opioid agonist treatment (M age=41.1, SD=9.0; 57% women; 85% non-Hispanic White) completed daily diary assessments for three weeks (1752 person-days). Multilevel logistic regression, controlling for baseline anhedonia and time in recovery, was used to predict days experiencing nondrug reward, using motivation for and perceived accessibility of nondrug rewards (5-point scale, "not at all" to "very") as both person-level predictors and within-person, day-level predictors. RESULTS: In separate models, people with higher average motivation (OR=2.64 [1.67-4.19]) or higher average perceived accessibility (OR=2.67 [1.58-4.51]) had significantly higher odds of reporting daily nondrug rewards. At the within-person level, days with higher-than-typical morning ratings of motivation (OR=1.23 [0.97-1.55]) or perceived accessibility (OR=1.32 [0.97-1.79]) were marginally associated with higher odds of experiencing nondrug rewards, but the associations were not statistically significant. CONCLUSION: Person-level characteristics were particularly strong in predicting motivation for and perceived access to daily nondrug rewards. Removing barriers to accessing nondrug rewards (e.g., financial, geographic, and social) is important to consider alongside other factors that contribute to experiencing nondrug rewards in recovery (e.g., motivation, anhedonia).
Effects of cannabis edible advertising messages and warnings on product perceptions among US young adults.
Cui Y, Speer MB, LoParco CR … +5 more , McCready DM, Wang Y, Yang YT, Cavazos-Rehg PA, Berg CJ
Drug Alcohol Depend · 2026 Jun · PMID 42000521 · Full text
BACKGROUND: Despite increased popularity of cannabis edibles, limited research has assessed effects of warnings or advertising emphasizing different characteristics. This study examined effects of different edible advert...
BACKGROUND: Despite increased popularity of cannabis edibles, limited research has assessed effects of warnings or advertising emphasizing different characteristics. This study examined effects of different edible advertising messages and warnings on young adults' product perceptions. METHODS: In June-November 2024, US adults ages 18-34 (n = 3579) participated in an online survey-based experiment using a 2 × 4 factorial design (advertising message: psychological effects vs. flavors; warning: none, adult-use, intoxication, edible-specific), then reported perceived addictiveness, harm, cautiousness, appeal, and interest (0 =not at all to 7 =extremely). Multivariable regression assessed advertising message, warning, and message-by-warning interactions in relation to outcomes, overall and by past-month use status. RESULTS: Few experimental effects were identified. The overall model showed: one direct, negative effect for flavors (vs. psychological effects) advertising messaging on interest (B=-0.20, SE=0.07, p = .003), shown in stratified analyses to be attributed to effects among those reporting past-month use (B=-0.28, SE=0.11, p = .003; no effect among participants reporting no past-month use-); and one direct, positive effect of the edible-specific (vs. no) warning on perceived harm (B=0.30, SE=0.10, p = .002), driven by those reporting non-use (B=0.32, SE=0.13; no effect among those reporting use). A significant interaction (B=0.38, SE=0.19, p = .048) indicated that adult-use warning exposure reduced perceived addictiveness among participants reporting non-use but had no effect for those reporting use. Among participants reporting use, an interaction (B=0.66, SE= 0.29, p = .019) indicated flavor (vs. effect) messaging alongside edible-specific warning exposure resulted in higher addictiveness. CONCLUSIONS: Regulations and interventions must consider effects of advertising messages and advertising message/warning combinations, particularly among different subgroups (e.g., those who use).
Residential rehabilitation treatment outcomes among women in women-only and mixed-gender services: A retrospective study.
Lee ML, Haynes C, Robinson LD … +5 more , Oytam Y, Stirling R, Campbell M, Kelly PJ, Larance B
Drug Alcohol Depend · 2026 Jun · PMID 42000520 · Publisher ↗
BACKGROUND: This study compared treatment outcomes for adult women in residential rehabilitation treatment attending women-only versus mixed-gender services. METHODS: Using routinely collected data from 32 non-government...
BACKGROUND: This study compared treatment outcomes for adult women in residential rehabilitation treatment attending women-only versus mixed-gender services. METHODS: Using routinely collected data from 32 non-government organisation alcohol and other drug services in NSW, Australia, mixed-effects logistic and linear regressions estimated the association between service types and treatment outcomes. Treatment outcomes included: completion rates and mean differences in aggregate Kessler Psychological Distress scale (K10), Severity of Dependence Scale (SDS) and EUROHIS-Quality of Life 8 (EQoL) scores from baseline to 30 days and 60 days. RESULTS: Among 11,632 treatment episodes from 7862 women (July 2012-June 2024), 60% were completed. Compared to mixed-gender episodes, women-only episodes more frequently reported Aboriginal and Torres Strait Islander women (29% vs 20%), meth/amphetamines as primary substance (46% vs 37%), living alone (33% vs 28%) or alone with children (13% vs 8%) and more recent treatment entry (43% vs 34% in 2020-2024). After adjusting for covariates, women-only episodes had higher odds of completion than mixed-gender episodes (aOR=1.56;95%CI:1.42,1.71). Among 5803 episodes with baseline outcome data, all showed improved K10, SDS and EQoL scores at 30 days (n = 2504) and 60 days (n = 1003) (all p < 0.001), with women-only episodes showing higher EQoL scores at 30 days (adjusted β=0.57;95%CI:0.16,0.98), and 60 days (adjusted β=0.95;95%CI:0.26,1.63). Baseline severity associated with improved K10, SDS and EQoL scores (all p < 0.001). CONCLUSIONS: Women characteristics differed between women-only and mixed-gender services. Although improvements were observed across both service types, higher treatment completion rates and modest quality of life improvements suggest additional benefit of women-only services.
Harms and benefits of discussing the brain disease model of addiction in therapeutic settings.
Casey D, Crowe M, Oldfield CJ … +1 more , Hogarth L
Drug Alcohol Depend · 2026 Jun · PMID 41985258 · Publisher ↗
INTRODUCTION: Discussion of the brain disease model of addiction in clinical settings could harm or benefit the expectations held by treatment-engaged persons who use drugs (PWUD) regarding their therapeutic outcomes, bu...
INTRODUCTION: Discussion of the brain disease model of addiction in clinical settings could harm or benefit the expectations held by treatment-engaged persons who use drugs (PWUD) regarding their therapeutic outcomes, but no study has experimentally tested this. METHODS: Thirty-four PWUD who were engaged with Waythrough drug and alcohol recovery services were interviewed. Utilising methods from consumer psychology, PWUD were asked to imagine brain disease and social stress models of addiction being discussed in two hypothetical therapist led support groups (in counterbalanced order within-subjects) and rate the therapeutic outcomes they expected would arise from each group. RESULTS: Participants agreed less with the brain disease model (d=0.37) and expected its discussion would reduce their likelihood of recovery (d=0.57), their therapeutic alliance with the facilitator and group peers (d=0.43), and self-blame for their addiction (d=0.40), compared to if the social stress model was discussed. Differences between conditions in expected quitting effort (d=0.29), adaptive coping (d=0.28), and negative self-perception (d=0.05) were not statistically significant. CONCLUSIONS: Treatment-engaged PWUD expected that discussion of the brain disease model of addiction in a hypothetical support group, compared to the social stress model, would harm their recovery chances and therapeutic alliance but benefit them by reducing self-blame for their addiction. Numeric effects on quitting effort and adaptive coping need replication with a larger sample. The null effect on negative self-perception informs theories of self-stigma. The study provokes reflection on how scientific addiction models are incorporated into clinical discourse to maximise clients' recovery capital and avoid inadvertent epistemic harms.
The Victoria SAFER initiative: A community-based prescribed safer supply program using fentanyl formulations in Victoria, BC.
Fajber K, Pauly B, Ranger C … +8 more , Cameron F, Clayton E, Rygnestad L, Henderson N, Irvine J, Herriot R, Urbanoski K, Kolla G
Drug Alcohol Depend · 2026 Jun · PMID 41980573 · Publisher ↗
BACKGROUND: In response to the severe mortality impacts of the shift in the North American unregulated drug supply to unregulated fentanyl and fentanyl analogues, the provision of pharmaceutical fentanyl formulations as...
BACKGROUND: In response to the severe mortality impacts of the shift in the North American unregulated drug supply to unregulated fentanyl and fentanyl analogues, the provision of pharmaceutical fentanyl formulations as part of prescribed safer supply programs has been piloted in a limited number of settings. The Victoria SAFER Initiative is a community-based prescribed safer supply program providing pharmaceutical alternatives; in 2021, they began offering multiple fentanyl or fentanyl-analogue formulations (buccal, injectable, transdermal) to individuals at high risk of opioid overdose. METHODS: Qualitative interviews and focus groups were completed with program staff (n = 10) and participants (n = 40) between May 2022 and April 2024. Guided by the Consolidated Framework for Implementation Research (CFIR), data was analyzed thematically to identify strengths and challenges in program implementation, including benefits and drawbacks of prescribing fentanyl products. RESULTS: Thematic analysis elicited three major themes linked to CFIR domains regarding the provision of prescribed fentanyl options: Fentanyl products provided a better substitute for the unregulated supply than other available medications (innovation domain); different formulations of fentanyl enabled individualized care and participant autonomy (innovation and implementation domains); and requirements for observed dosing of fentanyl options presented challenges for clients and providers (outer setting and implementation domains). CONCLUSION: This program provides a model for the prescription of multiple fentanyl or fentanyl-analogue formulations to complement other medications offered in prescribed safer supply programs. Primary barriers to innovation are the outer setting of the unregulated drug supply and government policies, while inner context factors and individuals implementing the innovation were facilitators.
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