Journal Of Addiction Medicine[JOURNAL]
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200 papers
Rating the Quality and Consistency of Local Opioid Settlement Expenditure Data.
Lindenfeld Z, Mauri AI, Winiker AK
J Addict Med · 2026 Jan · PMID 41540568 · Publisher ↗
OBJECTIVES: To assess whether states requiring public reporting of local opioid settlement expenditures make these data available in a detailed, consistent, timely, and analyzable format. METHODS: We reviewed state websi...
OBJECTIVES: To assess whether states requiring public reporting of local opioid settlement expenditures make these data available in a detailed, consistent, timely, and analyzable format. METHODS: We reviewed state websites to extract information on the quality of reported settlement data across 7 dimensions: (1) interest earned on settlement funds was reported, (2) nonremediation spending was reported separately, (3) expenditures were tied to specific programs or activities, (4) expenditures were reported at the sub-county level, (5) expenditures for each local government were consolidated into a single report, (6) all entities in a state report in a combined tracker, and (7) data from the most recent reporting year were available. States were coded dichotomously (1 = criterion met; 0 = not met). RESULTS: Of the 21 states requiring local reporting, 5 (23.8%) report interest earned on disbursements, while most document nonremediation expenditures (n = 17; 81.9%). Over half tied expenditures to specific program activities (n = 12; 57.1%), and all but 3 consistently report the most recent year. Local governments in 17 states (80.9%) report all expenditures in a single report, and 12 states (57.1%) consolidate all local spending within a single public tracker. Two states (9.5%) have not yet made these data publicly available. CONCLUSIONS: Among states with reporting requirements, there is substantial variation in the quality and detail of settlement expenditure data. Strengthening reporting standards and enforcement of standards would support rigorous research and enhance accountability for ensuring that funds are allocated in alignment with the goals of opioid remediation.
Ibogaine for Opioid Use Disorder: An Unrecognized Risk.
Terasaki D, Sackett N, Monte A
J Addict Med · 2026 Jan · PMID 41535993 · Publisher ↗
The psychedelic substance, ibogaine, has garnered growing interest among policymakers, researchers, and the public in its potential use for opioid use disorder (OUD). Many states are allocating significant funds to inves...
The psychedelic substance, ibogaine, has garnered growing interest among policymakers, researchers, and the public in its potential use for opioid use disorder (OUD). Many states are allocating significant funds to investigate it further. However, some proponents of ibogaine are framing it in opposition to (versus complementary to) standard, mortality-reducing medications for OUD (MOUD). Although the path to OUD remission and recovery varies greatly among individuals, the stakes are high: "detoxification" from methadone or buprenorphine in favor of an as-yet unproven therapy like ibogaine could result in an increased risk of opioid overdose for some. The addiction medicine community should be aware of this potential risk and defend evidence-based care, even as treatments like ibogaine are developed for OUD.
Descriptive Exploration of Features Among Infants With Prenatal Fentanyl Exposure in a Multisite Cohort of Maternal-Infant Dyads Affected by Opioid Use Disorder.
Dorsey AN, Rasmussen SA, Cragan JD … +18 more , Kim SY, Sanjuan PM, Wright T, Williams C, Woodworth K, Smid MC, Terplan M, Seligman NS, Thomas SA, O'Connor TG, Wachman E, Leeman LM, Henninger ML, Benninger KL, Rood KM, Shakib JH, Davidson A, Board A
J Addict Med · 2026 Jan · PMID 41530901 · Full text
OBJECTIVES: A recent case series suggested a possible syndrome associated with prenatal fentanyl exposure. We described, among a cohort of maternal-infant dyads affected by opioid use disorder (OUD), the prevalence of th...
OBJECTIVES: A recent case series suggested a possible syndrome associated with prenatal fentanyl exposure. We described, among a cohort of maternal-infant dyads affected by opioid use disorder (OUD), the prevalence of these observed infant features. METHODS: We used data from MAT-LINK, a surveillance system compiling electronic health record (EHR) information from 7 US clinical sites on pregnancies affected by OUD between 2014 and 2021. We described the prevalence of EHR-documented prenatal fentanyl exposure and infant features of interest (cleft palate, corpus callosum abnormality, foot positioning deformities, genital anomalies, microcephaly, micrognathia, toe syndactyly). RESULTS: Among 5053 maternal-infant dyads affected by OUD, 667 (13.5%; 95% CI: 13.0%-14.0%) had documented prenatal fentanyl exposure, including an over 20-fold increase from 2014 to 2021. Health insurance, prenatal care timing, and nonopioid substance exposures differed between dyads with and without documented prenatal fentanyl exposure. At least one feature of interest was documented for 406 (8.0%) infants, and at least 2 were documented for 0.7%. Among infants with at least one of these features, 18.9% (95% CI: 17.1%-20.8%) had documented prenatal fentanyl exposure, compared with 13.0% (95% CI: 12.5%-13.6%) of infants without any of these features. CONCLUSIONS: In this perinatal OUD cohort, prenatal fentanyl exposure was more commonly documented among infants with at least one compared with none of these infant features. However, features were rare and contextual factors differed among dyads by prenatal fentanyl exposure status. Further analyses examining these infant features, while considering multiple exposures, are needed before substantiating a fetal fentanyl syndrome.
Identifying Factors Associated With Intentional and Unintentional Fentanyl Use Among People Who Use Drugs in New York City.
Khezri M, Choe K, Griffin B … +1 more , Bunting AM
J Addict Med · 2026 Jan · PMID 41530897 · Full text
OBJECTIVE: Fentanyl is a major driver of the overdose crisis in the United States, yet little is known about the intentionality of fentanyl use and its correlates among people who use drugs (PWUD). We examined the intent...
OBJECTIVE: Fentanyl is a major driver of the overdose crisis in the United States, yet little is known about the intentionality of fentanyl use and its correlates among people who use drugs (PWUD). We examined the intentionality of fentanyl use and associated factors among PWUD. METHODS: We recruited 246 PWUD in New York City in 2023. Participants completed structured interviews and provided urine samples for toxicology screening. Fentanyl use was classified as no use (negative in both self-report and urine toxicology), unintentional use (self-report negative but toxicology positive), and intentional use (positive in self-report with or without positive toxicology). We used multinomial logistic regression to identify factors associated with fentanyl use intentionality. RESULTS: Fentanyl was detected in 40.7%, while 26.0% self-reported intentional fentanyl use. Intentional fentanyl use was significantly associated with chronic pain (RRR: 2.21; 95% CI: 1.02-4.80) and higher Risk Assessment Battery (RAB) scores (RRR: 1.09; 95% CI: 1.01-1.18), and inversely associated with high cannabis use severity (RRR: 0.16; 95% CI: 0.05-0.61). Unintentional fentanyl use was positively associated with older age (RRR: 1.08; 95% CI: 1.02-1.13) and negatively with moderate alcohol use severity (RRR: 0.25; 95% CI: 0.09-0.69). CONCLUSIONS: Unintentional fentanyl use was more common among older PWUD, highlighting the need for targeted outreach and fentanyl education. Intentional fentanyl use, while reflecting awareness of the drug supply, was associated with chronic pain and elevated HIV risk behaviors, indicating a subgroup with greater health and prevention needs. Tailored interventions integrating harm reduction, pain management, and HIV prevention are needed.
Appropriate Clinical Response Following Opioid Overdose: A Retrospective Analysis Within the Veterans Health Administration System.
Kazemitabar M, Reisman JI, Sung M … +6 more , Kerns RD, Druhl EB, Yu H, Li W, Becker WC, Gordon KS
J Addict Med · 2026 Jan · PMID 41521434 · Publisher ↗
BACKGROUND: Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors a...
BACKGROUND: Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors associated with appropriate postoverdose care is essential to addressing these gaps. METHODS: A retrospective cohort study of 1032 veterans who experienced a nonfatal opioid overdose and received care through the veterans Health Administration system was conducted. Data were extracted from electronic health records, including demographic, pharmacy, and clinical variables. The primary outcome was receipt of appropriate clinical response within 90 days postoverdose, defined as initiation of medication for opioid use disorder (MOUD), counseling for opioid use disorder (OUD), or a ≥25% reduction in morphine equivalent daily dose. A binary logistic regression model was used to examine factors associated with receiving appropriate overdose care. RESULTS: Of the total sample, 57.46% received an appropriate clinical response postoverdose, the majority of which reflected opioid dose reductions rather than initiation of MOUD or counseling for OUD. There were statistically significant differences between those who received appropriate clinical response versus not by rurality, marital status, substance use disorder and treatment, care access, bipolar disorder, and schizophrenia. In adjusted models, those with a documented substance use disorder had significantly higher adjusted odds of receiving appropriate clinical response (aOR=1.91; 95% CI: 1.38-2.63; P<0.0001). Black veterans had significantly lower odds of receiving appropriate clinical response compared with White veterans (aOR=0.71; 95% CI: 0.51-0.98; P=0.04). Other variables were not statistically significantly associated with appropriate clinical response in the adjusted model. CONCLUSIONS: The primary response to OD was dose reduction and MOUD was profoundly underutilized. Future research should incorporate social determinants of health to better understand contextual influences on overdose risk and care access.
Addictive Behaviors, Mental Health, and Quality of Life in Adolescents: Toward Integrative Assessment for Early Identification of Vulnerability.
Cabé J, de Chazeron I, Miele C … +6 more , Pereira B, Chalmeton M, Mortier R, Llorca PM, Cabé N, Brousse G
J Addict Med · 2026 Jan · PMID 41501975 · Publisher ↗
OBJECTIVES: Addictive behaviors are frequently associated with anxiety and depressive disorders. Adolescence represents a critical period of heightened vulnerability to both types of disorders. In recent years, a signifi...
OBJECTIVES: Addictive behaviors are frequently associated with anxiety and depressive disorders. Adolescence represents a critical period of heightened vulnerability to both types of disorders. In recent years, a significant global decline in adolescent mental health-especially among girls-has raised concerns about the short-term evolution of addictive behaviors. Despite available data, this relationship remains poorly understood, warranting further research to improve prevention and care strategies. METHODS: This study analyzed data from a French cross-sectional observational study (DOPADO), which aimed to assess addictive behaviors among adolescents aged 13 to 18 years attending middle and high schools. Data were collected between 2018 and 2020 using electronic surveys, enabling the evaluation of past-12-month psychoactive substance use, associated risky behaviors, sociodemographic characteristics, anxiety and depressive symptoms, psychological distress, and quality of life. RESULTS: Among 4844 adolescents, half exhibited anxiety and/or depressive symptoms. These were associated with higher levels of substance use, increased risky behaviors, and impaired quality of life. A Principal Component Analysis revealed 3 distinct profiles: one with preserved well-being, and 2 with significant impairment. These were characterized by higher anxiety-depressive symptoms (especially in the second cluster) and more pronounced addictive behaviors and risky use (notably in the third cluster). CONCLUSIONS: Our study highlights robust associations between anxiety/depressive symptoms, addictive behaviors, and quality of life. Several distinct adolescent profiles emerged with respect to mental health and addictive behaviors, each characterized by specific patterns of quality of life and functioning, underscoring the importance of integrated assessment, prevention, and treatment strategies in adolescents.
Testing the Efficacy of an Adaptive Approach to Delivering Psychosocial Interventions in Office-based Buprenorphine Treatment.
Dugosh KL, Burkley SB, McKay JR … +3 more , Kampman KM, Lynch KG, Lent MR
J Addict Med · 2026 Jan · PMID 41489605 · Publisher ↗
OBJECTIVES: Clinical guidelines recommend providing adjunctive psychosocial interventions with medications for opioid use disorder (MOUD); however, limited evidence exists regarding when and how to provide them. This 2-g...
OBJECTIVES: Clinical guidelines recommend providing adjunctive psychosocial interventions with medications for opioid use disorder (MOUD); however, limited evidence exists regarding when and how to provide them. This 2-group unblinded randomized controlled trial evaluated the efficacy of an adaptive approach to providing cognitive behavioral therapy and peer support for individuals receiving office-based buprenorphine treatment. METHODS: Between September 2020 and May 2023, 125 patients who recently initiated office-based buprenorphine treatment at 2 federally qualified health centers in the Mid-Atlantic region and provided informed consent were randomly assigned (1:1) to treatment as usual (TAU; n = 63) or TAU plus adjunctive psychosocial treatment delivered using an adaptive algorithm informed by baseline characteristics, engagement, and responsiveness (TAU+Adaptive; n = 62). Assessments occurred at baseline and 3- and 6-month follow-ups. Primary outcomes were treatment retention and opioid use. RESULTS: No significant between-group differences were observed. Across conditions, about 30% tested positive for opioids at follow-up, and 40% remained in MOUD treatment at 6 months. Exploratory post hoc analyses indicated greater retention among participants prescribed a 24 mg baseline buprenorphine dose (46%) compared with those on 16 (24%) or 8 mg (26%). No serious study-related adverse events were reported. CONCLUSIONS: Although the efficacy of the adaptive approach was not supported, high rates of treatment discontinuation and polysubstance use highlight the need for additional support for some patients. Findings also suggest that dosing strategies may need to be tailored to the increasing potency of the illicit opioid supply.
Pharmacological Interventions for Electronic Cigarette Cessation: A Systematic Review and Meta-analyses.
Aihemaiti A, Xie Y, Su Z … +7 more , Zhou X, Liu Z, Cheng A, Huang Z, Zhao L, Xiao D, Wang C
J Addict Med · 2026 Jan · PMID 41489602 · Publisher ↗
OBJECTIVES: The rising global prevalence of electronic cigarette (e-cigarette) use poses significant public health concerns, including nicotine dependence. This systematic review and meta-analysis evaluated the efficacy...
OBJECTIVES: The rising global prevalence of electronic cigarette (e-cigarette) use poses significant public health concerns, including nicotine dependence. This systematic review and meta-analysis evaluated the efficacy and safety of pharmacological interventions for e-cigarette cessation. METHODS: We systematically searched 5 databases, including Cochrane Library, PubMed, Ovid Embase, Sinomed, and Web of Science Core Collection, up to May 1, 2024, that evaluated the efficacy and safety of pharmacological intervention compared with placebo for e-cigarette cessation. Two investigators independently screened studies, extracted data, and assessed the risk of bias. The outcomes of interest were (1) continuous abstinence rate (CAR); (2) 7-day point prevalence of e-cigarette abstinence at different weeks; and (3) adverse effects. This study was registered with PROSPERO (CRD42024577356). RESULTS: Of 1567 initially identified records, 7 studies involving 1161 participants were included. Most studies had a low risk of bias. The results indicated that varenicline (4 studies, n=463; OR=2.52, 95% CI: 1.14-5.58) was effective, while the effect of nicotine replacement therapy (NRT; 2 studies, n=538; OR=1.38, 95% CI: 0.61-3.14) was not statistically significant. One study on cytisine also suggested potential benefit. CONCLUSIONS: Varenicline has demonstrated efficacy in supporting e-cigarette cessation, whereas the current evidence for NRT and cytisine remains insufficient to draw firm conclusions. Further well-designed studies are needed to clarify the effectiveness of these 2 interventions. Although pharmacotherapies used for cigarette smoking show potential for repurposing, their utility in e-cigarette cessation should be interpreted cautiously until stronger evidence becomes available.
A Scoping Review of Clinical Trials Evaluating Medications for Adolescents With Substance Use Disorders.
Westerman CA, Nielsen K, Flynn D … +4 more , Yule AM, Calihan JB, Hadland SE, Bagley SM
J Addict Med · 2025 Nov · PMID 41481865 · Publisher ↗
OBJECTIVES: Treatment recommendations for substance use disorder (SUD) emphasize medication as a key component of optimal care. Nonetheless, US Food and Drug Administration (FDA)-approved options for adolescents with SUD...
OBJECTIVES: Treatment recommendations for substance use disorder (SUD) emphasize medication as a key component of optimal care. Nonetheless, US Food and Drug Administration (FDA)-approved options for adolescents with SUD are limited. The purpose of this study was to systematically assess the number and characteristics of clinical trials testing medications for SUD in adolescent populations (aged <18) during the past 25 years. METHODS: We performed a scoping review to identify randomized-controlled trials of medications for SUD that were available in Cochrane CENTRAL or clinicaltrials.gov, active between January 1, 1999 and December 4, 2024, and included at least one participant aged 13-17, with none aged 26 years or older. Key study characteristics were extracted and analyzed to identify trends in design, medications tested, and participant diversity. RESULTS: Thirty-six trials of 15 unique medications met the inclusion criteria. Of these, 26 had published results, one was currently active, 3 had reported results on clinicaltrials.gov but lacked a publication, and 6 had not yet reported their results in any form. Medications for nicotine use disorder were most commonly studied (41.7%, N = 15), while stimulant use disorder (2.7%, N = 1) and benzodiazepine use disorder (N = 0) were the least represented. Although the collection and reporting of demographic-related factors were inconsistent, the demographic data available demonstrated low participation of individuals aged younger than 18, racial/ethnic minorities, and gender-diverse youth. CONCLUSIONS: The current evidence base informing medications to treat SUD in adolescents is small. Additional research is urgently needed to address knowledge gaps, enhance participant diversity, and promote access to evidence-based SUD treatment for youth.
Adjunctive Cannabidiol in Inpatient Buprenorphine Treatment for Opioid Use Disorder: A Pilot Randomized Trial.
London ED, Dean AC, De La Garza R … +10 more , Lachoff H, Mooney LJ, Torrington M, Whelan F, McClintick M, Ghahremani D, Elezi G, Whitelegge JP, Sugar C, Vocci FJ
J Addict Med · 2025 Dec · PMID 41467610 · Publisher ↗
OBJECTIVES: Despite the efficacy of medications for opioid use disorder (MOUD), return to illegal opioid use remains common. Cannabidiol (CBD) may reduce craving and improve outcomes. This pilot trial evaluated the safet...
OBJECTIVES: Despite the efficacy of medications for opioid use disorder (MOUD), return to illegal opioid use remains common. Cannabidiol (CBD) may reduce craving and improve outcomes. This pilot trial evaluated the safety and preliminary efficacy of CBD as adjunctive therapy to buprenorphine in an inpatient setting. METHODS: Adults (≥18 years), who met DSM-5 criteria for opioid use disorder and were admitted to an inpatient addiction treatment center between May 2022 and March 2024, were enrolled in a randomized, double-blind, placebo-controlled trial. Participants received oral CBD (600 mg/day) or placebo for 28 days alongside buprenorphine. Primary outcomes were safety and tolerability, monitored via adverse events and clinical laboratory tests. Efficacy was assessed as effects on opioid craving and withdrawal, and affective symptoms (anxiety, negative affect, and positive affect). RESULTS: Of 35 enrolled participants, 30 received at least one dose of study medication (CBD: n=18; placebo: n=12) and were included in the safety analysis. CBD was well tolerated; no serious adverse events or deaths occurred. Gastrointestinal symptoms occurred in both groups and were the most common adverse event. No significant pharmacokinetic interaction was observed between CBD and buprenorphine. Both groups showed reductions in opioid craving and negative affect over time, with mixed group-by time interactions (most favoring placebo, but cue-induced craving trending toward greater improvement with CBD). CONCLUSIONS: Adjunctive CBD was safe and well tolerated in combination with buprenorphine. No clear advantage over placebo was observed. Larger trials are needed to determine clinical utility in MOUD treatment.
A Conjunctive Standard Under the Controlled Substances Act: Why it Would Benefit Buprenorphine-prescribing Clinicians and Their Patients.
Andraka-Christou B
J Addict Med · 2025 Dec · PMID 41430747 · Publisher ↗
Buprenorphine is a prescribed controlled substance that effectively treats opioid use disorder. Fear of federal prosecution contributes to buprenorphine's under-prescribing. Such fears may be heightened in jurisdictions...
Buprenorphine is a prescribed controlled substance that effectively treats opioid use disorder. Fear of federal prosecution contributes to buprenorphine's under-prescribing. Such fears may be heightened in jurisdictions that follow a "disjunctive standard" of prosecution under the federal Controlled Substances Act (CSA). In jurisdictions with a "disjunctive standard," clinicians can be prosecuted for either (a) lack of a legitimate medical practice (eg, to improve the health of the patient) or (b) deviating from the "usual" course of professional practice. Problematically, the disjunctive standard could allow for the prosecution of clinicians even when no harm results and the clinician's deviation from usual practice was intended to improve the patient's health. This Commentary argues that the "conjunctive standard" is more approrpiate than the "disjunctive standard" for prosecution under the CSA. The conjunctive standard would require prosecutors to additionally prove the clinician lacked a legitimate medical purpose when prescribing. Therefore, federal prosecutors could focus on truly bad actors-those who clearly lack a legitimate medical purpose, such as those prescribing merely for profit to patients without health conditions that would benefit from the prescription. Ultimately, by decreasing fears of prosecution, a conjunctive standard might contribute to an increased buprenorphine treatment supply during the ongoing overdose crisis.
Trends in US Methamphetamine-related Mortality by Census Division, 2005-2023.
Hoopsick RA, Ni A, Sauda TH … +2 more , Lee T, Yockey RA
J Addict Med · 2025 Dec · PMID 41430546 · Publisher ↗
OBJECTIVES: We examine temporal trends in methamphetamine-related mortality across the 9 US Census Divisions from 2005 to 2023. METHODS: We leveraged data from the CDC WONDER multiple causes of death database to identify...
OBJECTIVES: We examine temporal trends in methamphetamine-related mortality across the 9 US Census Divisions from 2005 to 2023. METHODS: We leveraged data from the CDC WONDER multiple causes of death database to identify methamphetamine-related deaths among US residents aged older than or equal to 15 years from 2005 to 2023. Mortality rates were calculated per 100,000 population and stratified by Census Division. We used Joinpoint regression to estimate annual percent changes in mortality and identify statistically significant inflection points in mortality rates over time. RESULTS: From 2005 to 2023, methamphetamine-related deaths increased across all divisions, with the highest cumulative deaths in the Pacific, South Atlantic, and Mountain divisions. Mortality rates were lowest in New England and Middle Atlantic but grew rapidly in recent years. Several divisions demonstrated sharp increases during the 2010s (eg, East North Central and East South Central), followed by stabilization in some regions after 2021. By 2023, the highest mortality rates were observed in the Pacific, East South Central, and Mountain divisions. CONCLUSIONS: Methamphetamine-related mortality has intensified nationally, with pronounced geographic variation in timing and magnitude. Recent indications of stabilization in some divisions have occurred at historically high levels. These patterns underscore the need for regionally tailored harm reduction, treatment, and prevention strategies.
Rectal Methamphetamine Use, a Likely Cause of Sigmoid Colon Perforation: A Case Report.
Durai UNB, Ramic A, Reddy AS … +2 more , Abadier AE, Shaaban HF
J Addict Med · 2025 Dec · PMID 41430542 · Publisher ↗
Methamphetamine has potent stimulant effects on the central nervous system, resulting in significant behavioral and autonomic changes. There is substantial literature on the behavioral and cardiovascular complications of...
Methamphetamine has potent stimulant effects on the central nervous system, resulting in significant behavioral and autonomic changes. There is substantial literature on the behavioral and cardiovascular complications of methamphetamine use, but literature on the gastrointestinal complications of methamphetamine use is very sparse. Search of the published literature in English-language journals has not revealed any case of colonic perforation attributable to methamphetamine use. Here, we report a case of perforation of the sigmoid colon in the setting of chronic rectal administration of methamphetamine. A written informed consent to publish this case report was obtained from the patient.
Implantable Cardioverter Defibrillator Placement to Permit Ongoing Methadone Treatment Despite QT Prolongation and Torsades de Pointes: A Case Report.
Yang LC, Whitman IR, Moore J
J Addict Med · 2025 Dec · PMID 41430539 · Publisher ↗
Methadone is a highly effective medication for opioid use disorder (OUD) but has a risk of QT prolongation and life-threatening arrhythmias. This case report presents a patient with OUD on methadone treatment who experie...
Methadone is a highly effective medication for opioid use disorder (OUD) but has a risk of QT prolongation and life-threatening arrhythmias. This case report presents a patient with OUD on methadone treatment who experienced syncopal episodes due to recurrent episodes of polymorphic ventricular tachycardia (PMVT). Due to the effectiveness of methadone and prior lack of response to alternative treatments, including buprenorphine, rather than methadone dose-reduction, the patient ultimately received an extravascular implantable cardioverter defibrillator (ICD) for prevention of out-of-hospital arrest. This case highlights an important clinical dilemma in balancing the risks of procedures and arrhythmias with improved OUD-related outcomes with methadone. In this report, we review the literature and advocate for consideration of ICD placement in select, high-risk patients with methadone-related QT prolongation or arrhythmias.
Naloxone Use, Carrying Practices, Prior Training, and Confidence in Overdose Response Among Attendees of a 4-Day Music Festival in Colorado.
Piercey CJ, Pince CL, Karoly HC
J Addict Med · 2025 Dec · PMID 41430526 · Publisher ↗
BACKGROUND: The contamination of non-opioid drugs with fentanyl presents a risk at US music festivals, where environmental factors exacerbate overdose-related risks. Naloxone is an opioid antagonist medication that can b...
BACKGROUND: The contamination of non-opioid drugs with fentanyl presents a risk at US music festivals, where environmental factors exacerbate overdose-related risks. Naloxone is an opioid antagonist medication that can be used by festival attendees to reverse opioid overdose. METHODS: We conducted a field survey at a 4-day Colorado music festival (N=227) to characterize attendees' prior experience with naloxone and to investigate whether attendees carry naloxone with them in both festival and non-festival settings. We also assessed attendees' level of confidence in responding to an overdose with naloxone and asked attendees to report any barriers they experienced to carrying naloxone at festivals. RESULTS: Prevalence of carrying naloxone in any context was 55.5% (N=126). Festival carriage was more common than carriage in non-festival settings, with 55.1% reporting at least "sometimes" carrying at festivals compared with 32.7% outside festival settings. In addition, 8.4% had used naloxone to respond to an overdose, and 4.4% had personally been administered naloxone. Among participants who reported carrying naloxone, 65.3% had never received training. Regarding confidence in overdose response, 29.9% of naloxone carriers reported being only "slightly confident" or "not at all confident." Barriers included access, festival restrictions and legal concerns, lack of education, training, and awareness, convenience factors, and perceived responsibility of carrying naloxone. CONCLUSIONS: Findings highlight the need for increased naloxone access, training, and awareness among festival attendees. Actionable recommendations include free or low-cost naloxone distribution, on-site training, and transparent entry policies to reduce barriers and promote overdose response as a community responsibility.
Responses to Buprenorphine-associated Oral Diseases: The Critical Need for Mechanistic Understanding.
Tuan WJ
J Addict Med · 2025 Dec · PMID 41423780 · Publisher ↗
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Racial Disparities in Urine Toxicology Screening Among Pregnant People Admitted to Labor and Delivery.
Levy R, Nissly T, Ricco J … +7 more , Doering A, Lonergan-Cullum M, Jones C, Maynard S, Kim H, Fletcher L, Hooker SA
J Addict Med · 2025 Dec · PMID 41423775 · Publisher ↗
OBJECTIVES: Disparities in urine toxicology screening (UTS) during labor and delivery may perpetuate healthcare inequities with significant social and legal consequences for minoritized populations. This study examines w...
OBJECTIVES: Disparities in urine toxicology screening (UTS) during labor and delivery may perpetuate healthcare inequities with significant social and legal consequences for minoritized populations. This study examines whether UTS rates during labor and delivery differ by race or ethnicity. METHODS: A retrospective cross-sectional study was conducted using electronic health record data of labor and delivery admissions between July 1, 2018 and June 30, 2022 from 3 health systems in Minnesota and Wisconsin. Eligible records included labor and delivery admissions for patients aged 12 years and older, resulting in live birth or fetal demise. Patients who opted out of research at the health system level were excluded. RESULTS: Among 71,341 patients (81,999 admissions), most identified as White (66.2%), followed by Black/African American (14.8%), Asian (9.5%), multiracial (2.5%), American Indian or Alaskan Native (0.7%), and other races (1.4%). Hispanic/Latinx patients comprised 6.1%. UTS was ordered in 14.2% of admissions (n=10,176). Compared with White patients, UTS was more likely for Black (aOR=2.09, 95% CI=1.93-2.25), American Indian (aOR=2.50, 95% CI=2.00-3.13), and multiracial patients (aOR=2.04, 95% CI=1.77-2.36), despite similar positive test rates across groups when excluding cannabis/THC. CONCLUSIONS: Racial disparities in UTS persist, driven by nonclinical factors and biases, despite similar rates of substance use across groups. Standardized, equitable testing protocols are needed to mitigate harm and improve outcomes for minoritized birthing populations.
Precipitated Withdrawal following Emergency Department-initiated Buprenorphine: A Retrospective Study.
Chiu I, Donegan K, Gingold DB … +3 more , Poremba M, Stryckman B, Wilkerson RG
J Addict Med · 2025 Dec · PMID 41413779 · Publisher ↗
OBJECTIVES: Buprenorphine may be offered less frequently than indicated for treatment of opioid withdrawal in the emergency department (ED) due to patient and clinician concerns regarding precipitated withdrawal (PW). Ou...
OBJECTIVES: Buprenorphine may be offered less frequently than indicated for treatment of opioid withdrawal in the emergency department (ED) due to patient and clinician concerns regarding precipitated withdrawal (PW). Our objective is to determine an accurate estimate of the incidence of PW following buprenorphine initiation in the ED. METHODS: We performed a retrospective study of adults seen in one of the 15 EDs within the University of Maryland Medical System who received ED-initiated buprenorphine between January 1, 2019 and December 31, 2023. Patients were excluded if they were given buprenorphine to continue an established treatment regimen, had buprenorphine ordered by an inpatient clinician, or did not have a Clinical Opiate Withdrawal Scale (COWS) score recorded before treatment. PW was defined as either a ≥5-point increase in COWS score within 4 hours of buprenorphine administration or any increase in the COWS score associated with additional opioid administration within 4 hours of the first buprenorphine dose. RESULTS: A total of 1229 patients received buprenorphine in the ED during the study period; 990 were excluded. We identified 16 cases of PW [6.7% (95% CI: 3.5%-9.9%)]. No association was found between the development of PW and initial COWS, buprenorphine formulation, fentanyl use, or buprenorphine dose. CONCLUSIONS: PW was uncommon following ED-initiated buprenorphine in this cohort. However, the rate of PW was higher than reported in some prior studies. Patients should be counseled regarding the possibility of PW before treatment, and clinicians should be prepared to address symptoms of PW when they occur.
Admissions for Treatment of Opioid Use Disorder at a Safety-net Hospital Labor and Delivery Unit in San Francisco.
Rader MA, Vais S, Harter K … +3 more , Nijagal M, Martin M, Seidman D
J Addict Med · 2025 Dec · PMID 41405381 · Publisher ↗
OBJECTIVES: Pregnant and postpartum individuals' opioid overdose rates in the United States continue to rise, despite having safe and effective treatments in pregnancy and postpartum. This study examines the role of inpa...
OBJECTIVES: Pregnant and postpartum individuals' opioid overdose rates in the United States continue to rise, despite having safe and effective treatments in pregnancy and postpartum. This study examines the role of inpatient admissions to labor and delivery units for initiating or titrating medication for opioid use disorders (MOUD). METHODS: We conducted a retrospective review of all pregnant and postpartum (up to 1 y) patients admitted to a public safety-net hospital in San Francisco, for MOUD initiation or titration from 2019 to 2023. We excluded patients stable on MOUD. RESULTS: Among 124 individuals, 130 pregnancies met inclusion criteria. Ninety percent of individuals were unstably housed or homeless, and 78% had mental illness. The majority of patients (82%) initiated methadone and 18% initiated buprenorphine. The median admission length was 6 days. Patients were initiated or titrated on MOUD a median of 2 times during pregnancy/postpartum. Those with fentanyl OUD (defined as fentanyl being the primary opioid used) required longer admissions and higher MOUD doses compared with non-fentanyl OUD, and were more likely to initiate methadone over buprenorphine. The majority of patients experienced child protective services (CPS) involvement (79%), remained united as a parent-infant dyad at discharge (57%), and transitioned directly to residential treatment (63%). CONCLUSIONS: In this study, admissions for opioid use complicating pregnancy increased among a diverse population with high rates of homelessness and mental illness. Inpatient labor and delivery units serve as critical access points for OUD treatment in the perinatal period, particularly for individuals facing structural barriers to care.
Development and Implementation of a Substance Use Disorder eConsult.
Alves-Back DK, Moss J, Corapi JN … +2 more , Goldstein SA, Wakeman SE
J Addict Med · 2025 Dec · PMID 41405377 · Publisher ↗
OBJECTIVES: To evaluate types of substance use disorder (SUD), recommended medications, and implementation of a new SUD eConsult offering asynchronous chart review and recommendations for primary care clinicians at an ac...
OBJECTIVES: To evaluate types of substance use disorder (SUD), recommended medications, and implementation of a new SUD eConsult offering asynchronous chart review and recommendations for primary care clinicians at an academic medical center. In addition, to understand contextual factors that affected program implementation, as identified by the Practical, Robust Implementation and Sustainability (PRISM) model. METHODS: A retrospective analysis of SUD eConsults between December 1, 2020 and September 30, 2024 was performed, using SUD eConsult orders and electronic medical record chart review. The PRISM model was applied to understand contextual factors affecting the implementation of the eConsult program. RESULTS: There were 103 completed SUD eConsults. The most common reasons for eConsult were alcohol use disorder (46.6%), followed by opioid use disorder (37.9%), tobacco use disorder (4.9%), stimulant use disorder (3.9%), cannabis use disorder (1.9%), and benzodiazepine use disorder (1.0%). In total, 65.1% of eConsults recommended new prescriptions. Recommended medications were prescribed for 58.2% of patients, and 82.1% of these patients continued the medications for the study period. Utilizing the PRISM model, key factors that facilitated the SUD eConsult program include an existing eConsult infrastructure, a team of specialists available to review eConsults, a low threshold substance use disorder treatment clinic, and incentive pay for completed eConsults. Factors that hindered program implementation include competing demands within primary care, clinician hesitancy to use eConsults for SUD, stigma related to SUD, difficulty advertising, and reliance upon internal incentive pay. CONCLUSIONS: The SUD eConsult program extends addiction medicine expertise to and supports pharmacotherapy initiation by primary care providers.
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