Journal Of Addiction Medicine[JOURNAL]
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200 papers
Emergency Department Presentations Related to the Abuse of Illicit and Prescription Opioids Through a European Sentinel-centres-Based Registry.
Lyphout C, De Paepe P, Dines AM … +12 more , Eyer F, Giraudon I, Heyerdahl F, Hovda KE, Liechti ME, Miró Ò, Vallersnes OM, Wood DM, Yates C, Dargan PI, Mégarbane B, Euro-DEN research group
J Addict Med · 2025 Dec · PMID 41405372 · Publisher ↗
OBJECTIVES: Opioid use, both prescribed and illicit, has caused considerable harm and fatalities. This study aims at characterising patterns of emergency department (ED) presentations related to opioid abuse across Europ...
OBJECTIVES: Opioid use, both prescribed and illicit, has caused considerable harm and fatalities. This study aims at characterising patterns of emergency department (ED) presentations related to opioid abuse across Europe. METHODS: Data on demographics, clinical features, and epidemiology were extracted from the Euro-DEN Plus data set for presentations involving acute opioid toxicity between October 2013 and December 2021. RESULTS: Of 62,545 presentations, 3888 (6.2%) involved prescription opioids, 11,252 (18.0%) illicit opioids, and 587 (0.9%) both. Heroin accounted for 99.8% of illicit opioid cases. The most commonly reported prescription opioids were methadone (51.3%), buprenorphine (13.9%), morphine (9.3%), fentanyl (6.8%), and tramadol (6.7%). Co-use of benzodiazepines and Z-drugs (35.6%) and pregabalin (6.6%) was significantly higher in prescription opioid cases compared with illicit (20.6% and 1.5%, respectively; P < 0.001). Mortality was greater with prescription opioids (1.2%) than illicit opioids (0.4%, P < 0.001). CONCLUSIONS: Heroin remains the predominant opioid; though the relative contribution of prescription opioids varies significantly across centres and countries. Methadone and buprenorphine predominate among prescribed opioids, while fentanyl and oxycodone account for a small proportion, contrasting with North American patterns.
Performance of Xylazine Qualitative Immunoassays Designed for Drug Checking in Urine Samples.
Pattillo E, Xie Y, Monteiro A … +7 more , Srungaram D, Baime M, Brown N, Ellis JD, Bergeria CL, Huhn AS, Dunn KE
J Addict Med · 2025 Dec · PMID 41405371 · Publisher ↗
OBJECTIVES: Xylazine is a public health threat for individuals who use drugs. Data informing xylazine concentrations are hampered by a lack of point-of-care urinalysis testing. This study evaluated the performance of qua...
OBJECTIVES: Xylazine is a public health threat for individuals who use drugs. Data informing xylazine concentrations are hampered by a lack of point-of-care urinalysis testing. This study evaluated the performance of qualitative immunoassay strips designed for drug checking in identifying xylazine in urine samples. METHODS: The ability of 2 noncleared xylazine qualitative immunoassay test strips (W.H.P.M. Inc, 500 ng/mL and Rapid Response [BTNX Inc., 1000 ng/mL]), developed for use in drug-checking paradigms, to detect xylazine in urine samples of persons presenting for opioid use disorder treatment was evaluated. Samples were tested using each test strip twice, and consensus results were compared with results from quantitative LC-MS/MS analyses (5 ng/mL). RESULTS: Quantitative testing revealed 67% (71/106) samples tested positive for xylazine >5 ng/mL. Concentrations ranged between 5.3 and 30,900.50 ng/mL, 12 of which exceeded >500 ng/mL and 6 of which exceeded >1000 ng/mL. W.H.P.M. Inc. showed excellent sensitivity and specificity (92% and 94%, respectively) at the 500 ng/mL threshold but did not detect 63% of true positive samples (ie, those that tested positive in the quantitative testing >5 ng/mL). Rapid Response also had excellent sensitivity and specificity (100%, 100%, respectively) at the 1000 ng/mL threshold, but did not detect 74% of true positive samples. CONCLUSIONS: Two immunoassay strips designed for drug checking showed strong sensitivity and specificity at their detection thresholds; however, most samples testing positive for xylazine were below those thresholds, resulting in most participants with true xylazine exposure not being accurately identified. Prospectively designed urine point-of-care strips are necessary to help inform the relationship between xylazine exposure and its related consequences.
Buprenorphine-associated Oral Diseases: The Critical Need for Mechanistic Understanding.
da Silva Pedrosa M, de Aguiar Ribeiro A
J Addict Med · 2025 Dec · PMID 41398634 · Publisher ↗
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"None of Us Asked for It": Experiences of Xylazine Among Individuals With Xylazine-associated Wounds.
Shang M, Hull I, Schultz K … +5 more , Halpern D, McMurtrie G, Bell A, Liebschutz JM, Jawa R
J Addict Med · 2025 Dec · PMID 41392348 · Publisher ↗
OBJECTIVES: With emerging novel adulterants in the unregulated US drug supply, people who use drugs (PWUD) bear the downstream consequences of unpredictable effects and increased health risks. Xylazine, a veterinary seda...
OBJECTIVES: With emerging novel adulterants in the unregulated US drug supply, people who use drugs (PWUD) bear the downstream consequences of unpredictable effects and increased health risks. Xylazine, a veterinary sedative, is associated with severe sedation and chronic ulcerations. To better understand PWUD perspectives on xylazine adulteration, we interviewed individuals with xylazine-associated wounds in Pittsburgh, Pennsylvania. METHODS: From March to April 2024, we conducted semi-structured interviews with adult PWUD with at least 1 current or prior xylazine-associated wound and past-90-day xylazine exposure confirmed by urine toxicology or xylazine test strip. We thematically analyzed a subset of the data focused on xylazine experiences. RESULTS: Five major themes emerged from 20 interviews. First, PWUD recognition of xylazine developed only after experiencing its negative effects, including wounds. Second, xylazine was an unwanted adulterant with PWUD, citing its sedating effects and associated wounds as barriers to daily functioning. Third, xylazine wounds imposed significant physical, emotional, and social challenges. Fourth, PWUD found it challenging to avoid xylazine given the saturated supply and employ traditional harm reduction strategies such as transitioning routes of use. Lastly, PWUD felt unable to stop using the xylazine-adulterated opioid supply due to worsening withdrawal symptoms, uncontrolled pain from xylazine wounds, and difficulty with initiating and continuing medications for opioid use disorder. CONCLUSIONS: Overall, PWUD with xylazine-associated wounds perceived xylazine as harmful and undesired, yet difficult to avoid, highlighting the urgent need for adaptive harm reduction strategies, accessible drug checking services, tailored clinical interventions, and supportive policies to promote a safer drug supply.
A Critical Appraisal on the Alleged Carcinogenic Potential of Sublingual Buprenorphine.
Pedrosa MDS, Ribeiro AA
J Addict Med · 2025 Dec · PMID 41373105 · Publisher ↗
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Dosing and Safety of Methadone Initiation in the Setting of Fentanyl: A Systematic Review.
Bosshardt Z, Ortega Perez M, Casarella J … +2 more , Buresh M, Tang YL
J Addict Med · 2025 Dec · PMID 41373096 · Publisher ↗
BACKGROUND: The rise of high-potency synthetic opioids such as fentanyl in the illicit opioid supply has contributed to increased overdose deaths and complicated methadone initiation for opioid use disorder (OUD). Tradit...
BACKGROUND: The rise of high-potency synthetic opioids such as fentanyl in the illicit opioid supply has contributed to increased overdose deaths and complicated methadone initiation for opioid use disorder (OUD). Traditional methadone initiation protocols may be insufficient in the context of fentanyl's high potency and pharmacokinetics. This systematic review evaluates current evidence on accelerated (≥60 mg within the first 7 d of treatment) methadone initiation strategies. METHODS: Following PRISMA guidelines, we conducted a comprehensive search of databases for studies from 2013 to June 16, 2025, reporting on methadone initiation in fentanyl-exposed patients. Key outcomes included patient selection, dosing, retention, and adverse events. RESULTS: Ten observational studies met the inclusion criteria, with 8 inpatient, 2 outpatient, and 2 studies focused on pregnant individuals. Studies selected for 18- to 65-year-olds without end-organ failure, QTc prolongation, or medications affecting methadone metabolism. The mean and median dose on day 1 ranged from 30 to 53.4 mg (pooled weighted mean=40.7 mg). By day 5, doses increased to 59.2-90 mg (pooled weighted mean=70.2 mg), and by day 7 to 65-100 mg (pooled weighted mean=81.9 mg). Patient-directed discharge occurred in 0%-31% of patients. Sedation occurred in 0%-28.6% of patients, while severe adverse events (requiring naloxone, ICU admission, intubation, or death) occurred in 1.08% of treatment episodes. The certainty of evidence was very low using a GRADE framework. CONCLUSIONS: The current observational literature is limited, with some support for accelerated methadone initiation in inpatient and outpatient settings for appropriately selected patients exposed to fentanyl.
Changes to Personal Social Media Accounts and Use Among Those With Substance Use Disorder Who Are Currently in Treatment: A Cross-sectional Survey.
Phelan C, Katz APM, Merrill JE … +2 more , Jackson KM, Wray TB
J Addict Med · 2025 Dec · PMID 41369526 · Publisher ↗
OBJECTIVES: This study examined changes in social media use among adults with past-year treatment for substance use disorder (SUD) in New England, focusing on the prevalence of such changes, reasons for modifying social...
OBJECTIVES: This study examined changes in social media use among adults with past-year treatment for substance use disorder (SUD) in New England, focusing on the prevalence of such changes, reasons for modifying social media habits, perceived success, and factors associated with attempts to change social media use. METHODS: Participants [N = 255; 45% female, 85% white, mean age = 41.4 (9.6)] recently treated for SUD completed an online survey. The survey gathered demographics, SUD histories, and social media use data. We report descriptive statistics and logistic regression models testing relationships between attempts to change social media use while in treatment and individual factors. RESULTS: Overall, 62% of respondents reduced or stopped social media use during SUD treatment. A substantial minority (34%) viewed their attempts as unsuccessful or neutral. Logistic regressions indicated that having alcohol as one's drug of choice and having previously sought drugs on social media were both positively associated with attempting to reduce or quit social media. People who reported being motivated to avoid social media to reduce drug/alcohol triggers also reported being more successful in changing their social media use. CONCLUSIONS: Many individuals in SUD treatment actively limit social media to reduce exposure to substance-related triggers, yet success varies. Future research should explore how digital environments might be reshaped to support treatment goals, balancing the risk of exposure to substance use content with the potential benefits of online resources.
Pathways to 7-day Extended-release Buprenorphine (CAM2038) Administration in Emergency Department and Hospitalized Patients.
Logan A, Sluser J, Martin M
J Addict Med · 2025 Nov · PMID 41355410 · Publisher ↗
OBJECTIVES: To describe the clinical contexts, population characteristics, and outcomes of extended-release buprenorphine (CAM2038 7-day depot formulation) administration in emergency department and hospitalized patients...
OBJECTIVES: To describe the clinical contexts, population characteristics, and outcomes of extended-release buprenorphine (CAM2038 7-day depot formulation) administration in emergency department and hospitalized patients with opioid use disorder primarily using fentanyl. METHODS: We conducted a retrospective case series of patients who received CAM2038 at an urban safety-net hospital between June 2024 and June 2025. We collected data from electronic health records, including demographics, clinical characteristics, and outcomes. Outcomes included opioid withdrawal severity, buprenorphine-precipitated withdrawal, patient-directed discharge, and 30-day linkage to care within our health care system. RESULTS: Thirty-seven patients received CAM2038, with 33 utilizing CAM2038 to initiate buprenorphine and 4 transitioning from another formulation of therapeutic buprenorphine. Most patients (91.9%) primarily used fentanyl. Among patients using CAM2038 to initiate buprenorphine, 25 patients (75.8%) received pretreatment of opioid withdrawal with short-acting full agonist opioids. Two patients (6%) had suspected precipitated withdrawal. Among patients with documented Clinical Opiate Withdrawal Scale scores post-injection (n=24), 91.7% experienced minimal-to-mild withdrawal (score <12). Patient-directed discharge was uncommon (10.8%), and 47% of patients linked to buprenorphine treatment within 30 days. CONCLUSIONS: CAM2038 administration, including for the initiation of therapeutic buprenorphine, seems to be feasible and well-tolerated in inpatient and emergency department settings, with low rates of precipitated withdrawal and patient-directed discharge. The use of short-acting opioids for initial withdrawal management may contribute to successful outcomes. These findings support CAM2038 as a valuable option for treating opioid use disorder in the emergency department and hospital settings, particularly among patients who use fentanyl.
Association Between Excessive Alcohol Consumption When Starting Antiretroviral Therapy and Long-term Mortality in People Living With HIV.
Fuster D, Moreno C, Sanvisens A … +9 more , Cabello-Clotet N, Gutiérrez F, Fanjul F, Bernal-Morell E, García García J, Reus Bañuls S, Jarrin I, Muga R, CoRIS Cohort
J Addict Med · 2025 Dec · PMID 41337756 · Publisher ↗
OBJECTIVE: We examined the association between alcohol consumption and mortality among people living with HIV (PWH). METHODS: We included individuals aged ≥18 years, enrolled between 2004 and 2022 in CoRIS, a Spanish mul...
OBJECTIVE: We examined the association between alcohol consumption and mortality among people living with HIV (PWH). METHODS: We included individuals aged ≥18 years, enrolled between 2004 and 2022 in CoRIS, a Spanish multicenter cohort study of ART-naive PWH at enrolment. We calculated mortality rates per 100 persons-year (p-y) of follow-up, and used multivariable Cox models to estimate hazard ratio (HR) (95% confidence interval [CI]) for the association between alcohol consumption at enrolment and mortality after controlling for confounders (sex at birth, age, mode of HIV infection, education level, region of origin, HCV infection [EIA+], CD4 cell count and HIV-RNA load at enrolment). FINDINGS: We included 6087 participants (14% women); median age 36 years (interquartile range [IQR]: 29-45). Men who had sex with men were 63.2% of the participants, 27.9% were heterosexuals, and 4.9% were persons who inject drugs. Prevalence of HCV was 7.5%, median RNA-HIV load was 70,431 copies/mL (IQR: 16,982-261,000), and median CD4 count was 363 cells/mm3 (IQR: 196-547). Two hundred seventy participants (4.4%) reported alcohol consumption of ≥40 g/d. Over 31,171 p-y of follow-up, 240 participants (3.9%) died. The mortality rate among individuals who drank ≥40 g/d was 2.13 (95% CI: 1.56-2.93) per 100 p-y compared with 0.68 (95% CI: 0.60-0.79) per 100 p-y among those who drank <40 g/d. After adjustment, alcohol consumption of ≥40 g/d was associated with increased mortality (adjusted HR: 1.54 [95% CI: 1.06-3.42], P =0.02). CONCLUSION: In this cohort of PWH, excessive alcohol use was associated with a higher risk of death.
Characterization of Tobacco Cessation Services, Pharmacotherapies, and Policies at Adolescent-serving Substance Use Treatment Facilities in 2023.
Vidyasagar N, Whitney E, Brett E … +6 more , Ogunniyi V, Beem A, Richardson A, King A, Fridberg DJ, Ari M
J Addict Med · 2025 Nov · PMID 41287149 · Full text
OBJECTIVES: Adolescents with substance use disorder report high rates of tobacco use. Despite recommendations for counseling and pharmacotherapies for tobacco cessation among adolescents, their use remains low. The objec...
OBJECTIVES: Adolescents with substance use disorder report high rates of tobacco use. Despite recommendations for counseling and pharmacotherapies for tobacco cessation among adolescents, their use remains low. The objective of this study was to characterize the availability of tobacco cessation counseling and pharmacotherapies, as well as smoking and vaping policies, in adolescent-serving substance use treatment facilities in the United States. METHODS: The present study analyzed facility-reported data from the 2023 National Substance Use and Mental Health Services Survey. Substance use treatment facilities serving adolescents only (ages 11-21) were compared with those serving both adolescents and adults on tobacco use screening, availability of tobacco cessation education/counseling and pharmacotherapies (nicotine replacement therapy, bupropion, and varenicline), and smoking and vaping policies. RESULTS: Most adolescent-only facilities offered tobacco use screening (82.6% vs 82.8% in adult/adolescent facilities) and education/counseling for tobacco cessation (71.9% vs 70.0% in adult/adolescent facilities). Adolescent-only facilities were more likely than adult/adolescent facilities to prohibit onsite smoking (84.7% vs 33.1%, respectively, P < 0.001) or vaping (87.7% vs 41.9%, respectively, P < 0.001), yet less likely to offer tobacco cessation pharmacotherapies to patients (20.7% vs 45.5%, respectively, P < 0.001). CONCLUSIONS: While most adolescent-only substance use treatment facilities offered tobacco cessation education or counseling and restricted tobacco use at their sites, they were less likely than adult/adolescent facilities to offer pharmacotherapy for tobacco cessation. This reflects a missed opportunity to offer robust options to treat tobacco use among adolescents with substance use disorders.
Supporting Patients With Stimulant Use Disorder During and After Hospitalization With a Mobile App-based Contingency Management Intervention: A Feasibility and Acceptability Study.
Peng L, Young K, Titus H … +6 more , Peeples J, Song E, DeFrancesco C, Roellich P, Phillips R, Englander H
J Addict Med · 2025 Nov · PMID 41287143 · Full text
OBJECTIVES: Contingency management (CM) is the most effective intervention for stimulant use disorder (StUD) but is underutilized. This study examined the feasibility and acceptability of a novel mobile app-based CM inte...
OBJECTIVES: Contingency management (CM) is the most effective intervention for stimulant use disorder (StUD) but is underutilized. This study examined the feasibility and acceptability of a novel mobile app-based CM intervention for patients with StUD during and after hospitalization. METHODS: We recruited hospitalized patients with moderate to severe StUD and an expected hospital length of stay of >2 weeks or a heart failure diagnosis. Patients received gift cards for participating in incentivized activities (counseling, drug testing, and recovery-oriented reflections) through the mobile app. Patients could participate for 2 months (including after hospital discharge), earning up to $330. An in-person nurse supported implementation. We collected intervention engagement data (app usage, rewards earned) and conducted qualitative interviews on participants' experiences. RESULTS: Fifty-six participants (68% male, 70% with unstable housing) completed intake. The average hospital length of stay was 33 days, with 64% admitted for infection. Participants engaged for an average of 33.9 days. Engagement varied widely-those in the top quartile earned $173.31 on average, while those in the bottom quartile earned $6.27 on average. Eighty-nine percent of submitted drug tests were negative for stimulants. Participants felt the "positivity" of CM helped them stay "motivated" and "focused" on recovery instead of being "bored" or stressed in the hospital. Thirty-nine (69.6%) patients continued engaging after hospital discharge. Barriers to engagement included physical limitations, feeling overwhelmed, competing priorities, and technological challenges. CONCLUSIONS: A novel hospital-based mobile app CM intervention helped patients with StUD cope with hospitalization and supported recovery goals, although program engagement varied widely.
Letter to the Editor: Medetomidine-associated Opioid Overdoses in Chicago, Illinois: A Report of 3 Cases (By Nayani Et Al, 2024).
Zemtsov RK
J Addict Med · 2025 Nov · PMID 41276913 · Publisher ↗
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A Longitudinal Analysis of PrEP Eligibility in Women With a History of Injection Drug Use.
Hoff E, Verinumbe T, Astemborski J … +4 more , Kirk G, Mehta S, Genberg B, Falade-Nwulia O
J Addict Med · 2025 Nov · PMID 41276907 · Full text
OBJECTIVES: Pre-exposure prophylaxis (PrEP) is a critical strategy for HIV prevention in women who inject drugs (WWID); however, only 1%-2% of WWID use PrEP. We aim to characterize factors associated with longitudinal Pr...
OBJECTIVES: Pre-exposure prophylaxis (PrEP) is a critical strategy for HIV prevention in women who inject drugs (WWID); however, only 1%-2% of WWID use PrEP. We aim to characterize factors associated with longitudinal PrEP eligibility in women with a history of injection drug use to inform optimization of PrEP implementation strategies. METHODS: Women who did not have HIV and were participating in the AIDS Linked to the Intravenous Experience (ALIVE) Cohort between 2014 and 2020 were included. Data on sociodemographic characteristics, substance use, depressive symptoms, and HIV risk behaviors were collected at semiannual visits. PrEP-eligibility was defined as sex-related (>1 partner with condomless sex, partner with HIV or who injects drugs, transactional sex or sexually transmitted infection) or injection-related (sharing drug use equipment) in the past 6 months. Associations between individual factors and PrEP eligibility were estimated using unadjusted and adjusted logistic regression with generalized estimating equations. RESULTS: Among 382 women, the average follow-up was 3.2 years, and 41% were PrEP-eligible. At baseline, among PrEP-eligible women, 89% met sex-related, 41% met injection-related, and 30% met both sex-related and injection-related criteria; women were eligible for PrEP during 58% of follow-up. Periods of PrEP-eligibility were longitudinally associated with younger age [adjusted odds ratio (95% CI): 0.92 (0.90-0.94)], recent incarceration [aOR=2.29 (1.17-4.50)], severe depression [aOR=1.31 (1.06-1.62)], and recent overdose [aOR=1.56 (1.07-2.28)]. CONCLUSIONS: PrEP implementation efforts that incorporate strategies to support the needs of women with recent incarceration, severe depression, and recent overdose have the potential to maximize outcomes for WWID.
Secondary Analysis to Advance Characterization of On-body Electrocardiographic Sensors in a Clinical Cocaine Self-administration Paradigm.
Angarita GA, Mayerson TF, Pittman B … +7 more , Natarajan A, Parate A, Marlin B, Gueorguieva R, Potenza MN, Ganesan D, Malison RT
J Addict Med · 2025 Nov-Dec 01 · PMID 41249021 · Full text
OBJECTIVES: Our group has previously established how remote on-body electrocardiogram (ECG) sensors may discriminate cocaine use from other sympathomimetic conditions. The current analyses assess whether discriminatory p...
OBJECTIVES: Our group has previously established how remote on-body electrocardiogram (ECG) sensors may discriminate cocaine use from other sympathomimetic conditions. The current analyses assess whether discriminatory power is mainly driven by differences in heart rate between conditions. METHODS: Individuals who use cocaine (N = 11) wore ECG sensors during (1) cocaine self-administration, (2) methylphenidate administration, (3) aerobic exercise, and (4) tobacco use (N = 9). Primary outcomes included: (1) time elapsed between 2 successive R waves (ie, RR interval), (2) ECG interval proxies, and (3) waveforms. ECG traces were matched for heart rate between conditions for all discriminations. RESULTS: ECG interval proxies and waveforms exhibited high discriminatory power in distinguishing cocaine use from methylphenidate, exercise, and tobacco use, with mean areas under the receiver operating characteristics ranging from 0.87 to 0.99, while RR-related measures ranged from 0.49 to 0.5, reflecting low discriminatory power. CONCLUSION: Our results suggest that the ECG sensors' discriminatory power is based on nuances in ECG data beyond mere changes in heart rate.
Impact of Longitudinal Patterns of Alcohol Use on Mortality in People Who Inject Drugs: A Prospective, Community-based Cohort Study.
Chen PH, Baimaji F, Astemborski J … +6 more , Verma S, Cameron AM, Chander G, Mehta SH, Kirk GD, Sun J
J Addict Med · 2025 Nov · PMID 41225714 · Full text
OBJECTIVES: People who inject drugs (PWID) have higher mortality risks and excessive alcohol use compared with the general population. However, long-term alcohol usage trajectories' impacts on mortality outcomes among PW...
OBJECTIVES: People who inject drugs (PWID) have higher mortality risks and excessive alcohol use compared with the general population. However, long-term alcohol usage trajectories' impacts on mortality outcomes among PWID are not well-established. We aim to characterize different longitudinal alcohol use patterns and evaluate their mortality outcomes among lifetime PWID. METHODS: Data are from our community-based, prospective cohort study of PWID in Baltimore, Maryland, United States. The analysis included participants from January 1, 2005, through February 29, 2020, who answered alcohol use screening questions at least once. We first performed group-based trajectory modeling to identify longitudinal patterns of alcohol use. Next, we applied time-to-event methods to assess the mortality risks associated with these patterns. RESULTS: The analysis included 1935 participants. Five alcohol use patterns emerged: consistent high-risk use (7.1%), gradual decline from moderate-risk to lower-risk use (25.8%), faster decline from moderate-risk to minimal use (10.4%), consistent lower-risk use (28.6%), and minimal use (28.1%). Compared with high-risk use, faster decline [adjusted hazard ratio (aHR): 0.44 (95% CI: 0.30, 0.65)], lower-risk [aHR: 0.54 (95% CI: 0.39, 0.74)], and minimal [aHR: 0.58 (95% CI: 0.42, 0.80)] use each had a lower all-cause mortality risk. Furthermore, these 3 comparison groups also showed reduced noncommunicable disease-related mortality risks. CONCLUSIONS: Relative to consistent high-risk alcohol use, alcohol reduction/cessation and long-term lower-risk or minimal alcohol use have lower all-cause and noncommunicable disease-related mortality risks. Our findings highlight the importance of alcohol use treatment services as a preventive health care strategy among lifetime PWID and other high-risk populations.
US Youth Exposed to Parental Substance Use Disorder in the Home: A Comparison of DSM-IV and DSM-5 Criteria.
Schepis TS, Veliz PT, West BT … +4 more , McCabe VV, Hulsey E, Kcomt L, McCabe SE
J Addict Med · 2025 Nov-Dec 01 · PMID 41220059 · Full text
PURPOSE: Youth (children and adolescents under 18 yrs) exposed to parental substance use disorder (SUD) are at high risk for poor outcomes that include substance use, psychopathology, and child welfare involvement. With...
PURPOSE: Youth (children and adolescents under 18 yrs) exposed to parental substance use disorder (SUD) are at high risk for poor outcomes that include substance use, psychopathology, and child welfare involvement. With the changing SUD criteria from DSM-IV to DSM-5, revised estimates of youth exposed to parental SUD in the home are needed to provide more recent estimates and investigate whether the change from DSM-IV to DSM-5 may change estimated SUD exposure. METHODS: Nationally representative data from the 2020 National Survey on Drug Use and Health were used. Weighted counts of youth exposed to parental nonnicotine SUD in the home were estimated using both DSM-IV and DSM-5 criteria, which were assessed for every substance used by the parent in the past year; further analyses estimated counts by parental race/ethnicity, sex, household income, urbanicity, and substance leading to the SUD diagnosis. RESULTS: Parents with DSM-IV SUD had an estimated 9,341,336 youth in their households, versus an estimated 16,937,783 using DSM-5 criteria (81.3% greater). Larger increases were observed in Asian (262.9%) or multiracial (161.9%) parents versus parents of other racial/ethnic groups and in parents with cannabis use disorder (246.4%), with smaller increases observed in parents with alcohol use disorder (71.2%). DISCUSSION: The change from DSM-IV to DSM-5 criteria resulted in a large increase in youth exposed to parental SUD. The health needs of these youth will require large-scale planning to limit poor outcomes in the roughly 17 million exposed youth; family-based interventions may help limit harms to all members of the family.
Non-medical Mephentermine Use: A Systematic Review of Literature.
Patel V, Harsha, Kumar A … +2 more , Quraishi R, Rao R
J Addict Med · 2025 Nov-Dec 01 · PMID 41220058 · Publisher ↗
OBJECTIVES: The objective of the study was to conduct a systematic review of the available literature on non-medical use of mephentermine, including its pattern of use, associated complications, and treatment approaches....
OBJECTIVES: The objective of the study was to conduct a systematic review of the available literature on non-medical use of mephentermine, including its pattern of use, associated complications, and treatment approaches. METHODS: We conducted a systematic search across PubMed, Scopus, EMBASE, Web of Science, and EBSCO, to identify studies reporting non-medical mephentermine use. Two independent reviewers screened the studies, and methodological quality was assessed using the Joanna Briggs Institute tools. Extracted data included demographics, use patterns, psychiatric and physical complications, cooccurring substance use, and treatment approaches. RESULTS: Of 695 retrieved studies, 23 full-text studies met inclusion criteria (4 case series, 19 case reports, 30 cases). The majority (n = 28, 93.3%) were from India, all male (age: 19-39 y, mean = 27.9). Most used mephentermine for performance enhancement (63%), primarily through intravenous injection (77.8%). Psychiatric comorbidities were reported in 60%, with psychosis (43.3%) being the most common. Cooccurring substance use (40%) included alcohol, tobacco, and anabolic steroids. Treatment was largely symptomatic, with antipsychotics and benzodiazepines being most frequently prescribed. CONCLUSIONS: Non-medical mephentermine use appears to be rising, particularly among athletes and bodybuilders, with notable psychiatric complications. Targeted education and clinical awareness are needed. Further research should explore addiction potential, long-term effects, and treatment strategies.
Dutasteride as a Treatment to Support Reduced Drinking: A Randomized Placebo-Controlled Trial.
Covault J, Tennen H, Feinn R
J Addict Med · 2025 Nov · PMID 41208092 · Publisher ↗
OBJECTIVES: Preclinical studies indicate that neuroactive steroids mediate some effects of alcohol. Dutasteride is an inhibitor of 5-alpha reductase enzymes, which play a central role in the production of 5α-reduced neur...
OBJECTIVES: Preclinical studies indicate that neuroactive steroids mediate some effects of alcohol. Dutasteride is an inhibitor of 5-alpha reductase enzymes, which play a central role in the production of 5α-reduced neuroactive steroids. A prior randomized clinical trial in men found that dutasteride reduced drinking compared with placebo. The purpose of this study was to examine dutasteride's tolerability and efficacy for reducing drinking in a sample of men and women. METHODS: A total of 167 participants who were current heavy drinkers and had a goal to stop or reduce drinking to nonhazardous levels were randomized to placebo or 1 mg dutasteride daily for 12 weeks. We hypothesized that both dutasteride-treated men and women would be more successful in reducing drinking compared with placebo. RESULTS: Dutasteride was well tolerated. Generalized linear mixed models identified significant effects of medication such that dutasteride-treated participants reduced drinking and heavy drinking more than placebo-treatment. During the last month of treatment, dutasteride-treated participants had reduced heavy drinking days by 40% versus 23% for placebo-treated participants (P=0.041, Cohen's d=0.48) and the number of drinks per week by 32% versus 16% for placebo participants (P=0.016, Cohen's d=0.42). When the sample was stratified by sex, a significant effect of medication compared with placebo was evident for men (n=88) but not for women (n=67) due to a large placebo response rate in women. CONCLUSION: Dutasteride 1 mg daily was efficacious in reducing the number of heavy drinking days and drinks per week in treatment-seeking men, confirming findings from a prior RCT involving 142 men.
Glutamate Dynamics in Reward-associated Areas During Smoking Cue Exposure in Male Smokers: A Proton Magnetic Resonance Spectroscopy Study.
Abdullah M, Lin SH, Huang LC … +4 more , Lin RY, Chen PS, Tseng HH, Yang YK
J Addict Med · 2025 Nov · PMID 41208089 · Publisher ↗
OBJECTIVES: Functional magnetic resonance imaging studies have shown that smoking cues activate reward-related brain regions, with activation intensity increasing with smoking addiction severity. A recent study on cocain...
OBJECTIVES: Functional magnetic resonance imaging studies have shown that smoking cues activate reward-related brain regions, with activation intensity increasing with smoking addiction severity. A recent study on cocaine addiction reported increased striatal glutamatergic tone in response to cocaine-associated cues; however, the role of glutamate in smoking cue-induced brain activation and its relationship with addiction severity remain unclear. METHODS: This study investigated glutamate modulation in the anterior striatum and dorsal anterior cingulate cortex (ACC) of male participants, comprising smokers (n = 38) and healthy controls (n = 48), exposed to smoking cues. Magnetic resonance spectroscopy (MRS) was used to measure glutamate levels at baseline (neutral images) and during smoking cue (smoking images) presentation. RESULTS: A mixed-model ANOVA followed by post hoc paired t tests revealed a significant increase in striatal glutamate levels in smokers exposed to smoking cues, whereas no changes were observed in controls. This effect on striatal glutamate in smokers remained significant after controlling for age. No significant changes were observed in the ACC in either smokers or controls. Although a positive association trend was found between smoking severity, as measured by the Fagerström Test for Nicotine Dependence (FTND) scores, and striatal cue-induced glutamate changes, it was not statistically significant. CONCLUSIONS: These findings suggested that smoking cue-induced increases in striatal glutamate tone may reflect the neurochemical mechanisms underlying cue-induced phenomena in humans.
Substance Use Disorder Following Consumption of a Novel Synthetic 7-Hydroxymitragynine Product.
Reif B, Adkins A, Boyer EW … +3 more , Kanumuri SRR, Sharma A, Smith KE
J Addict Med · 2025 Nov · PMID 41189061 · Publisher ↗
BACKGROUND: Products containing semi-synthetic 7-hydroxymitragynine (7-OH), a potent mu-opioid receptor (MOR) agonist, have proliferated in the United States. In kratom leaf, trace amounts of 7-OH are formed by spontaneo...
BACKGROUND: Products containing semi-synthetic 7-hydroxymitragynine (7-OH), a potent mu-opioid receptor (MOR) agonist, have proliferated in the United States. In kratom leaf, trace amounts of 7-OH are formed by spontaneous oxidization of kratom's primary alkaloid, mitragynine. Hepatic and intestinal microsomes also convert mitragynine to 7-OH. Some products have sublingual and nasal administration routes that circumvent hepatic first-pass metabolism, increasing bioavailability and accelerating effect onset, features that increase risk. We report a patient who developed substance use disorder (SUD) related to a 7-OH sublingual film. CASE PRESENTATION: A 35-year-old man with supraventricular tachycardia and profound urinary retention described using "Hydroxie," a novel, semi-synthetic 7-OH product. He currently vaped cannabis and nicotine, and reported injection heroin addiction a decade prior. He used kratom 6 months before trying Hydroxie, which began 10 weeks before hospitalization. Within days of initiating use, he noticed tolerance; within 2 weeks, he was using one film every 1-2 hours. The patient met criteria for severe SUD related to Hydroxie and was inducted onto buprenorphine. Analysis confirmed 7-OH in the product and blood. DISCUSSION: The MOR selectivity and brief duration of action of some 7-OH formulations support our observation that repeated use may lead to physical dependence. Standard laboratory testing can detect mitragynine but not 7-OH due to its relatively shorter half-life, an issue that may confuse semi-synthetic 7-OH use with kratom. Novel 7-OH products are not kratom. The potency of 7-OH places unwitting consumers who may believe they are using kratom, not a partial MOR agonist, at risk.
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