Journal Of Addiction Medicine[JOURNAL]
Sun
200 papers
"The Sky Didn't Fall": Patient and Clinician Experiences With Increased Buprenorphine Prescription Lengths During Pandemic-related Telehealth Expansion.
Cheng A, Weinstein ZM, Davoust M … +6 more , Ventura AS, Magane KM, Theisen J, Blakemore S, Saitz R, Bazzi AR
J Addict Med · 2026 Apr · PMID 41997587 · Full text
OBJECTIVES: Pandemic-related telehealth expansion changed how buprenorphine care was delivered. However, patient and clinician experiences with how these changes shaped decisions about prescription length remain underexp...
OBJECTIVES: Pandemic-related telehealth expansion changed how buprenorphine care was delivered. However, patient and clinician experiences with how these changes shaped decisions about prescription length remain underexplored, particularly in safety-net settings. METHODS: From May 2021 to May 2022, we purposively sampled patients and clinicians from an office-based buprenorphine treatment clinic at an urban, safety-net hospital. Trained interviewers used semistructured interview guides to explore experiences with changes in care during the pandemic. We used a collaborative codebook development process and thematic analysis to identify key perspectives on buprenorphine prescription length changes. RESULTS: From interviews with 25 patients and 16 clinicians, 3 topics of relevance emerged: (1) changes to buprenorphine prescribing practices to support patients during the pandemic, (2) factors influencing clinical decision making and criteria for longer prescriptions, and (3) patient views and internalized expectations. Overall, both patients and providers reported increased duration of buprenorphine prescriptions and positive views of this change. Clinicians generally prioritized ensuring medication access over concerns about misuse and diversion. Influences on clinical decision making included medical conditions, transportation access, housing status, and patient communication. To receive longer prescriptions, some patients described deliberate efforts to build and maintain trust with clinicians. CONCLUSIONS: We identified largely positive patient and clinician experiences with increased buprenorphine prescription lengths. As practices continue to update their clinic policies, these findings support continued flexibility and extended prescription lengths to support medication access. Findings also demonstrate heterogeneity in clinicians' decision-making and an opportunity for improved transparency and patient-provider communication regarding criteria for extended prescriptions.
Mixed Presentation of Heroin-Associated Spongiform Leukoencephalopathy and CHANTER Syndrome After Fentanyl Use: A Case Report.
Marshall N, Balasanova AA
J Addict Med · 2026 Apr · PMID 41997585 · Publisher ↗
BACKGROUND: Toxic leukoencephalopathy is a heterogenous syndrome characterized by destruction of brain white matter. Inhalational heroin has been linked to a specific set of neuroimaging findings termed heroin-associated...
BACKGROUND: Toxic leukoencephalopathy is a heterogenous syndrome characterized by destruction of brain white matter. Inhalational heroin has been linked to a specific set of neuroimaging findings termed heroin-associated spongiform leukoencephalopathy (HSLE). Clinical findings in HSLE generally develop and progress through an initial, intermediate, and terminal stage. Fentanyl has been linked to a separate set of neuroimaging findings and neurological symptoms labeled Cerebellar Hippocampal And Basal Ganglia Transient Edema with Restriction (CHANTER) syndrome, in which patients often present with an acute onset of stupor or coma hours to days after opioid use. Fentanyl has also been documented to cause a constellation of white matter changes mirroring HSLE. CASE SUMMARY: A 50-year-old man presented with an acute onset of somnolence, dysarthria, and ataxia following a subacute history of headaches, memory deficits, weight loss, and diaphoresis. He endorsed regular fentanyl use though details about quantity and route of administration remained unclear. Brain imaging suggested a mixed picture as findings were consistent with both HSLE and CHANTER syndrome. The patient's clinical course fluctuated until 3 weeks after admission, when he began showing signs of the terminal stage of HSLE, ultimately resulting in death 1 week later. CONCLUSIONS: HSLE and CHANTER syndrome have not previously been reported as occurring concurrently, nor has fentanyl previously been linked to HSLE. This case highlights the potential for HSLE and CHANTER syndrome to coexist and for fentanyl to cause a set of findings consistent with both syndromes. The patient's spouse provided written and verbal consent to publish the information in this report.
Methamphetamine Use Among Older Adults Living With HIV: A Qualitative Study.
Han BH, Kepner WE, Nguyen AL … +4 more , Colaneri N, Collins A, Coveney M, Karris MY
J Addict Med · 2026 Apr · PMID 41985197 · Publisher ↗
OBJECTIVES: Methamphetamine can complicate the management of chronic diseases and is associated with a range of health complications. This study examines the contextual motivations and perceived risks of methamphetamine...
OBJECTIVES: Methamphetamine can complicate the management of chronic diseases and is associated with a range of health complications. This study examines the contextual motivations and perceived risks of methamphetamine use in the setting of aging and chronic disease among older adults living with HIV. METHODS: We conducted 1-to-1, semistructured qualitative interviews with 20 adults aged 50 years or older and living with HIV in San Diego, California, who used methamphetamine in the past 30 days. Interviews were audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding reasons for methamphetamine use in older age, perceived benefits and harms, impact on chronic disease management, and knowledge of harm reduction interventions. RESULTS: Participants had a mean age of 60.0 years (range: 51-69), 75% identified as male, 30% as Hispanic/Latino, and 70% had ≥2 chronic medical diseases other than HIV. Regarding methamphetamine use, 55% used every day, with the most common route of use being smoking (70%). Three major themes emerged: (1) motivations for methamphetamine use shifted with age, from using for sexual enhancement to mainly using to help perform every day activities, treat chronic symptoms, or cope with increasing isolation; (2) increasingly experiencing negative physical consequences related to use with less perceived benefit, but difficulty cutting down; and (3) lack of knowledge regarding risk for overdose or harm reduction interventions. CONCLUSIONS: In this qualitative analysis, older adults living with HIV who use methamphetamine reported changing motivations for use with age, while not accessing treatment or harm reduction interventions to reduce overdose risk.
Sex-specific Trends in Methamphetamine Use in the United States, 2002-2022.
Joe S, Carley JA, Kim E … +2 more , Soltani M, Marienfeld C
J Addict Med · 2026 Apr · PMID 41985193 · Publisher ↗
OBJECTIVES: To characterize long-term sex-specific trends in past-year methamphetamine use in the United States and to assess whether prevalence trajectories differ between males and females, with implications for the pr...
OBJECTIVES: To characterize long-term sex-specific trends in past-year methamphetamine use in the United States and to assess whether prevalence trajectories differ between males and females, with implications for the practice of addiction medicine. METHODS: We analyzed nationally representative, repeated cross-sectional data from the National Survey on Drug Use and Health spanning 2002-2022 (N=1,155,417). Survey-weighted annual prevalence estimates of past-year methamphetamine use were calculated by sex. Survey-weighted logistic regression models, including a sex-by-year interaction were used to test whether temporal trends differed by sex. RESULTS: Past-year methamphetamine use was consistently more prevalent among males than females throughout the study period. Annual prevalence declined in the early 2000s and increased after the mid-2010s in both sexes, with larger increases among males. Male prevalence increased from 0.8% (95% CI: 0.6-1.0) in 2002 to 1.4% (95% CI: 1.0-1.8) in 2022, whereas female prevalence increased from 0.6% (95% CI: 0.5-0.7) to 0.7% (95% CI: 0.6-0.8). Additional analyses confirmed significantly different temporal trajectories between males and females. CONCLUSIONS: From 2002 to 2022, methamphetamine use in the United States demonstrated persistent and widening sex differences, with higher prevalence and larger increases among males than females in the past decades. These findings support the importance of incorporating sex-informed approaches into addiction medicine screening, prevention, harm reduction, and treatment planning.
Beyond Age: Transition Age Adults Have Distinct Identities, Substance Use Patterns Compared With Other Adults in Substance Use Disorder Treatment.
Drury V, Aleksanyan J, Narayanan N … +12 more , Echenique J, Melkonian M, Renteria D, Fawole A, Choi S, Kawola S, Del Rosario J, Lincourt P, Morris ML, Neighbors CJ, Cunningham CO, Jordan AE
J Addict Med · 2026 Apr · PMID 41980706 · Publisher ↗
OBJECTIVES: Transition age (TA, 18-5 years old) adults experience disproportionately high rates of substance use disorders (SUD) but are less likely than other adults to engage in treatment. To better understand TA adult...
OBJECTIVES: Transition age (TA, 18-5 years old) adults experience disproportionately high rates of substance use disorders (SUD) but are less likely than other adults to engage in treatment. To better understand TA adults engaged in SUD treatment, we explored the characteristics of this age group compared with other adults 26 years or older. METHODS: Using New York State administrative data, we compared sociodemographic characteristics and substance use patterns of TA adults and other adults (≥26 years) in SUD treatment in 2023 at the individual level, overall and stratified by specific SUD (alcohol, cannabis, opioid, stimulant, or sedative use disorder). Two-sample proportion tests by age group were conducted, and prevalence ratios (PR) were calculated. Effect size was determined with Cohen's h. RESULTS: TA adults accounted for 8.1% (N = 12,103) of adults engaged in SUD treatment in 2023 (N = 148,611). Compared with other adults, TA adults were significantly more likely to identify as LGBT (11.7% vs 5.6%, p < 0.01, h = 0.22), report criminal legal system involvement (46.2% vs 33.3%, p < 0.01, h = 0.27), and be engaged for cannabis use disorder (32.8% vs 7.4%, p < 0.01, h = 0.67). Compared with other adults, they were significantly less likely to be unstably housed (15.6% vs 24.3% p < 0.01, h = -0.22) and engaged in opioid use disorder (20.0% vs 37.5%, p < 0.01, h = -0.39). CONCLUSIONS: TA adults in SUD treatment have distinct identities and substance use patterns compared with other adults in SUD treatment. These characteristics can inform age-specific treatment programs and guide resource allocation, outreach, and engagement strategies.
Association of Coverage-Promoting Policies With Initiation and Discontinuation of Buprenorphine Treatment During Medicaid Unwinding.
Landis RK, Kapinos KA, Levine PR … +1 more , Stein BD
J Addict Med · 2026 Apr · PMID 41980697 · Full text
OBJECTIVES: We examined associations between coverage-promoting policies and changes in initiation and discontinuation of buprenorphine treatment during Medicaid unwinding. METHODS: We conducted a retrospective analysis...
OBJECTIVES: We examined associations between coverage-promoting policies and changes in initiation and discontinuation of buprenorphine treatment during Medicaid unwinding. METHODS: We conducted a retrospective analysis of national retail pharmacy data (2021-2023) to examine the association between 4 separate coverage-promoting policies and the number of initiations and discontinuations of buprenorphine treatment episodes in the 6 months after unwinding began. Statistical significance was assessed using 2-sample t tests. RESULTS: Following up with enrollees nonresponsive to renewal requests and improving ex parte renewal rates were associated with smaller decreases in initiations (-1.4 percentage point difference [pp] [95% CI: -1.5 to -1.4] and -1.5 pp [95% CI: -1.5 to -1.5], respectively) and smaller increases in discontinuations (0.6 pp [95% CI: 0.5-0.7] and 0.6 pp [95% CI: 0.6-0.7], respectively). Following up on returned mail and mostly automated renewal processing had mixed effects. Following up on returned mail was associated with a larger decrease in initiations (1.1 pp [95% CI: 1.0-1.2]) but a smaller increase in discontinuations (1.1 pp [95% CI: 1.0-1.2]); automated renewal processing was associated with a smaller decrease in initiations (-1.6 pp [95% CI: -1.6 to -1.6]) but a larger increase in discontinuations (-2.5 pp [95% CI: -2.6 to -2.5]). CONCLUSIONS: Some coverage-promoting policies were associated with smaller disruptions in buprenorphine treatment during Medicaid unwinding; potential protective effects varied by policy type.
Evaluating the Impact of Pharmacist-Based Models of Care on Treatment Retention Among Individuals With Opioid Use Disorder: A Systematic Review and Meta-Analysis.
Jeminiwa RN, Yu JMM, Foy M … +4 more , Kwon S, Isaacs L, Lockstein D, Goodstein D
J Addict Med · 2026 Apr · PMID 41974104 · Publisher ↗
OBJECTIVES: This review aimed to evaluate the effectiveness of pharmacist-based interventions on treatment retention and nonprescribed opioid use among individuals with opioid use disorder (OUD). A secondary objective wa...
OBJECTIVES: This review aimed to evaluate the effectiveness of pharmacist-based interventions on treatment retention and nonprescribed opioid use among individuals with opioid use disorder (OUD). A secondary objective was to characterize the types of pharmacist-based interventions for treating OUD. METHODS: PubMed, PsycINFO, and CINAHL were searched for records published from the inception of each database until 2025 by 2 independent reviewers. We also searched clinicaltrial.gov and Google Scholar. Eligible studies reported retention in treatment following pharmacist-based interventions for patients with OUD. We performed meta-analyses using the generic inverse variance method and random effects models to estimate the pooled retention rates and the proportion of negative urine opioid toxicology tests following pharmacist-based interventions. RESULTS: Of 3318 records screened and 47 full‑text reviewed, 13 were included. The overall pooled retention rate following pharmacist-based intervention was 77% (pooled proportion=0.77, 95% CI: 0.67-0.87). A pooled retention rate of 76% at 6 months (pooled proportion=0.76, 95% CI: 0.63-0.90) and 59% at 1 year (pooled proportion=0.59, 95% CI: 0.50-0.68) were observed. The pooled proportion of negative urine opioid toxicology test was 84% (pooled proportion=0.84, 95% CI: 0.73-0.96). Pharmacists performed comprehensive functions, including collaborating on OUD diagnostic confirmation, prescribing, and initiating medications for OUD. CONCLUSIONS: Pharmacist-based interventions were associated with a pooled retention rate of 77% and reduced nonprescribed opioid use. Our findings underscore the value of pharmacists' multifaceted roles and support their integration into comprehensive care models addressing OUD.
Outpatient Direct Initiation of Injectable Buprenorphine in a Harm Reduction Agency and Primary Care Clinic: A Retrospective Case Series.
O'Conor C, Brady E, Hayes B … +8 more , Buonora M, Deluca J, Gibson B, Spratt S, Mota J, Allen G, Jakubowski A, Holm M
J Addict Med · 2026 Apr · PMID 41974036 · Publisher ↗
OBJECTIVES: Initiating weekly long-acting injectable buprenorphine (LAIB) without prior sublingual buprenorphine ("direct-to-inject" or DTI) may reduce buprenorphine initiation barriers. In this case series, we describe...
OBJECTIVES: Initiating weekly long-acting injectable buprenorphine (LAIB) without prior sublingual buprenorphine ("direct-to-inject" or DTI) may reduce buprenorphine initiation barriers. In this case series, we describe outpatient DTI outcomes. METHODS: We conducted a manual chart review of 24 patients undergoing DTI between October 2024 and February 2025 at 3 New York City sites: 2 harm reduction agency-based clinics and a federally qualified health center. Pre- and post-DTI withdrawal data were collected from chart documentation and provider report. Buprenorphine retention was ascertained using electronic medical record medication administration and prescription data and defined as being within the LAIB therapeutic window or having an active sublingual buprenorphine prescription at 30 and 90 days with no gaps greater than 9 or 14 days, respectively. We also measured median buprenorphine treatment days over 90 days post-DTI. RESULTS: Of the 23 patients with available data, 19 (83%) had no withdrawal symptoms pre-DTI. Of the 20 patients with documented post-DTI withdrawal symptoms, 3 (15%) had no withdrawal, 12 (60%) had mild, 4 (20%) had moderate, and one (5%) patient had severe withdrawal. Thirty days post-DTI, 14 (58%) patients were retained on any buprenorphine formulation, and 11 (46%) patients were retained at 90 days. The median post-DTI buprenorphine treatment days were 77 (range: 9-90). CONCLUSIONS: The majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post-DTI, and were retained on buprenorphine at 30 days post-DTI, with nearly half retained at 90 days. DTI is a promising buprenorphine initiation strategy, but further research is warranted.
Trends in Buprenorphine and Methadone Initiation for Opioid Use Disorder Among Patients Using Fentanyl: A Mixed-methods Analysis From an Inpatient Addiction Consult Service.
Kee DP, Feder KA, Wood L … +2 more , Garneau WM, Buresh ME
J Addict Med · 2026 Apr · PMID 41945891 · Publisher ↗
OBJECTIVES: To analyze trends in initiation of medications for opioid use disorder (MOUD) among hospitalized patients with opioid use disorder (OUD) and explore patient-reported factors underlying medication selection am...
OBJECTIVES: To analyze trends in initiation of medications for opioid use disorder (MOUD) among hospitalized patients with opioid use disorder (OUD) and explore patient-reported factors underlying medication selection amid widespread fentanyl prevalence. METHODS: This retrospective mixed-methods study included adult patients with OUD hospitalized at an urban academic hospital between January 2018 and December 2022. Eligible patients were not on MOUD before admission and were seen by the addiction consult service. We evaluated trends in MOUD (buprenorphine, methadone and no MOUD) selection and performed multivariable logistic regression to examine the association between admission year and methadone initiation. In addition, we performed an in-depth review of 100 medical records (10 per MOUD type per year) to examine patient perspectives on prior MOUD experiences and potential challenges influencing selection. RESULTS: Among 1034 patients, methadone selection increased from 14.6% in 2018 to 41.4% in 2022, while buprenorphine was not significantly different (34.6%-37.9%). Selection of no MOUD decreased from 50.8% to 20.7%. Later admission year was associated with a higher likelihood of methadone selection compared with no MOUD, highest in 2021 (aRRR: 9.29, 95% CI: 4.98-17.33) compared with 2018. In qualitative review, most patients (70%) were afraid of fentanyl contamination; 90% had prior MOUD experience, primarily positive; 38% (23/61) expressed fear of precipitated withdrawal, and 63% (33/52) were concerned about slow methadone titration. CONCLUSIONS: Methadone selection increased during the study period. Early initiation challenges were the primary patient-reported barriers. These findings underscore evolving challenges related to fentanyl and need to optimize MOUD stabilization strategies.
Opioid Overdose Risk Perceptions and Barriers and Facilitators to Naloxone Distribution for Hospitalized Patients Who Use Stimulants: A Qualitative Study of Patients and Clinicians.
Bredenberg E, Callister C, Kruse G … +4 more , Kwan BM, Mann S, McWilliams E, Calcaterra SL
J Addict Med · 2026 Apr · PMID 41941717 · Publisher ↗
OBJECTIVES: Most stimulant-related deaths in the United States involve opioids due to intentional or unintentional fentanyl toxicity. It is critical to ensure patients who use nonprescribed stimulants have access to nalo...
OBJECTIVES: Most stimulant-related deaths in the United States involve opioids due to intentional or unintentional fentanyl toxicity. It is critical to ensure patients who use nonprescribed stimulants have access to naloxone, and hospitalization is an opportunity to provide this lifesaving medication. We aimed to understand perceptions on opioid overdose risk as well as barriers to and facilitators of take-home naloxone distribution through the perspectives of hospitalized patients who use stimulants and the clinicians who care for them. METHODS: We conducted key-informant interviews with hospitalized patients who use cocaine or methamphetamine and hospital-based, nonaddiction medicine specialized nurses, physicians, and advanced practice providers. We analyzed results using a rapid matrix-based qualitative technique. RESULTS: Thirteen patients and 13 clinicians participated. Themes included: (1) people who use stimulants have personal, traumatic experiences with opioid overdose, even if they do not intentionally use opioids (patients); (2) despite awareness of stimulant adulteration with fentanyl, patients and hospital-based clinicians differ in their perceptions of opioid overdose risk (patients and clinicians); and (3) factors impacting in-hospital naloxone distribution include competing work-related priorities, logistical considerations necessary to ensure patients receive naloxone in-hand before discharge, and the cost of naloxone (clinicians). CONCLUSIONS: Strategies to increase take-home naloxone receipt among hospitalized patients must consider the specific needs of patients who use stimulants, who may view themselves as low-risk for opioid overdose but be open to carrying naloxone for the benefit of others. Clinicians suggested strategies to address logistical considerations of naloxone delivery unique to the hospital environment.
Naltrexone as Pre-exposure Prophylaxis for Unintentional Opioid Overdose in Stimulant Use Disorder: A Case Report.
Jaffe GA, Goodstein D
J Addict Med · 2026 Apr · PMID 41925760 · Publisher ↗
BACKGROUND: Stimulant-involved overdose deaths have increased sharply in the United States, largely driven by adulteration of the stimulant drug supply with fentanyl and other high-potency synthetic opioids. Individuals...
BACKGROUND: Stimulant-involved overdose deaths have increased sharply in the United States, largely driven by adulteration of the stimulant drug supply with fentanyl and other high-potency synthetic opioids. Individuals with stimulant use disorder (StUD) who do not intentionally use opioids remain at elevated risk for unintentional opioid overdose. Pharmacologic strategies for overdose prevention in this population remain limited. CASE PRESENTATION: We describe a 32-year-old woman with severe stimulant use disorder who smoked crack cocaine and denied intentional opioid use but experienced 2 nonfatal opioid overdoses attributed to fentanyl-adulterated cocaine. After emergency department treatment with naloxone, we initiated daily oral naltrexone off-label as a harm-reduction strategy to reduce the risk of future opioid overdose. The patient tolerated naltrexone well after brief nausea and reported consistent adherence without reduction in stimulant effects or cravings. She continued daily cocaine use but experienced no further opioid overdoses during 5 months of follow-up. DISCUSSION: This case highlights the potential role of naltrexone as pre-exposure prophylaxis (PrEP) for unintentional opioid overdoses. Framing naltrexone use around unintentional opioid overdose prevention may enhance acceptability and adherence in patients not seeking a decrease or cessation of stimulant use. This strategy does not prevent non-opioid-involved stimulant deaths and should complement, not replace, naloxone distribution and other first-line overdose prevention measures. CONCLUSIONS: Oral naltrexone may represent a novel harm-reduction intervention to mitigate opioid-related morbidity and mortality in the setting of an increasingly adulterated stimulant supply. Further research is needed to evaluate efficacy and implementation.
Kava-potentiated Withdrawal in Persons Using Multiple Substances: A Case Series of Kava and Kratom Co-ingestion.
Kiyokawa M, Okuno C, Nguyen D
J Addict Med · 2026 Mar · PMID 41885052 · Publisher ↗
OBJECTIVES: Kava (Piper methysticum) is indigenous to Pacific Island nations and has a long history of use in traditional medicine and ceremonies. Kava has effects similar to benzodiazepines, but its detailed mechanisms...
OBJECTIVES: Kava (Piper methysticum) is indigenous to Pacific Island nations and has a long history of use in traditional medicine and ceremonies. Kava has effects similar to benzodiazepines, but its detailed mechanisms are uncertain. Although legal across the United States, kava is not without side effects. Currently, there are many kava and kratom blends accessible at stores and online. Recent case reports have emerged describing patient experiences with kava withdrawal when co-ingesting kava and kratom together; however, research remains scarce. This case series aims to add to the limited literature on kava withdrawal in co-ingestion of kava-kratom. METHODS: Publications before July 2025 were searched using the Ovid Medline, PubMed, and Google Scholar databases using the terms "kava", "kratom", "withdrawal", and "case report". The 2 case reports were found describing kava withdrawal symptoms and treatment when co-ingesting with kratom. This case series presents 2 additional cases from our institutions. RESULTS: All 4 patients were male with underlying histories of psychiatric illness and alcohol use disorder. All consumed more than the recommended amounts of the kava and kratom. Kava withdrawal symptoms were similar to sedative withdrawal. The onset of these symptoms varied considerably in relation to the last dose. Paradoxically, symptoms of kava withdrawal were observed in some cases despite sedatives still being present in the patients' systems; however, the involvement of polysubstance complexes the exact etiology of symptoms. All patients improved with phenobarbital and/or benzodiazepines. CONCLUSIONS: Exact kava mechanism is complex and not fully understood. Further research is warranted.
Do US Adults View Drug and Alcohol Addiction as a Health Condition?
Earnshaw VA, Davoodi T, Fox AB … +1 more , Hulsey J
J Addict Med · 2026 Mar · PMID 41885045 · Publisher ↗
OBJECTIVES: The current study aimed to estimate the percentage of US adults who disagree or do not know that addiction is a health condition and explore associations between disagreement that addiction is a health condit...
OBJECTIVES: The current study aimed to estimate the percentage of US adults who disagree or do not know that addiction is a health condition and explore associations between disagreement that addiction is a health condition with indicators of beliefs about addiction treatment and intentions to support loved ones with addiction. METHODS: A nationally representative sample of US adults was recruited from Gallup's probability-based panel. A total of n=5250 (out of n=12,500 invited) responded to a web-based survey including questions about beliefs about drug or alcohol addiction and treatment. Survey sample weights were applied to correct for unequal selection probability and nonresponse rates, and data were analyzed using descriptive statistics and regression. RESULTS: Close to one-quarter of US adults (23.0%) are estimated to either disagree or not know that addiction is a health condition. Respondents who disagreed or did not know that addiction is a health condition were less likely to believe that addiction is treatable by health care professionals (disagreed: OR=0.33, 95% CI=0.28-0.39; did not know: OR=0.28, 95% CI=0.21-0.36), early intervention for addiction is helpful (disagreed: OR=0.57, 95% CI=0.48-0.66; did not know: OR=0.40, 95% CI=0.31-0.53), or medications are effective treatments for addiction (disagreed: OR=0.47, 95% CI=0.40-0.55; did not know: OR=0.28, 95% CI=0.21-0.37). They were also less likely to indicate that they would help a loved one with addiction (disagreed: OR=0.50, 95% CI=0.40-0.63; did not know: OR=0.65, 95% CI=0.44-0.97). CONCLUSIONS: US adults likely have heterogenous views on addiction, and more research is needed to further understand how US adults conceptualize addiction.
A Case of 7-Hydroxymitragynine Use Disorder Treated With Buprenorphine.
Hendler R, Karavolis Z, Kim J … +1 more , Gonzalez G
J Addict Med · 2026 Mar · PMID 41875249 · Publisher ↗
BACKGROUND: Kratom is a plant widely consumed for the stimulant and opioid properties of its primary psychoactive component, mitragynine. A related compound, 7-hydroxymitragynine (7-HMG), also known colloquially as "7-OH...
BACKGROUND: Kratom is a plant widely consumed for the stimulant and opioid properties of its primary psychoactive component, mitragynine. A related compound, 7-hydroxymitragynine (7-HMG), also known colloquially as "7-OH," "7-Hydroxy," "7-OHMG," or "7," is present in kratom in smaller amounts but is much more potent at the µ-opioid receptor. Increasingly, concentrated 7-HMG is being marketed at gas stations, smoke shops, and online, exposing people to this higher potency opioid in larger quantities. Little has been published about the management of withdrawal from and addiction to 7-HMG. CASE SUMMARY: This case concerns a man in his 30s hospitalized for intensive treatment of 7-HMG use disorder. Opioid withdrawal symptoms emerged within 8 hours and were stabilized with methadone 50 mg over 36 hours. Methadone was then tapered, and buprenorphine 16 mg per day was initiated via low-dose induction, with resolution of craving and improvement in co-occurring depression by discharge from residential aftercare. CONCLUSIONS: 7-HMG is a widely available, largely unregulated, underrecognized substance with potency at the µ-opioid receptor that may increasingly concern clinicians and policymakers. Patients with 7-HMG use disorder may benefit from medication for opioid use disorder. More research is needed to characterize the effects of 7-HMG in humans and guide management.
Evaluating Clinicians' Perspectives on Initiation of Medications for Opioid Use Disorder During Psychiatric Admissions.
Nedell E, Ponce Martinez C
J Addict Med · 2026 Mar · PMID 41875244 · Publisher ↗
OBJECTIVE: Despite high rates of opioid use disorder (OUD) among patients admitted for acute inpatient psychiatric treatment, medications for opioid use disorder (MOUD) are not routinely prescribed in this setting. Duall...
OBJECTIVE: Despite high rates of opioid use disorder (OUD) among patients admitted for acute inpatient psychiatric treatment, medications for opioid use disorder (MOUD) are not routinely prescribed in this setting. Dually diagnosed individuals are more likely to present to the mental health system for treatment than to substance use disorder programs; therefore, initiating MOUD in psychiatric units would increase treatment access. Following the implementation of a protocol to offer MOUD to patients admitted to psychiatric units, clinical staff perspectives were evaluated. METHODS: Semistructured interviews were conducted with 15 staff members following protocol implementation in 2 psychiatric units. Interviews were inductively coded and thematically analyzed. RESULTS: Five themes emerged: (1) co-occurring OUD and psychiatric disorders are common in psychiatric units; (2) opioid withdrawal treatment during psychiatric admission is widely acceptable to staff, but support for maintenance treatment varies; (3) misconceptions regarding MOUD persist among staff; (4) patients with co-occurring disorders have complex psychosocial needs requiring multimodal treatment; (5) stigma can be a barrier to OUD treatment. CONCLUSIONS: Staff recognized the high prevalence of OUD in psychiatric units and the need for treatment. Despite some reluctance about MOUD initiation in this setting, MOUD remains the gold standard and should be available to patients with OUD wherever they seek medical care, consistent with a "No Wrong Door" approach. Improved education and multidisciplinary collaboration may increase staff acceptance of MOUD. Finally, MOUD initiation for dually diagnosed patients will be most successful when integrated within a multidisciplinary treatment model and coordinated community-based care.
The Association Between Receiving Medications for Opioid Use Disorder and Human Immunodeficiency Virus Testing: Findings From the Rural Opioid Initiative.
Zinsli KA, Mixson LS, Delaney JA … +17 more , Feinberg J, Stopka TJ, Seal DW, Smith GS, Pho MT, Wu EL, Jenkins W, Cooper HLF, Young AM, Khoury D, Friedmann PD, Miller WC, Go VF, Korthuis PT, Spencer H, Westergaard RP, Tsui JI
J Addict Med · 2026 Mar · PMID 41875202 · Full text
OBJECTIVES: Injection drug use is associated with increased risk of blood-borne infectious disease transmission. People with opioid use disorder (OUD) may be less likely to receive health care services, including human i...
OBJECTIVES: Injection drug use is associated with increased risk of blood-borne infectious disease transmission. People with opioid use disorder (OUD) may be less likely to receive health care services, including human immunodeficiency virus (HIV screening), especially in rural areas. Addiction treatment settings may provide additional opportunities to screen for HIV in this population. METHODS: The rural opioid initiative (ROI) conducted a survey of people who use drugs (PWUD) on substance use, health care access, and utilization. From January 2018 to March 2020, PWUD were enrolled across 65 rural counties in 10 US states. Eligible participants either used opioids or reported injecting any drug "to get high" in the past 30 days. We evaluated the association between reporting past 30-day medication for OUD (MOUD) receipt and past-year HIV testing using relative risk regression. RESULTS: Participants (N = 2649, mean age = 36 y) were predominantly male (57%), reporting White race (85%) and non-Hispanic ethnicity (96%). Among participants receiving MOUD (methadone or buprenorphine) in the past year, 42% (179/431) were HIV-tested in the past year compared with 29% (636/2,218) among those not receiving MOUD. The prevalence of HIV testing in the past year was 1.42 times greater when comparing those who received MOUD in the past 30 days compared with those who did not (95% CI: 1.25-1.62). CONCLUSIONS: Recent HIV testing prevalence among this rural population of PWUD was low, given testing guidelines. Future research should explore ways to increase testing in rural drug treatment settings and whether there are differences by treatment setting type.
Stimulant-induced Psychosis: A Comparative Systematic Review and Meta-analysis of Psychotic Outcomes from Therapeutic and Nontherapeutic Use of Stimulants.
Jangra D, Tejwani R, Ahluwalia Y … +2 more , Sarkar S, Balhara YPS
J Addict Med · 2026 Mar · PMID 41874961 · Publisher ↗
OBJECTIVES: Stimulant medications are increasingly prescribed for conditions including stimulant use disorders, yet both therapeutic and nontherapeutic use have been linked to stimulant-induced psychosis. Despite extensi...
OBJECTIVES: Stimulant medications are increasingly prescribed for conditions including stimulant use disorders, yet both therapeutic and nontherapeutic use have been linked to stimulant-induced psychosis. Despite extensive literature, no prior systematic review has compared psychotic outcomes across these 2 contexts of use. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Scopus through April 2025 and registered the protocol in PROSPERO (CRD420251049204). Eligible studies examined stimulant-induced psychosis among therapeutic (prescribed) and nontherapeutic (illicit, recreational, or misused) users. Data were extracted on demographics, stimulant type, dosage, route, comorbidities, clinical characteristics, and outcomes. Meta-analyses were conducted for incidence and prevalence where data permitted. Risk of bias was assessed using RoB 2.0, ROBINS-I, and JBI tools. RESULTS: Seventy-seven studies (n = 687,912) were included: 9 therapeutic and 68 nontherapeutic. Therapeutic stimulants were primarily oral methylphenidate or amphetamine at guideline doses, while nontherapeutic use commonly involved high-dose methamphetamine or mixed stimulants through intravenous or smoked routes. The pooled incidence of stimulant-induced psychosis in therapeutic use was 0.6% (95% CI: 0.3-0.9). Prevalence estimates differed markedly: 0.2% (95% CI: 0.0-0.3) in therapeutic users versus 32.8% (95% CI: 25.5-40.2) in nontherapeutic users. Nontherapeutic psychosis was characterized by higher dosages, acute onset, persecutory delusions, hallucinations, and greater recurrence risk, whereas therapeutic cases often resolved with dose reduction or discontinuation. Evidence on treatment effectiveness, neurobiology, and genetic factors was limited and heterogeneous. CONCLUSIONS: Stimulant-induced psychosis occurs in both therapeutic and nontherapeutic contexts but at vastly different prevalence rates. While prescribed stimulants pose a low but clinically relevant risk, particularly in individuals with psychiatric vulnerability, nontherapeutic use carries a substantial burden of psychosis with significant public health implications. These findings underscore the need for careful monitoring in clinical practice, risk profiling, and targeted harm-reduction strategies in nonmedical use settings.
Prenatal Fentanyl Exposure Association With Characteristic Neonatal Anomalies.
Mirsky E, Cockerham C, O'Brien J … +3 more , Whitley W, Hawk G, Parilla B
J Addict Med · 2026 Mar · PMID 41856964 · Publisher ↗
OBJECTIVES: To investigate if previously described anomalies associated with fentanyl could be identified in our cohort of individuals with active fentanyl use in pregnancy. METHODS: Potential cases of a novel syndrome w...
OBJECTIVES: To investigate if previously described anomalies associated with fentanyl could be identified in our cohort of individuals with active fentanyl use in pregnancy. METHODS: Potential cases of a novel syndrome were identified from a prospectively collected database of obstetric patients with substance use disorder enrolled in a multispecialty treatment program from 2014 to 2024 in this case series study. Suspected Fetal Fentanyl Syndrome (FFS) was defined as small head circumference (<10%ile) and at least one other sign: cleft palate, clubfoot, rocker bottom feet, toe syndactyly, single palmar crease, hypoplastic corpus callosum, and hypospadias. The database was screened for findings consistent with this syndrome resembling Smith-Lemli-Opitz Syndrome. RESULTS: From 2014 to 2024, 639 patients were enrolled in the cohort. Of the 103 patients found to have neonates with a small head circumference, 51 individuals self-reported fentanyl use within the last year. Six of these individuals had confirmatory toxicology testing for fentanyl upon program enrollment. Of these individuals' neonates, 4 displayed characteristic anomalies consistent with FFS. All cases shared lagging head growth, while additional anomalies identified included cleft palate (n=3), short nasal tip (n=1), thin upper lip (n=1), micrognathia (n=1), and hypospadias (n=1). Genetic screening/diagnostic testing varied but an assessment of cholesterol metabolism was not performed. CONCLUSIONS: In this cohort, 7.8% of individuals with self-reported fentanyl use had neonates with signs of the previously described FFS. FFS is a proposed syndrome and results should be interpreted with caution. Similar data is needed to confirm and delineate this association and determine long-term developmental effects.
Fetal Fentanyl Syndrome: An Opportunity to Quantify the Risk in Prospective Cohorts of Patients With Substance Use Disorder.
Hernandez-Diaz S, Huybrechts KF
J Addict Med · 2026 Mar · PMID 41856958 · Publisher ↗
The increased availability of fentanyl in the United States over the past decade extends to women of reproductive age, raising concern about maternal and fetal risks when used in pregnancy. A 2023 case series of 10 infan...
The increased availability of fentanyl in the United States over the past decade extends to women of reproductive age, raising concern about maternal and fetal risks when used in pregnancy. A 2023 case series of 10 infants exposed to fentanyl in utero proposed a "fetal fentanyl syndrome" (FFS), characterized by distinctive craniofacial features, limb anomalies, and genitourinary defects. However, as with any case series, concerns about selective case ascertainment, uncontrolled confounding, imprecise timing of exposure, phenotype heterogeneity, and lack of a denominator preclude causal inference or risk quantification. Two new studies in this issue-Mirsky et al and Dorsey et al-had the opportunity to quantify the risk in prospective cohorts of patients with substance use disorder. However, they leave key questions unresolved. Mirsky et al identify 4 additional infants with craniofacial anomalies and prenatal fentanyl exposure, but their analysis remains effectively a case series. Dorsey et al use a case-control analysis and report a modestly elevated odds of FFS-compatible anomalies with fentanyl exposure, but broad exposure windows, limited phenotype specificity, and lack of adjustment for confounding limit interpretability. Further studies are needed to clarify to what extent prenatal fentanyl exposure contributes to specific patterns of congenital structural anomalies.
Determinants of Illness Severity and Mortality Risk Among Hospitalized Patients With Opioid Use Disorder: A National Analysis, 2015-2022.
Qeadan F, Thornquist R, Tingey B
J Addict Med · 2026 Mar · PMID 41856947 · Publisher ↗
OBJECTIVES: Illness severity may influence the relationship between opioid use disorder (OUD) and adverse outcomes, yet factors affecting severity are not fully understood. The objective of this study is to examine socio...
OBJECTIVES: Illness severity may influence the relationship between opioid use disorder (OUD) and adverse outcomes, yet factors affecting severity are not fully understood. The objective of this study is to examine sociodemographic and hospital-related factors associated with severity among OUD-related hospitalizations. METHODS: We used data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2015 to 2022. The HCUP NIS includes severity measures that assign patients overall severity of illness (SOI) and risk of mortality (ROM) subclasses (ie, minor, moderate, major, and extreme) based on their secondary diagnoses and other clinical characteristics (eg, age, procedures). Partial proportional odds models were used to measure the association between sociodemographic/clinical factors and SOI/ROM subclass severity among OUD-related hospitalizations. RESULTS: SOI shifted toward more severe subclasses in 2019-2022 and ROM in 2015-2022 (higher share major/extreme). Medicare and self-pay, compared with private insurance, were associated with higher odds (adjusted odds ratio [aOR] [95% CI]) of extreme SOI (vs. minor, moderate, or major) (Medicare: 1.07 [1.05, 1.09]; self-pay: 1.08 [1.05, 1.11]). Rural hospitals, compared with urban ones, had lower odds of higher SOI severity (aOR 0.80 [0.77, 0.82]). Results were similar for ROM. Age, sex, race, income, region, hospital size, admission timing, and admission type were also significantly associated with SOI/ROM. CONCLUSIONS: Structural/systematic factors play a role in shaping the course of inpatient OUD. These findings highlight the need to strengthen hospital addiction care capacity, address insurance and income-related inequities, and develop targeted inpatient risk stratification strategies to improve outcomes for patients with OUD.
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