Journal Of Addiction Medicine[JOURNAL]
Sun
200 papers
Reducing Hospital Readmissions for Injection Drug Use-Related Infections: A Rapid Qualitative Analysis of Health Care Teams' Consultations to Inform Intervention Design.
Key S, Mansfield ME, Traver EC … +15 more , Reece R, Cooper G, Carpenter J, Steck A, Catalanotti JS, Kuo I, Raman S, Silk R, Gaglio B, Nguyen V, Fujita AW, Masur H, Kattakuzhy S, Rosenthal E, Lavoie MC
J Addict Med · 2026 Mar · PMID 41844540 · Publisher ↗
OBJECTIVES: People who inject drugs (PWID) face elevated risks of hospitalizations and readmissions due to serious injection-related infections, yet few evidence-based interventions exist to prevent readmissions. This st...
OBJECTIVES: People who inject drugs (PWID) face elevated risks of hospitalizations and readmissions due to serious injection-related infections, yet few evidence-based interventions exist to prevent readmissions. This study aimed to explore factors contributing to rehospitalization among PWID, potential strategies, and assess the acceptability of 2 proposed interventions and implementation considerations. METHODS: We conducted 22 semistructured interviews with 36 health care providers and staff across 4 study sites in Georgia, Maryland, the District of Columbia, and West Virginia from June 2023 to September 2023. Participants were purposively sampled to represent diverse roles in providing or overseeing care to PWID. Interviews explored barriers to care, challenges contributing to rehospitalization, and perceptions of 2 proposed interventions: (1) integrated care for addiction and infectious diseases, and (2) patient navigation to support linkage to care postdischarge. Data were analyzed using rapid qualitative analysis informed by framework and thematic approaches. RESULTS: Three main themes emerged regarding rehospitalization factors (unaddressed structural, health system, and social determinants; gaps in addiction care training; and continuity of care). Participants expressed high acceptability toward the proposed interventions. Three main themes emerged as recommendations for the implementation of the proposed interventions (organizational needs and capacity; leveraging existing resources; patient engagement and retention). CONCLUSIONS: Reducing readmissions among PWID requires addressing provider training gaps, care fragmentation, and structural barriers. Both proposed interventions were deemed acceptable by health care team members. Key implementation factors include strengthening organizational capacity, leveraging existing resources effectively, and using person-centered approaches to build trust and maintain patient engagement and retention.
Treatment Initiation and Retention Among Medicaid Enrollees Diagnosed With Opioid Use Disorder in South Carolina.
Gross S, Giannouchos T, Rogers A … +5 more , Chen S, Li Y, Zhang J, Olatosi B, Andrews C
J Addict Med · 2026 Mar · PMID 41842616 · Publisher ↗
OBJECTIVES: This study assesses treatment initiation and retention among South Carolina Medicaid enrollees newly diagnosed with opioid use disorder in 2021, situating these outcomes within the broader opioid treatment ca...
OBJECTIVES: This study assesses treatment initiation and retention among South Carolina Medicaid enrollees newly diagnosed with opioid use disorder in 2021, situating these outcomes within the broader opioid treatment cascade of care. We examine how patient characteristics and community context shape progression through the stages of the cascade. METHODS: Using South Carolina Medicaid claims data for 464,493 enrollees aged 18-64 in 2021, we identify 2930 individuals newly diagnosed with OUD and examine initiation and 90-day retention in psychosocial and medication treatment. Generalized estimating equation models were used to estimate associations between treatment outcomes and sociodemographic and area-of-residence characteristics. RESULTS: Among newly diagnosed individuals, 34.6% initiated psychosocial treatment and 49.6% initiated medication treatment; 27.0% and 55.0%, respectively, were retained for at least 90 days. Non-Hispanic black enrollees had lower odds of initiating psychosocial (AOR = 0.72; 95% CI = 0.54-0.96) and medication treatment (AOR = 0.51; 95% CI = 0.44-0.58) compared with non-Hispanic white enrollees. Age differences were pronounced: enrollees aged 25-34 were more likely to initiate psychosocial treatment (AOR = 1.16; 95% CI = 1.00-1.35), while those aged 35-44 were more likely to initiate and retain medication treatment. Associations between treatment outcomes and county-level factors were not significant. CONCLUSIONS: Rates of OUD treatment initiation and retention among South Carolina Medicaid enrollees remain low, with pronounced demographic variations. Findings highlight the need for targeted interventions to improve access and engagement in treatment.
Detecting Suicidality in Opioid Use Disorder Requires an Understanding of Intentional Opioid Overdose.
Spaderna M, Bergeria C
J Addict Med · 2026 Mar · PMID 41839803 · Publisher ↗
Since 2000, the suicide rate from opioid overdoses has more than doubled, and the number of self-reported intentional opioid overdoses is likely undercounted. This commentary discusses how a sensitive and validated asses...
Since 2000, the suicide rate from opioid overdoses has more than doubled, and the number of self-reported intentional opioid overdoses is likely undercounted. This commentary discusses how a sensitive and validated assessment is crucially needed to identify those at risk for intentional opioid overdose. Developing this, however, requires an understanding of the affective, cognitive, and behavioral factors that uniquely contribute to this phenomenon. These include higher prevalences of psychiatric diagnoses and pain in the opioid use disorder (OUD) population; a deleterious negative emotional state that occurs with chronic opioid use; and risky opioid-use patterns worsened by the introduction of fentanyl into the illicit opioid supply that give individuals with OUD easy access to lethal means for dying by suicide. Although there is an urgent need to identify intentional opioid overdose risk, previous research has shown that validated screening tools for suicide risk, which ask about previous suicide attempts, may not detect all those at risk for intentional opioid overdose. This may be because the intent preceding opioid overdoses is ambiguous, making it challenging for individuals with OUD to identify these as suicide attempts. Because validated screening tools for suicide risk are insufficient for detecting intentional opioid overdose risk, a screening tool developed specifically for this purpose using validated psychometric methods is necessary to identify and intervene in the morbidity and mortality associated with intentional opioid overdose.
Postpartum Buprenorphine: A Descriptive Analysis of Dose Adjustments and Treatment Retention.
Woods GT, Shadowen H, Shadowen C … +1 more , Martin CE
J Addict Med · 2026 Mar · PMID 41839787 · Publisher ↗
OBJECTIVES: Buprenorphine is a partial opioid agonist used in the treatment of opioid use disorder. Dosing of buprenorphine is determined clinically, with peripartum adjustments often indicated due to physiological and p...
OBJECTIVES: Buprenorphine is a partial opioid agonist used in the treatment of opioid use disorder. Dosing of buprenorphine is determined clinically, with peripartum adjustments often indicated due to physiological and psychosocial changes in pregnancy and the postpartum period. We sought to describe these postpartum dose changes, how adjustments varied across demographics, and their association with treatment retention. METHODS: This is a retrospective, descriptive analysis of antenatal buprenorphine initiations at one academic institution over 2 years. The primary outcome of interest was the difference in buprenorphine dose at 3 months postpartum compared with the delivery dose. RESULTS: Sixty-six individuals were included in this study. The majority (36/66; 55%) had no change in buprenorphine dose between delivery and 3 months postpartum. One-third of patients had their dose increased postpartum, with a minority of individuals (8/66; 12%) reducing their dose postpartum. Individuals who were incarcerated at the time of delivery were more likely to experience a dose reduction (P = 0.045). There was no significant difference in treatment retention at 1 year postpartum between the groups. CONCLUSIONS: Our data suggest heterogeneity in the management of buprenorphine dosing in the postpartum period. The vast majority (58/66; 88%) of patients either increased or maintained their total daily dose between delivery and 3 months postpartum. These results underscore the importance of an individualized approach to postpartum buprenorphine, factoring in delivery dose, biopsychosocial factors, and risk of return to use and overdose. Future qualitative work is needed to explore the dynamic patient and provider priorities at play in this decision-making.
Too Many Pills, Too Little Attention: Emphasizing Psychotropic Polypharmacy in the Overdose Conversation.
Benz MB, Stein MD, Clifford C … +1 more , Gaudiano BA
J Addict Med · 2026 Mar · PMID 41839785 · Publisher ↗
Despite a recent decline in overdose deaths, the United States continues to have the highest global overdose mortality rate. Polysubstance use-taking opioids along with other drugs-has been increasingly recognized as a k...
Despite a recent decline in overdose deaths, the United States continues to have the highest global overdose mortality rate. Polysubstance use-taking opioids along with other drugs-has been increasingly recognized as a key contributor to preventable overdose cases. We propose that psychotropic polypharmacy, or the co-use of multiple psychiatric medications, is emerging as a related but distinct and underappreciated issue that is crucial for continued progress in slowing the pace of the overdose epidemic. This commentary aims to center psychotropic polypharmacy in the overdose prevention conversation, given its high rates in the United States and an increasing prevalence of psychiatric prescription medications implicated in overdose deaths. We present evidence for multiple mechanisms through which psychotropic polypharmacy increases overdose risk, including drug-drug interactions, lethal means access in cases of suicidality, and desensitization to overdose-related behaviors. We also propose several potential solutions to address this public health crisis, including discontinuing inappropriate and unnecessary medications, broadening access to evidence-based nonpharmacological prevention strategies for persons at risk for overdose, and improving overdose monitoring and surveillance.
A Digital Therapeutic Mobile App, ReSET-O, as Adjunct to Medication Treatment for Opioid Use Disorder: A Randomized Clinical Trial at an Opioid Treatment Program.
Kawasaki S, Lehman E, Kong L … +3 more , Spangler A, Aydingolo N, Nunes E
J Addict Med · 2026 Mar · PMID 41833956 · Publisher ↗
OBJECTIVES: This study evaluated ReSET-O, a mobile app derived from the previously studied, computer-based therapeutic education system (TES), delivering cognitive behavioral therapy (CBT) lessons plus contingency manage...
OBJECTIVES: This study evaluated ReSET-O, a mobile app derived from the previously studied, computer-based therapeutic education system (TES), delivering cognitive behavioral therapy (CBT) lessons plus contingency management, rewarding CBT lesson completion and drug-negative urines, as an intervention to improve medication retention for opioid use disorder (MOUD). METHODS: A 24-week randomized controlled trial was conducted in an outpatient opioid treatment program where patients starting methadone or buprenorphine treatment were randomized to treatment as usual (TAU) or TAU plus the app. The primary outcome, medication retention, was defined as at most a 28-day gap in the first 24 weeks of medication dispensation or prescription. Secondary outcomes examined urine drug tests, mood assessments, app engagement, and app feedback. Fifty-two participants were randomized to TAU (29 on buprenorphine, 23 on methadone) and 48 (28 on buprenorphine, 20 on methadone) to TAU+ the app. RESULTS: 51.9% (n=27) on TAU met 24-week MOUD medication retention, compared with 70.8% (n=34) on TAU + the app (OR: 2.28; 95% CI: [0.99, 5.24]); P=0.053; Rate difference: 18.9% (95% CI: [0.2, 37.6]). No significant differences resulted between groups in urine toxicology or mood outcomes. Adherence to the app varied, with over half of participants (53%, 25/48) completing <10 out of 48 CBT therapy lessons. CONCLUSIONS: ReSET-O had no significant impact on MOUD retention. The study did not meet its recruitment target, was underpowered, and adherence to the app was poor. Further research is indicated on apps delivering CBT plus contingency management for improving MOUD outcomes, including improving adherence to app use.
Longitudinal Patterns of Dental Health Care Utilization 18 Months Before and 36 Months After Initiation of Index Medications for Opioid Use Disorder.
Roy PJ, Yuan N, Li Y … +7 more , Butler AM, Nickel KB, Gibson G, Hubbard CC, Boyer TL, Suda KJ, Durkin MJ
J Addict Med · 2026 Mar · PMID 41813623 · Full text
OBJECTIVES: In 2022, the FDA issued a drug safety communication based on case studies that transmucosal buprenorphine, a medication for opioid use disorder (MOUD), may contribute to dental disease. We sought to assess lo...
OBJECTIVES: In 2022, the FDA issued a drug safety communication based on case studies that transmucosal buprenorphine, a medication for opioid use disorder (MOUD), may contribute to dental disease. We sought to assess longitudinal dental care utilization patterns among patients with opioid use disorder (OUD) in the 18 months before and 36 months after MOUD initiation. METHODS: Using data from the Veterans Affairs Corporate Data Warehouse (2003-2020), we created a cohort of patients coded for OUD and prescribed MOUD. Outcomes included preventive and therapeutic dental visits and oral infections within 18 months before and up to 36 months after index MOUD. We used unadjusted Poisson models to estimate incidence per 1000 patients by MOUD. We performed analyses with and without interval censoring for edentulism, death, or a 60-day gap in MOUD. RESULTS: Among 49,675 eligible patients, 21,551 received methadone, 17,759 transmucosal buprenorphine, 8993 oral naltrexone, and 1372 injectable naltrexone. Median (IQR) days on treatment varied by drug: methadone 95 (52, 257), buprenorphine 309 (102, 968), oral naltrexone 49 (30, 101), injectable naltrexone 28 (28, 85). We observed an immediate increase in dental visits from a baseline range of 135-144 visits/1000/6-month period to 223-686 visits/1000/6-month period after initiating any MOUD. Patterns were similar by MOUD agent and formulation. Results were similar in analyses with and without interval censoring. CONCLUSIONS: Both preventive and therapeutic dental utilization increased immediately following initiation with MOUD. Future observational studies of the effects of MOUD on adverse dental outcomes should account for confounding due to health-seeking behavior.
Community-based Care Coordination and Treatment Retention in Opioid Use Disorder: A 5-year Retrospective Cohort Study.
Langabeer JR, Yatsco AJ, Sarah CA … +2 more , Walia S, Champagne-Langabeer T
J Addict Med · 2026 Mar · PMID 41811231 · Publisher ↗
OBJECTIVES: Treatment for opioid use disorder (OUD) is constrained by financial and geographic barriers. Community-based approaches may help address these challenges, yet evidence regarding their sustained impact on trea...
OBJECTIVES: Treatment for opioid use disorder (OUD) is constrained by financial and geographic barriers. Community-based approaches may help address these challenges, yet evidence regarding their sustained impact on treatment retention and quality of life (QOL) remains limited. This study evaluated treatment retention and QOL outcomes in a community-based care coordination program for OUD. METHODS: We conducted a retrospective cohort study of participants enrolled in the Houston Emergency Opioid Engagement System (HEROES), a community-based treatment program in the Texas Medical Center. From January 1, 2020, through December 31, 2024, 1124 participants received individualized treatment plans, including medical visits, counseling, peer support, and group services. The primary outcome was treatment retention at 90 days. As a secondary descriptive measure, mean days retained within a 180-day observation window were compared across service utilization categories using analysis of variance. Additional secondary outcomes included substance use reoccurrence, overdose, and mortality. RESULTS: Participants were 57.7% male with a mean age of 34.9 years (SD, 9.76); 62.8% were uninsured, and 63.6% had a prior overdose. At 90 days, 74.1% of participants remained in treatment. Mean days retained differed significantly across service utilization categories, with greater engagement associated with longer retention. Nearly 71% of participants reported improvements in QOL, with a mean increase of 13.2 points. CONCLUSIONS: In this 5-year retrospective cohort study, greater participation in a community-based care coordination program for OUD was associated with improved treatment retention and quality of life. Strategies that increase patient engagement through counseling and peer support may improve outcomes.
Liver Injury Associated With Kratom ( Mitragyna speciosa ): A Systematic Review.
Calicdan XA, Kopczynski A, Medina E … +4 more , Singh S, Sotelo D, Wu AC, Suzuki J
J Addict Med · 2026 Mar · PMID 41803068 · Publisher ↗
OBJECTIVES: Kratom ( Mitragyna speciosa ) is a psychoactive herbal product increasingly used for pain, anxiety, and opioid withdrawal. Although marketed as a natural dietary product, concerns have emerged regarding adver...
OBJECTIVES: Kratom ( Mitragyna speciosa ) is a psychoactive herbal product increasingly used for pain, anxiety, and opioid withdrawal. Although marketed as a natural dietary product, concerns have emerged regarding adverse effects like cardiotoxicity, seizures, opioid-like physical dependence, and, particularly, liver toxicity. METHODS: We conducted a systematic review following PRISMA 2020 guidelines of all studies on kratom use and liver toxicity. RESULTS: Thirty-one studies were included, comprising 32 cases of kratom-associated liver injury. Most reports originated from the United States and were single-patient case reports. Most patients were adult males, with frequent co-occurrence of polysubstance use and comorbid conditions. Concomitant exposures were commonly reported but variably characterized across studies. Baseline liver disease was present in 3 patients (9%). Kratom dose, form, frequency, and duration were inconsistently reported. Only 7 cases (22%) provided complete exposure details, whereas the remainder lacked one or more elements. Kratom use was temporally associated with the onset of liver injury, commonly presenting with jaundice and elevations in liver enzymes. The patterns of injury were predominantly cholestatic. In most cases, liver enzymes and function improved after cessation of kratom use. In 4 cases, the patient's liver function did not improve and progressed to liver transplantation. Although formal causality assessments were inconsistently reported, many reports supported an association based on exclusion of alternative etiologies and, in some cases, rechallenge episodes. CONCLUSIONS: Further research is needed to better characterize kratom's mechanisms of liver injury and to inform clinical decision-making and public health policy.
Trends and Predictors of Prescription Drug Substance Use Disorders in the United States: The Role of Recovery Capital.
Koga M, Coulombe S, Tanaka H … +2 more , Saatcioğlu OC, Sahker E
J Addict Med · 2025 Nov · PMID 41766409 · Publisher ↗
OBJECTIVES: To examine trends and predictors of prescription drug substance use disorders (RxSUDs), highlighting risk and protective factors, with a particular focus on patient recovery capital (social factors known to p...
OBJECTIVES: To examine trends and predictors of prescription drug substance use disorders (RxSUDs), highlighting risk and protective factors, with a particular focus on patient recovery capital (social factors known to protect against SUDs) for strengthening policy and practice guidelines. METHODS: This retrospective cross-sectional study used National Survey on Drug Use and Health (NSDUH) data to assess individuals with RxSUDs between 2016 and 2022. RxSUDs include opioid, sedative, hypnotic, anxiolytic, stimulant, or tranquilizer use disorders. Trends were assessed using time-series logistic regression. Demographic, recovery capital, access, and screening characteristics were investigated as RxSUD predictors using cross-sectional multivariate modeling. RESULTS: The sample (survey n = 292,505; weighted n = 250,414,772) was mostly female (52%), White (63%), and aged 35-49 (25%). Time-series analysis (2016-2020) showed no change in RxSUD prevalence (OR = 0.96, 95% CI = 0.91-1.01). Age showed a clinically meaningful association with older adults being less likely to report RxSUDs (OR = 0.43, 95% CI = 0.31-0.59). Recovery capital strengths showed large clinically meaningful odds predicting RxSUD in 6 of 6 variables (OR >2.0). Healthcare provider substance use screening was associated with lower odds of RxSUDs (OR = 0.39, 95% CI = 0.12, 1.27). CONCLUSIONS: Recovery capital reduces the odds of an RxSUD, adjusting for demographics, access, and screening variables. In addition, patient access and healthcare provider drug use screening are important factors to consider in clinical assessment and health care policies aimed at reducing RxSUDs. Improving recovery capital requires targeted policies addressing individual and community needs and can have far-reaching outcomes as they can improve constituencies' wellbeing in addition to RxSUD liability.
Rapid Buprenorphine Initiations for Cardiac Emergencies in Patients on High-dose Methadone: A Case Report.
Fourie E, Mitchell MT, Anaya P … +2 more , Fanucchi LC, South AM
J Addict Med · 2025 Nov · PMID 41766401 · Publisher ↗
BACKGROUND: Methadone remains the most utilized medication for opioid use disorder (MOUD) with significant mortality reduction. Methadone carries a black box warning for the prolongation of the corrected QT interval (QTc...
BACKGROUND: Methadone remains the most utilized medication for opioid use disorder (MOUD) with significant mortality reduction. Methadone carries a black box warning for the prolongation of the corrected QT interval (QTc), which can be fatal. Buprenorphine is another mortality-reducing MOUD that does not carry this same risk and should be considered as an alternative in patients for whom methadone reinitiation is not feasible. However, given that buprenorphine is a high-affinity partial mu opioid receptor agonist, transition from methadone to buprenorphine can lead to precipitated withdrawal. Currently, there is no consensus on the preferred method for urgent transition from high-dose methadone to buprenorphine. CASE PRESENTATION: We highlight 2 patients with opioid use disorder (OUD) on high-dose methadone who required immediate cessation with rapid transition to buprenorphine due to life-threatening arrhythmias. One patient experienced precipitated withdrawal despite a short-acting full agonist opioid bridge, but was eventually stabilized with higher doses of buprenorphine. The other patient did not experience precipitated withdrawal during transition and did not require short-acting full agonist opioids. DISCUSSION: Life-threatening arrhythmias are a rare but serious complication of methadone. If QTc prolongation limits the ability to reach a therapeutic methadone dose during reinitiation, transitioning to buprenorphine should be considered. Given the emergent nature of the transition in these cases, cross-titration with buprenorphine can be helpful. However, patient response remains variable and precipitated withdrawal can occur. Therefore, a thorough discussion with patients regarding risks and benefits, as well as an action plan for precipitated withdrawal, is necessary before initiation.
Opioid Agonist Therapy for Fentanyl-Related Opioid Use Disorder: A Systematic Review.
Solak AD, Boynton J, Riches J … +6 more , Souter A, Dong K, Zaree M, Woods N, Iansavitchene A, Byrne C
J Addict Med · 2026 Feb · PMID 41749427 · Publisher ↗
OBJECTIVES: While treatment guidelines for opioid use disorder (OUD) are well-established, specific guidance for people who use fentanyl remains limited. This systematic review is the first to examine effectiveness and s...
OBJECTIVES: While treatment guidelines for opioid use disorder (OUD) are well-established, specific guidance for people who use fentanyl remains limited. This systematic review is the first to examine effectiveness and safety outcomes associated with opioid agonist therapy (OAT), specifically buprenorphine, methadone, and slow-release oral morphine, in this patient population. METHODS: Following PRISMA guidelines, we systematically searched EMBASE, Medline, PsycINFO, CENTRAL (all via Ovid), and Scopus from inception to April 2025 for studies reporting OAT for fentanyl-related OUD. Primary outcomes included OAT titration time, treatment retention, withdrawal symptoms, remission, nonprescribed fentanyl use, and mortality. Risk of bias was assessed using the Cochrane risk of bias tools. Results were synthesized narratively. RESULTS: We identified 180 studies for inclusion (sample sizes ranging from 1 to 150,000). Several reports described treatment success using novel strategies, including low-dose ("microdosing," Bernese method) and high-dose buprenorphine ("macrodosing"), and rapid high-dose methadone protocols that deviate from standard guidelines. CONCLUSIONS: Emerging, yet primarily low-quality evidence suggests novel OAT induction strategies for fentanyl-related OUD are feasible and show a consistent direction toward positive clinical and safety outcomes. High-quality research specific to this population, comparing conventional to novel strategies, is needed.
Low-threshold Buprenorphine: Proposing the Ideal Service Model to Engage People With Severe Opioid Use Disorder.
Fox AD, Messmer SE, Hayes BT … +3 more , Salisbury-Afshar E, Chatterjee A, Jakubowski AU
J Addict Med · 2026 Feb · PMID 41731662 · Full text
Low-threshold buprenorphine treatment has been described as a general approach to office-based buprenorphine treatment that prioritizes access to care, flexibility, and patient-centeredness. Proposed principles have incl...
Low-threshold buprenorphine treatment has been described as a general approach to office-based buprenorphine treatment that prioritizes access to care, flexibility, and patient-centeredness. Proposed principles have included same-day treatment entry, flexible policies and procedures, a harm reduction orientation, and availability in unconventional settings. This commentary, which summarizes critical insights from practitioners of low-threshold buprenorphine treatment, expands on these principles by describing clinical and social services that have been included in successful programs. Potential critiques of low-threshold buprenorphine treatment are also addressed. The main goal of the commentary is to describe the ideal components of low-threshold buprenorphine treatment that could inform the development, evaluation, and dissemination of these innovative programs.
Metabolism, Not Mendacity: Rethinking Prolonged Cocaine Positivity.
Bowen DM, Soltani M
J Addict Med · 2026 Feb · PMID 41730530 · Publisher ↗
BACKGROUND: Urine toxicology is a cornerstone of monitoring abstinence in substance use disorder treatment, yet commonly cited detection windows are based on studies in healthy volunteers and do not account for metabolic...
BACKGROUND: Urine toxicology is a cornerstone of monitoring abstinence in substance use disorder treatment, yet commonly cited detection windows are based on studies in healthy volunteers and do not account for metabolic variability. Prolonged metabolite positivity is typically interpreted as continued use, which can jeopardize treatment engagement and erode the therapeutic alliance. CASE SUMMARY: We describe a 42-year-old man with severe stimulant use disorder whose urine toxicology remained positive for cocaine metabolites for 18 days, including 12 days after verified abstinence in a residential program. Laboratory evaluation revealed hepatic steatosis, and pharmacogenomic testing demonstrated a poor metabolizer phenotype at CYP2D6 and CYP3A5. Creatinine-corrected benzoylecgonine levels showed steady monotonic decline without fluctuation, consistent with delayed elimination rather than recurrent use. No cross-reactive medications or confounding substances were present. DISCUSSION: Cocaine metabolism depends on cytochrome P450 enzymes-particularly CYP2D6 and CYP3A isoforms-and nonspecific esterases. Impaired activity of these pathways, combined with hepatic steatosis and chronic stimulant exposure, can significantly prolong metabolite clearance. This case highlights the importance of distinguishing biological variability from behavioral relapse, especially in settings where misinterpretation may undermine therapeutic rapport. CLINICAL IMPLICATIONS: Unexpectedly persistent cocaine positivity should prompt consideration of pharmacogenomic variation, hepatic function, and confirmatory testing rather than immediate assumptions of relapse. Integrating biological, behavioral, and contextual data supports accurate interpretation and protects the therapeutic alliance. CONCLUSIONS: Prolonged cocaine metabolite detection can reflect delayed metabolic clearance rather than continued use. Awareness of pharmacokinetic and pharmacogenomic factors is essential for accurate urine toxicology interpretation and patient-centered addiction care.
Gains in Employment Status Are Associated With Lower Methamphetamine Use Frequency at Outpatient Specialty Treatment Discharge.
Bormann NL, Oesterle TS, Weber AN … +3 more , Lynch AC, Arndt S, Nidey N
J Addict Med · 2026 Feb · PMID 41730527 · Publisher ↗
OBJECTIVES: Employment can provide structure and economic opportunity. We examined whether changes in employment status from treatment admission to discharge co-occurred with changes in methamphetamine use frequency over...
OBJECTIVES: Employment can provide structure and economic opportunity. We examined whether changes in employment status from treatment admission to discharge co-occurred with changes in methamphetamine use frequency over the same period. METHODS: The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Discharges (2017-2022) provided the data. Methamphetamine use frequency (daily use, some use, and no use in the past month) and employment status (full-time, part-time, unemployed, and not in the labor force) were reported at treatment admission and discharge. Changes in methamphetamine use frequency were recorded as a reduction or no reduction. Logistic regression modeled reduced methamphetamine use frequency as the dependent variable. Analyses included employment status at admission, discharge, and their interaction. An adjusted model estimated marginal probabilities of reduced methamphetamine use at discharge. RESULTS: There were 89,015 first treatment admissions. Individuals who gained full-time employment showed the greatest reductions in methamphetamine use frequency (75.7% [95% CI: 72.9-78.4] and 73.9% [95% CI: 72.2-75.6]), compared with 25.5% (95% CI: 25.1-26.0) among those who remained unemployed. More people completed treatment in the reduction group (45.2% vs 22.6%). CONCLUSIONS: Results indicate that gains in employment status during treatment co-occurred with reduced methamphetamine use frequency. This is consistent with prior research linking stable employment to improved health and recovery outcomes. Integrating employment‑support services into outpatient treatment may complement existing interventions and support patient-centered goals. Future prospective studies are needed to establish temporal ordering between employment transitions and methamphetamine use changes and to evaluate employment-support strategies as an adjunct to treatment.
Estimated Prevalence of Current Posttraumatic Stress Disorder Among Pregnant Women With Opioid Use Disorder-MATernaL and Infant Clinical NetworK (MAT-LINK), 2014-2021.
Peck KR, Chen MH, Lee B … +10 more , Board A, Debessai H, Sanjuan PM, O'Connor TG, Elansary M, Smid MC, Rood KM, Henninger ML, Louis J, Heil SH
J Addict Med · 2026 Feb · PMID 41730526 · Publisher ↗
OBJECTIVES: Posttraumatic stress disorder (PTSD) during pregnancy is associated with adverse consequences and has an estimated prevalence of 3% in community samples. The prevalence of current PTSD among pregnant women wi...
OBJECTIVES: Posttraumatic stress disorder (PTSD) during pregnancy is associated with adverse consequences and has an estimated prevalence of 3% in community samples. The prevalence of current PTSD among pregnant women with opioid use disorder (OUD), a population at increased risk of adverse birth outcomes and other mental disorders, has been estimated at 16%-37% based on 3 small studies. We used the Centers for Disease Control and Prevention's MATernaL and Infant clinical NetworK (MAT-LINK) surveillance network to (1) further examine current PTSD prevalence among pregnant women with OUD and (2) compare characteristics of those with and without PTSD. METHODS: PTSD prevalence estimates during the current pregnancy were based on (1) presence of an ICD-9/10-CM code indicating PTSD (ie, extracted); (2) documentation of a PTSD diagnosis in abstracted data (ie, abstracted); and (3) PTSD identified by either source. RESULTS: Of 3315 pregnancies among women with OUD, estimated current PTSD prevalence was 14.7% (95% CI: 13.5-15.8) based on extracted data alone, 23.3% (95% CI: 22.0-24.6) based on abstracted data alone, and 25.9% (95% CI: 24.1-27.7) when based on either data source. Those with PTSD had a higher prevalence of most substance use and mental health disorders examined compared with those without. CONCLUSIONS: These estimates underscore the substantial prevalence of PTSD among pregnant women with OUD and emphasize the need to screen for and treat PTSD and other mental health disorders in this population. Given that evidence-based treatments for PTSD have not been systematically evaluated in pregnant women, more research is sorely needed.
When a Withdrawal Aid Mimics a Brainstem Lesion: Gabapentin-associated Transient Ophthalmoplegia.
Soltani M
J Addict Med · 2026 Feb · PMID 41693038 · Publisher ↗
OBJECTIVES: Gabapentin is frequently used as a benzodiazepine-sparing agent for the management of mild to moderate alcohol withdrawal and is generally considered well-tolerated. Although neurological adverse effects have...
OBJECTIVES: Gabapentin is frequently used as a benzodiazepine-sparing agent for the management of mild to moderate alcohol withdrawal and is generally considered well-tolerated. Although neurological adverse effects have been reported, objective ocular motor abnormalities associated with gabapentin use during alcohol withdrawal are rarely described. Recognition of such effects is important to guide evaluation and management. METHODS: We report a 60-year-old man admitted to a residential treatment program for alcohol use disorder who developed acute diplopia and transient ophthalmoplegia shortly after initiation of gabapentin for mild alcohol withdrawal. The patient had no history of withdrawal seizures or delirium tremens and presented with a low CIWA-Ar score. Gabapentin was initiated at a total daily dose of 1800 mg using a fixed-dose taper. Within 24 hours, he developed diplopia, gaze-evoked nystagmus, and mild gait ataxia. Neurological examination revealed unilateral ophthalmoplegia, while neuroimaging and laboratory evaluation were unremarkable. Gabapentin was discontinued, and symptoms resolved completely within 24 hours without recurrence. RESULTS: The temporal relationship between gabapentin initiation and symptom onset, along with rapid resolution after discontinuation, supports a medication-induced neurological effect rather than alcohol withdrawal-related encephalopathy or structural neurological disease. The findings localize to cerebellar-brainstem pathways and are consistent with gabapentin's known effects on voltage-gated calcium channels. CONCLUSIONS: Gabapentin remains a useful option for mild to moderate alcohol withdrawal; however, rapid dose escalation may increase the risk of reversible neurological adverse effects. New-onset diplopia or ocular motor abnormalities should prompt medication review and appropriate neurological evaluation to ensure patient safety.
Treatment of Kratom Use Disorder With Methadone in an Opioid Treatment Program.
Sherrick RC
J Addict Med · 2026 Feb · PMID 41673921 · Publisher ↗
BACKGROUND: Kratom (Mitragyna speciosa) and its active alkaloids, mitragynine and 7-hydroxymitragynine, can produce opioid-like dependence and withdrawal meeting DSM-5 criteria for opioid use disorder (OUD). While bupren...
BACKGROUND: Kratom (Mitragyna speciosa) and its active alkaloids, mitragynine and 7-hydroxymitragynine, can produce opioid-like dependence and withdrawal meeting DSM-5 criteria for opioid use disorder (OUD). While buprenorphine has been described for kratom use disorder (KUD), published experience with methadone is limited. METHODS: We identified 14 patients across multiple Opioid Treatment Programs (OTPs) with KUD who were treated with methadone between January 2024 and October 2025. Demographic, dosing, and urine toxicology data were reviewed. RESULTS: The mean age was 36.8 years; 71% were male. Sixty-four percent reported using both kratom and 7-OH. The mean first-day methadone dose was 27.5 mg (range 15-30), and the mean maximum dose was 98.6 mg (range 35-190). Thirteen patients (93%) remained in treatment at the last follow-up. No adverse events were reported. CONCLUSIONS: Methadone was well tolerated and effective in stabilizing patients with KUD, supporting its use as a viable alternative when buprenorphine is not suitable.
Xylazine Exposure and Association With Early Physiological and Withdrawal Symptoms in People With Opioid Use Disorder.
Strickland JC, Bergeria CL, Huhn AS … +4 more , McKendrick G, Srungaram D, Pattillo E, Dunn KE
J Addict Med · 2026 Feb · PMID 41668254 · Full text
OBJECTIVES: The prevalence of xylazine, an agonist at the alpha-2 adrenergic receptor often used in veterinary medicine, has increased in the illicit opioid drug supply. Case series and survey data suggest that xylazine...
OBJECTIVES: The prevalence of xylazine, an agonist at the alpha-2 adrenergic receptor often used in veterinary medicine, has increased in the illicit opioid drug supply. Case series and survey data suggest that xylazine may increase the nature and severity of opioid withdrawal. We sought to evaluate the association between quantified levels of xylazine exposure and withdrawal symptoms in people undergoing opioid withdrawal. METHODS: People (n=36; 11 female) with opioid use disorder and physical dependence were enrolled in two harmonized clinical trials. Urine specimens were collected at admission to a residential unit and were analyzed for xylazine, fentanyl, and its inactive metabolite norfentanyl. Opioid withdrawal and physiological effects were collected during stabilization on oral hydromorphone without illicit opioid access. RESULTS: Urinary xylazine was detected in 69% of samples with concentrations ranging from 5.7 to 15481.1 ng/mL. Among participants with detectable urinary xylazine, higher xylazine concentrations were significantly associated with higher systolic blood pressure (b=7.68 [2.03, 13.33], P=0.011) and COWS total scores (b=1.53 [0.17, 2.88], P=0.029). No significant differences in blood pressure or COWS were observed between participants with and without xylazine detected. CONCLUSIONS: Potential rebound hypertensive effects following xylazine exposure were observed, consistent with alpha-2 adrenergic mechanisms, which may be accompanied by an exacerbated withdrawal syndrome. Continued preclinical and clinical evaluation of strategies are needed to understand how co-exposure to drug adulterants like xylazine influences withdrawal expression and the utility of existing pharmacological approaches for withdrawal management in clinical settings.
Opioid Use Disorder Care Presentations After High-deductible Health Plan Enrollment.
Shuey B, Zhang F, Argetsinger S … +3 more , Costa R, Wen H, Wharam JF
J Addict Med · 2026 Feb · PMID 41668241 · Full text
OBJECTIVE: Determine whether employer-mandated transitions from low- to high-deductible health plans (HDHPs) are associated with delays in opioid use disorder (OUD)-related care presentations. Cost-sharing may negatively...
OBJECTIVE: Determine whether employer-mandated transitions from low- to high-deductible health plans (HDHPs) are associated with delays in opioid use disorder (OUD)-related care presentations. Cost-sharing may negatively impact timely diagnosis and treatment of OUD. METHODS: Using 2003-2017 national commercial insurance claims data, we used a matched time-to-event and difference-in-differences design to examine the association between employer-mandated transitions from low to HDHPs on OUD-related care presentations. Study group included 574,058 adults aged 18-64 years continuously enrolled in low-deductible (<$500) health plans during a baseline year followed by up to 4 years in HDHPs (≥$1000) after an employer-mandated transition (exposure). Control group included 4,386,636 adults contemporaneously enrolled in low-deductible plans matched on employee and employer characteristics. Outcomes included first OUD-related office visit, buprenorphine pharmacy fill, and OUD-related high-acuity visit. The secondary outcome was the yearly number of high-acuity care days. RESULTS: After an employer-mandated HDHP transition, there were no differences in time-to-first OUD-related office visit (HR, 1.02, 95% CI: 0.94, 1.11) or buprenorphine fill (HR, 1.05, 95% CI: 0.97-1.13) in the HDHP versus control cohort. In contrast, the HDHP transition was associated with delays in time-to-first OUD-related high-acuity visits compared with control members (HR 0.86, 95% CI: 0.79-0.93). HDHP members experienced a 37.4% (95% CI: -57.8, -17.0) relative reduction in high-acuity care days relative to the control group from baseline to follow-up. CONCLUSIONS: Employer-mandated transitions to HDHPs were associated with delays and reductions in OUD-related high-acuity presentations. Such delays and reductions in timely OUD care could lead to adverse health outcomes.
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