Journal Of Addiction Medicine[JOURNAL]
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200 papers
GLP-1 RA Medication Associations With Hazardous Alcohol Drinking Reductions in Patients With Overweight or Obesity: A Prospective Observational Study.
King AC, Wellendorf C, Atkinson EA … +3 more , de Carvalho MEA, Fridberg DJ, Pannain S
J Addict Med · 2026 May-Jun 01 · PMID 40792626 · Publisher ↗
PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) approved for type 2 diabetes and overweight or obesity may affect alcohol drinking behavior. The present prospective observational study investigated hazardo...
PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) approved for type 2 diabetes and overweight or obesity may affect alcohol drinking behavior. The present prospective observational study investigated hazardous alcohol drinking in patients at the University of Chicago Weight Loss Clinic. They received GLP-1 RA therapy and underwent body weight and hazardous drinking assessments before and during treatment. METHODS: Fourteen patients were prescribed a GLP-1 RA for overweight or obesity (liraglutide [n=1], semaglutide [n=8], and tirzepatide [n=5]), along with standard care dietary counseling and physical activity recommendations. All but one patient met the body mass index (BMI) cutoff for obesity in the United States (n=13, BMI ≥30 kg/m 2 ; n=1, BMI=29.50 kg/m 2 ). Patients screened positive for hazardous drinking on the Alcohol Use Disorders Identification Test (AUDIT; score ≥8) and were categorized into subgroups of high (score 8-14) and very high AUDIT (score ≥15). The AUDIT was readministered on average 9.6 (±4.8) months after medication initiation. RESULTS: There were significant reductions in BMI and AUDIT scores over time, with patients in the very high AUDIT group reporting more pronounced reductions in AUDIT scores compared with those in the high AUDIT group. Effect sizes were large, indicating a high magnitude of the effect of GLP-1 RA medications on reducing hazardous drinking scores. CONCLUSIONS: These findings support the association between GLP-1 RA treatment and reduced alcohol consumption, particularly for individuals with very hazardous alcohol drinking levels. A better understanding of the acute mechanisms underlying GLP-1 RA therapies and randomized clinical trials may aid in the development of pharmacotherapies for hazardous drinking beyond patients with diabetes and/or obesity.
Butorphanol-induced Precipitated Opioid Withdrawal With Stress Cardiomyopathy in the Setting of Chronic Fentanyl Use.
Oyekanmi O, Kissel-Smith H, Melmer MN … +1 more , Wills B
J Addict Med · 2025 Aug · PMID 40778644 · Publisher ↗
BACKGROUND: Precipitated opioid withdrawal due to partial opioid agonists other than buprenorphine is rarely reported. We present a case of severe precipitated opioid withdrawal and stress cardiomyopathy after butorphano...
BACKGROUND: Precipitated opioid withdrawal due to partial opioid agonists other than buprenorphine is rarely reported. We present a case of severe precipitated opioid withdrawal and stress cardiomyopathy after butorphanol use in the setting of chronic fentanyl use. CASE SUMMARY: Emergency medical services responded to a 61-year-old female with opioid use disorder (OUD) who was severely agitated requiring multiple doses of sedatives. Emergency department examination was notable for extreme agitation and restlessness. An electrocardiogram showed sinus tachycardia without ischemic changes. Urine drug immunoassay was positive for benzodiazepines and fentanyl, despite no fentanyl administration by providers. A transthoracic echocardiogram showed evidence of stress cardiomyopathy. A subsequent comprehensive urine drug analysis was positive for norfentanyl and butorphanol. The patient confirmed using butorphanol immediately before the onset of symptoms. The patient's goals were to resume treatment of OUD with buprenorphine. She stabilized on buprenorphine 16 mg/4 mg sublingual film daily, then transitioned to buprenorphine long-acting injectable 96 mg subcutaneous monthly. DISCUSSION: Butorphanol is a synthetic partial agonist at the μ-opioid receptor and full agonist at the κ-opioid receptor. It is available in several formulations and is frequently used as a veterinary analgesic. Precipitated opioid withdrawal from butorphanol has been demonstrated in experimental settings but has not been described in clinical practice. CONCLUSIONS: This case emphasizes the importance of recognizing butorphanol as a partial opioid agonist capable of causing precipitated opioid withdrawal in the setting of chronic opioid agonist exposure, and underscores potential medical consequences of precipitated opioid withdrawal including stress cardiomyopathy.
Integration of Substance Use Disorder Services in Veterans Affairs Primary Care Clinics Serving Homeless Women.
Collingridge BN, Huebler S, Kertesz SG … +3 more , Gelberg L, Gordon AJ, Jones AL
J Addict Med · 2026 May-Jun 01 · PMID 40778637 · Full text
OBJECTIVES: Women experiencing homelessness (WEH) often face barriers to accessing substance use disorder (SUD) treatment. The Veterans Health Administration (VHA) has invested in primary care redesign efforts for women'...
OBJECTIVES: Women experiencing homelessness (WEH) often face barriers to accessing substance use disorder (SUD) treatment. The Veterans Health Administration (VHA) has invested in primary care redesign efforts for women's health (women's primary care clinics, "PCCs") and for homelessness (homeless-tailored PCCs). There have been no comparative examinations of SUD integration in these PCCs. We aim to compare VHA SUD integration across homeless-tailored and women's PCCs, identifying areas to improve care for WEH. METHODS: A 40-question provider survey was administered online. PCC physicians, nurses, and mental health providers were randomly sampled from 57 VHAs across the United States. Likert-type items assessed active service arrangement, active communication, same-day reachability of SUD specialists, collaboration with SUD specialists, and preparedness to meet women's needs and SUD needs. Multiple-choice items assessed time to referral completion, location of routine and urgent treatment, medication, counseling, staffing, and resource needs. Ordinal logistic regressions assessed Likert-type measures. χ 2 tests assessed multiple-choice items. RESULTS: Based on 114 respondents (response=23.6%), women's PCCs scored below homeless-tailored PCCs on several items: collaboration via shared patient discussions, service consults, and treatment plan coordination; women's health preparedness; SUD preparedness; urgent treatment location; and medication availability (all P values<0.05). Most providers (90% and 86%) reported access to staff with mental health or addiction expertise, but SUD treatment remained predominantly confined to specialty care rather than primary care. The most frequently endorsed resource need was on-demand access to addiction specialists. CONCLUSIONS: VHA PCCs that serve WEH report modest SUD integration; lessons from homeless-tailored PCCs could strengthen SUD practices in women's PCCs.
The Role of the Local Political Economy in the Opioid Settlement.
Mauri AI, Lindenfeld Z, Willison C … +1 more , Silver D
J Addict Med · 2026 May-Jun 01 · PMID 40762452 · Publisher ↗
Although local governments are responsible for delivering and financing many public health services, the existing public health literature has largely overlooked how the local political economy, or how political and econ...
Although local governments are responsible for delivering and financing many public health services, the existing public health literature has largely overlooked how the local political economy, or how political and economic structures interact to distribute resources across and within local governments, shapes health disparities. Since local governments will control over half of opioid settlement funds, variables related to the local political economy will be crucial for understanding variation in how local governments spend these funds and their effects. This commentary pursues 3 objectives. First, we highlight 3 critical aspects of the local political economy: local government fragmentation, the privatization of public health services, and local government fiscal stability. Second, we illustrate their significance to the opioid crisis and settlement spending. Finally, we discuss the implications of these variables for both research and practice. For researchers, we offer operationalizations, and for practitioners, we propose strategies for considering fragmentation, privatization, and fiscal stability when allocating settlement funds. We aim to convince researchers to integrate these variables into future studies and empower practitioners to design more effective interventions to address the opioid crisis.
A Case of 7-OH Mitragynine Use Requiring Inpatient Medically Managed Withdrawal.
Wightman RS, Hu D
J Addict Med · 2025 Aug · PMID 40758956 · Publisher ↗
OBJECTIVES: There is an increased interest in kratom and kratom-related products such as 7-hydroxymitragynine (7-OH). Here we present the case of a patient seeking inpatient substance use treatment for daily 7-OH use and...
OBJECTIVES: There is an increased interest in kratom and kratom-related products such as 7-hydroxymitragynine (7-OH). Here we present the case of a patient seeking inpatient substance use treatment for daily 7-OH use and the clinical course of care including clinical opiate withdrawal scale (COWS) and medication treatment response. METHODS: This is a single case report from an inpatient medically managed withdrawal level of substance use treatment care. RESULTS: A 38-year-old man with a history of opioid use disorder reported escalation of use including kratom to 7-OH complicated by the development of use disorder, tolerance, and withdrawal. The patient experienced a withdrawal syndrome consistent with opioid withdrawal upon stopping use, with COWS peaking at 14. The patient was treated with a short course of buprenorphine sublingual (daily dosing 2-8 mg) based on signs and symptoms. He did not want to remain on buprenorphine after the medically managed withdrawal period and was successfully tapered off buprenorphine during his treatment stay and transitioned to residential level of care. CONCLUSIONS: Given the widespread availability of kratom and kratom-related products it is important for health care providers to screen for use and development of use disorder and be prepared to provide counseling, support, and treatment for patients.
Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA.
London KS, Huo S, Murphy L … +16 more , Warrick-Stone T, Goodstein D, Montesi M, Carter M, Butt S, Alexander K, Satz W, Tasillo A, Xu L, Arora M, Casey E, McKeever R, Lowenstein M, Durney P, Hart B, Perrone J
J Addict Med · 2026 Mar-Apr 01 · PMID 40747932 · Full text
OBJECTIVES: Medetomidine, a potent veterinary α2-adrenergic agonist, has emerged as an adulterant in the illicit fentanyl supply in Philadelphia, PA. Accompanying this change, a severe withdrawal syndrome, distinct from...
OBJECTIVES: Medetomidine, a potent veterinary α2-adrenergic agonist, has emerged as an adulterant in the illicit fentanyl supply in Philadelphia, PA. Accompanying this change, a severe withdrawal syndrome, distinct from opioid and more comparable to dexmedetomidine withdrawal, emerged. We describe it. METHODS: A multicenter case series is described across 3 hospital systems in Philadelphia between September 2024 and April 2025. The cohort included patients who reported opioids as the primary drug of choice, who presented with opioid withdrawal complicated by severe sympathetic activation and required hospitalization. Data extraction from the electronic health record included demographics, clinical outcomes, and confirmatory toxicology in a subset. RESULTS: Two hundred nine patients met the inclusion criteria; the median age was 38 years and 29% were female. Intensive care unit (ICU) admission occurred in 77.5%, with 20.1% requiring intubation. Symptoms were often refractory to traditional opioid withdrawal management, and 73.7% received dexmedetomidine infusion. In the cohort subset with toxicology testing (n=43), 100% had fentanyl and medetomidine metabolites, while xylazine metabolites were not always present (24, 55.8%). Severe complications included encephalopathy (35.4%), myocardial injury (28.7%), and rarely seizures (5%). Patients suffered from severe withdrawal, with a median maximum recorded Clinical Opiate Withdrawal Score (COWS) score of 23. CONCLUSIONS: This study describes individuals experiencing severe withdrawal, temporally associated with medetomidine-adulterated fentanyl exposure. Clinicians should be alert to the limitations of standard withdrawal protocols for fentanyl or opioids and the need for aggressive α2-agonist therapies, such as dexmedetomidine. As medetomidine continues to spread in the illicit drug supply, adapting clinical and public health responses will be critical.
Predictors of Risky Sexual Behaviors Among Female Adolescents and Young Adults Seeking Withdrawal Management Treatment: A Lifestyle-routine Activities Theory Approach.
Rabinovitz S, Kalimi S, Nagar M
J Addict Med · 2026 May-Jun 01 · PMID 40747927 · Publisher ↗
OBJECTIVES: This study examines prevalence and predictors of risky sexual behaviors (RSBs) among female adolescents and young adults admitted to withdrawal management treatment (WM) for substance use disorders (SUD), a c...
OBJECTIVES: This study examines prevalence and predictors of risky sexual behaviors (RSBs) among female adolescents and young adults admitted to withdrawal management treatment (WM) for substance use disorders (SUD), a critical point where addressing co-occurring risk behaviors could considerably enhance treatment outcomes and recovery. Utilizing lifestyle-routine activities theory (LRAT), we aimed to identify vulnerability factors contributing to sexual victimization. METHODS: A 1:1 sample (n = 194; ~45%) was drawn from all admissions over 5 years to the sole national acute WM unit serving females aged 13-34. Data were collected through clinical intake interviews and standardized questionnaires, assessing substance use, mental health, social context, and risky sexual experiences. RESULTS: Sexual victimization and RSBs (eg, unprotected or transactional sex) were highly prevalent, with 89% reporting experiencing sexual assault and 84.9% engaging in at least one recent RSB. Notably, 28% reported participating in 6-7 RSB types. Significant RSB predictors included earlier SUD diagnosis, poor mental health, limited social support, and strained parental relationships. SUD severity (β = 0.15, P = 0.042), peer drug use (β = 0.31, P < 0.001), and living on the street (β = 0.15, P = 0.048) significantly increased the likelihood of multiple RSBs. CONCLUSIONS: Findings underscore the importance of integrated, trauma-informed approaches in SUD treatment among young females. The complex interplay between trauma exposure, substance use, and RSBs, influenced by environmental factors, necessitates comprehensive treatment strategies encompassing these co-occurring risk domains simultaneously. LRAT offers a valuable framework for understanding how disrupted environments and diminished protective factors contribute to vulnerability. Implementing tailored, trauma-informed care may enhance recovery while addressing broader public health implications.
Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs.
Franz B, Ford JH, Cheng H … +3 more , Garneau HC, Mount K, McGovern MP
J Addict Med · 2025 Aug · PMID 40747925 · Full text
OBJECTIVES: Efforts to increase access to highly effective medications for opioid use disorder (MOUD) have largely focused on primary care. Ironically, many specialty addiction treatment programs have yet to adopt MOUD....
OBJECTIVES: Efforts to increase access to highly effective medications for opioid use disorder (MOUD) have largely focused on primary care. Ironically, many specialty addiction treatment programs have yet to adopt MOUD. To bring MOUD access to scale, researchers need to better understand medication practices across these 2 major portals of care for patients with opioid use disorder (OUD). In this study, our team examined baseline prescribing data from 62 primary care clinics and specialty addiction treatment programs (SATPs) participating in MOUD implementation endeavors across 2 states. METHODS: Our primary outcomes included MOUD prescribing practices, measured by the integrating medications for addiction treatment (IMAT), which includes 7 dimensions of guideline-adherent delivery of MOUD, and an additional subscale on low threshold care. We also measured reach of MOUD to patients and adoption as the number of current MOUD prescribers. Secondary outcomes included community characteristics surrounding each type of organization. Descriptive statistics and bivariate tests explored differences between primary and specialty care settings. RESULTS: SATPs had lower MOUD capacity and implementation as compared with primary care clinics. Specialty settings also had lower organizational support for low threshold prescribing. SATPs were located in counties with higher overdose rates, higher unemployment, fewer MOUD prescribers, and with more opioid prescriptions per capita. CONCLUSIONS: SATPs have lower MOUD implementation capacity than their primary care counterparts and are more likely to be in counties with greater OUD-related needs, economic distress, and fewer treatment resources. Selecting more precise implementation support strategies for SATPs that are late adopters of MOUD is a major need.
The Concept of Treatment-refractory Addiction: Drawing on Psychiatric Insights to Improve Addiction Research.
Burgess-Hull A
J Addict Med · 2026 Mar-Apr 01 · PMID 40747915 · Publisher ↗
The concept of treatment-refractory addiction (TRA), while relatively new to the addiction field, is a well-established concept in other areas of medicine and psychiatry. Recent commentaries have highlighted the need for...
The concept of treatment-refractory addiction (TRA), while relatively new to the addiction field, is a well-established concept in other areas of medicine and psychiatry. Recent commentaries have highlighted the need for clearer conceptualization and definition of TRA. This commentary argues that conceptual frameworks established in other psychiatric domains (eg, depression, schizophrenia, obsessive-compulsive disorder) can and should inform the development of criteria and strategies for identifying and addressing TRA in substance use disorders (SUDs). Central to this effort is the recognition that treatment response variability is the norm rather than the exception in SUD care. Conceptualizations and definitions of TRA should seek to distinguish true refractoriness from suboptimal or incomplete treatment exposure, which can arise from inadequate treatment exposure or adherence, and consider whether nonresponse is present from the start (primary refractoriness) or emerges over time (secondary refractoriness). Advanced analytic methods, including unsupervised clustering, offer opportunities to characterize heterogeneity in treatment outcomes in aggregate or over time, identify patient subgroups that do not benefit from standard therapies, and explore underlying mechanisms of nonresponse. By integrating lessons learned from other psychiatric disorders, addiction scientists can develop more precise definitions of TRA, which will ultimately inform the development of diagnostic/prognostic frameworks, and targeted interventions.
Neurological Injury and Outcomes in Fentanyl-related Cardiac Arrest.
Otero M, Shih J, Zhou B … +8 more , Ghandi S, Talbott J, Singhal NS, Calabrese E, Randazzo D, Coffin PO, Hemphill Iii JC, Amorim E
J Addict Med · 2026 May-Jun 01 · PMID 40747898 · Publisher ↗
OBJECTIVES: Fentanyl has become the primary drug responsible for fatal overdoses in most urban US regions. Information about the impact of fentanyl-related overdose in neurological outcomes after cardiac arrest (CA) comp...
OBJECTIVES: Fentanyl has become the primary drug responsible for fatal overdoses in most urban US regions. Information about the impact of fentanyl-related overdose in neurological outcomes after cardiac arrest (CA) compared with other etiologies of CA is limited. METHODS: Retrospective review of medical records from adult patients with out-of-hospital CA who had admission drug testing for fentanyl and opioids from August 2019 to June 2021. Good outcome was defined as a Cerebral Performance Category score of 1-2 at discharge. χ 2 was used for group comparison. RESULTS: Neurological prognosis evaluation was pursued for 233 patients, and 61 (26.2%) met criteria for good outcome. Thirty-six (15.45%) patients tested positive for fentanyl and 13 for other opioids (5.58%). The proportion of good outcomes was similar between groups (fentanyl 22.2%, other opioids 38.5%, nonopioid 26.1%, P = 0.52). Fewer fentanyl-related CA had bystander cardiopulmonary resuscitation (19.4% vs other opioids 38.5% vs nonopioid 43.8%, P = 0.02) shockable rhythms (2.9%, 16.7%, 25%, P = 0.01) or corneal reflexes 72 hours after CA (25.8%, 66.7%, 39.8%, P = 0.046), but no difference was seen for pupillary response at 72 hours ( P = 0.17). More fentanyl-related CA cases had signs of severe brain dysfunction on EEG with burst suppression (54.8%, 0%, 39.4%, P = 0.01). CONCLUSIONS: Cardiac arrest associated with fentanyl use was linked to decreased rates of bystander cardiopulmonary resuscitation, increased incidence of nonshockable Rhythms, and greater neurological injury as indicated by electroencephalography (EEG) suppression measures. However, the proportion of good neurological outcomes (CPC: 1-2) was similar across groups.
Feasibility of an Inpatient Split-Dose Rapid Methadone Induction Protocol for Pregnant Individuals.
Nacev EC, Prewitt KC, Yang WT … +5 more , Sokolski E, Winer JM, Rudolf V, Englander H, Liu P
J Addict Med · 2025 Aug · PMID 40747892 · Publisher ↗
OBJECTIVES: Opioid use disorder (OUD) is associated with adverse perinatal outcomes. Pregnant patients often require higher doses of methadone, including split-dosing, due to physiologic changes, and stabilization is cri...
OBJECTIVES: Opioid use disorder (OUD) is associated with adverse perinatal outcomes. Pregnant patients often require higher doses of methadone, including split-dosing, due to physiologic changes, and stabilization is critical. Little guidance exists for methadone titration in this population, and hospitalization offers a unique opportunity to rapidly initiate methadone. This report describes our experience with inpatient split-dose, rapid methadone induction among high-risk pregnancies at 1 tertiary care center. METHODS: We conducted a retrospective chart review of hospitalized pregnant individuals with OUD seen by our interprofessional addiction medicine consult service between June 2023 and July 2024. We included patients who were initiated on the rapid inpatient split dose methadone protocol, which includes dose recommendations (maximum 70 mg day 1, 80 mg day 2, 100 mg day 3, 120 mg day 4, and 140 mg day 5) and strict inclusion and exclusion criteria. RESULTS: Fourteen unique pregnant patients received the protocol. Average total daily doses of methadone on days 1-5 were 57, 80, 85, 93, and 105 mg, respectively. The titration for one patient was slowed for asymptomatic bradycardia; otherwise, there were no adverse events. After discharge, 12 patients (86%) attended an opioid treatment program (OTP) intake, and 8 (57%) remained on methadone at 30 days postdischarge. Of patients who were discharged on split-dose methadone and followed up at an OTP, all were continued on split-dosing by the OTP. CONCLUSIONS: Inpatient split dose, rapid methadone initiation for appropriately selected pregnant individuals is feasible. Posthospitalization OTP retention rates were comparable to the general population, highlighting the need for more support for this vulnerable population.
Performance of a Xylazine Test Strip in Urine Biospecimens.
Unsihuay D, Wang P, Milone M … +2 more , Thakrar A, Perrone J
J Addict Med · 2025 Jul-Aug 01 · PMID 40737132 · Publisher ↗
OBJECTIVE: Herein, we evaluate the performance of xylazine test strips (XTS) in urine samples. XTS is used for community drug checking (powders and liquids) but lacks regulatory approval for human specimen testing. METHO...
OBJECTIVE: Herein, we evaluate the performance of xylazine test strips (XTS) in urine samples. XTS is used for community drug checking (powders and liquids) but lacks regulatory approval for human specimen testing. METHODS: We obtained n=85 human urine specimens from a toxicology laboratory in Philadelphia, originally submitted for qualitative mass spectrometry (MS) expanded drug analysis. Residual urine was tested for xylazine using XTS (BTNX Inc.), and results were then compared against the MS method. Synthetic urine spiked with xylazine standards was used to determine the XTS cutoff. An external quantitative MS method was used to investigate potential mismatches. RESULTS: Of n = 85 human urine specimens, XTS demonstrated 86% sensitivity and 93% specificity using a XTS cutoff of 750 ng/mL established with synthetic urine samples. Six false negatives (14%) among 43 qualitative MS-positive samples were observed, primarily due to XTS's lower sensitivity. Among 3 false positives (7%) observed in 42 qualitative MS-negative samples, lidocaine likely causes the interference. Interestingly, some XTS-positive samples were found to have xylazine concentration lower than 750 ng/mL using quantitative MS, suggesting cross-reactivity with unknown metabolites or analogs. CONCLUSIONS: XTS requires further refinement to achieve lab-quality performance, with a focus on improving sensitivity and minimizing false positives caused by nonspecific interactions with urine components. Further research is necessary to optimize their design, establish accurate detection thresholds, supporting clinical decision-making, and obtain regulatory validation.
Public Xylazine Awareness and Support for Policies and Initiatives to Address the Xylazine Threat Among US Adults.
Golan OK, Liu W, Taylor B
J Addict Med · 2025 Jul-Aug 01 · PMID 40737131 · Publisher ↗
OBJECTIVES: Xylazine, a nonopioid veterinary tranquilizer, is increasingly being added to the illicit opioid supply. When used by humans, xylazine can cause severe skin ulcers and extreme sedation. This study aimed to ex...
OBJECTIVES: Xylazine, a nonopioid veterinary tranquilizer, is increasingly being added to the illicit opioid supply. When used by humans, xylazine can cause severe skin ulcers and extreme sedation. This study aimed to examine awareness of xylazine and support for policies/initiatives to address the xylazine threat among US adults. METHODS: An AmeriSpeak survey with US nationally representative adults aged 18 and older was administered in March 2024. Survey questions assessed awareness of xylazine and potential xylazine use, drug/opioid use history, and support for 10 policies/initiatives to address the xylazine threat (including a range of drug checking initiatives, wound care initiatives, punitive policies, harm reduction policies, and xylazine education campaigns). We conducted weighted descriptive and regression analysis of survey data from a nationally representative sample of 1215 US adults. RESULTS: Most respondents were not aware of xylazine (88%, n = 1063). Approximately 10% (n = 117) were aware of xylazine but had not used it, and around 2% (n = 23) were aware of xylazine and possibly had used it. On average, participants supported only 1.52 (SD = 2.41) of 10 listed policies/initiatives to address the xylazine threat. The number of policies/initiatives supported varied by xylazine awareness, gender, marital status, and drug use history. CONCLUSIONS: Among the US public, xylazine awareness and support for policies/initiatives to address the xylazine threat are low. Public xylazine educational campaigns may be warranted to help the public understand the severity of the xylazine threat, garner support for associated policies/initiatives, and reduce xylazine-related harms.
The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder.
Costa GPA, Ra J, Meyerovich J … +3 more , Pittman B, C Nunes J, De Aquino JP
J Addict Med · 2026 May-Jun 01 · PMID 40728216 · Full text
OBJECTIVES: This study explored the correlations between childhood trauma, chronic pain, and substance use among individuals receiving methadone for opioid use disorder (OUD). We hypothesized that, among individuals with...
OBJECTIVES: This study explored the correlations between childhood trauma, chronic pain, and substance use among individuals receiving methadone for opioid use disorder (OUD). We hypothesized that, among individuals with OUD, a history of childhood trauma would correlate with more severe pain and substance use compared with those without such history. METHODS: We conducted a cross-sectional study of 82 individuals receiving methadone for OUD. Participants completed the Childhood Trauma Questionnaire (CTQ) to assess childhood trauma exposure, the Brief Pain Inventory (BPI) to characterize chronic pain, and the Timeline Followback (TLFB) method to assess substance use in the past 28 days. Correlation analyses and ANOVA examined the relationships between these variables. RESULTS: Higher childhood trauma scores correlated with greater pain severity (r = 0.27, P = 0.03), increased alcohol consumption (r = 0.25, P = 0.04), and earlier age of cannabis initiation (r = -0.45, P < 0.001). Among trauma subscales, emotional abuse most closely correlated with greater pain severity (r = 0.33, P = 0.008) and interference (r = 0.28, P = 0.03), and alcohol consumption (r = 0.28, P = 0.02). Individuals who used cannabis reported significantly higher levels of emotional abuse ( P = 0.04), sexual abuse ( P = 0.03), and physical neglect ( P = 0.02) compared with those who did not. Conversely, our analysis did not reveal significant correlations between childhood trauma and heroin, tobacco, cocaine, or stimulant use. CONCLUSIONS: Childhood trauma correlated with greater pain severity and interference, higher alcohol use, earlier cannabis initiation, and increased likelihood of cannabis use among individuals receiving methadone for OUD. These findings suggest the importance of integrating trauma-focused assessment and treatment into OUD treatment programs.
Implementing a Collaborative Approach to Caring for Patients With Substance Use Disorders Requiring Outpatient Parenteral Antimicrobial Therapy After Discharge.
Keller SC, Abdel Galil R, Brenon JR … +8 more , Buzzalino LG, Hessel A, de Brito D, Townsend J, Wright WF, Hawes AM, Falade-Nwulia O, Buresh ME
J Addict Med · 2025 Jul · PMID 40728209 · Publisher ↗
OBJECTIVES: Injection-related infections (IRI) are common and often require treatment with prolonged intravenous antibiotics via outpatient parenteral antimicrobial therapy (OPAT). However, patients with substance use di...
OBJECTIVES: Injection-related infections (IRI) are common and often require treatment with prolonged intravenous antibiotics via outpatient parenteral antimicrobial therapy (OPAT). However, patients with substance use disorders (SUD) being treated for IRI with OPAT receive suboptimal postdischarge care. We describe a novel program to co-locate OPAT and SUD supports at skilled nursing facilities (SNFs) in a pilot program to improve clinical outcomes. METHODS: We performed a retrospective chart review of patients with a history of SUD discharged from 2 academic medical centers 2021-2023 to SNFs, including those discharged to pilot SNF and SNFs that were not in a pilot program. We use descriptive statistics to report sociodemographic variables, OPAT outcomes, and SUD outcomes. RESULTS: Twenty-six patients were discharged to a pilot program SNF, and 172 were discharged to an alternative SNF. Patients discharged to pilot program SNFs went to infectious diseases appointments 73% of the time, versus 51% for alternative SNFs. Patients discharged to pilot program SNFs had a 15% 30-day hospital readmission rate and an 8% infection relapse rate, versus 21% and 22% at the alternative SNFs, respectively. Rates of self-directed discharge from SNFs were similar between groups. CONCLUSIONS: We detail successful implementation of an innovative approach to the care of patients with SUD requiring OPAT at SNFs. More work is needed to evaluate outcomes from similar initiatives and determine how to sustainably scale-up interventions for these patients.
Quetiapine: A Novel Additive to the Illicit Heroin Supply in Los Angeles.
Friedman JR, Molina CA, Romero R … +5 more , Pyfrom EM, Appley MG, Marienfeld C, Sisco E, Shover CL
J Addict Med · 2026 May-Jun 01 · PMID 40709772 · Publisher ↗
INTRODUCTION: The rise of the "fourth wave" of the US overdose crisis has been characterized by the increasing polysubstance use of illicit opioids combined with other drug classes. Polysubstance combinations are increas...
INTRODUCTION: The rise of the "fourth wave" of the US overdose crisis has been characterized by the increasing polysubstance use of illicit opioids combined with other drug classes. Polysubstance combinations are increasingly better understood through community-based drug checking. Here we share findings from a drug checking program in Los Angeles, California, highlighting quetiapine-a commonly used atypical antipsychotic-as a novel additive in heroin samples. METHODS: This study leveraged data from a community-based drug checking program in Los Angeles, CA. Substance determination was performed through direct analysis in real-time mass spectrometry (DART-MS). Fisher exact tests were used to assess differences in heroin samples containing versus not containing quetiapine. RESULTS: Of n=52 samples containing heroin, n=13 (25.0%) contained quetiapine. Among quetiapine-positive heroin samples, n=4 (30.8%) contained fentanyl, compared with n=27 (69.2%) quetiapine-negative heroin samples ( P =0.022). No significant differences were observed between quetiapine-positive and negative samples with respect to xylazine, cocaine, or methamphetamine prevalence. All quetiapine-positive samples were identified by clients as expected to contain black tar heroin, and no clients reported expecting their samples to contain quetiapine. Anecdotally, some participants identified increased euphoria and "pins and needles" sensations from quetiapine-positive samples. CONCLUSIONS: This small observational study provides the first drug-checking-based evidence in the academic literature-to our knowledge-of quetiapine as an additive to the illicit heroin supply. The presence of quetiapine was associated with less fentanyl adulteration and may reflect an alternative augmentation strategy. Further confirmatory studies are needed to assess the degree to which this phenomenon exists in other locations and the potential health implications.
Stigmatizing Language in Large Language Models for Alcohol and Substance Use Disorders: A Multimodel Evaluation and Prompt Engineering Approach.
Wang Y, Hsu K, Brokus C … +5 more , Huang Y, Ufere N, Wakeman S, Zou J, Zhang W
J Addict Med · 2026 May-Jun 01 · PMID 40705021 · Publisher ↗
OBJECTIVES: Large language models (LLMs) are increasingly used in health care communication but can inadvertently perpetuate stigmatizing language toward individuals with alcohol and substance use disorders. Despite grow...
OBJECTIVES: Large language models (LLMs) are increasingly used in health care communication but can inadvertently perpetuate stigmatizing language toward individuals with alcohol and substance use disorders. Despite growing interest in LLM performance, a focused evaluation of their propensity for SL and strategies to mitigate it remains lacking. METHODS: We generated 60 clinically relevant questions ["prompts"; 20 each for alcohol use disorder (AUD), alcohol-associated liver disease (ALD), and substance use disorder (SUD)] and tested 14 LLMs. Two physicians independently assessed all responses for stigmatizing language using guidelines from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism; discrepancies were resolved by a third physician. We employed iterative prompt engineering (PE)-a process of strategically crafting input instructions to guide model outputs towards nonstigmatizing language-to reduce stigmatizing language by incorporating a list of specific terms to avoid and identifying model-specific pitfalls. We compared the prevalence of SL in responses to native prompts (baseline, unengineered) versus engineered prompts, adjusting for word count in multivariate analyses. RESULTS: Of 840 responses generated from native prompts, 297 (35.4%) contained stigmatizing language, totaling 592 terms. With prompt engineering, only 53 (6.3%) of 840 responses contained stigmatizing language, comprising 104 terms. Prompts on topic of ALD yielded higher odds of stigmatizing language than those addressing AUD (adjusted odds ratio, 2.11; 95% CI, 1.47-3.02; P < 0.001), whereas prompts on substance use disorder (SUD) did not differ significantly from AUD (adjusted odds ratio, 1.17; 95% CI, 0.81-1.69; P = 0.40). Prompt engineering reduced the likelihood of stigmatizing language by 88% in univariate analysis ( P < 0.001), and this effect persisted after adjusting for word count (adjusted odds ratio, 0.15; 95% CI, 0.11-0.20; P < 0.001). CONCLUSIONS: LLMs frequently generated stigmatizing language when discussing alcohol-related and substance use-related conditions, potentially undermining patient-centered care. However, targeted prompt engineering substantially reduced stigmatizing language occurrences across diverse models. These findings emphasize the need for ongoing model refinement and structured prompting strategies to ensure stigma-free language in health care communication.
Xylazine Test Strip Use Among People Who Use Drugs in New York State.
Gelberg KH, Montero F, Chang M … +7 more , Russo MR, Lootens MR, David JL, Chandler R, Oga E, Gilbert L, El-Bassel N
J Addict Med · 2025 Jul · PMID 40693665 · Publisher ↗
OBJECTIVES: Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) wh...
OBJECTIVES: Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) who use XTS and examines risk reduction behaviors associated with XTS use. METHODS: This observational cohort study was conducted in New York between September and December 2023 as part of a larger study. Questions about XTS use were added to the parent study's baseline survey of PWUDs and were completed by 254 PWUDs. Sociodemographic characteristics compared XTS users to nonusers. Propensity score weighting using inverse probability of treatment weights was used to examine the association of ever-using XTS with risk reduction behaviors and the drug type used. RESULTS: Sixty-six participants (26%) had used XTS; 80% trusted the results, and 79% were confident in their ability to use XTS to detect xylazine. Those who had used XTS were more likely to have naloxone nearby (aOR=7.51, 95% CI: 2.26-24.95, P=0.001), use a test shot (aOR=2.43, 95% CI: 1.18-5.01, P=0.016), have someone check on them while using (aOR=2.52, 95% CI: 1.23-5.19, P=0.012), and watch someone use the same drugs (aOR=2.35, 95% CI: 1.19-4.65, P=0.014). XTS use was associated with using opioids (aOR=3.68, 95% CI: 1.38-9.81, P=0.009) and injecting drugs (aOR=4.32, 95% CI: 1.91-9.77, P<0.001). CONCLUSIONS: Our study demonstrates that XTS use appears to be associated with engaging in risk reduction behaviors, suggesting XTS can be a useful harm reduction tool. More research is needed to assess whether PWUDs change their drug consumption behaviors based on XTS results.
"She Was Real About It and Made Me Feel Life Is Important": Patient Perspectives on Peers' Role in Peer-Assisted Telemedicine Hepatitis C Treatment for People Who Use Drugs in Rural Communities.
Hoffman K, Gillian L, Shin S … +4 more , Seaman A, Gailey T, Spencer HC, Korthuis PT
J Addict Med · 2026 May-Jun 01 · PMID 40693655 · Full text
OBJECTIVES: Telemedicine is a promising approach to reach people with limited access to treatment for hepatitis C. People who use drugs (PWUD) and are disengaged from services, however, experience barriers to telemedicin...
OBJECTIVES: Telemedicine is a promising approach to reach people with limited access to treatment for hepatitis C. People who use drugs (PWUD) and are disengaged from services, however, experience barriers to telemedicine access. The Oregon HOPE TeleHCV study employed peer support specialists to provide outreach to engage PWUD, support pretreatment screening, facilitate telemedicine Hepatitis C virus visits, and assist HCV medication initiation and adherence. In our randomized controlled trial (N =203), the model demonstrated substantially higher HCV treatment initiation and cure compared with enhanced usual care. Our qualitative investigation examined the role of peers from the perspective of patients. METHODS: We conducted semistructured phone interviews with 34 patients to better understand the influence of peer interactions on patient experiences and the role of peer support in shaping patient outcomes. The domains of interest were to better understand (1) the influence of peer interactions on patient experiences and (2) the role of peer support in shaping patient outcomes. Interviews were recorded, professionally transcribed and analyzed using Thematic Analysis. RESULTS: We identified 3 major themes regarding the role of peers in the model: (1) peers' lived experience and ways of engaging with patients create an alliance with patients, (2) peers serve as a communication bridge with the health care system, and (3) peers facilitate access to resources and support. CONCLUSIONS: Peers were key to the success of the model. Expansion of the Oregon HOPE TeleHCV model of using peer support specialists to engage, retain, and support PWUD could galvanize efforts to eliminate HCV.
Patients' Perspectives on Alternative Antibiotic Treatment Strategies for Infective Endocarditis Among Persons Who Inject Drugs.
Cooper DK, Okumu EA, McInnes B … +9 more , Ansary MM, Esposito M, Merenbloom C, Ostrach B, Chu VH, Wu LT, Golin C, Rosen DL, Schranz AJ
J Addict Med · 2026 May-Jun 01 · PMID 40673603 · Full text
OBJECTIVES: Injection drug use is a leading and growing risk factor for infective endocarditis (IE), as evidenced by a marked national increase in hospitalizations for drug use-associated infective endocarditis (DUA-IE)....
OBJECTIVES: Injection drug use is a leading and growing risk factor for infective endocarditis (IE), as evidenced by a marked national increase in hospitalizations for drug use-associated infective endocarditis (DUA-IE). The typical treatment approach for persons with DUA-IE is a 6-week inpatient course of intravenous antimicrobials. This approach is resource-intensive, requiring substantial hospital resources and lengthy stays. Alternative methods of antibiotic delivery for DUA-IE treatment have been proposed and piloted, but their acceptance among people who inject drugs is unknown. METHODS: Persons hospitalized with DUA-IE (N = 16) completed semi-structured interviews to identify facilitators and barriers to 3 proposed IE treatment options: (A) hospitalization for the entirety of antibiotic treatment, the current standard of care; (B) home-based outpatient parenteral antimicrobial therapy via indwelling catheter; or (C) weekly outpatient visits for long-acting antibiotic infusion. Interviews were transcribed and thematically coded to identify participant perspectives and preferences among these strategies. RESULTS: Option A was ranked the most preferred treatment regimen (8 participants, 50%), followed by options C (5 participants, 31%) and B (3 participants, 19%). Participants felt option A provided the most effective treatment for their endocarditis, despite dissatisfaction with the hospitalization length. Options B and C appealed to participants given the convenience of outpatient care; however, inadequate transportation and housing instability were prominently cited as barriers. CONCLUSIONS: These diverse patient perspectives should inform trials to evaluate the effectiveness of alternative antibiotic delivery strategies, as well as interventions to improve patient-centered decision-making for DUA-IE treatment.
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