Journal Of Addiction Medicine[JOURNAL]
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200 papers
Substance Use Disorder and Substance Use-Related Mortality in US Immigration Detention (2018-2025).
Tirado B, Ling R, Gong L … +5 more , Petion E, Flores MG, Rolin AI, Xu KY, Rolin SA
J Addict Med · 2025 Nov · PMID 41182848 · Publisher ↗
OBJECTIVES: To assess documented substance use indicators and the probable role of substance use disorders (SUDs) in deaths occurring in US Immigration and Customs Enforcement (ICE) custody between April 2018 and May 202...
OBJECTIVES: To assess documented substance use indicators and the probable role of substance use disorders (SUDs) in deaths occurring in US Immigration and Customs Enforcement (ICE) custody between April 2018 and May 2025. METHODS: A retrospective cross-sectional review was conducted using all 69 publicly available ICE Detainee Death Reviews (DDRs) during the study period. Medically licensed reviewers analyzed each DDR for documented substance use indicators, clinical screening or diagnosis, referral, treatment, and emergency response. Additional variables included demographic information, psychiatric symptoms, and access to medical or mental health care. RESULTS: Among 27 deaths involving a probable substance use history or related medical/psychiatric conditions, none showed documentation of SUD diagnosis, referral, or evidence-based treatment. Nine individuals (33.3%) died from complications potentially related to untreated substance use, including opioid and alcohol withdrawal. Over half of these cases showed documented signs of delayed emergency response. Although DDRs frequently noted patient "refusal" of care (n=11), none documented formal assessments of decision-making capacity. Most individuals in the sample had resided in the United States for over 2 decades before ICE detention. CONCLUSIONS: Our findings reveal probable gaps in the documented identification and treatment of SUD among individuals who died in ICE custody. Standardized behavioral health protocols, timely emergency response, and greater transparency are needed to address substance-related risks in immigration detention settings.
Impact of Cocaine Use Disorder History on Receipt of Guideline-indicated Medications and Therapies Following ST-elevated Myocardial Infarction.
Davis EI, Sarda D, Saxena R … +4 more , Qadeer A, Allencherril J, Jneid H, Gaalema DE
J Addict Med · 2025 Nov · PMID 41177961 · Publisher ↗
OBJECTIVES: Following ST-elevation myocardial infarction (STEMI), there are standard guideline-indicated therapies including revascularization (percutaneous coronary intervention or coronary artery bypass surgery), medic...
OBJECTIVES: Following ST-elevation myocardial infarction (STEMI), there are standard guideline-indicated therapies including revascularization (percutaneous coronary intervention or coronary artery bypass surgery), medications (aspirin, angiotensin converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs], beta-blockers, high-intensity statins, P2Y12 inhibitors], and outpatient rehabilitation (cardiac rehabilitation [CR]). Those with substance use disorder (SUD), including cocaine use disorder (CUD), have been shown to be less likely to receive certain medical treatments, but the effect of SUD history on receipt of post-STEMI therapies is not well known. METHODS: The TriNetX Research database was used to identify adults aged 18 years or older hospitalized with STEMI between 2014 and 2024. Patients were divided into two groups: those with and without a history of CUD. After 1:1 propensity score matching for demographic, psychosocial, and medical characteristics, differences in receipt of guideline-indicated therapies by CUD history were examined. RESULTS: After propensity matching, 1366 patients were identified in each group. Those with a history of CUD were more likely to be prescribed ACE/ARBs [OR: 1.22, 95% CI: 1.05-1.41] or statins [OR: 1.19, 95% CI: 1.03-1.39], less likely to receive revascularization [OR: 0.69, 95% CI: 0.51-0.94] and much less likely to attend CR [OR: 0.41, 95% CI: 0.28-0.61] as compared with those without. No differences were seen by group in prescription of other medications. CONCLUSIONS: History of CUD was associated with modest effects on receipt of prescriptions post-STEMI. However, revascularization and attendance at CR were much lower in those with CUD. There is a need for more targeted, individualized, and supportive treatment plans in patients with CUD who present with STEMI.
Complicating Factors Surrounding Concurrent Use of Kratom and a Novel 7-hydroxymitragynine Product Among a Participant Enrolled in a Kratom Clinical Trial.
Smith KE, Rama Raju Kanumuri S, Sharma A … +5 more , Rattenni R, LeComte R, McCurdy CR, Boyer EW, Strain EC
J Addict Med · 2025 Oct · PMID 41177541 · Publisher ↗
BACKGROUND: 7-Hydroxymitragynine (7-OH) is a highly selective mu opioid receptor agonist with binding affinity greater than morphine. Although trace amounts of 7-OH are found in kratom, it is formed by metabolism in huma...
BACKGROUND: 7-Hydroxymitragynine (7-OH) is a highly selective mu opioid receptor agonist with binding affinity greater than morphine. Although trace amounts of 7-OH are found in kratom, it is formed by metabolism in humans after kratom ingestion. Novel semi-synthetic 7-OH products are manufactured by mono-oxidation of kratom's primary alkaloid, mitragynine. Formulations include sublingual tablets, powders, and liquid shots. We report a case of a study participant with self-reported 7-OH use. CASE PRESENTATION: A 23-year-old man using kratom for 3 years was enrolled into a clinical trial evaluating kratom pharmacokinetics, behavioral pharmacology, and withdrawal. He typically used 1.5-2g of kratom whole-leaf powder 6 times/day. Following scheduled kratom product self-administration during the study, several outcomes were atypical, including blunted subjective kratom effects. He reported recent initiation of a "new kratom product" ("Opia") identified as semi-synthetic 7-OH; he was using 20 mg 3 times/day for 4 days before study admission. Mitragynine (29.7 ng/mL) plasma concentration peaked at 1.5 hours post kratom self-administration, while 7-OH Cmax (11.7 ng/mL) occurred before self-administration, confirming prior ingestion of 7-OH. The participant reported withdrawal symptoms and requested early discharge from the study, but refused the study protocol kratom "rescue dose," stating he preferred to take his "stronger" product. DISCUSSION: Clinicians must obtain detailed self-reports from patients who report any kratom use. As 7-OH products are misleadingly marketed as kratom, and as both long-time kratom consumers and kratom-naive individuals may experiment with these novel products, improved assessment methods are urgently needed in the absence of real-time confirmatory testing.
Online Narcotics Anonymous: An Option for Addressing Methamphetamine Use Disorder.
Galanter M, White WL, Hunter B
J Addict Med · 2025 Oct · PMID 41172060 · Publisher ↗
OBJECTIVE: Although 11% of all US drug overdose deaths have been attributed to methamphetamine, there are limited treatments for it that have a substantial impact on clinical outcomes. Online access to the community-base...
OBJECTIVE: Although 11% of all US drug overdose deaths have been attributed to methamphetamine, there are limited treatments for it that have a substantial impact on clinical outcomes. Online access to the community-based fellowship Narcotics Anonymous (NA) may offer support for remission for some persons with methamphetamine use disorder (MUD). Our objective was to characterize the role that online NA participation can play in remission of MUD. METHODS: Persons who accessed a website for participating in online NA meetings were offered the option of participating in an anonymous, structured survey consisting of items related to their clinical status, substance use, and prior experience with the website. Responses of those who designated their primary drug problem as methamphetamine were analyzed. RESULTS: Of the 1645 respondents who accessed the NA online meeting site in 2023, 356 indicated that methamphetamine was their principal drug problem. Levels of remission by respondents who reported turning to the website primarily for MUD were analyzed for those: (1) new to the online site (44%), (2) longtime abstinent (mean 2.3 y), or (3) still using methamphetamine (13%). Respondents' subjective experiences, such as their belief in the 12 Steps, spiritual awakening, and level of relief provided from distress, were also associated with remission. CONCLUSIONS: Online NA meetings can provide support for promoting abstinence for some persons with MUD, and can be studied relative to their clinical status. Such meetings can therefore be useful for professional referral, and their function and utility merit further investigation.
A Case of Maternal and Neonatal Withdrawal After Exposure to Fentanyl Adulterated With Medetomidine.
Hull I, Gates M, Dimattio K … +3 more , Bangiolo L, Tamama K, Bishop CE
J Addict Med · 2025 Oct · PMID 41152206 · Publisher ↗
The emergence of medetomidine, a potent veterinary alpha-2 adrenergic receptor agonist, as a common fentanyl adulterant in many areas of the United States poses new threats to pregnant women who use illicit opioids and t...
The emergence of medetomidine, a potent veterinary alpha-2 adrenergic receptor agonist, as a common fentanyl adulterant in many areas of the United States poses new threats to pregnant women who use illicit opioids and their neonates. We present a case of severe withdrawal seen in a postpartum woman and her neonate after exposure to fentanyl adulterated with medetomidine up to the time of delivery. The case demonstrates the need for obstetric and pediatric providers to be aware of this emerging trend to allow for early recognition and prompt treatment of the potentially life-threatening symptoms of medetomidine withdrawal, which differs from traditional withdrawal patterns, and highlights the importance of communication and coordination between obstetric and pediatric teams caring for this population.
Associations Between Alcohol Use and Self-reported Pain: Insights From the 2020 National Health Interview Survey.
Liu L, Maleki N
J Addict Med · 2025 Oct · PMID 41131680 · Publisher ↗
OBJECTIVES: Alcohol use and pain are both prevalent public health concerns, yet their associations at the population level remain understudied. This study examines the relationship between alcohol consumption and self-re...
OBJECTIVES: Alcohol use and pain are both prevalent public health concerns, yet their associations at the population level remain understudied. This study examines the relationship between alcohol consumption and self-reported pain among US adults. METHODS: A cross-sectional analysis was conducted using data from the 2020 National Health Interview Survey, a nationally representative data set by the National Center for Health Statistics. The analytic sample included 24,499 adults aged ≥18 years (mean age=51.6, SD=18.0). Alcohol consumption in the past 12 months was categorized as nondrinking (<1 drink ever), light (≤3 drinks/wk), moderate (males: 4-14; females: 4-7 drinks/wk), and heavy (males: >14; females: >7 drinks/wk) drinking. Pain (acute or chronic) frequency, severity, and interference over the past 3 months were assessed via self-report. Adjusted logistic regression models were used to estimate associations. RESULTS: A dose-response relationship was observed: compared with nondrinkers, odds of experiencing pain were higher among heavy drinkers (aOR=1.76; 95% CI: 1.30-2.37), moderate (aOR=1.39; 95% CI: 1.10-1.76), and light (aOR=1.32; 95% CI: 1.10-1.60). Our analyses further revealed that while pain frequency and severity were significantly associated with the severity of alcohol use, pain-related interference with daily life and family functioning did not differ significantly by drinking status. Opioid use was also more common among moderate and heavy drinkers. CONCLUSIONS: Higher alcohol consumption is significantly associated with increased likelihood of pain, with a clear dose-response pattern. Findings underscore the need for integrated screening and intervention targeting both alcohol use and pain.
Methylphenidate for the Treatment of Cocaine Use Disorder: A Systematic Review and Meta-analysis.
Biso L, Lebosi M, Bonaso M … +2 more , Carli M, Scarselli M
J Addict Med · 2025 Oct · PMID 41131674 · Publisher ↗
OBJECTIVES: Cocaine use disorder (CUD) is a chronic condition, often associated with attention deficit hyperactivity disorder (ADHD). No medications have been approved for the treatment of CUD, but methylphenidate (MPH)...
OBJECTIVES: Cocaine use disorder (CUD) is a chronic condition, often associated with attention deficit hyperactivity disorder (ADHD). No medications have been approved for the treatment of CUD, but methylphenidate (MPH) has been explored as a potential candidate. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of MPH in patients with CUD with and without ADHD. METHODS: Following PRISMA guidelines, we developed a search string for PubMed, ISI Web of Science, and Scopus databases. We included randomized and nonrandomized clinical studies that used MPH in CUD treatment. RESULTS: Twenty studies were included in the systematic review, 6 of them were included in the meta-analysis. In the meta-analysis, MPH did not reduce craving (ES: -0.33, 95% CI: 1.69 to 1.03; Z = -0.473; P = 0.636) or cocaine use (ES: -0.01, 95% CI: -0.35 to 0.33) (Z= -0.084; P = 0.933) compared with placebo. However, the route of administration and the presence of ADHD associated with CUD influenced the outcomes on cocaine craving measures. Similarly, although the results were inconclusive, a trend toward the reduction of cocaine consumption was observed in patients with ADHD treated with MPH. Regarding safety, MPH can be used in patients with CUD up to 90 mg/d and monitoring the cardiovascular parameters is strictly required. CONCLUSIONS: Evidence on the efficacy of MPH for the treatment of CUD is still limited and inconclusive. However, there might be a rationale for its use in patients with both CUD and ADHD, therefore, further clinical studies are needed in this particular category.
Recurrent Polymicrobial Pathogens From Licking Syringe Plungers: A Case Report and Artificial-intelligence-augmented Scoping Review of Oropharyngeal Bacterial Infections Linked to Unsafe Injection Practices.
Perri MM, Borelli C, Cheng A
J Addict Med · 2025 Oct · PMID 41111174 · Publisher ↗
OBJECTIVES: People who inject drugs are at an increased risk of infectious complications. Certain injection practices can lead to bacterial complications from oral flora, including licking needles or using saliva to clea...
OBJECTIVES: People who inject drugs are at an increased risk of infectious complications. Certain injection practices can lead to bacterial complications from oral flora, including licking needles or using saliva to clean the skin. We report the first case in the literature of a patient licking the syringe plunger and present a scoping review to identify other injection practices associated with oropharyngeal bacterial complications from injecting drugs. METHODS: The authors searched OVID Medline, Embase, and APA PsycINFO to identify case reports and case series of patients with infections related to salivary contamination in the injection process. Studies with suspected unsafe injection practices based on the pathogen, but with no specific injection practices reported, were excluded. Artificial intelligence (AI) was utilized to augment the traditional scoping review by refining search criteria for a repeated traditional search and conducting iterative AI literature searches using embedded links. RESULTS: Nine sources were identified with AI-augmented embedded article searching that were not identified in the traditional scoping review. One source was identified with AI-augmented search criteria. If only the traditional scoping review had been used, 3 of the 13 articles would have been identified. CONCLUSIONS: The scoping review identified unexpected etiologies of oropharyngeal bacterial contamination, not limited to licking needles, illustrating the importance of gaining an in-depth, step-by-step understanding of how each patient with intravenous drug use injects to identify potential modes of infection. This case also provides an example of potential advancements in artificial intelligence to augment research by improving search strategies, such as MeSH terms and identifying articles.
Health Care Service Presence, Social Vulnerability, and Opioid Overdose Rate Acceleration: A United States, County-level Analysis, 2020-2022.
Baillieu R, Maring J, Olsen Y
J Addict Med · 2025 Oct · PMID 41111168 · Publisher ↗
BACKGROUND: The United States continues to experience an opioid overdose epidemic with mortality patterns that reflect existing social and environmental inequities. Although research has examined various factors associat...
BACKGROUND: The United States continues to experience an opioid overdose epidemic with mortality patterns that reflect existing social and environmental inequities. Although research has examined various factors associated with opioid-related mortality, the relationships between social-environmental vulnerability (SEV), health care presence, and geography remain poorly characterized. PURPOSE: To explore whether SEV accelerates opioid overdose rates and to assess how the presence of health care services-specifically opioid treatment programs (OTPs) and primary care providers (PCPs)-modifies these patterns across rural and urban contexts. METHODS: A retrospective ecological analysis using hierarchical linear modeling was conducted from January 2020 to December 2022, analyzing 172,359 observations across 57,453 census tracts within 1219 US counties. The primary exposure was census-tract-level SEV, operationalized using the CDC Environmental Justice Index. Health care indicators included county-level presence of OTPs and PCPs. RESULTS: Areas in the highest quartile of SEV demonstrated elevated acceleration coefficients (β=3.224; SE=0.803; P<.001), with pronounced patterns observed in rural areas, though ecological design limitations preclude individual-level causal inference. Interaction analyses suggested that high-SEV counties containing both OTP and primary care resources demonstrate lower acceleration coefficients (β= -11.478, SE=5.429, P=0.035). Areas without health care presence showed higher baseline rates in overdose acceleration, particularly in urban high-vulnerability settings. CONCLUSIONS: High SEV was associated with accelerated opioid overdose rates during 2020-2022, particularly in rural areas. The presence of OTPs and primary care services within counties was associated with attenuated acceleration in high-vulnerability areas. This may indicate that policies prioritizing comprehensive health care services in high-SEV communities could address opioid overdose disparities.
Global, Regional, and National Burdens Attributable to Drug Use Across 204 Countries and Territories Between 1990 and 2021: The Global Burden of Disease Study 2021.
Wu X, Fitzpatrick T, Wu G … +3 more , Chen Y, Fu L, Zou H
J Addict Med · 2025 Oct · PMID 41077644 · Publisher ↗
OBJECTIVES: Diseases, injuries, and death attributable to drug use are a major global public health problem. METHODS: This was a cross-sectional study that used data from the Global Burden of Diseases (GBD) 2021. Data on...
OBJECTIVES: Diseases, injuries, and death attributable to drug use are a major global public health problem. METHODS: This was a cross-sectional study that used data from the Global Burden of Diseases (GBD) 2021. Data on years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life years (DALY), and deaths from HIV/AIDS, acute hepatitis B, acute hepatitis C, cirrhosis, liver cancer, drug use disorders, and self-harm attributable to drug use in 204 countries and territories from 1990 to 2021 were retrieved from the GBD 2021. RESULTS: Globally, drug use accounted for 463.4 thousand deaths, 18.0 million YLLs, 9.6 million YLDs, and 27.7 million DALYs in 2021. Globally, 0.96% of all DALYs (95% uncertainty intervals 0.85% to 1.07%) were attributable to drug use in 2021, and 71.82% of age-standardized rates of DALYs attributed to drug use disorders were due to opioid use disorders. High-income North America (2117.6), Eastern Europe (911.1), and Australasia (559.4) had the highest DALYs attributable to drug use in 2021. Globally there was not a nonsignificant annual trend [estimated annual percentage change (EAPC) 0.16, 95% CI: -0.16 to 0.47] in age-standardised DALYs attributable to drug use from 1990 to 2021; however, there were regional increases during this period, with the largest increases seen in High-income North America (4.83, 4.52 to 5.14), Western sub-Saharan Africa (1.84, -0.79 to 4.55), and Eastern Europe (1.07, 0.21 to 1.93). CONCLUSIONS: Burdens attributable to drug use were high and continued to grow rapidly in some regions, particularly high-income North America.
A Novel Intravenous Buprenorphine Micro-Infusion Strategy: Application in Critical Care and Opioid Use Disorder.
Carroll DK, King A, Yakey B … +7 more , Darling A, Woodcock EA, Wahby K, Wein R, Greenwald MK, Isaacson AR, Dolcourt BA
J Addict Med · 2025 Oct · PMID 41063335 · Full text
OBJECTIVES: Buprenorphine (BUP), a partial mu-opioid receptor (MOR) agonist, is an effective analgesic and is standard-of-care for treating opioid use disorder (OUD). Transitioning from full MOR agonists to stable BUP do...
OBJECTIVES: Buprenorphine (BUP), a partial mu-opioid receptor (MOR) agonist, is an effective analgesic and is standard-of-care for treating opioid use disorder (OUD). Transitioning from full MOR agonists to stable BUP dosing can be challenging as some patients experience BUP-precipitated opioid withdrawal (BPOW) due to its ability to displace full MOR agonists. To improve patient tolerability low-dose BUP initiation protocols deliver small, progressively escalating BUP doses, allowing gradual displacement of other opioids and replacement with BUP. We describe a case series using a novel intravenous BUP "micro-infusion" protocol for rapid medication transition with no patients meeting the operational criteria for BPOW. METHODS: A retrospective case series of patients who received an 8-hour 1200 mcg BUP infusion (150 mcg/hr) and one (or more) sublingual BUP doses after medical or nonmedical full MOR agonist administration. Variables included demographic characteristics, presence of OUD, opioid medications, BUP continuation/prescription fill rates, and evidence of BPOW based on Clinical Opiate Withdrawal Scale (COWS) scores. RESULTS: Of 23 patients included, 8 presented with current OUD (34.8%) and 15 were treated with full MOR agonists for analgesia (65.2%) before BUP micro-infusion. There were no instances of BPOW. Among the 8 patients with OUD, 5 (62.5%) continued sublingual BUP and filled their prescription for BUP upon discharge. CONCLUSIONS: Overall, the 8-hour intravenous 1200 mcg BUP micro-infusion protocol was well-tolerated with no clinically apparent cases of BPOW and similar rates of continued sublingual BUP treatment post-discharge among patients with OUD compared with other low-dose BUP initiation protocols.
Extended-release Buprenorphine for Opioid Use Disorder in Hospital and Emergency Department Settings.
Heeney M, Anderson E, Roller Sirey L … +6 more , Benard R, Patregnani M, Lind K, Liang A, Ullal M, Herring AA
J Addict Med · 2025 Oct · PMID 41058016 · Publisher ↗
OBJECTIVES: Hospitalization and emergency department (ED) visits are an underutilized opportunity to reach high-risk patients with opioid use disorder (OUD) with buprenorphine (BUP) treatment and reduce the ongoing and w...
OBJECTIVES: Hospitalization and emergency department (ED) visits are an underutilized opportunity to reach high-risk patients with opioid use disorder (OUD) with buprenorphine (BUP) treatment and reduce the ongoing and widespread treatment gap. Monthly extended-release BUP (XR-BUP) potentially facilitates successful initiation and delivers sustained treatment. XR-BUP provides up to 30 days of medication for opioid use disorder (MOUD) with each administration and could improve retention in care during transition to outpatient addiction treatment. We aim to describe the patient characteristics and clinical outcomes of hospitalized and ED patients with OUD treated with monthly XR-BUP. METHODS: We conducted a retrospective chart review of a cohort of ED or hospitalized patients who received monthly XR-BUP at an urban, safety-net hospital over a 6-month period from September 2023 through March 2024. RESULTS: There were 61 patient encounters where XR-BUP was administered. Within 30 days of discharge, 40/61 (65.6%) patients who received XR-BUP engaged in outpatient addiction treatment through an in-person or telemedicine provider visit; within 45 days, 29/61 (47.5%) patients received a subsequent XR-BUP. Thirty-eight (62.3%) initiated XR-BUP with low-dose initiation of sublingual buprenorphine with full agonist opioid continuation, 20 (32.8%) started after high-dose sublingual buprenorphine, 2 (3.3%) after low-dose initiation of IV buprenorphine, and 1 (1.6%) received "direct to inject" XR-BUP. CONCLUSIONS: In this observational retrospective study, rates of engagement in addiction treatment after discharge among patients with OUD receiving XR-BUP were high. Clinical teams utilized novel strategies to initiate XR-BUP during ED and hospital-based encounters.
Illicit Fentanyl Exposures in Cats and Dogs Reported to a North American Veterinary Poison Control Center From 2019 to 2023.
Ware OD, Watts Brown G
J Addict Med · 2025 Oct · PMID 41056068 · Publisher ↗
OBJECTIVES: As a prominent concern for addiction medicine, illicit fentanyl and its analogues have been implicated in numerous poisonings among people. Many households in Canada and the United States include cats or dogs...
OBJECTIVES: As a prominent concern for addiction medicine, illicit fentanyl and its analogues have been implicated in numerous poisonings among people. Many households in Canada and the United States include cats or dogs as pets who may be exposed to substances such as fentanyl. METHODS: This case-series examined data from the American Society for the Prevention of Cruelty to Animals' Poison Control, a 24-hour call center for animal poison-related emergencies. Descriptive statistics were used on records in which cats or dogs had a reported exposure to illicit fentanyl between 2019 and 2023. RESULTS: The sample included 117 animals (n=4 cats and n=113 dogs). Breeds most identified in this sample were Chihuahuas (n=21) and American Pit Bull Terriers (n=14). Among dogs, the average age was 1.9 (SD=2.8) years and the average weight was 10.5 (SD=11.1) kg. Among cats, the average age was 2.0 (SD=1.2) years and the average weight was 6.0 (SD=2.8) kg. Among dogs, the most reported illicit fentanyl exposure formulation included powder/crystals (n=34; 30.1%). Hypersalivation was reported as a clinical sign for n=2 (50.0%) cats in the sample. The top clinical signs reported among dogs in the sample include lethargy (n=39; 34.5%), vocalization (n=37; 32.7%), and ataxia (n=27; 23.9%). CONCLUSIONS: Impacts of illicit fentanyl and its analogues on society extend to 2 common household animals, cats and dogs. Any potential exposure to illicit fentanyl among cats or dogs should promptly seek emergency veterinarian services for reversal with naloxone and supportive care.
Evaluating the Impact of Low Threshold Bridge Clinic Expansion on Equitable Access to Substance Use Disorder Treatment.
Lambert E, Irvin J, Regan S … +12 more , Applewhite DP, Kane M, Powell E, Jordan L, Hubbell H, Sharma S, Kung S, Lopez N, Cunningham R, Taveras EM, Sequist TD, Wakeman SE
J Addict Med · 2025 Oct · PMID 41056053 · Publisher ↗
OBJECTIVES: Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may im...
OBJECTIVES: Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across 4 distinct sites. METHODS: Between October 2021 and 2023, 3 hospital-based Bridge Clinics were expanded, and a community-based Bridge Clinic was established, all in regions with high racial and language inequities in overdose mortality. Implementation included creating Bridge Clinic performance measures, which were reviewed with clinic leadership monthly, developing a toolkit, and launching mobile services. We present Bridge Clinic visit volume aggregated by calendar year for Black-non Hispanic, Hispanic (any race), and LEP patients. We calculated the percent of total visits for each patient group and assessed the change over time. RESULTS: Comparing 2021 to 2023, total visits increased from 5323 to 10,350, and unique patients increased from 1893 to 3316. Annual visits increased from 437 to 1151 visits for Black patients; 566 to 1609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black (8.21% vs. 10.24%, P<0.001), Hispanic (10.63% vs. 15.55%, P<0.001) and LEP patients (1.80% vs. 2.56%, P=0.003) from 2021 to 2023. CONCLUSIONS: Expanding low-barrier Bridge Clinics may increase substance use disorder (SUD) treatment visits for Black and Hispanic patients and those with LEP.
Naltrexone in the Treatment of Ketamine Use Disorders: A Case Report and Literature Review.
Verma R, Colley T, Waldock C … +2 more , Bird L, Guerrini I
J Addict Med · 2025 Oct · PMID 41036801 · Publisher ↗
BACKGROUND: Nonprescribed use of ketamine has increased worldwide due to its hallucinogenic and psychedelic effects. Ketamine use disorders (KUDs) are marked by intense cravings and tolerance, which often trigger relapse...
BACKGROUND: Nonprescribed use of ketamine has increased worldwide due to its hallucinogenic and psychedelic effects. Ketamine use disorders (KUDs) are marked by intense cravings and tolerance, which often trigger relapses and worsen recovery outcomes, defined as sustained ketamine abstinence with reduced cravings, resolved withdrawal symptoms, and improved psychosocial functioning. Currently, there are no approved pharmacological treatments for KUDs. This report examines the off-label use of naltrexone in a patient with KUDs. CASE PRESENTATION: The case was a 25-year-old woman diagnosed with KUDs enrolled in an outpatient, specialist addiction service. The patient presented with ketamine daily use and intense cravings when trying to stop. The patient was prescribed oral naltrexone at the initial dose of 25 mg/day, which was increased to 50 mg/day after 7 days. After the initiation of treatment, the patient experienced a marked reduction in ketamine cravings. She was able to maintain abstinence and to progress in her recovery. The positive response to naltrexone suggests its potential as an effective intervention for managing KUDs. CONCLUSIONS: Our findings are consistent with 2 prior reports that have highlighted the use of naltrexone in KUDs. The 2 previous case reports indicated that naltrexone at the dosage of 50 mg/day successfully helped the patients to achieve abstinence. Studies have shown that naltrexone reduces the antidepressant effects of ketamine in treatment-resistant depression, indicating an overlap between the opioid system and ketamine's NMDA receptor activity. Larger, double-blind studies are needed to evaluate naltrexone's efficacy, safety, and optimal dosing for KUDs.
Trends in Newly Filled GLP-1 Receptor Agonist Prescriptions for US Patients With Versus Without Comorbid Alcohol Use Disorder, 2016-2024.
Wallach JD, O'Malley SS, Lipska KJ … +3 more , Ross JS, Jeffery MM, Savitz ST
J Addict Med · 2025 Oct · PMID 41036780 · Full text
OBJECTIVES: To evaluate trends in newly filled GLP-1 receptor agonist (GLP-1RA) prescriptions among U.S. adults with type 2 diabetes (T2DM) and/or obesity, comparing those with and without comorbid alcohol use disorder (...
OBJECTIVES: To evaluate trends in newly filled GLP-1 receptor agonist (GLP-1RA) prescriptions among U.S. adults with type 2 diabetes (T2DM) and/or obesity, comparing those with and without comorbid alcohol use disorder (AUD), and to assess differences in their demographic and clinical characteristics. METHODS: We used national claims data from Optum Labs Data Warehouse, which includes de-identified administrative and pharmacy claims from commercially insured and Medicare Advantage (MA) enrollees throughout the U.S., to identify adults who newly filled GLP-1RA-based prescriptions between April 1, 2016, and March 31, 2024. We calculated quarterly rates of new GLP-1RA fills per 100 person-years and compared the characteristics of individuals with T2DM and/or obesity with and without comorbid AUD. RESULTS: From 2016 to 2024, 555,224 individuals with T2DM and/or obesity newly filled prescriptions for GLP-1RAs, of whom 6606 had comorbid AUD. The rate of new GLP-1RA fills for individuals with comorbid AUD increased from 1.27 to 6.02 per 100 person-years between 2016-2024 [incident rate ratio (IRR): 4.73 (95% CI 3.38, 6.79)], compared with an increase of 2.21 to 6.55 per 100 person-years among individuals without comorbid AUD [IRR: 2.96 (95% CI 2.88, 3.05)]. Individuals with AUD were more likely to be MA enrollees under age 65, male, have had a recent emergency department visit, and have co-occurring psychiatric and medical conditions compared with those without comorbid AUD. CONCLUSIONS: From 2016 to 2024, the rate of newly filled GLP-1RA prescriptions increased among individuals with T2DM and/or obesity and comorbid AUD. Individuals with comorbid AUD were more likely to be male and to have clinical characteristics linked to greater AUD severity. Additional clinical studies on the efficacy and safety of GLP-1RAs for AUD are needed to guide their appropriate use.
Experiences With Substance Use Disorder Treatment and the Role of Social Norms in the Asian American Pacific Islander Community: A Qualitative Study.
Yamashita W, Wang JA, Perez G … +8 more , Chen C, Tian C, Nakashini D, Villongco C, Fong T, Deng H, Lembke A, Castellon-Lopez Y
J Addict Med · 2025 Sep · PMID 40996072 · Publisher ↗
OBJECTIVES: The Asian American Pacific Islander (AAPI) community accesses substance use disorder (SUD) services less frequently and at more advanced stages compared with the general population. Understanding experiences...
OBJECTIVES: The Asian American Pacific Islander (AAPI) community accesses substance use disorder (SUD) services less frequently and at more advanced stages compared with the general population. Understanding experiences of AAPI patients with SUDs is important to identify opportunities to engage patients into treatment earlier and address community needs. This study explored the experiences of diverse AAPI patients with SUD and treatment services in a large urban setting, specifically examining influences of social norms within the AAPI community. METHODS: We conducted semi-structured qualitative interviews with AAPI participants who received SUD treatment in Los Angeles. Participants discussed their experiences with SUD and treatment services. We used the Rigorous and Accelerated Data Reduction (RADaR) data analysis approach to identify key themes related to SUD treatment experiences, specifically highlighting facilitators or barriers to accessing care. RESULTS: Among 20 interviews analyzed, the following themes were identified: the model minority myth, family dynamics, and AAPI community connection. Sub-themes are presented as facilitators or barriers to SUD treatment services. CONCLUSIONS: We found that social norms within the AAPI community can be both facilitators and barriers to treatment. We explored the role of the model minority myth and saving face as barriers to care, and family dynamics rooted in cultural beliefs and AAPI community values as facilitators during recovery. These findings reveal opportunities for cultural nuances to be incorporated into SUD care, inform more inclusive clinical practices, and potentially improve AAPI patient outcomes. Such insights may help reduce stigma and enhance SUD treatment engagement in the AAPI community.
Estimated Hospital Cost Reduction Following Implementation of Hospital-dispensed Discharge Methadone.
Calcaterra SL, Scherbak YJ, Nickell J … +3 more , Grimm E, Schonlau D, Optican G
J Addict Med · 2025 Sep · PMID 40990324 · Full text
OBJECTIVES: US regulatory changes now allow practitioners to dispense up to a 3-day supply of methadone from the inpatient pharmacy at hospital dishcarge at one time. We characterized outcomes related to hospital-dispens...
OBJECTIVES: US regulatory changes now allow practitioners to dispense up to a 3-day supply of methadone from the inpatient pharmacy at hospital dishcarge at one time. We characterized outcomes related to hospital-dispensed discharge methadone, including saved hospital days and reductions in hospital costs. METHODS: We included all hospitalizations involving hospital-dispensed discharge methadone for opioid use disorder. We identified the mean number of discharge methadone doses ordered per hospitalization to determine a reduction in length of hospital stay, where 1 discharge methadone dose equals 1 hospital day saved. We used 2 approaches: a health care cost accounting approach that uses patient-level health care cost data and an adjusted inpatient day metric that uses data from the hospital's aggregated operating costs to estimate hospital cost reductions related to discharge methadone. RESULTS: Between April 2023 and July 2025, 175 hospitalizations involving 374 orders for discharge methadone reduced length of stay by 357 days after accounting for split doses, that is, twice daily doses for pain, pregnancy, or rapid methadone metabolism. The mean number of discharge methadone doses per hospitalization was 2.1. Using a health care cost accounting approach, the median cost reduction was $850/d with a total cost reduction of $304,450 over the study period. Using an adjusted inpatient day estimate, the total cost reduction was $3953/d with a total cost reduction of $1,411,221 over the study period. CONCLUSIONS: Hospital-dispensed discharge methadone reduced costs by facilitating hospital discharges. Cost savings related to reduced emergency department overcrowding or avoidance of nosocomial infections were not captured and should be considered when implementing discharge methadone processes.
The Shifting Landscape of a Fentanyl Adulterant: Moving From Xylazine to Medetomidine.
Huo S, Perrone J
J Addict Med · 2026 May-Jun 01 · PMID 40990306 · Publisher ↗
Medetomidine has been increasingly found in the illegal opioid supply across the country over the last few years. In 2024, it replaced xylazine as the most common adulterant of the illegal opioid supply in the Philadelph...
Medetomidine has been increasingly found in the illegal opioid supply across the country over the last few years. In 2024, it replaced xylazine as the most common adulterant of the illegal opioid supply in the Philadelphia area. Medetomidine is estimated to be over 100 times as potent and selective for the alpha-2 receptor than xylazine. This leads to increased sedative effects compared with other alpha-2 agonists and in some patients, a severe autonomic withdrawal syndrome when medetomidine is abruptly stopped. Severe hypertension, tachycardia, vomiting, and tremors have been seen, often requiring hospital admission and critical care. As a result, the capacity of local health systems and ability to accurately triage patients to the proper level of care have been stretched. Drug checking and testing of biospecimens for medetomidine remains limited. Clinician and public health awareness of this new entity will be foundational to robust responses to this next adulterant threat.
Identifying Areas to Improve Care and Support Parent-Child Relationships From the Perspective of Pregnant and Parenting People in Recovery.
Karnosh C, Simon J, Krans EE … +1 more , Guyon-Harris KL
J Addict Med · 2026 May-Jun 01 · PMID 40961537 · Full text
OBJECTIVES: Opioid use during pregnancy is a critical public health concern that has given rise to significant treatment needs throughout the perinatal period. The purpose of this study was to gather perspectives of preg...
OBJECTIVES: Opioid use during pregnancy is a critical public health concern that has given rise to significant treatment needs throughout the perinatal period. The purpose of this study was to gather perspectives of pregnant and parenting individuals in recovery from opioid use disorder (OUD) to better understand their needs and identify ways to improve care and support parenting. METHODS: We conducted semi-structured interviews with 18 pregnant and postpartum people receiving medication for opioid use disorder (MOUD) at an outpatient buprenorphine clinic. The coding team developed a codebook using both inductive and deductive methods that was applied to all interviews. Key topics and trends were identified using thematic analysis. RESULTS: Four themes emerged from participants' reflections on their experiences with health care as pregnant and parenting people in recovery: (1) need for support with parenting, (2) concerns about MOUD, (3) difficulty accessing resources, and (4) value of peer support and options for receiving information. CONCLUSIONS: There is a need to prioritize support with parenting, understanding MOUD, and accessing basic needs to better prepare pregnant and early postpartum individuals for parenting in recovery from OUD. It is also important to incorporate peer support into services to better support pregnant and parenting people in recovery.
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