Journal Of Addiction Medicine[JOURNAL]
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200 papers
Substance-specific Mortality Risk Stratification Among Adults With Substance Use Disorders During Acute Respiratory Infection: A 3.4-Million-patient N3C Cohort Study.
Adams MCB, Love T, Xie C … +7 more , Singh S, Pargman S, Patil A, De A, Hill EL, Hurley RW, N3C Consortium
J Addict Med · 2026 Jul · PMID 42397951 · Publisher ↗
OBJECTIVES: To quantify 30-day all-cause mortality associated with pre-existing substance use disorders (SUDs) during acute SARS-CoV-2 infection, to compare mortality risk across major SUD subtypes (tobacco, alcohol, opi...
OBJECTIVES: To quantify 30-day all-cause mortality associated with pre-existing substance use disorders (SUDs) during acute SARS-CoV-2 infection, to compare mortality risk across major SUD subtypes (tobacco, alcohol, opioid, cannabis, cocaine, amphetamine, inhalant, and unspecified), and to evaluate the extent to which documented comorbidity burden accounts for observed SUD-associated mortality differences. METHODS: Retrospective cohort study of adults aged 18-65 years or older with confirmed SARS-CoV-2 infection (March 2020-June 2023) from 63 US healthcare organizations contributing to the National COVID Cohort Collaborative (N3C). Confirmed infection required any 1 of an International Classification of Diseases, 10th Revision (ICD-10) diagnosis code of U07.1, a positive SARS-CoV-2 laboratory test (polymerase chain reaction or antigen), or a nirmatrelvir-ritonavir (Paxlovid) prescription. Multivariable logistic regression estimated adjusted odds ratios (aORs) for 30-day mortality associated with any SUD and with each SUD subtype, adjusting for age, sex, race and ethnicity, body mass index, and tobacco smoking status. Sensitivity analyses added the Elixhauser Comorbidity Index (ECI) and used an unrestricted cohort. RESULTS: Among 3,435,480 adults with confirmed SARS-CoV-2 infection, 406,064 (11.8%) had a pre-existing SUD documented before the index date, and 14,866 (0.43%) died within 30 days of the index date. Thirty-day mortality was higher among individuals with SUDs than those without (1.05% vs. 0.35%). SUDs were associated with more than doubled adjusted odds of mortality (aOR 2.38; 95% CI: 2.28-2.49). Additional adjustment for comorbidity burden attenuated but did not eliminate the association (aOR 1.53; 95% CI: 1.46-1.61). Alcohol use disorder (AUD) (aOR 2.63; 95% CI: 2.48-2.78) and opioid use disorder (OUD) (aOR 2.53; 95% CI: 2.35-2.74) conferred the highest risks. Mortality differentials between individuals with and without SUD persisted throughout the study period despite overall declines in COVID-19 mortality. CONCLUSIONS: Pre-existing SUDs, particularly alcohol (AUD) and opioid use disorders (OUD), identified a population at substantially increased 30-day all-cause mortality after COVID-19 diagnosis. Because unmeasured structural, behavioral, and treatment-related factors likely contribute to the residual excess risk beyond measured comorbidity, SUD is best interpreted as a clinically useful marker of heightened vulnerability rather than as an independent biological cause of mortality. SUD status, AUD, and OUD in particular, warrant explicit incorporation into short-term risk stratification for respiratory infections in both routine clinical care and pandemic preparedness planning.
Exploring Diversion Concerns as a Modifiable Buprenorphine-prescribing Barrier Among Primary Care Professionals.
Abrams EA, Fenstemaker C, King K … +4 more , Rausch J, Tripathy R, Shalash J, Franz B
J Addict Med · 2026 Jul · PMID 42385369 · Publisher ↗
OBJECTIVES: Efforts to increase medications for opioid use disorder (MOUD) prescribing among primary care professionals (PCPs) are a priority for reducing overdose and related harms. A primary concern among PCPs, however...
OBJECTIVES: Efforts to increase medications for opioid use disorder (MOUD) prescribing among primary care professionals (PCPs) are a priority for reducing overdose and related harms. A primary concern among PCPs, however, is that prescriptions will be diverted or sold to someone else. Understanding and contextualizing diversion concerns among PCPs can inform implementation strategies to support buprenorphine adoption and expand access to medication. METHODS: We conducted semistructured interviews with Ohio PCPs as part of the design and pilot of a training intervention to increase PCP buprenorphine prescribing. Interviews were transcribed and analyzed using three-step thematic analysis in Dedoose. Detailed memos on all codes were written and inductively informed key themes pertaining to addressing PCPs' diversion concerns. RESULTS: Twenty-six PCPs completed in-depth interviews. Diversion concerns were common and limited willingness to prescribe buprenorphine or changed the way PCPs prescribed. Three key themes emerged: (1) Diverse diversion concerns continue to influence prescribing behavior; (2) Prescribing experience and comfort with harm reduction shaped views on diversion; and (3) Specific forms of diversion information can motivate buprenorphine prescribing. CONCLUSIONS: Buprenorphine is highly effective for reducing mortality in patients with opioid use disorder, but it is vastly underutilized in the primary care setting. Diversion concerns among both nonprescribers and current prescribers are a significant barrier to expanding access in this setting. Leveraging data and personal anecdotes on the scope of, public health impact of, and reasons for diversion may help overcome this commonly cited barrier to prescribing MOUD.
Substance Use Among US Adults at Midlife: Risk Factors and Protective Factors Among National and Milwaukee Black American Samples.
Hsu YT, Ransome Y, Becker WC … +4 more , Frater J, Demuyakor I, Fiellin D, Barry DT
J Addict Med · 2026 Jun · PMID 42372082 · Publisher ↗
OBJECTIVES: Pain interference and financial insecurity are risk factors for substance use. This study examined whether possible protective factors-religious service attendance, spirituality, and social connectedness-mode...
OBJECTIVES: Pain interference and financial insecurity are risk factors for substance use. This study examined whether possible protective factors-religious service attendance, spirituality, and social connectedness-moderate the associations between risk factors and substance use among national and Milwaukee Black American samples of adults at midlife in the United States. METHODS: Participants were adults from the Midlife in the United States Study (MIDUS) national sample (N=4962) and the Milwaukee Black American sample (N=866). A sequential modeling approach tested main effects and moderation effects, examining whether possible protective factors (religious service attendance, spirituality, and social connectedness) moderated the associations between risk factors (pain interference and financial insecurity) and substance use. RESULTS: Our findings revealed different patterns across samples. In the national sample, pain interference (β = 0.11, 95% CI = 0.08, 0.14) and financial insecurity (β = 0.06, 95% CI = 0.03, 0.09) independently predicted substance use risk. Religious service attendance moderated the pain interference-substance use link (β = -0.03, 95% CI = -0.06, -0.002). In the Milwaukee Black American sample, financial insecurity (β = 0.15, 95% CI = 0.08, 0.22), but not pain interference, independently predicted substance use. Spirituality moderated the pain interference-substance use association (β = -0.12, 95% CI = -0.18, -0.05). Religious service attendance, spirituality, and social connectedness did not moderate the financial insecurity-substance use association in either sample. CONCLUSIONS: Religious service attendance and spirituality seem to serve as protective moderators in the association between pain interference and substance use. Faith-based interventions for those with pain interference or substance use may warrant testing.
When "Kava" Isn't Kava: Opioid-like Withdrawal Responsive to Buprenorphine: A Case Study.
Malhotra A, McPherson GE, Scott KS … +1 more , Li L
J Addict Med · 2026 Jun · PMID 42372078 · Publisher ↗
We report a case of severe opioid-like withdrawal symptoms following cessation of a commercially available beverage marketed as a "kava" product. A 36-year-old White male with opioid use disorder in sustained remission d...
We report a case of severe opioid-like withdrawal symptoms following cessation of a commercially available beverage marketed as a "kava" product. A 36-year-old White male with opioid use disorder in sustained remission developed rapid tolerance, frequent redosing, nocturnal withdrawal, prominent gastrointestinal and autonomic symptoms, and generalized pruritus after heavy use of a gas-station-sold "kava" shot. Symptoms were refractory to benzodiazepines but improved rapidly with buprenorphine/naloxone; this suggests µ-opioid receptor-mediated dependence. The clinical presentation was inconsistent with kava withdrawal, which is typically mild and anxiety predominant. Review of product labeling indicated the presence of akuamma (Picralima nitida), a botanical containing μ-opioid receptor-active alkaloids; secondary qualitative testing of independently purchased samples of the same product by the UAB toxicology lab confirmed the presence of kratom (Mitragyna speciosa) derivatives and kavalactones. In the context of kratom prohibition in Alabama and overlapping manufacturer product lines, this case highlights the risks of mislabeled or adulterated polyherbal products and underscores the need for clinicians to consider opioid-mediated mechanisms and symptom-guided treatment when evaluating withdrawal from purported nonopioid supplements.
The Association of Alcohol Withdrawal Severity Scales that Incorporate Vital Signs and Withdrawal Outcomes: A Multicenter Cohort Study.
Roberts AE, Yarbrough P, Vargas J … +29 more , Tuck M, Trubitt M, Smeraglio A, Shah MN, Rose R, Ronan M, Rodwin BA, Pescetto M, Mitchell C, Laudate JD, Krug M, Kaboli P, Jagannath AD, Hoegh M, Heppe D, Gutierrez J, Guidry M, Gordon KS, Godwin P, Elzweig J, Ehlers E, Cyr J, Cornia PB, Caldwell P, Boggan JC, Arundel C, Akwe J, Allaudeen N, Gunderson CG
J Addict Med · 2026 Apr · PMID 42360115 · Publisher ↗
OBJECTIVES: Guidelines recommend symptom-triggered therapy for the management of alcohol withdrawal, and the most commonly used assessment scale is the Clinical Institute Withdrawal Assessment, Revised (CIWA-Ar). CIWA-Ar...
OBJECTIVES: Guidelines recommend symptom-triggered therapy for the management of alcohol withdrawal, and the most commonly used assessment scale is the Clinical Institute Withdrawal Assessment, Revised (CIWA-Ar). CIWA-Ar has been criticized, however, for relying on patient self-report, and numerous alternative scales have been developed that incorporate vital signs to be more objective. Few studies compare alcohol withdrawal outcomes based on the type of assessment scale. METHODS: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Hospital outcomes, including treatment duration and the occurrence of complicated withdrawal were analyzed based on the use of CIWA-Ar compared with withdrawal scales that incorporated vital signs. RESULTS: In total, 461 (78%) patients were managed using CIWA-Ar, and 127 (22%) patients were managed using symptom scales that included vital signs. The mean duration of treatment was 3.4 days (SD, 2.0) for patients managed with CIWA compared with 3.9 days (SD, 2.0) for patients managed with scales incorporating vital signs (P=0.007). In multivariable analysis, duration of treatment remained longer using scales with vital signs (RR 1.30, 95% CI, 1.15-1.48). There was no difference in rates of complicated withdrawal (OR 1.00, 95% CI, 0.41-2.46). CONCLUSIONS: Our results indicate that the use of alcohol withdrawal scales that incorporate vital signs are associated with increased treatment duration and no difference in rates of complicated withdrawal. Randomized clinical trials are needed to ascertain which assessment scale is best.
Changes in Exposures of US Children Ages 12 and Under to Cannabis from 2000 to 2024.
Bertino RE, Feldman R, Leikin JB
J Addict Med · 2026 Jun · PMID 42359703 · Publisher ↗
OBJECTIVES: In the United States, significant federal cannabis policy changes occurred in 2009, 2013, and in 2018. This study reviews trends in reported cannabis exposures to children in light of those policy changes. ME...
OBJECTIVES: In the United States, significant federal cannabis policy changes occurred in 2009, 2013, and in 2018. This study reviews trends in reported cannabis exposures to children in light of those policy changes. METHODS: Retrospective descriptive observational time-trend analysis. Secondary analysis of annual data from US poison centers. Participants were cases reported to US poison centers and entered in the National Poison Data System from 2000 to 2024. Rates of pediatric cannabis exposures reported to America's Poison Centers are given, along with trends in those exposures. RESULTS: Reported pediatric exposures of the under-6-year age group to cannabis were stable from 2000 to 2009. Starting in 2010, exposures began to increase, with the rise continuing to 2024, the most recent year of data availability. Between 2009 and 2024, such exposures increased by 6386% from 132 to a total of 8430 exposures. Cannabis exposures in the 6-12 age group also increased during the same period (increase from 21 to 2894; 13,781%). CONCLUSIONS: There was an increase of more than 6000% in reported pediatric exposures to cannabis in the United States between 2009 and 2024 in both the under-6 and the 6-12 years age groups. This rise is temporally associated with changes in federal cannabis policy that began in 2009. Because of the negative effects on children's health, public health policy adjustments are warranted.
Trends in Public Opinion About US Illicit Drug Policy: Results From the 2000 to 2025 Gallup Survey.
Saloner B
J Addict Med · 2026 Jun · PMID 42339987 · Publisher ↗
OBJECTIVES: Illicit drugs have had a profound societal impact in the last 25 years, including 1.2 million Americans dying from overdose. This study seeks to understand whether Americans perceive policy progress against i...
OBJECTIVES: Illicit drugs have had a profound societal impact in the last 25 years, including 1.2 million Americans dying from overdose. This study seeks to understand whether Americans perceive policy progress against illicit drugs and how they perceive the drug problem nationally and locally. METHODS: I analyzed data collected on 13 occasions between 2000 and 2025 as part of the Gallup Poll Social Survey (GPSS), an ongoing, nationally representative, cross-sectional telephone survey of American adults (N = 13,311). GPSS asks respondents to rate their perceptions of progress against illicit drugs and how severe they perceive the drug problem nationally and in their own communities. RESULTS: Less than half of all Americans in most years perceived that progress has been made against illicit drugs. Perceived progress was at its lowest point in 2023 (23.4% of all respondents), but sharply increased in 2025 (44.2%). Americans have been more likely to perceive progress when the president is from their party, and partisan effects have grown since the mid-2010s. For example, Republican perceptions of progress swung upward by 54.0 points between 2023 and 2025. Most Americans have perceived that drugs are a serious problem nationally, but only a minority said that they are a serious problem in their own community. Perception of a serious problem have held steady among Republicans, but Democrats' sense of concern about the national problem has decreased. CONCLUSIONS: Partisanship has become a major factor in how Americans perceive progress in drug policy. With widening political polarization, it may prove difficult to achieve a broad consensus in society, which itself could limit public support for a cohesive national drug control strategy.
Medicaid Prior Authorization and Discontinuation of Buprenorphine.
Andrews CM, Westlake MA, Abraham AJ … +4 more , Dick A, Hinds OM, Sorbero M, Stein BD
J Addict Med · 2026 Jun · PMID 42339975 · Publisher ↗
OBJECTIVES: Buprenorphine is effective in reducing opioid-related overdose, yet many patients discontinue prematurely. Little is known regarding the influence of utilization management policies on buprenorphine discontin...
OBJECTIVES: Buprenorphine is effective in reducing opioid-related overdose, yet many patients discontinue prematurely. Little is known regarding the influence of utilization management policies on buprenorphine discontinuation. This study assesses the duration of buprenorphine episodes paid by fee-for-service (FFS) and managed care organization (MCO) plans with and without prior authorization (PA) in Medicaid. METHODS: Cross-sectional analysis was conducted using 2018 national prescription claims data with 810,449 treatment episode months involving dispensed buprenorphine prescriptions with an FDA-approved indication for opioid use disorder treatment reimbursed by Medicaid. Standard discrete-time survival models using logistic regression were conducted to examine differences in duration to buprenorphine discontinuation in months by reimbursement type. RESULTS: Buprenorphine continuation decreased over time across all Medicaid insurance types; this decline was slightly sharper for episodes paid for by MCO plans with PA. The adjusted survival for buprenorphine treatment for 12 months was statistically significantly (P < 0.01) lower for episodes among enrollees in MCO plans with PA (21.6%) compared with episodes paid for by FFS with PA (22.5%); it was also lower in MCO plans without a PA (22.7%) compared with FFS without a PA (23.1%). CONCLUSIONS: Buprenorphine discontinuation was high across all treatment episodes, with few differences across Medicaid plan arrangement type or PA status. The sharpest declines in buprenorphine continuation were observed across all types within the first 3 months of the episode starting, highlighting an important period to target buprenorphine continuation improvements. Future research is needed to explore other insurer policies, like concurrent reviews and quantity limits, which may also influence discontinuation.
Implementation of Dyadic Care to Support Clinical, Administrative, and Service Wraparound Needs for the Opioid-Exposed Mother and Infant.
Jilani SM, Jones HE, Davis JM … +3 more , Liv C, Terplan M, Jansson LM
J Addict Med · 2026 Jun · PMID 42339669 · Publisher ↗
OBJECTIVES: Although a dyadic approach to clinical care is recommended for opioid-exposed mothers and their infants, there is a lack of practice-based guidance on clinical implementation. To address this knowledge gap, a...
OBJECTIVES: Although a dyadic approach to clinical care is recommended for opioid-exposed mothers and their infants, there is a lack of practice-based guidance on clinical implementation. To address this knowledge gap, a comparative evaluation of outpatient dyadic care practice models in the US was conducted. METHODS: This 2-phase qualitative study was designed to identify essential commonalities and distinctions in dyadic practice across 3 domains: clinical, administrative, and service wraparound. Five programs serving urban and rural communities participated from private, academic, and federally qualified health centers (FQHC) with business models spanning grant-funded, fee-for-service, and FQHC. Data were analyzed by applying descriptive statistics. RESULTS: Across programs (1 rural, 4 urban), dyadic care was consistently defined but variably operationalized across clinical, administrative, and service wraparound domains. Clinically, all programs treated the mother-infant dyad as a single unit, yet care delivery was typically fragmented across time and setting due to resource constraints. Administratively, billing practices were heterogeneous, with reliance on existing obstetric, pediatric, maternal mental health, and family therapy codes; no program used dyad-specific billing mechanisms. All programs incorporated wraparound services, including food, housing, transportation, lactation support, infant supplies, and parenting education, though the extent and integration of these services varied. CONCLUSIONS: Despite challenges, including funding, space, and coordination across clinicians/departments associated with providing dyadic care, key practice-based elements were identified that can facilitate the implementation of dyadic care across clinical, administrative, and service wraparound domains. Consideration should be given to address common resource limitations to significantly improve mother-infant dyad care across these domains.
Prevalence of Alcohol Use Disorder and Alcohol-related Liver Disease in Women Undergoing Cervical Cancer Screening: A Missed Opportunity to Screen?
Thomson M, Tessier KM, Jones C … +1 more , Lim N
J Addict Med · 2026 Jun · PMID 42311203 · Publisher ↗
OBJECTIVES: Early recognition of alcohol use disorder (AUD) in women can reduce the risk of developing alcohol-related liver disease (ALD). For many women, reproductive health visits, including cervical cancer screening...
OBJECTIVES: Early recognition of alcohol use disorder (AUD) in women can reduce the risk of developing alcohol-related liver disease (ALD). For many women, reproductive health visits, including cervical cancer screening may be their only health care contact. We aimed to evaluate the prevalence of AUD and ALD in women undergoing cervical cancer screening and whether these visits represent missed opportunities for AUD identification. METHODS: This is a retrospective analysis of adult women aged 21-65 who underwent cervical cancer screening in the nationwide MarketScan Database 7/1/2013-12/31/2021. ICD coding was used to identify inpatient/outpatient AUD/ALD diagnoses. Median time to AUD/ALD diagnosis was calculated, and the cumulative incidence of inpatient AUD/ALD following an initial outpatient encounter was estimated using the Kaplan-Meier method. RESULTS: A total of 11,429,720 women underwent cervical cancer screening (mean age 41.7 y). AUD was identified in approximately 1 in 50 women, one-quarter of whom required hospitalization. Notably, 30.7% of women hospitalized for AUD previously saw a provider for cervical cancer screening where AUD was not diagnosed. ALD was present in 0.1% (1 in 1,000) of women screened for cervical cancer, with about half requiring hospitalization. Among those hospitalized for ALD, 24.5% previously saw a provider for cervical cancer screening where AUD had not been identified. CONCLUSIONS: A notable proportion of women hospitalized for AUD/ALD had a prior cervical cancer screening visit where AUD was not identified, representing a missed opportunity for intervention. Standardized screening and referral for treatment at these visits may reduce downstream consequences of harmful alcohol use.
ASAM Consensus Standards for Substance Use Disorder Care Capabilities in Hospitals and Emergency Departments.
Wakeman S, Bachireddy C, Campbell A … +8 more , Danovitch I, Englander H, Fuller D, Herring A, McCollough M, Lindsay D, Norrington J, Boyle M
J Addict Med · 2026 Jun · PMID 42311189 · Publisher ↗
IMPORTANCE: The morbidity, mortality, and costs associated with untreated substance use disorder (SUD) in hospitals are substantial. In 2017 alone, $13 billion was spent on medical costs associated with SUD care in hospi...
IMPORTANCE: The morbidity, mortality, and costs associated with untreated substance use disorder (SUD) in hospitals are substantial. In 2017 alone, $13 billion was spent on medical costs associated with SUD care in hospitals and emergency departments (EDs). However, SUD often goes unaddressed during hospital and ED encounters despite the existence of effective treatments. METHODS: In 2024, the American Society for Addiction Medicine (ASAM) initiated a consensus development process to update The ASAM Criteria standards for general hospital settings. These standards outline the capabilities all hospitals are recommended to meet to enable effective care for SUD. The development process included convening an expert Task Force, evidence review and synthesis, formal consensus development, field review, and approval through ASAM's Quality Improvement Council. RESULTS: The Task Force defined 7 core competencies for hospital and ED-based SUD care: (1) identification, engagement, and approach to patient care, (2) intoxication and withdrawal management, (3) overdose and post-overdose care, (4) initiation and continuation of addiction medications, (5) assessment and management of common co-occurring conditions, (6) linkage to ongoing SUD care, and (7) risk reduction. The Task Force used these competencies to define consensus standards within The ASAM Criteria service characteristic domains including setting, staff, support systems, assessment and treatment planning, services, and documentation. CONCLUSIONS: Rapidly evolving evidence demonstrates the importance and feasibility of providing SUD care in hospitals. These consensus standards aim to coalesce the field around a common set of expectations for meeting the needs of patients with SUD.
Use of Medication for Addiction Treatment Among Physicians and Pharmacists Monitored for Substance Use Disorder by One State Physician Health Program.
Araujo CNP, Polles A, Merlo LJ
J Addict Med · 2026 Jun · PMID 42283207 · Publisher ↗
OBJECTIVES: This study explored the utilization of medication for addiction treatment (MAT) by participants in one state physician health program (PHP) over the course of 30 years, and reviewed patterns of use and monito...
OBJECTIVES: This study explored the utilization of medication for addiction treatment (MAT) by participants in one state physician health program (PHP) over the course of 30 years, and reviewed patterns of use and monitoring outcomes. METHODS: Data were extracted from the PHP records of 45 physicians and 37 pharmacists with substance use disorder (SUD), with or without co-occurring pain disorder, who used opioid [partial] agonist or antagonist medication, with or without other MAT. Variables of interest included demographics, type/length of monitoring, use of medications during monitoring, results of neurocognitive testing, and monitoring outcomes. Descriptive statistics were used to characterize PHP participants. χ2 tests, Fisher exact test, and t tests were used for group comparisons. RESULTS: Findings demonstrated positive outcomes among the PHP participants, regardless of MAT use status, with over 70% graduating monitoring or currently in good standing. A minority completed their initial monitoring but returned to the PHP due to return-to-use (n=4, 4.9%), discontinued monitoring against recommendations (n=4, 4.9%), or were turned over to the licensing board due to noncompliance with monitoring (n=4, 4.9%). There were 5 deaths (unrelated to substance use). Periods of MAT use were not associated with worse outcomes or additional impairment. CONCLUSIONS: All FDA-approved MAT should be considered for physicians and pharmacists monitored by a PHP, on an individual basis, when deemed clinically appropriate. Extended-release formulations may be particularly helpful for this population. Results may help clarify misunderstandings and controversies surrounding the use of MAT for PHP participants, while also advancing patient-centered, evidence-based care.
An Equitable Behavioral Engagement Framework for Stimulant Medication Treatment in Methamphetamine Use Disorder.
Kelly D, Lites A, Campbell A … +1 more , Bottyan T
J Addict Med · 2026 Jun · PMID 42283199 · Publisher ↗
The 2024 American Society of Addiction Medicine and American Academy of Addiction Psychiatry Clinical Practice Guideline includes a conditional recommendation for long-acting methylphenidate as a pharmacologic option for...
The 2024 American Society of Addiction Medicine and American Academy of Addiction Psychiatry Clinical Practice Guideline includes a conditional recommendation for long-acting methylphenidate as a pharmacologic option for amphetamine-type stimulant use disorder, including methamphetamine use disorder. Although this recommendation is conditional and based on low-certainty evidence, it reflects an evolving consideration of pharmacologic treatment approaches for methamphetamine use disorder and raises questions regarding clinical implementation, particularly given the schedule II regulatory status of methylphenidate and the associated oversight and risk considerations. In this commentary, we review the guideline's recommendation in the context of real-world prescribing challenges, including clinical safety considerations, monitoring requirements, and potential implications for equitable access. We highlight the absence of established behavioral readiness or engagement frameworks to guide the initiation and continuation of schedule II stimulant medications for methamphetamine use disorder. To address this gap, we describe an approach adapted from prior work in office-based buprenorphine treatment. This 5-domain framework-adherence, abstinence progress, attendance, alternative activities, and accessing support-offers a structured method for integrating behavioral engagement into patient selection and ongoing monitoring when considering prescribing a psychostimulant for stimulant use disorders. By emphasizing objective, transparent engagement metrics alongside pharmacologic decision-making, such a framework may help support safety, accountability, and a more equitable application of an emerging treatment option.
Perspectives of Youth Experiencing Homelessness on Substance Use and Harm Reduction: A Qualitative Youth Participatory Action Research Study.
Robinson A, LeBouef S, Krahl W … +3 more , Hokanson C, Mohamud Z, Gewirtz O'Brien JR
J Addict Med · 2026 Jun · PMID 42259284 · Publisher ↗
OBJECTIVES: Youth experiencing homelessness (YEH) report higher substance use than stably housed youth, yet their perspectives and system supports are poorly understood. This youth participatory action research examines...
OBJECTIVES: Youth experiencing homelessness (YEH) report higher substance use than stably housed youth, yet their perspectives and system supports are poorly understood. This youth participatory action research examines YEH perspectives on substance use and harm reduction, and identifies youth-driven opportunities to improve responses by health care providers and YEH-serving agencies (YSA). METHODS: In partnership with a local YSA, we conducted 2 focus groups with YEH (n=21) to describe their (1) perspectives on substance use and harm reduction, (2) experiences navigating substance use disorder resources, and (3) recommendations for shelters and health care organizations to enhance support for YEH who use substances. Utilizing thematic analysis and an iterative youth participatory action research process generated recommendations for YEH-serving agencies and health care professionals. RESULTS: Five key themes were identified: (1) Youth understanding of substance use terminology highlighted varied interpretations of "substance use" and "harm reduction" and the need for shared definitions. (2) Characteristics of ideal services for YEH envisioned compassionate, nonjudgmental care and accessible resources. (3) Mitigating bias among youth-serving professionals and (4) supporting and defining recovery for YEH who use substances emphasized waiving sobriety requirements in YEH-serving agencies. (5) Advice for youth-serving professionals regarding recovery emphasized individualized, youth-centered approaches with integrated harm reduction and mental health support. CONCLUSIONS: Our study underscores the importance of uplifting the voices of youth with lived experiences when addressing their health needs and identifies youth-driven opportunities for systems improvements. Future directions include providing opportunities for youth to co-create systems of care that serve them.
Case Report: Oral-Nasal Damage in a Person Using Fentanyl and Xylazine.
Kmiec J, Choby G
J Addict Med · 2026 Jun · PMID 42259281 · Publisher ↗
BACKGROUND: Xylazine, an alpha-2-adrenergic agonist, was added to illicitly manufactured fentanyl within the past decade. Intranasal drug use is common and associated with damage to nasal structures and the palate. There...
BACKGROUND: Xylazine, an alpha-2-adrenergic agonist, was added to illicitly manufactured fentanyl within the past decade. Intranasal drug use is common and associated with damage to nasal structures and the palate. There have been no case reports detailing intranasal damage secondary to fentanyl and xylazine use. CASE SUMMARY: We present a case of a 39-year-old woman with a long history of intranasal opioid use and, more recently, xylazine use who presented for treatment due to nasal septum perforation and oral-nasal fistulas. She started treatment for opioid use disorder and was referred to otolaryngology for further examination and treatment of palate damage thought to be secondary to intranasal fentanyl and xylazine use. She exhibited severe damage to her palate, nasal structures, and skull base. CLINICAL SIGNIFICANCE: This case illustrates damage to the nose, palate, and skull base, likely secondary to co-use of fentanyl and xylazine intranasally. It is important for clinicians to recognize that nasal damage may result from fentanyl and xylazine use and refer to appropriate substance use disorder and otolaryngology treatment to prevent further destruction.
Postmortem Toxicology Positivity for Medications for Opioid Use Disorder in Illinois Unintentional Opioid Overdose Deaths 2019-2024.
Hazekamp C, Mason M
J Addict Med · 2026 Jun · PMID 42240015 · Publisher ↗
OBJECTIVES: Currently, most unintentional opioid overdose deaths (OODs) in the United States are attributed to fentanyl. Buprenorphine and methadone reduce mortality associated with opioid use disorder. Despite the prote...
OBJECTIVES: Currently, most unintentional opioid overdose deaths (OODs) in the United States are attributed to fentanyl. Buprenorphine and methadone reduce mortality associated with opioid use disorder. Despite the protective effects of these medications for opioid use disorder (MOUD), adverse outcomes are possible. The aim of this study is to describe the detection of MOUD in unintentional fentanyl-attributed OODs in Illinois. METHODS: We conducted a retrospective cross-sectional analysis of unintentional overdose deaths using the Illinois Statewide Unintentional Drug Overdose Reporting System data from 2019 to 2024. Descriptive statistics summarized demographics and MOUD detection in fentanyl-attributed unintentional OODs. Modified Poisson regression with robust SEs was used to estimate adjusted prevalence ratios (aPRs) for fentanyl-attributed unintentional OODs, adjusting for demographics, coingestants, education, housing instability, recent jail release, recent health care utilization, and calendar year. RESULTS: Among 17,757 unintentional OODs, 74% (13,135) were attributed to fentanyl by a coroner or medical examiner. Median age was 44.5 years; 75% were males, and 45% were white non-Hispanic. Detection of each MOUD in fentanyl attributed unintentional OODs was consistently low over time. After adjustment, methadone detection was associated with a lower risk of fentanyl-attributed unintentional OOD (aRR: 0.92; 95% CI: 0.88-0.96). Buprenorphine (aRR: 1.05; 95% CI: 0.99-1.11) and naltrexone (aRR: 0.98; 95% CI: 0.86-1.11) were not significantly associated with fentanyl-attributed unintentional OODs. CONCLUSIONS: MOUD detection in unintentional fentanyl-attributed OODs in Illinois was low from 2019 to 2024. Methadone was the only MOUD to have a protective association with fentanyl-attributed unintentional OODs.
Opioid Agonist Treatment Use Among First Nation Peoples in Ontario, Canada: A Repeated Cross-sectional Study of Prevalence Trends From 2013 to 2023.
Rebić N, Ledlie S, Hamzat B … +12 more , Wang T, Bragg S, Iacono A, Shearer D, General Z, Mecredy G, McGregor L, Bertram J, Pine K, Corbiere Y, Smoke A, Gomes T
J Addict Med · 2026 Jun · PMID 42235058 · Publisher ↗
OBJECTIVES: The opioid toxicity crisis has disproportionately harmed First Nation Peoples, prompting efforts to expand access to opioid agonist therapy (OAT). We described trends in OAT use among this population in Ontar...
OBJECTIVES: The opioid toxicity crisis has disproportionately harmed First Nation Peoples, prompting efforts to expand access to opioid agonist therapy (OAT). We described trends in OAT use among this population in Ontario, Canada. METHODS: We conducted a population-based repeated cross-sectional study of registered ("Status") First Nation Peoples aged 15 years or older dispensed OAT in Ontario, Canada, between January 1, 2013 and December 31, 2023. We reported quarterly proportions (%) of First Nation Peoples who were dispensed OAT, including methadone, buprenorphine/naloxone, or buprenorphine extended-release (BUP-ER), overall and by OAT formulation. In addition, we examined the annual prevalence of OAT dispensing, overall and by formulation, stratified by age, sex, and residence within/outside of First Nation communities in 2023. RESULTS: Between 2013 and 2023, quarterly OAT dispensed among First Nation Peoples doubled from 2.7% to 5.0%, plateauing at ∼5% in early 2020. Methadone dispensing remained steady, ranging from 2.0% to 2.6% of all First Nation Peoples, and was the most commonly prescribed OAT until mid-2018 when it was overtaken by buprenorphine-containing products (i.e., buprenorphine/naloxone, BUP-ER). Dispensing of buprenorphine-containing products among this population rose from 0.6% in Q1 of 2013 to 3.1% in Q4 of 2023; specifically, 2.8% buprenorphine/naloxone, 0.5% BUP-ER. In 2023, 6.1% (N = 8,518/140,615) First Nation Peoples accessed OAT, with higher rates among individuals aged 25-44 years and residing within First Nation communities. CONCLUSIONS: Information on changing trends in OAT use among First Nation Peoples may inform evolving approaches to delivering quality OUD treatment to this population that uphold their rights to dignity, autonomy, and culturally safe care.
Advancing Kratom Science and Regulation: A Comparative Framework With Cannabis.
Thomas YT, Iqbal M, Mun CJ … +6 more , Zamarripa CA, Kosten TR, Vocci F, Bobb R, Samad F, Verrico CD
J Addict Med · 2026 Jun · PMID 42235057 · Publisher ↗
Kratom ( Mitragyna speciosa ) is a psychoactive botanical with a long history of use in Southeast Asia and growing uptake in the United States for its analgesic, stimulant, and mood-altering properties. The evidence base...
Kratom ( Mitragyna speciosa ) is a psychoactive botanical with a long history of use in Southeast Asia and growing uptake in the United States for its analgesic, stimulant, and mood-altering properties. The evidence base remains limited, and retail products vary widely in composition and potency. This narrative review highlights what is known about kratom's pharmacology and suggests a practical research and regulatory path toward evaluating its potential therapeutic applications within current regulatory frameworks, based on lessons from cannabis. A central distinction is between whole leaf products and those that are enriched in active constituents or that include semisynthetic derivatives. Because these categories differ in chemistry, pharmacology, and expected risk, they require different evidence standards. Priorities include development of chemically defined botanical preparations, validated analytical methods, and human studies that link exposure to effect through pharmacokinetic and pharmacodynamic modeling, abuse liability assessment, and cognitive and behavioral testing. The regulatory framework for kratom should consider a dual track. This includes enhanced standards for product quality, including composition, purity, labeling, and safety surveillance for botanical products, and conventional drug development pathways for enriched or semisynthetic constituents that include toxicology and human abuse potential studies. Coordinated federal support is urgently needed to align product standardization, early phase trials, and comparative evaluations across product classes. With this structure, kratom's possible therapeutic applications can be examined while safeguarding public health.
Buprenorphine for the Management of 7-Hydroxymitragynine (7-OH) Use: A Retrospective Case Series.
Fenske E, Williams B, Hallock-Koppelman L … +1 more , Buchheit BM
J Addict Med · 2026 Jun · PMID 42225057 · Publisher ↗
BACKGROUND: Kratom (Mitragyna speciosa) is increasingly used in the United States as a dietary supplement for pain, mood regulation, and opioid withdrawal. Its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH), demo...
BACKGROUND: Kratom (Mitragyna speciosa) is increasingly used in the United States as a dietary supplement for pain, mood regulation, and opioid withdrawal. Its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH), demonstrate μ-opioid receptor activity, with 7-OH exhibiting substantially greater opioid-like potency than mitragynine. There are concerns from the US Food and Drug Administration (FDA) regarding dependence and adverse effects. Purified 7-OH products may bypass metabolic pathways and deliver disproportionately strong opioid effects compared with natural kratom preparations, increasing the risk of dependence. Despite these concerns, 7-OH remains federally unscheduled, though listed as a "Drug of Concern" by the DEA. Although there is no standardized clinical guidance, buprenorphine has been used to manage kratom and 7-OH withdrawal with varying initiation strategies. OBJECTIVES: To describe the clinical course and outcomes of buprenorphine initiation among patients with problematic 7-OH use, focusing on initiation timing, dosing strategies, and symptom monitoring. METHODS: Retrospective chart review of patients treated at a low-barrier telehealth addiction medicine clinic between April and October 2025. RESULTS: Nine patients with purified 7-OH product use (as opposed to kratom use) met the inclusion criteria. The mean age was 33.5 years; 7 patients were identified as male. Low-dose initiation was used in 6 cases and standard initiation in 3 cases. Successful initiation and stabilization occurred in 88.9%, with no precipitated withdrawal or adverse events. Symptom improvement was reported in 8 of the total cases at a median 6-week follow-up. CONCLUSIONS: Buprenorphine initiation for problematic 7-OH use was feasible, well tolerated, and associated with symptom improvement, supporting development of pragmatic clinical approaches for this emerging substance use disorder.
Fertility Beliefs and Menstrual Experiences Among Women Entering Opioid Use Disorder Treatment.
Bello JK, Fuerst M, Levander XA … +9 more , Xu KY, Chrusciel T, Keegan Garrett E, Nigeda B, Walsh M, Kimmel M, Grucza RA, Edelman A, Ellis M
J Addict Med · 2026 May · PMID 42212469 · Full text
OBJECTIVES: Although many people with OUD may believe they are infertile due to chronic opioid use contributing to menstrual irregularities, minimal data exists on how opioid cessation and OUD treatment may impact fertil...
OBJECTIVES: Although many people with OUD may believe they are infertile due to chronic opioid use contributing to menstrual irregularities, minimal data exists on how opioid cessation and OUD treatment may impact fertility. We examine fertility perceptions and menstrual cycle characteristics of treatment-seeking women with OUD. METHODS: Data came from the Survey of Key Informants' Patients (SKIP) Program, a US-based opioid surveillance study of individuals newly entering OUD treatment. The SKIP Program recruits adults newly entering treatment for OUD to complete anonymous, self-report surveys. Respondents who identified as female or non-binary from 49 SUD treatment programs in 25 states were asked questions about their perceptions of fertility and menstrual cycle characteristics from January to March 2024. Analyses were restricted to women 18-49 years old with no history of hysterectomy. RESULTS: Of 637 respondents, 179 met criteria for analysis. The average age was 34.8 years (SD 7.0), 15.1% identified as Black, 10.6% Native American/Alaskan Native, and 58.7% White. The most common OUD treatment was buprenorphine (47.5%). Of respondents, 51.5% (85/165) did not believe they could become pregnant. Half (57.0%, 102/179) reported either irregular or no menstrual cycles in the year prior. Respondents who believed they could become pregnant were younger (32.0 vs. 37.1 y, P<0.0001) than those who believed they were infertile. CONCLUSIONS: Menstrual irregularities and perceptions of infertility were high among a nationally representative sample of treatment-seeking women with OUD, highlighting the need for patient-provider discussions about these topics in the context of OUD treatment.
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