Journal Of Addiction Medicine[JOURNAL]
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200 papers
Clinical and Demographic Characteristics of Hospitalized Patients With Xylazine-related Wounds.
Novick E, Seval N, Coppock D … +4 more , Tucker M, Taupin D, Zurlo J, Kramer C
J Addict Med · 2026 May-Jun 01 · PMID 40961536 · Full text
OBJECTIVES: Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wou...
OBJECTIVES: Little is known about the demographic and clinical features of patients with xylazine-related wounds. We sought to characterize hospitalized patients with substance use disorder (SUD) and xylazine-related wounds seen for infectious diseases consultation. METHODS: We retrospectively reviewed the medical records of 193 patients diagnosed with SUD at 3 Philadelphia hospitals between October 2023 and January 2024. Patients were identified as either being diagnosed with (n=73) or without (n=120) xylazine-related wounds. We compared the demographic and clinical features between the 2 groups. RESULTS: Patients diagnosed with wounds were younger ( P <0.001), more likely to be White or Hispanic and less likely to be Black/AA ( P <0.001), more likely to have tested positive for fentanyl ( P <0.001), amphetamines ( P <0.001), and cocaine ( P 0.001), more likely to acknowledge injection ( P <0.001), and more likely to leave the hospital by patient-directed discharge (PDD) ( P <0.001). Most patients had multiple wounds (75%), and more than half (53%) had at least one wound greater than 10 cm at its widest dimension. Although most patients diagnosed with wounds received antibiotics, many did not have symptoms or signs of infection. CONCLUSIONS: Xylazine-related wounds are highly associated with illicitly manufactured fentanyl (IMF) use and with drug injection in the city of Philadelphia. Many patients with xylazine-associated wounds do not have signs of infection and may not benefit from antibiotics. Understanding precisely how xylazine is responsible for wound development and how to best manage the wounds, including wound care and the role of antibiotics, is urgent.
Veterans Health System Leader and Clinician Perspectives on Expanding Access to Methadone Treatment for Opioid Use Disorder.
Rahim F, Vanneman ME, Tuckett S … +5 more , Zickmund SL, Gordon AJ, Jones AL, Nelson RE, Schlechter CR
J Addict Med · 2025 Sep · PMID 40961535 · Full text
OBJECTIVES: Private methadone treatment paid for by the Department of Veterans Affairs (VA), called community care (CC), and mobile opioid treatment programs (OTPs) are strategies to expand Veteran access to methadone tr...
OBJECTIVES: Private methadone treatment paid for by the Department of Veterans Affairs (VA), called community care (CC), and mobile opioid treatment programs (OTPs) are strategies to expand Veteran access to methadone treatment for opioid use disorder. The purpose of this evaluation was to investigate leader and clinician perspectives on these modalities compared with treatment provided directly by VA OTPs. METHODS: Semi-structured interviews were conducted with VA OTP leaders and clinicians from 12 of the 33 VA OTP sites nationwide. Participants (N=24) were asked to compare access, quality, and cost of methadone treatment between VA OTPs and CC and asked about the feasibility of deploying mobile OTP services. Two analysts independently coded the transcribed data and used thematic analysis to identify salient themes and representative quotes. RESULTS: VA leaders and clinicians perceived CC to have longer wait times and lower quality care, but expected these services to be less expensive than VA OTPs. Mobile OTP services were viewed as a potential solution to improve access, though concerns were raised about staffing and the reduced availability of wrap-around services. Key considerations for successful mobile OTP implementation included identifying high-need localities, addressing patient needs, and ensuring financial viability. CONCLUSIONS: Within and outside VA, there is growing interest in expanding access to medications for OUD, such as methadone. Leaders and clinicians highlighted important access, quality, and cost considerations when exploring innovative treatment modalities for methadone, such as mobile OTP services and CC. Findings from this VA evaluation may guide methadone treatment improvement in other health systems.
Validity of International Classification of Diseases Codes for Identifying Alcohol Use and Repeated or Harm-associated Alcohol Use in Pregnancy.
Devlin PM, Riggs Z, Charron E … +5 more , Yakub S, Sward KA, Shakib J, Sivaloganathan V, Smid MC
J Addict Med · 2025 Sep · PMID 40955910 · Publisher ↗
OBJECTIVES: To describe the validity of alcohol use disorder (AUD), the International Classification of Diseases (ICD) codes for alcohol use and repeated or harm-associated use in pregnancy. METHODS: We conducted a retro...
OBJECTIVES: To describe the validity of alcohol use disorder (AUD), the International Classification of Diseases (ICD) codes for alcohol use and repeated or harm-associated use in pregnancy. METHODS: We conducted a retrospective study of pregnancies in individuals who sought care at a medical center from May 2014 to August 2023. We selected all pregnancies with an ICD 9th (ICD-9) or 10th (ICD-10) revision AUD code (ICD-9: 303.9x and 305.x; ICD-10: F10.x and O99.31x) and calculated their positive predictive value (PPV) for capturing alcohol use and repeated or harm-associated use in pregnancy using review of health record as the reference standard. We defined alcohol use as any alcohol consumption during pregnancy and repeated or harm-associated alcohol use as a repeated pattern associated with adverse consequences. RESULTS: AUD ICD codes were associated with 305 unique pregnancies. The most common AUD ICD code group was 305.x (n=177, 56.4%), followed by F10.x (n=105, 33.4%), O99.31x (n=25, 8.0%), and 303.9x (n=7, 2.2%). The PPV of AUD codes for capturing alcohol use in pregnancy ranged from 10.0% (95% confidence interval [CI], 8.9%-11.2%) for 305.x to 100% (95% CI, 80.9%-99.5%) for O99.31x. The PPV of AUD codes for capturing repeated or harm-associated use in pregnancy ranged from 1.7% (95% CI, 1.6%-1.8%) for 305.x to 28.0% (95% CI, 21.3%-35.9%) for O99.31x. CONCLUSIONS: The PPV of AUD codes for identifying alcohol use and repeated or harm-associated use in pregnancy varies widely across ICD-9 and ICD-10 code groups. These results should be considered when estimating alcohol exposure in pregnancy from administrative data.
Understanding Sex Differences in Substance Use and Substance Use Disorders: A Moving Target.
Lorenzetti V, Christensen E, Valentino R
J Addict Med · 2025 Sep · PMID 40951979 · Publisher ↗
Sex differences in the prevalence of substance use disorders (SUD) are well recognized. While a greater proportion of males endorse consuming substances and SUDs, the gap between the sexes has been narrowing over time, d...
Sex differences in the prevalence of substance use disorders (SUD) are well recognized. While a greater proportion of males endorse consuming substances and SUDs, the gap between the sexes has been narrowing over time, due to an increased rate of substance use among females. Yet, the mechanisms underlying sex differences in SUD are unclear, and evidence is lacking to inform the development of personalised preventions and treatment for males and females. The neuroscientific evidence to date is inadequate to explain sex differences in SUD, due to a range of methodological issues (eg, study design, recruitment, and statistical modelling). A harmonised multidisciplinary approach that considers sex at each stage of the research cycle is required to create new mechanistic knowledge and to inform the identification of prevention and treatment targets for males and females with an SUD.
Developing Community Pharmacist Prescribing Models to Expand Access to Medications for Opioid Use Disorder.
Bacci JL, Zhang B, Brackeen S … +3 more , Arnold J, English CD, Hansen RN
J Addict Med · 2025 Sep · PMID 40937905 · Publisher ↗
OBJECTIVES: The Mainstreaming Addiction Treatment Act removed the separate registration requirement to prescribe scheduled medications for maintenance or detoxification treatment, creating an opportunity to utilize commu...
OBJECTIVES: The Mainstreaming Addiction Treatment Act removed the separate registration requirement to prescribe scheduled medications for maintenance or detoxification treatment, creating an opportunity to utilize community pharmacists' expertise and accessibility to expand access to medications for opioid use disorder (MOUD). This study aimed to develop pharmacist prescribing models of care within community pharmacies. METHODS: Data were collected via interviews with community pharmacists and pharmacy technicians, treatment providers, and people with lived experience in Washington State from January to May 2024. Interviews were analyzed using a rapid content analysis approach guided by the Practice, Robust Implementation and Sustainability Model and existing evidence-based models of care for MOUD in primary care settings. The research team utilized the themes to develop models of care with input from an interdisciplinary advisory panel. RESULTS: Thirty-one interviews were conducted with 9 community pharmacy staff, 11 treatment providers, and 11 people with lived experience. In total, 21 themes were identified, including 8 themes regarding intervention characteristics, 5 regarding recipients, 5 regarding implementation and sustainability infrastructure, and 3 regarding external environment. Within intervention characteristics, 3 themes were identified regarding medication therapy, 3 regarding education, 1 regarding coordination of care, and 1 regarding psychosocial services. Two models of care were developed: one for MOUD initiation and another for maintenance or ongoing treatment. CONCLUSIONS: This study resulted in the development of models of care for MOUD initiation and maintenance at community pharmacies. Future research is needed to evaluate the effectiveness of these models of care.
Attitudes About Alcohol Misuse Among Alaska Native People in a Tribal Health Care System.
Dillard DA, Hebert LE, Dirks LG … +6 more , Shaw JL, Trinidad SB, Lillie K, Donovan DM, Burke W, Ludman EJ
J Addict Med · 2025 Sep · PMID 40928084 · Publisher ↗
OBJECTIVES: Attitudes about alcohol misuse influence help-seeking behaviors. We assessed attitudes among Alaska Native/American Indian (AN/AI) patients, providers, and leaders to inform outreach, prevention, and treatmen...
OBJECTIVES: Attitudes about alcohol misuse influence help-seeking behaviors. We assessed attitudes among Alaska Native/American Indian (AN/AI) patients, providers, and leaders to inform outreach, prevention, and treatment. METHODS: Participants included a cross-sectional sample of 72 AN/AI providers/leaders and 704 AN/AI adult patients in randomly selected clinics within a tribal health care system. Attitudes associated with addiction models (Psychosocial, Moral, Disease, Environment, Nature) were assessed using a survey developed for AN/AI people. Independent variables included role (patient, provider/leader), sex, age, residence type (urban, rural, mixed, other), alcohol misuse or behavioral health issue in self, family, or friends, and alcohol or behavioral health help-seeking. RESULTS: Attitudes corresponding to Psychosocial and Disease models were more highly endorsed than Nature or Moral models. The Environment model was moderately endorsed. The Disease model was more highly endorsed by AN/AI patients with alcohol help-seeking but less endorsed by providers/leaders. AN/AI patients who were male, had rural residence, and a self-reported behavioral health issue had higher endorsement of the Moral model. Male patients and providers/leaders more highly endorsed the Nature model. Roughly one-third (35%) of patient participants were men. CONCLUSIONS: Efforts to counteract moralistic attitudes about alcohol misuse among male and rural AN/AI people, as well as beliefs that alcohol misuse will spontaneously resolve, may facilitate prevention and treatment efforts. Leaders should also be aware of the potential negative impacts of local laws restricting alcohol. Holistic treatment approaches that address psychosocial factors and contextual issues are indicated. Oversampling of male AN/AI patients may also be warranted.
Validating the Waterpipe Addiction, Craving, and Anticipation Scale: An Exploratory Factor Analysis.
Bou Malhab S, Sacre H, Haddad C … +3 more , Khalifeh P, Daher E, Salameh P
J Addict Med · 2025 Sep · PMID 40928083 · Publisher ↗
OBJECTIVES: Waterpipe smoking is increasingly becoming a public health threat due to its appealing features and misperceptions of its harmful effects. Tools assessing waterpipe addiction are essential for understanding w...
OBJECTIVES: Waterpipe smoking is increasingly becoming a public health threat due to its appealing features and misperceptions of its harmful effects. Tools assessing waterpipe addiction are essential for understanding waterpipe smokers' behaviors and designing effective smoking cessation plans. This study aimed to develop and validate the Waterpipe Addiction, Craving, and Anticipation Scale (WACAS) and describe the specific patterns and multidimensional aspects of waterpipe smoking behavior. METHODS: A cross-sectional study was conducted to develop the WACAS based on previously published smoking assessment tools. Snowball sampling was used to recruit 107 waterpipe smokers. Several procedures were performed to examine the scale's validity, including construct and convergent validity. Known-group validity was examined using trend analysis, while path analysis was conducted to confirm the theoretical framework. RESULTS: The WACAS showed high construct validity (generating 6 factors) and internal consistency, with excellent convergent and known-group validity. It could distinguish between various behavioral expressions of waterpipe smoking, that is, addiction, craving, and anticipation of smoking outcomes, which were initially conceptualized in the theoretical framework. CONCLUSIONS: The WACAS developed in this study is a comprehensive scale comprising 6 factors that distinguish between different behavioral expressions among waterpipe smokers. It captures a unique waterpipe-specific mode of craving explained by anticipation of outcomes and addictive behaviors, confirming the theoretical framework. The scale demonstrated strong validity and reliability. Nevertheless, further refinement and external validation are recommended to establish WACAS as a robust tool for a broad-scope evaluation of waterpipe smoking.
A Randomized Pilot Trial of an Integrated Intervention Combining Computerized Behavioral Therapy and Recovery Coaching for People With Opioid Use Disorder: The OVERCOME Study.
Pericot-Valverde I, Heo M, Ortiz EG … +6 more , King AC, Perez A, Sivaraj LB, Lopes SS, Byrne KA, Litwin AH
J Addict Med · 2025 Sep · PMID 40920407 · Publisher ↗
BACKGROUND: People with opioid use disorder (OUD) often exhibit high rates of nonprescribed drug use and low retention on buprenorphine. This study tested the feasibility, acceptability, and preliminary efficacy of an in...
BACKGROUND: People with opioid use disorder (OUD) often exhibit high rates of nonprescribed drug use and low retention on buprenorphine. This study tested the feasibility, acceptability, and preliminary efficacy of an intervention combining peer recovery coaching and CBT4CBT-buprenorphine (CBT4CBT+RC) to reduce nonprescribed drug use and increase buprenorphine retention. METHODS: A randomized trial conducted from December 15, 2020, to November 24, 2021, compared an 8-week CBT4CBT+RC intervention to treatment as usual (TAU). Outcomes included feasibility (recruitment, treatment initiation, and completion), acceptability (of CBT4CBT, recovery coaching, and integrated intervention), and preliminary efficacy (saliva toxicology and buprenorphine retention during treatment and at 1- and 3-mo follow-ups). Participants (N=38) had been receiving buprenorphine for an average of 270.1 days (SD=444.0) and reported recent nonprescribed drug use. RESULTS: Recruitment feasibility was 33.7%. Of the 19 participants assigned to CBT4CBT+RC, 94.7% met with a coach, and 52.6% initiated CBT4CBT. The average number of modules completed was 6.0 (299.7 min). Satisfaction with the intervention, coach, and CBT4CBT-buprenorphine was high (M≥4.9). Drug use was significantly lower in the CBT4CBT+RC group compared with TAU during treatment (35% vs. 69%, P=0.03), at 1 month (34% vs. 69%, P=0.009), and at 3 months (0% vs. 88%, P<0.001). Retention and opioid-positive tests did not differ between groups. CONCLUSIONS: The CBT4CBT+RC condition resulted in lower rates of saliva toxicology positive for drug use during treatment and follow-ups, but showed comparable buprenorphine retention rates to TAU. These findings provide promising support for the potential of CBT4CBT+RC to reduce drug use among individuals with OUD.
Problematic Use of Buspirone and Tandospirone: A Scoping Review.
Yu P, Zhou C, Wong S … +1 more , Olagunju AT
J Addict Med · 2025 Sep · PMID 40919772 · Publisher ↗
OBJECTIVES: Azapirone-class drugs are partial 5-HT1A receptor agonists commonly used to treat anxiety disorders. Prior experimental studies have so far demonstrated that these drugs have low potential for dependence and...
OBJECTIVES: Azapirone-class drugs are partial 5-HT1A receptor agonists commonly used to treat anxiety disorders. Prior experimental studies have so far demonstrated that these drugs have low potential for dependence and problematic use and are considered safe treatment options compared with benzodiazepines. However, recent evidence suggesting the contrary raises concerns about their safety. This review examines current evidence on problematic azapirone use. METHODS: This study was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Major databases, including MEDLINE/PubMed, PsycInfo, and EMBASE, were searched to identify eligible papers. Additional searches were conducted to supplement. Article selection and data extraction were completed by at least 2 independent reviewers. RESULTS: Thirteen reports made up of clinical studies (n = 9) and case reports (n = 4) were included. All abuse liability studies comparing azapirones (buspirone and tandospirone), benzodiazepines, and placebo reported no association of buspirone and tandospirone with key features of problematic use. Conversely, all case reports (n = 4) described problematic use, involving patients with a history of incarceration or substance use disorder (SUD) who insufflated buspirone to achieve a sedative effect. CONCLUSIONS: Findings highlight a discrepancy in the primary literature. Specifically, experimental studies conclude that so far, buspirone and tandospirone have a low potential for problematic use. However, more recent case reports document instances of nonprescribed buspirone misuse, particularly among individuals with a history of incarceration or SUD, possibly stemming from a complex interplay of biopsychosocial-behavioral rather than purely pharmacological factors. Further research is needed to guide strategies for preventing problematic azapirone use while ensuring effective anxiety treatment in high-risk populations.
Characteristics of Ongoing Clinical Trials for Cocaine Use Disorder Registered on Global Clinical Trial Databases.
Gushken F, Fidalgo TM, Tardelli VS
J Addict Med · 2025 Sep · PMID 40919756 · Publisher ↗
OBJECTIVES: Cocaine use disorder (CUD) affects 1.4 million people in the United States, yet no FDA-approved treatments exist. In 2023, the Food and Drug Administration (FDA) released a draft guideline on treatments for s...
OBJECTIVES: Cocaine use disorder (CUD) affects 1.4 million people in the United States, yet no FDA-approved treatments exist. In 2023, the Food and Drug Administration (FDA) released a draft guideline on treatments for stimulant use disorders, providing direction for trial design, outcomes, and population selection. In this study, we aimed to review ongoing clinical trials for CUD and assess their alignment with the FDA's recommendations. METHODS: We conducted a systematic search of the 6 major clinical trial databases (United States, Australia, Canada, Iran, Netherlands, and Switzerland) to identify ongoing interventional studies for CUD. We included trials evaluating pharmacological, behavioral, device-based, and mixed treatments. We extracted data on intervention type, target population, study design, duration, and primary outcomes. Trials were assessed for alignment with 5 key FDA recommendations, including trial duration, use of both self-reported and biological outcome measures, randomization, placebo control, and double blinding. RESULTS: In total, 38 trials were identified, primarily from the United States (32). Most trials were randomized: 36 (94.7%), while 21 (55.3%) trials had combined endpoints or a 3-month minimum duration. Only 7 trials (18.4%) met all 5 key FDA recommendations. New treatment approaches were identified, including psilocybin and the dAd5GNE vaccine, as well as digital platforms for behavioral therapies. CONCLUSIONS: A variety of promising treatments for CUD are under investigation. However, many trials fall short of current FDA design recommendations. Improved adherence to regulatory guidance and stronger collaboration between researchers and regulators will be essential to advance effective, scalable treatments for CUD.
DSM-5 Stimulant Use Disorder Severity, Stimulant Craving, and Other Clinical Characteristics Based on Stimulant Type (Cocaine, Methamphetamine, Nonmedical Prescription Stimulants, or Polystimulants).
Truchan J, Schepis TS, Pasman E … +2 more , McCabe VV, McCabe SE
J Addict Med · 2025 Sep · PMID 40899710 · Full text
OBJECTIVES: This study examined DSM-5 stimulant use disorder (StimUD) symptom severity, stimulant craving, and clinical characteristics associated with different stimulant types. METHODS: Nationally representative cross-...
OBJECTIVES: This study examined DSM-5 stimulant use disorder (StimUD) symptom severity, stimulant craving, and clinical characteristics associated with different stimulant types. METHODS: Nationally representative cross-sectional data from the 2021-2022 National Survey on Drug Use and Health (N = 117,103) was analyzed to determine the past-year prevalence and adjusted odds of DSM-5 StimUD symptom severity, stimulant craving, psychological distress, suicidality, and major depressive episodes among individuals who used crack cocaine, methamphetamine, non-crack cocaine, nonmedical prescription stimulants (NPSU), or polystimulants (≥2 stimulants). RESULTS: Past-year DSM-5 StimUD was most prevalent and severe among individuals who used crack cocaine, methamphetamine-only, or polystimulants, versus non-crack cocaine-only and NPSU-only. Stimulant craving was the most prevalent DSM-5 StimUD symptom, highest among those reporting polystimulant use (56.6%), followed by methamphetamine-only (51.2%), crack cocaine (48.0%), non-crack cocaine-only (18.6%), and NPSU-only (16.6%). Stimulant craving showed a dose-response association with more frequent use. Polystimulant use was associated with the highest rates of psychological distress, suicidal ideation, suicide attempt, and major depressive episodes. In controlled analyses, adjusted odds of impaired control, social impairment, risky use, pharmacologic indicators, and craving were greater among those using crack cocaine, methamphetamine-only, and polystimulants, relative to NPSU-only. Individuals reporting non-crack cocaine use-only had lower odds of psychological distress [AOR = 0.63 (95% CI = 0.44-0.92)] and major depressive episodes [AOR = 0.61 (95% CI = 0.40-0.91)] compared with NPSU-only. CONCLUSIONS: Individuals using different stimulant types differ in DSM-5 StimUD symptoms, craving, and other clinical characteristics, especially those engaged in crack cocaine, methamphetamine, and polystimulant use. Health care professionals should consider these differences when treating individuals who use stimulants.
Approaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi Technique.
Malette N, Parmar G, Ross J … +2 more , Crabtree A, Bach P
J Addict Med · 2025 Aug · PMID 40844135 · Publisher ↗
OBJECTIVES: Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians...
OBJECTIVES: Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians lack evidence to guide care of patients potentially experiencing benzodiazepine withdrawal when ceasing use of unregulated opioids. We used a Delphi technique to build consensus around assessment and management of people at risk for benzodiazepine dependence due to the use of unregulated opioids. METHODS: We administered a Delphi Technique with 12 clinicians (physicians, nurses, nurse practitioners, pharmacists) with expertise in substance use disorders, from a Canadian province with a high prevalence of benzodiazepine-adulterated unregulated opioids. The technique involved 4 rounds of consensus building and resulted in 122 consensus statements related to direct clinical care. RESULTS: Final consensus statements include approaches to risk stratification, diagnosis, and management of benzodiazepine withdrawal secondary to use of benzodiazepine-adulterated opioids. At-risk groups include daily/high-volume opioid users, those who intentionally seek benzodiazepine-contaminated opioids, and those who abruptly cease using unregulated opioids. Common co-opioid and benzodiazepine withdrawal symptoms include anxiety, agitation, gastrointestinal upset, insomnia, and confusion, usually peaking around 72 hours from the time of last use. Experts formed consensus on tracking benzodiazepine withdrawal using vitals, CIWA-B, and treatment response to benzodiazepines administered in inpatient settings. CONCLUSIONS: As benzodiazepines become more prevalent in the unregulated drug supply, there is an urgent need for evidence-based care. Key future priorities should focus on developing evidence-based clinical guidance, creating decision-support tools, and advancing research efforts.
Medicaid Unwinding: Association With New and Ending Buprenorphine Treatment Episodes.
Landis RK, Sheng F, Stein BD
J Addict Med · 2025 Sep-Oct 01 · PMID 40838627 · Full text
IMPORTANCE: Medicaid is an important source of coverage for buprenorphine treatment for opioid use disorder (OUD). The loss of Medicaid coverage through Medicaid unwinding may substantially impact individuals' ability to...
IMPORTANCE: Medicaid is an important source of coverage for buprenorphine treatment for opioid use disorder (OUD). The loss of Medicaid coverage through Medicaid unwinding may substantially impact individuals' ability to initiate and continue buprenorphine, but little is known about how Medicaid unwinding is associated with buprenorphine OUD treatment. OBJECTIVE: Examine the association of Medicaid unwinding overall and by magnitude of unwinding with changes in buprenorphine OUD treatment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using 2021-2023 national retail pharmacy data on dispensed buprenorphine prescriptions. EXPOSURE: Magnitude of Medicaid disenrollment in the 6 months after unwinding began. MAIN OUTCOMES AND MEASURES: Average monthly change in new and ending buprenorphine treatment episodes, defined as starting buprenorphine treatment after 30 days without buprenorphine and ending after 30 days without buprenorphine. Statistical significance was assessed using 95% CI constructed from 2-sample t tests. RESULTS: Medicaid unwinding was associated with increases in Medicaid buprenorphine episodes ending (+3.0%, 95% CI: -1.1, 7.0, n=+5350) and decreases in new Medicaid episodes (-2.6%, 95% CI: -5.3, 0.1, n=-5756). The greatest changes were in states with the greatest disenrollment (+5.5%, 95% CI: 0.8, 10.1; n=+2320 for episodes ending and -3.9%, 95% CI: -7.3, -0.6; n=-1843 for episodes starting). Changes in Medicaid-covered episodes were not offset by other payers: among all payers, we observed an increase in episodes ending (+2.7%, 95% CI: 1.9, 3.4, n=+10,300) and a negligible increase in new episodes (+0.1%, 95% CI: -0.7, 1.0, n=+570). CONCLUSIONS AND RELEVANCE: Medicaid unwinding may have resulted in substantial disruptions to buprenorphine treatment.
Individuals With Opioid Use Disorder in the Perinatal Period: Characteristics and Engagement in Integrated Treatment.
Faucher MA, Afsari MA, Cordova P … +8 more , Kleinschmidt K, Morillos S, McNeil J, Onisko N, Kern J, Andino A, Pruszynski JE, Adhikari EH
J Addict Med · 2025 Aug · PMID 40833012 · Publisher ↗
OBJECTIVES: The objectives of the study were to describe an integrated screening, brief intervention, treatment and referral (SBIRT) prenatal care program for opioid use disorder (OUD), factors influencing program engage...
OBJECTIVES: The objectives of the study were to describe an integrated screening, brief intervention, treatment and referral (SBIRT) prenatal care program for opioid use disorder (OUD), factors influencing program engagement, and the characteristics of pregnant and postpartum people with OUD. METHODS: This was a retrospective cohort study of 245 pregnant and postpartum people with OUD who had access to a 30-day SBIRT program at a safety-net hospital between March 15, 2021, and March 15, 2024. Multivariable logistic regression models assessed predictors of program completion, defined as engaging in 4 weekly outpatient visits. RESULTS: Forty-two percent of participants completed the program, and 86% received medication for opioid use disorder (MOUD). Factors that increased the likelihood of program completion included entry through referral versus the emergency department (OR: 3.05, 95% CI: 1.58-6.04), family history of SUD (OR: 2.28, 95% CI: 1.31-4.01), and comorbid psychiatric diagnosis (OR: 1.87, 95% CI: 1.04-3.39). The use of multiple substances (OR: 0.43, 95% CI: 0.19-0.92) and positive fentanyl screens (OR: 0.26, 95% CI: 0.12-0.55) decreased the likelihood of program completion. Neither trimester of pregnancy nor severity of OUD influenced program completion. Social determinants of health were common. CONCLUSIONS: An SBIRT program offering 24-hour coverage with skilled providers offering trauma-informed care and social supports integrated with prenatal care results in high engagement and acceptance of MOUD. Policy implications support improved access to naloxone, fentanyl testing strips, and maternity housing. Results suggest further research into the specific nature of how family history of SUD improves engagement in treatment programs.
Opioid Use Disorder Screening Practices in US Jails.
Bunting AM, Sobh S, Lee WY … +2 more , Lee M, Farabee D
J Addict Med · 2025 Aug · PMID 40810406 · Full text
OBJECTIVES: To describe the screening processes for opioid use disorder by jails in localities with high concentrations of opioid involved overdose deaths. METHODS: A secondary data analysis of structured interviews on o...
OBJECTIVES: To describe the screening processes for opioid use disorder by jails in localities with high concentrations of opioid involved overdose deaths. METHODS: A secondary data analysis of structured interviews on opioid use disorder practices from 185 jails in the United States was conducted. Descriptive statistics detailed jail screening characteristics, and bivariate statistics examined the association between screening characteristics and annual jail population. RESULTS: The majority of jails in high-overdose-burden localities had screening protocols in place for opioid use disorder (95.1%). The protocols varied, with most jails reporting the use of substance use (85.4%) or opioid use (77.0%) specific screeners. Yet few jails used validated screening tools (23.3%) and instead relied on agency or state-specific tools (89.0%). Significant differences by annual jail population were found related to who conducted screenings, such that the use of medical staff for screening (P<0.01) and clinical assessments (P<0.05) was more likely among larger jails. CONCLUSIONS: Screening and assessment of opioid use disorder is essential for individuals in jails, given the disproportionate burden of the disorder. Jails tended to rely on agency-created tools over the use of validated screeners, and more efforts may be needed to close the research-practice divide.
Parental Literacy on Adolescent Substance Use: A Crucial Yet Overlooked Factor.
Cohen M, Mikulincer M, Weller A
J Addict Med · 2026 May-Jun 01 · PMID 40801413 · Publisher ↗
Adolescent substance use (SU) presents a significant public health challenge that affects physical, psychological, and social well-being. Parents hold a vital role in recognizing early warning signs and facilitating inte...
Adolescent substance use (SU) presents a significant public health challenge that affects physical, psychological, and social well-being. Parents hold a vital role in recognizing early warning signs and facilitating intervention, yet parents' knowledge and ability to identify SU-related symptoms, locate trustworthy information, or navigate available treatment options (SU literacy) remain largely unexamined. This commentary explores the importance of parental SU literacy, the obstacles impeding it, and possible strategies to enhance parental awareness. Many parents encounter difficulties in recognizing symptoms, often misjudge the risks associated with occasional substance use or compulsive behaviors and are unsure about where to seek reliable support. In addition, stigma, misinformation, and a lack of accessible resources further hinder parents' ability to take timely action. Strategies to enhance parental SU literacy are discussed, aiming not only to promote early detection and intervention but also to reduce the long-term societal burden of adolescent SU.
N-acetylcysteine Efficacy on Cocaine Base Paste Use Disorder: A Randomized Double-blind Placebo-controlled Clinical Trial.
Betancur-Moreno C, Moraga-Escobar E, Gómez C … +3 more , Casanova MP, Bustos C, Vicente B
J Addict Med · 2025 Aug · PMID 40801394 · Publisher ↗
OBJECTIVES: To evaluate the clinical safety and efficacy of N-acetylcysteine (NAC) in prolonging abstinence time among adults with cocaine base paste (CBP) use disorder. METHODS: A phase II, randomised, double-blind, pla...
OBJECTIVES: To evaluate the clinical safety and efficacy of N-acetylcysteine (NAC) in prolonging abstinence time among adults with cocaine base paste (CBP) use disorder. METHODS: A phase II, randomised, double-blind, placebo-controlled clinical trial, with a parallel group design, was conducted in CBP use disorder treatment-seeking adults in public outpatient mental health units in the province of Concepción, Chile (n = 140). Participants were randomised to receive daily doses of 2400 mg of NAC or placebo. They were followed for 4 weeks, attending twice-weekly to assess medication-related evaluate adverse effects and to measure abstinence in terms of the days until first new CBP use after study entry. Statistical analysis was performed using the R statistical program, and survival analysis was conducted using Kaplan-Meier. RESULTS: NAC was a safe treatment without a severe adverse reaction, but it was not better than placebo to prolong the CBP abstinence time (P = 0.12). However, when considering a previous abstinence time of more than 7 days, differences were found in the NAC treatment arm, with better survival in the subgroup that had greater prior abstinence (P = 0.0052), which was not observed in the placebo treatment arm (P = 0.12). CONCLUSIONS: Although NAC did not demonstrate superiority over placebo in prolonging CBP abstinence, evidence suggests that its efficacy may be influenced by prior abstinence. These findings underscore the need for further research into how prior abstinence affects NAC efficacy, while also supporting the notion that NAC may be more effective for relapse prevention than for initiating abstinence.
Impact of X-Waiver Elimination on Post-Hospital Discharge Buprenorphine Prescribing: An Interrupted Time Series Analysis.
Wang PR, Mascha EJ, Li Y … +5 more , Bobak L, Dorney I, Costa G, Barnett B, Anand A
J Addict Med · 2025 Aug · PMID 40794490 · Publisher ↗
OBJECTIVES: This study aimed to assess the impact of the X-waiver elimination on buprenorphine prescribing following hospital discharge in patients with opioid use disorder (OUD). METHODS: We conducted a retrospective co...
OBJECTIVES: This study aimed to assess the impact of the X-waiver elimination on buprenorphine prescribing following hospital discharge in patients with opioid use disorder (OUD). METHODS: We conducted a retrospective cohort study using TriNetX, an aggregated electronic health record (EHR) research network containing the de-identified EHR data from over 60 million patients. Hospitalized adult patients with OUD were identified using diagnostic and discharge procedure codes between January 2022 and June 2023, spanning 1 year before and 6 months after waiver elimination. The primary outcome was the proportion of patients receiving a buprenorphine prescription within 1 month of discharge. We used an interrupted time series design with segmented logistic regression to examine changes in the prescription rate over time while adjusting for patient demographics and medical comorbidities. RESULTS: Among 64,979 hospitalizations, 45,288 occurred before and 19,691 after the X-waiver elimination. Overall, 14.3% of patients received a postdischarge buprenorphine prescription. Unadjusted analysis revealed an initial increase in prescriptions at the start of the postelimination period [odds ratio (OR): 1.2, 95% CI: 1.1-1.3, P < 0.001]. However, after adjusting for potential confounding due to baseline imbalances, both the immediate change in the proportion with prescriptions [OR: 1.12 (0.97, 1.3), P = 0.11] and slope [difference (SE) of -0.0074 (0.0057), P = 0.20] between the periods were not statistically significant. CONCLUSIONS: The elimination of the X-waiver does not appear to have altered buprenorphine prescribing practices in the short term, which suggests that long-term studies and additional strategies may be needed to address persistent barriers to effective treatment for OUD.
Pharmacokinetic Interactions Between Ethanol and PT150, a Selective Glucocorticoid Receptor Antagonist, in Healthy Volunteers.
Vaughan A, Mensah CK, Pennycuff J … +8 more , Venneman SS, Risborough V, Baker DG, Nowak KJ, Williams RL, Nolen TL, Kosten TR, Verrico CD
J Addict Med · 2025 Aug · PMID 40794488 · Publisher ↗
OBJECTIVES: PT150, a novel competitive glucocorticoid receptor antagonist, is hypothesized to be a potential treatment for alcohol use disorder, with safety studies as an important first step for medication development....
OBJECTIVES: PT150, a novel competitive glucocorticoid receptor antagonist, is hypothesized to be a potential treatment for alcohol use disorder, with safety studies as an important first step for medication development. We aimed to assess PT150 safety and tolerability, including impact on pharmacokinetics when administered concomitantly with ethanol in healthy participants. METHODS: This nonrandomized, single-site, drug-drug interaction study of PT150, coadministered with oral ethanol (alcohol beverage), was conducted at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, TX. Participants, each of whom received the same exposure sequence and served as their own control, were healthy, alcohol-experienced volunteers aged 21-64 years. Blood samples were obtained before and after 1.03 mL/kg ethanol exposure, before and after the fifth dose of PT150 (900 mg/d), and again before and after a sixth dose of PT150 (900 mg/d) administered with 1.03 mL/kg of ethanol. The primary pharmacokinetic outcomes included differences in peak plasma concentrations (Cmax), time to reach peak plasma concentrations (tmax), terminal elimination half-life (t1/2), and area under the concentration-time curve (AUC) of PT150 alone and in combination with ethanol. RESULTS: There was no statistically significant evidence that coexposure to ethanol impacted PT150 pharmacokinetics, and no statistically significant evidence that coexposure to PT150 impacted ethanol pharmacokinetics. There were no clinically significant abnormal electrocardiograms or serious adverse events. CONCLUSIONS: These data suggest that coadministration of PT150 and alcohol does not produce significant pharmacokinetic interactions, supporting the feasibility of evaluating PT150 in future clinical trials for alcohol use disorder.
Sex Moderates Relationships Between Alcohol Use Disorder, Brain Structure, and Perceived Emotional Support in Young Adults.
McCurdy LY, Cheng A, Potenza MN … +1 more , Zhao Y
J Addict Med · 2026 Mar-Apr 01 · PMID 40794481 · Publisher ↗
OBJECTIVES: Social support is associated with myriad health benefits, including recovery from alcohol use disorder (AUD). Understanding its neural features may aid in intervention development. However, most neuroimaging...
OBJECTIVES: Social support is associated with myriad health benefits, including recovery from alcohol use disorder (AUD). Understanding its neural features may aid in intervention development. However, most neuroimaging studies investigating social support do not consider potential neuroanatomical differences related to sex and AUD, even though both factors have been related to social support. This study investigated neuroanatomical correlates of perceived emotional and instrumental support as a function of sex and lifetime AUD using Human Connectome Project data. METHODS: T1-weighted magnetic resonance imaging data were collected. Gray-matter volume in brain regions associated with social support was quantified in a large sample of young adults (522 women and 432 men) who did and did not have a lifetime AUD status. Perceived emotional and instrumental support were determined via self-report scales. Relationships between gray-matter volumes and perceived emotional/instrumental support were determined for each demographic category (women/men, lifetime AUD/no-AUD) via interaction analyses. RESULTS: Gray-matter volumes in 2 brain regions (left rostral anterior cingulate cortex and left lateral orbitofrontal cortex) were inversely associated with perceived emotional support in women with lifetime AUD, such that larger gray-matter volume was associated with lower perceived emotional support. This relationship was not observed in women without lifetime AUD or men with or without lifetime AUD. No associations were observed with instrumental support. CONCLUSIONS: Women differ from men in brain-behavior relationships involving perceived emotional support in a manner linked to AUD status. Sex differences warrant further investigation as social support in AUD may operate differently in women and men.
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