Journal Of Addiction Medicine[JOURNAL]
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200 papers
Medetomidine-Involved Overdoses Among Emergency Department Patients: Results From a US Multicenter Sentinel Surveillance Program.
Stolbach A, Culbreth R, Falise A … +15 more , Aldy K, Perrone J, Liss D, Krotulski A, Logan B, Walton S, Campleman S, Buchanan J, House S, Rogers B, Wax P, Schwarz E, Pizon AF, Brent J, ToxIC DOTS Study Group
J Addict Med · 2026 Feb · PMID 41668237 · Publisher ↗
OBJECTIVES: Medetomidine is an alpha-2 adrenoreceptor agonist approved only for veterinary sedation and was reported in the US illicit drug supply starting in 2022. Our aim was to determine the prevalence of medetomidine...
OBJECTIVES: Medetomidine is an alpha-2 adrenoreceptor agonist approved only for veterinary sedation and was reported in the US illicit drug supply starting in 2022. Our aim was to determine the prevalence of medetomidine exposure and associated clinical characteristics among emergency department patients presenting with opioid and/or stimulant overdoses. METHODS: The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program included 17 US medical centers. Emergency department (ED) patients with acute opioid and/or stimulant overdose were enrolled between April 2023 and September 2024. Blood was obtained for toxicological analysis, and chart reviews and structured patient interviews were conducted. RESULTS: Among 964 cases, medetomidine was detected in 2.8% (n = 27). After adjusting for confounders, medetomidine exposure was associated with an increased odds (odds ratio: 4.03; 95% CI: 1.35, 10.58) of bradycardia (<50 beats per minute) within 24 hours of presentation. Patients with medetomidine exposure had significantly higher rates of BVM (20.5%) than those without medetomidine exposure (3.7%; P=0.03) but did not require more intubation, BiPAP/CPAP, or naloxone than medetomidine-unexposed patients. No differences between medetomidine-exposed and unexposed groups were found for length of stay, critical care unit disposition, hypotension (<50 mmHg), or sedation. No patients completing an interview (n = 24) reported medetomidine use. CONCLUSIONS: Medetomidine exposure among ED patients with overdose was associated with increased bradycardia but not greater sedation, respiratory support, or need for higher level of care. Sentinel toxico-surveillance can identify emerging drug trends not captured through routine clinical data.
Antecedents of Fentanyl Coinvolvement in Deaths Attributed to Stimulant Poisoning in San Francisco, CA.
Chang YG, McMahan VM, Rodda LN … +6 more , Antolin Muñiz M, Brennan S, Luna Marti X, Lutz SM, Knoll J, Coffin PO
J Addict Med · 2026 Feb · PMID 41664290 · Full text
OBJECTIVES: Deaths attributed to stimulants in the United States are largely driven by fentanyl coinvolvement. We sought to compare antecedents of acute stimulant deaths involving fentanyl to those that do not involve op...
OBJECTIVES: Deaths attributed to stimulants in the United States are largely driven by fentanyl coinvolvement. We sought to compare antecedents of acute stimulant deaths involving fentanyl to those that do not involve opioids. METHODS: We analyzed data from 31 fentanyl-stimulant and 70 stimulant-no-opioid decedents in a psychological autopsy study in San Francisco, CA. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify variables potentially associated with coinvolvement of fentanyl in death. We included 36 variables (sociodemographic characteristics, substance use, medical history, and circumstances surrounding death) from medical examiner reports, informant interviews, and medical records. We conducted multivariable logistic regression using variables selected by the LASSO model to assess associations with coinvolvement of fentanyl in death. RESULTS: Past-year fentanyl use and opioid-related emergency department visits in the 3 years before death were associated with higher odds of fentanyl involvement in death [adjusted odds ratio (aOR) = 3.10, 95% CI: 1.16-8.29, P = 0.02 and aOR = 4.62, 95% CI: 1.03-20.66, P = 0.045, respectively]. Having a cardiac condition (from medical history, autopsy, or informant report) was associated with lower odds of fentanyl involvement in death (aOR = 0.13, 95% CI: 0.03-0.46, P < 0.002). CONCLUSIONS: Our findings add to existing evidence that fentanyl-stimulant deaths are markedly different than stimulant-no-opioid deaths. The association of opioid-related emergency department history with fentanyl involvement in death reinforces a potential touch point for overdose prevention efforts (eg, naloxone, medications for opioid use disorder). Our finding of cardiac conditions being associated with lower odds of fentanyl involvement in death supports the hypothesis that stimulant-no-opioid deaths may be driven by cardiovascular conditions.
Xylazine Use in Pregnancy: A Case Report and Narrative Review.
Kasemodel K, Ilstrup S, Avenido J … +3 more , Lynch A, Castiglia R, Reneer D
J Addict Med · 2026 Feb · PMID 41662665 · Publisher ↗
Xylazine, an alpha-2 adrenergic agonist veterinary sedative, has emerged as a frequent adulterant in illicit opioids, contributing to the ongoing "tranq dope" crisis. Its effects on human pregnancy are largely unknown, p...
Xylazine, an alpha-2 adrenergic agonist veterinary sedative, has emerged as a frequent adulterant in illicit opioids, contributing to the ongoing "tranq dope" crisis. Its effects on human pregnancy are largely unknown, posing new challenges in obstetric addiction medicine. We present the case of a 25-year-old woman (G4P2113) with opioid use disorder who unknowingly used fentanyl adulterated with xylazine throughout pregnancy. She developed preeclampsia with HELLP syndrome, requiring urgent preterm cesarean delivery at 34 weeks. The neonate was treated for neonatal abstinence syndrome. Four days postpartum, the patient-discharged without medication for opioid use disorder-suffered intractable vomiting from withdrawal, leading to a Mallory-Weiss tear with massive hemorrhage and cardiac arrest. She required intensive care with transfusions, endoscopic hemostasis, and mechanical ventilation. Upon extubation, she disclosed fentanyl-xylazine ("tranq") use. She was transitioned to buprenorphine maintenance with supportive care for xylazine withdrawal and discharged in improved condition. We review the sparse human literature on xylazine exposure in pregnancy and relevant animal studies. Human data confirm placental transfer of xylazine, with umbilical cord assays detecting exposure, and suggest that xylazine may contribute to maternal CNS depression and neonatal sedation. Animal models demonstrate dose-dependent uterine vasoconstriction, reduced uteroplacental blood flow, fetal growth restriction, and pregnancy loss. We discuss management considerations for pregnant patients using xylazine-adulterated opioids, including challenges in diagnosis, withdrawal management, and the need for expanded harm-reduction strategies. This case and review highlight the urgent need for surveillance and evidence-based protocols to address xylazine in the perinatal setting.
Hospitalizations and Mortality Following Skilled Nursing Facility Admission by Opioid Use Disorder Status.
Dow PM, George M, Zullo AR … +2 more , Ritter AZ, Rahman M
J Addict Med · 2026 Jan-Feb 01 · PMID 41656557 · Full text
OBJECTIVES: Prior studies have documented rising rates of referrals to skilled nursing facilities (SNFs) for hospitalized patients with opioid use disorder (OUD). However, the care transitions and survival of people with...
OBJECTIVES: Prior studies have documented rising rates of referrals to skilled nursing facilities (SNFs) for hospitalized patients with opioid use disorder (OUD). However, the care transitions and survival of people with OUD who enter SNFs have not been evaluated. We examined differences in hospital readmissions and mortality between individuals with and without OUD discharged to SNFs. METHODS: Using 2016-2020 100% Medicare inpatient claims, we identified acute hospitalizations with discharge to SNFs. We matched each beneficiary with OUD with up to 5 without OUD based on age, sex, low-income subsidy status, and residential county. Outcomes were hospital readmissions and all-cause mortality within 180 days following hospital discharge. Inverse-probability weighting (IPW) covariates included demographics, state of residence, year of SNF admission, intensive care use, Gagne comorbidity score, and conditions associated with SNF admission or that disproportionately affect people with OUD. Unadjusted and IPW-adjusted risk differences were calculated. RESULTS: There were 30,922 fee-for-service beneficiaries with OUD and 137,454 matched beneficiaries without OUD, with a mean age of ~71 years. Of those with OUD, 5.3% had evidence of receiving medications for OUD. In unadjusted analyses, beneficiaries with OUD had higher readmission risk (44.5% vs 27.9%) and comparable mortality risk (17.8% vs 16.5%) relative to beneficiaries without OUD. After adjustment through IPW, there were minimal differences in mortality; however, beneficiaries with OUD remained at a greater risk for readmissions than those without OUD. CONCLUSIONS: Hospital readmissions were dramatically higher among Medicare beneficiaries with OUD than those without OUD, suggesting that important gaps in OUD care exist in SNFs.
A Content Analysis of Xylazine-associated Stigma in Web-based Media Driven by the Zombie Term and Stigmatizing Imagery.
Jawa R, Goswami M, Ismail S … +5 more , Shang M, McMurtrie G, Murray S, Liebschutz JM, Colditz JB
J Addict Med · 2026 Jan-Feb 01 · PMID 41656556 · Full text
BACKGROUND: Drug use-related stigma amplifies the harms faced by people who use drugs (PWUD). Media often dehumanizes PWUD, particularly those using xylazine, a veterinary sedative and opioid adulterant, by labeling them...
BACKGROUND: Drug use-related stigma amplifies the harms faced by people who use drugs (PWUD). Media often dehumanizes PWUD, particularly those using xylazine, a veterinary sedative and opioid adulterant, by labeling them with terms like "zombie." This perpetuates discrimination and stigma, distracting from the public health crisis. To assess this, we conducted a content analysis to quantify the prevalence of stigmatizing terms like "zombie" and related imagery in xylazine-related web-based media. METHODS: We analyzed web-based news media reporting on xylazine from October 1, 2022, to September 30, 2023, using Google News. "Stigmatizing term" was defined as the use of the word "zombie," and "stigmatizing imagery" was defined as an embedded image of nonsterile or discarded drug use supplies, visibly intoxicated individuals, unhoused persons, or necrotic wounds. Two trained reviewers followed a standardized protocol to examine article titles, text, and images. Articles using stigmatizing term and/or imagery were coded as stigmatizing; and data were aggregated by month to assess any temporal changes in relation to federal xylazine alerts. RESULTS: In a 12-month period, 910 news articles mentioned xylazine, 23.9% featured stigmatizing content, of which 57% (124/217) used "zombie" only, 26.3% (57/217) had stigmatizing imagery only, and 16.6% (36/217) had both. Stigmatizing articles peaked in March and July 2023, coinciding with federal alerts about xylazine in the opioid supply. Of the 601 articles with embedded images, 15% had stigmatizing imagery. CONCLUSIONS: Stigmatizing content in web-based news media about xylazine continues to proliferate, highlighting the need for more efforts to challenge these narratives.
Loneliness Among US Veterans With Problematic Substance Use: Results From the National Health and Resilience in Veterans Study.
Na PJ, Pless Kaiser A, McCurdy LY … +5 more , Fischer IC, Jeste DV, Petrakis IL, Potenza MN, Pietrzak RH
J Addict Med · 2026 Jan-Feb 01 · PMID 41656555 · Publisher ↗
OBJECTIVES: Loneliness is a pervasive public health problem, especially among individuals with problematic substance use (PSU). To date, however, scarce research has examined the prevalence and correlates of loneliness i...
OBJECTIVES: Loneliness is a pervasive public health problem, especially among individuals with problematic substance use (PSU). To date, however, scarce research has examined the prevalence and correlates of loneliness in vulnerable segments of the population, such as US military veterans. METHODS: Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans. The Three-Item Loneliness Scale was used to assess clinically significant loneliness (≥6). Multivariable logistic regression and relative importance analyses were conducted to identify correlates of loneliness in 593 veterans with PSU. RESULTS: Nearly half of US veterans with PSU (47.4%) reported clinically significant loneliness. In a multivariable analysis, loneliness was independently associated with being unmarried/unpartnered, greater current psychological distress (depressive and posttraumatic stress symptoms), lifetime suicide attempt, and physical disability, smaller social network size, and lower levels of purpose in life and optimism. In a relative importance analysis, major depressive and posttraumatic stress symptoms (35.4%), smaller social network size (16.7%), and lower purpose in life (15.0%) and optimism (13.6%) explained the majority of the variance in loneliness. Purpose in life also moderated the link between depressive symptoms and loneliness: among veterans with depressive symptoms, those with higher purpose in life had a lower likelihood of loneliness. CONCLUSIONS: Nearly half of US veterans with PSU report significant loneliness. Prevention and treatment strategies that address psychological distress, foster meaningful social connections, and enhance veterans' sense of purpose may help mitigate the burden of loneliness in this population.
Treating Hepatitis C Within Real-world Telemedicine Addiction Care.
Lira MC, Hendy LE, Tsui JI … +5 more , Page K, Jimes C, Barrett E, Brigham S, Coffey MJ
J Addict Med · 2026 Jan-Feb 01 · PMID 41656554 · Full text
OBJECTIVES: Individuals receiving treatment for opioid use disorder (OUD) represent a key population for hepatitis C diagnosis and treatment. Integrating hepatitis C treatment within telemedicine addiction care offers a...
OBJECTIVES: Individuals receiving treatment for opioid use disorder (OUD) represent a key population for hepatitis C diagnosis and treatment. Integrating hepatitis C treatment within telemedicine addiction care offers a new opportunity to reach this population. METHODS: We conducted a chart review of individuals prescribed hepatitis C treatment within a telemedicine treatment program for OUD. Patient medical records were reviewed to extract details on demographics, hepatitis C history, medication prior authorization, initiation and completion, and viral clearance testing. RESULTS: Sixty-three treatment-naïve patients were prescribed antiviral therapy for hepatitis C by their addiction treatment medical providers with a median age of 36, 41% of patients identifying as female, and 57% insured by Medicaid. Approximately 1 in 5 patients were denied prior authorization for antiviral therapy. Among 63 patients initially prescribed medication, 33 (52%) completed treatment. CONCLUSIONS: Telehealth programs for addiction are a feasible platform for expanding hepatitis C treatment to patients with OUD. Policies to reduce restrictions on antiviral coverage by payers could increase medication access through telehealth.
Impact of Project ECHO on Obstetric Providers Caring for Pregnant and Postpartum Individuals With Opioid Use Disorder: A Qualitative Analysis.
Koester M, Porto A, Lomotey L … +3 more , Forray A, Yonkers K, Ashley K
J Addict Med · 2026 Jan-Feb 01 · PMID 41656553 · Publisher ↗
OBJECTIVES: Opioid use disorder (OUD) among pregnant individuals has increased, indicating a need to better equip obstetric providers (OB/GYNs) and their care teams with tools and strategies to address OUD. Telementoring...
OBJECTIVES: Opioid use disorder (OUD) among pregnant individuals has increased, indicating a need to better equip obstetric providers (OB/GYNs) and their care teams with tools and strategies to address OUD. Telementoring programs such as Project ECHO (Project Extension for Community Healthcare Outcomes) may pose one strategy. The Support Models for Addiction Related Treatment (SMART) trial compared the effectiveness of 2 support models for OB/GYNs caring for individuals with OUD. This qualitative evaluation aimed to assess facilitators and barriers to the implementation of one of the 2 models, SMART ECHO, and the implementation of program content. METHODS: Semistructured participant interviews following a Consolidated Framework for Implementation Research-informed interview guide were conducted with SMART ECHO participants. An inductive thematic analysis was utilized to analyze the interview transcripts. RESULTS: Participants included 4 OB/GYNs and 2 social workers. The interviews were analyzed using an inductive thematic analysis. Six themes emerged from the analysis: (1) benefits of SMART ECHO, (2) supportive clinic environment, (3) facilitators to implementing medication treatment for OUD (MOUD), (4) barriers to implementing MOUD, (5) practice changes, and (6) lack of primary care provider (PCP) collaboration. Participants noted practice changes because of their participation in the series and shared key facilitators and barriers to implementing MOUD. CONCLUSIONS: This study identified facilitators and barriers to the implementation of SMART ECHO and its content. The lessons learned might help with the wider implementation of similar programs aimed at educating OB/GYNs and their care teams on optimizing care for pregnant individuals experiencing OUD.
Characterization of a Young Adult Sample Accessing Buprenorphine Via Telehealth in Philadelphia, PA.
Herrera MC, Lazariu V, O'Donnell N … +6 more , Gehri G, Rohacs N, Barnes J, Wilson JD, Perrone J, Lowenstein M
J Addict Med · 2026 Jan-Feb 01 · PMID 41656552 · Publisher ↗
BACKGROUND: Adolescents and young adults (AYA) face distinct barriers when accessing care for opioid use disorder (OUD). Our objective was to compare characteristics of young adults to older adults seeking buprenorphine...
BACKGROUND: Adolescents and young adults (AYA) face distinct barriers when accessing care for opioid use disorder (OUD). Our objective was to compare characteristics of young adults to older adults seeking buprenorphine via telehealth and examines retention in care. METHODS: This retrospective cohort study compares young adults (ages 18-29) to older callers (age 30 and above) prescribed buprenorphine via a health system-based telehealth bridge clinic, CareConnect, in Philadelphia, Pennsylvania from 2021 to 2023. We compared patient and treatment characteristics using χ2 tests. Interactions between the age groups and independent variables were analyzed. Significant interactions were retained. Multivariable logistic regression evaluated factors associated with buprenorphine retention. RESULTS: Of the 1023 telehealth callers, 152 (15%) were young adults. The majority identified as male (60%) and were enrolled in Medicaid (74%). Of the sample, 45% identified as White, 36% identified as Black, and 12% identified as Hispanic. Young adult callers were more likely to identify as Hispanic than older callers (19% vs. 11%, P<0.03) and more likely to report incarceration in the last 1 month (17% vs. 9%, P<0.03). There were no significant differences in buprenorphine retention between younger and older adults. Lack of insurance among all adults was associated with lower odds of retention in buprenorphine treatment than insured patients (aOR=0.4, 95% CI=0.2-0.6). Young adults who identified as Black had lower odds of buprenorphine retention(aOR=0.3, 95% CI=0.1-0.8). CONCLUSIONS: Our study highlights the importance of insurance coverage to support continued buprenorphine treatment engagement. This analysis also underscores the need for interventions to mitigate OUD treatment disparities among minoritized young.
Response to: Buprenorphine Initiation, Patient Autonomy, and Informed Consent.
Moore J, Gangemi A
J Addict Med · 2026 Feb · PMID 41634916 · Publisher ↗
Abstract loading — click title to view on PubMed.
Buprenorphine Initiation, Patient Autonomy, and Informed Consent.
Williams JB
J Addict Med · 2026 Feb · PMID 41634909 · Publisher ↗
Abstract loading — click title to view on PubMed.
High Levels of Substance Use Disorder Among Critically Ill Virginia Medicaid Beneficiaries.
Marks SJ, Lowe J, Catlin JN … +3 more , Wills B, Barnes AJ, Iwashyna TJ
J Addict Med · 2026 Feb · PMID 41627384 · Full text
OBJECTIVES: Substance use disorder (SUD) affects critically ill patients before, during, and after their intensive care unit (ICU) stay. Medicaid is the primary payor for patients with SUD and an increasing number of ICU...
OBJECTIVES: Substance use disorder (SUD) affects critically ill patients before, during, and after their intensive care unit (ICU) stay. Medicaid is the primary payor for patients with SUD and an increasing number of ICU stays; however, little is known about the prevalence of SUD among Medicaid-covered ICU beneficiaries. METHODS: Using Medicaid claims from Virginia in 2023-2024, we examined the prevalence of SUD, demographic characteristics, specific types of SUD, and SUD-related characteristics among Medicaid beneficiaries ages 18-64 with an ICU and compared these ICU beneficiaries to 2 groups: beneficiaries with a non-ICU hospitalization and beneficiaries with no acute hospitalizations. RESULTS: Nearly half of Medicaid ICU beneficiaries have a SUD [49.2% (95% CI: 48.3-50.1)], over 8 times higher than general Medicaid and >20% higher than beneficiaries with non-ICU hospitalizations. Almost one in 5 ICU beneficiaries [19.2% (95% CI: 18.3%-19.8%)] had a stay for overdose or withdrawal, twice the rate of Medicaid beneficiaries with a non-ICU hospitalization. SUD was more prevalent among beneficiaries with an ICU hospitalization across most beneficiary demographic characteristics and types of SUD with alcohol and "other" (polysubstance/unknown) SUD relatively greater among beneficiaries with an ICU hospitalization compared with beneficiaries with non-ICU hospitalizations and all beneficiaries. CONCLUSIONS: SUD is highly prevalent among Medicaid beneficiaries with an ICU hospitalization. Further studies are required to understand the needs of critically ill patients with SUD. Efforts by Medicaid and managed care organizations to promote SUD treatment during hospitalization may improve the long-term recovery of critically ill patients.
Self-Reported History of Precipitated Withdrawal: A Cross-Sectional Study of People Who Use Unregulated Opioids.
Figgatt MC, Serafinski RL, Ujeneza M … +6 more , Turbidez J, McKenzie M, Park JN, Grossman ER, Rich J, Green TC
J Addict Med · 2026 Feb · PMID 41622516 · Full text
OBJECTIVES: In contrast to methadone, buprenorphine is susceptible to precipitated withdrawal complicated by fentanyl in the unregulated opioid supply. The objective of this study was to examine associations between drug...
OBJECTIVES: In contrast to methadone, buprenorphine is susceptible to precipitated withdrawal complicated by fentanyl in the unregulated opioid supply. The objective of this study was to examine associations between drug supply characteristics and the prevalence of precipitated withdrawal. METHODS: We conducted a cross-sectional analysis of a cohort study during 2023-2025 among people with a lifetime history of buprenorphine or methadone treatment currently using a drug checking program. Explanatory variables included drug supply, health care, and treatment characteristics. The primary outcome was a self-reported lifetime history of precipitated withdrawal during a buprenorphine induction. Binomial linear regression models were used to calculate prevalence ratios with 95% CIs. RESULTS: Among 234 people, 64% were men, 67% were non-Hispanic white, 41 was the median age, 94% reported a history of fentanyl use, 92% had a history of methadone treatment, and 68% had a history of buprenorphine treatment. Among those with a history of buprenorphine treatment, 29% reported precipitated withdrawal during buprenorphine inductions, of which 67% occurred when starting via outpatient pathways. Buprenorphine-associated precipitated withdrawal was slightly higher among those with recent xylazine use compared with those without (32% vs 22%, prevalence ratio: 2.10, 95% CI: 0.94, 4.67). People with recent buprenorphine inductions commonly started without clinical or social support (63%) or used standard dosing (53%). CONCLUSIONS: Buprenorphine-associated precipitated withdrawal was commonly reported. Improved guidance and treatment approaches should be prioritized to minimize these complications, particularly in outpatient settings.
Prevalence and Correlates of Past-year Kratom Use Among US Adults: Findings From the 2021-2023 National Survey on Drug Use and Health.
Mun CJ, Timmons P, Cano M
J Addict Med · 2026 Jan · PMID 41582323 · Publisher ↗
OBJECTIVES: Kratom is now widely available in the United States, yet epidemiological data remain sparse. This study examined the prevalence and correlates of kratom use among adults in the civilian noninstitutionalized U...
OBJECTIVES: Kratom is now widely available in the United States, yet epidemiological data remain sparse. This study examined the prevalence and correlates of kratom use among adults in the civilian noninstitutionalized US population using the most recent National Survey on Drug Use and Health (NSDUH) data. METHODS: Data from the 2021-2023 NSDUH were limited to adults aged 18+ years (n = 139,524). Weighted prevalence estimates were calculated overall, by year, and by demographic and clinical characteristics. Logistic regression models were used to examine correlates of past-year kratom use. RESULTS: The combined (2021-2023) weighted prevalence of past-year kratom use among US adults was 0.68% (95% CI, 0.60%-0.77%), remaining stable across survey years. Kratom use was more common among males, adults aged 26-49, and non-Hispanic white or multiracial adults. Prevalence exceeded 2% among adults reporting serious psychological distress or a major depressive episode, and exceeded 5% among those reporting certain types of substance use or prescription medication misuse. In covariate-adjusted analyses, higher odds of kratom use were observed among men, adults aged 35-49 years, and those reporting prescription pain reliever use or misuse, as well as cigarette, cannabis, and ketamine use, whereas lower odds were observed among black and Hispanic adults compared with white adults. CONCLUSIONS: Kratom use among adults in the United States was relatively stable between years 2021 and 2023 and concentrated among individuals with reported psychological distress and substance use. Future studies should include more comprehensive assessments of kratom use, and screening for kratom use in high-risk clinical populations may be warranted.
Naloxone Prescribing and Naloxone Administration in Response to Overdose Events Among Women With Opioid Use Disorder During Pregnancy and Postpartum Period - MAT-LINK, Seven Clinical Sites, 2014-2021.
Schrote K, Board A, Thomas SA … +11 more , Cote PO, Miele K, Terplan M, Seligman NS, Sanjuan PM, Smid M, Elansary M, Rood K, Davidson A, Kendle A, Kim SY
J Addict Med · 2026 Jan · PMID 41582317 · Publisher ↗
OBJECTIVES: Opioid use disorder (OUD) and overdose among pregnant and postpartum women pose severe risks to maternal and infant health. Naloxone, a life-saving opioid antagonist, effectively reverses opioid overdoses but...
OBJECTIVES: Opioid use disorder (OUD) and overdose among pregnant and postpartum women pose severe risks to maternal and infant health. Naloxone, a life-saving opioid antagonist, effectively reverses opioid overdoses but remains underutilized in this population. We examined naloxone prescription or receipt and administration during overdose events among perinatal women with OUD from the MATernaL and Infant Clinical NetworK (MAT-LINK). METHODS: We analyzed data collected through 7 MAT-LINK clinical sites from pregnant women with OUD and known pregnancy outcomes between January 1, 2014 and August 31, 2021. Outcomes included naloxone prescriptions and naloxone administration during overdose events during pregnancy or within 12 months postpartum (perinatal period). Weighted prevalence estimates and confidence intervals were calculated by demographic characteristics, substances involved in overdoses, and receipt of medications for opioid use disorder (MOUD). RESULTS: Only 3.1% of women received a naloxone prescription during the perinatal period; the percentage of women receiving naloxone from the clinic without a prescription was unknown and not systematically captured in the data. Women experiencing overdose events most commonly were non-Hispanic, white, had public health insurance, and lived in urban areas, reflecting the demographic composition of the MAT-LINK cohort, with high co-occurrence of tobacco/nicotine (80.5%) and stimulant use disorders (59.2%). Among women who experienced an opioid-involved overdose event, 23.4% were not administered naloxone. No significant demographic differences were observed by naloxone administration. CONCLUSIONS: These findings highlight the need for further investigation into barriers and facilitators to naloxone clinical documentation, access, and use during the perinatal period.
A Long-acting Naltrexone Implant (iSTEP-N) for Opioid Use Disorder: First-in-Human Phase I Trial.
Cohen SM, Benner J, Soni P … +4 more , Ravis WR, Bertoch T, Ransom J, Berman J
J Addict Med · 2026 Jan · PMID 41582307 · Publisher ↗
OBJECTIVES: iSTEP-N is a novel, bioresorbable, subcutaneous implant designed to release naltrexone for 6-12 months after a single procedure and improve adherence. This first-in-human study evaluated the safety and pharma...
OBJECTIVES: iSTEP-N is a novel, bioresorbable, subcutaneous implant designed to release naltrexone for 6-12 months after a single procedure and improve adherence. This first-in-human study evaluated the safety and pharmacokinetics of iSTEP-N. METHODS: This was a single-center, randomized, double-blind, placebo-controlled, single-ascending-dose trial. Sixteen healthy adults (6 females and 10 males) were assigned to receive either 1 implant (4.8 g naltrexone), 2 implants (9.6 g naltrexone), or placebo implants. Participants were followed for 12 weeks, after which implants were removed per regulatory requirement. Plasma naltrexone concentrations and safety outcomes were assessed throughout. RESULTS: All participants completed the study. The 9.6 g cohort maintained mean plasma naltrexone concentrations above the 2.0 ng/mL opioid blockade threshold from Tmax at 10 hours through the end of the study at 12 weeks; no mean value fell below 2.8 ng/mL during this time. The 4.8 g cohort maintained therapeutic levels of naltrexone through week 6 but dropped below threshold thereafter. In both cohorts, ∼22% of implant drug content was released over 12 weeks, based on plasma exposure and estimated clearance, indicating potential for extended coverage. In the 9.6 g group, seroma formation was observed in 3 of 6 participants (50%) and resolved without intervention. No serious adverse events occurred. CONCLUSIONS: At the 9.6 g dose, iSTEP-N provided sustained therapeutic naltrexone exposure for 12 weeks with a favorable safety profile, while releasing less than one-fourth of its drug content. Further studies will evaluate longer-term exposure, safety, and clinical feasibility in individuals with opioid use disorder.
Factors Associated With Emergency Department Distribution of Fentanyl Test Strips.
Gazzola MG, Hayman C, Wright D … +8 more , Kim JG, Genes N, Wittman I, Doran KM, Koziatek C, Wang Y, Smith SW, Boatright DH
J Addict Med · 2026 Jan · PMID 41566569 · Publisher ↗
OBJECTIVES: Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS dis...
OBJECTIVES: Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS distribution across a large NYC health system and examine characteristics associated with clinicians' ordering FTS compared with the current standard-of-care, take-home naloxone (THN), to identify opportunities to optimize FTS distribution. METHODS: We conducted a retrospective review of THN and FTS provision across a large urban health system in its first year of FTS distribution. We evaluated the demographic and clinical characteristics of visits in which clinicians ordered FTS, compared with THN only. RESULTS: From July 20, 2022 to July 20, 2023, 237 (of 423) clinicians ordered THN for 1279 unique individuals in 1376 eligible visits (436 with FTS, 940 without). In pairwise analysis, FTS receipt was associated with being male, younger, non-White, lacking commercial insurance; substance-related or overdose-related visit chief complaint or diagnosis, attending physician, and patient-directed discharge ( P <0.05 for each). In multivariable regression, higher odds of FTS receipt were associated with male gender (OR=2.4; 95% CI=1.8-3.5), a substance-related chief complaint (OR=2.0; 95% CI=1.2-3.2) or visit diagnosis (OR=5.5; 95% CI=3.8-8.0), and overdose visit diagnosis (OR=1.7; 95% CI=1.1-2.8). Lower odds of FTS receipt were associated with older age (OR=0.98; 95% CI=0.97-0.99), noncommunity hospital sites (OR=0.71; 95% CI=0.60-0.83), and non-attending clinicians (OR=0.83; 95% CI=0.69-0.98). CONCLUSIONS: Integrating FTS into an existing ED THN program was feasible without disrupting clinical workflow. ED encounters where FTS were dispensed differed significantly from THN-only, revealing opportunities to optimize FTS ordering.
"Whatever it is, it Works" Understanding of Buprenorphine/Naloxone and Sources of Information: A Qualitative Study Among People Who Use Fentanyl and Clinicians.
Gregorich OL, Tsui JI, Chander G … +2 more , Merlin JS, Bhatraju EP
J Addict Med · 2026 Jan · PMID 41558014 · Publisher ↗
OBJECTIVES: Most persons with opioid use disorder (OUD) are not receiving effective treatment with medications. A lack of understanding and misinformation may impede an individual's decision to begin or continue medicati...
OBJECTIVES: Most persons with opioid use disorder (OUD) are not receiving effective treatment with medications. A lack of understanding and misinformation may impede an individual's decision to begin or continue medications for OUD (MOUD). This study explored the understanding of the role of naloxone, and sources of information related to buprenorphine/naloxone products among people who use fentanyl (PWUF) and clinicians. METHODS: Qualitative study utilizing semi-structured interviews with PWUF and clinicians providing buprenorphine care. Participants were recruited via flyers and word of mouth (PWUF), and direct emails (clinicians). Interviews were audio recorded, transcribed, and analyzed using a rapid qualitative analysis process, which consists of creating templated summaries separated by domains to formulate themes. RESULTS: Forty-three adults (28 PWUF and 15 clinicians) from Seattle, WA, participated in interviews between April and November 2024. The analyses identified 3 themes: (1) PWUF and clinicians both acknowledge confusion around how buprenorphine and naloxone work; (2) misconceptions may lead to adverse events, anxiety, and/or lack of interest in starting buprenorphine, especially in the setting of fentanyl use; (3) while PWUF had high regards for clinicians, the primary and most trusted source of information is people with lived experience taking buprenorphine/naloxone. CONCLUSIONS: Findings suggest confusion and lack of information about the role of naloxone in buprenorphine/naloxone, potentially limiting medication uptake. The finding that patients mainly hear about buprenorphine/naloxone from people with lived experience should be incorporated into outreach strategies. Future efforts should increase involvement from people with lived experience taking buprenorphine in disseminating accurate information regarding MOUD.
Response to: "Clinician Perspectives on Barriers and Facilitators to Providing Medications for Opioid Use Disorder for Adolescents".
Ross JA, Mountain-Ray S, Straus J … +1 more , Levy S
J Addict Med · 2026 Jan · PMID 41558013 · Publisher ↗
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Benzodiazepine Tapering: A Marathon, Not a Sprint.
Olsen Y, Brunner E, Ogbonna C … +1 more , Boyle MP
J Addict Med · 2026 Jan · PMID 41558012 · Publisher ↗
Clinicians have prescribed benzodiazepines for a range of symptoms and conditions since the Food and Drug Administration approved chlordiazepoxide in 1960. Between 1969 and 1982, the benzodiazepine diazepam was the most...
Clinicians have prescribed benzodiazepines for a range of symptoms and conditions since the Food and Drug Administration approved chlordiazepoxide in 1960. Between 1969 and 1982, the benzodiazepine diazepam was the most prescribed medication in the United States. Since then, recognition of benzodiazepine's risks-such as falls, psychomotor and cognitive impairment, withdrawal, benzodiazepine use disorder (BzUD), and suicidality-and limited data on long-term safety and efficacy have created challenges for clinicians and patients, including when and how to safely taper these medications. In 2025, 10 professional societies, including the American Society of Addiction Medicine (ASAM), released the Joint Clinical Practice Guideline on Benzodiazepine Tapering. This commentary explores implications for addiction treatment.
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