Drug And Alcohol Dependence[JOURNAL]
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200 papers
Cannabinoid (CB) 1 receptor antagonists block fentanyl conditioned place preference but not fentanyl antinociception.
Morrisson D, Smith EC, Alkhelb D … +5 more , Ho T, Ji L, Sromek AW, Makriyannis A, Desai RI
Drug Alcohol Depend · 2026 Jun · PMID 42401067 · Publisher ↗
BACKGROUND: Preclinical studies have found the cannabinoid (CB) 1 receptor inverse agonist/antagonist rimonabant and CB neutral antagonists (AM4113, AM6527) to attenuate the addiction-related behavioral effects of opioid...
BACKGROUND: Preclinical studies have found the cannabinoid (CB) 1 receptor inverse agonist/antagonist rimonabant and CB neutral antagonists (AM4113, AM6527) to attenuate the addiction-related behavioral effects of opioids, suggesting that these drugs may be useful for managing opioid use disorder (OUD). However, the psychiatric side effect profile of rimonabant in clinical trials-an effect partially attributable to its inverse agonist activity-has impeded the clinical utility of CB antagonists. Consequently, CB neutral antagonists that are devoid of an inverse agonist-like side-effect profile may be useful as treatments for OUD. Here, we evaluated whether rimonabant, AM4113, and AM6527 attenuated the rewarding effects of fentanyl and whether they impacted its antinociceptive properties. METHODS: Conditioned place preference (CPP) procedures were used to analyze modulation of fentanyl-induced reward; CB antagonists were administered either with fentanyl during conditioning (acquisition) or on test day after conditioning was complete (expression). Warm water tail withdrawal procedures were used to evaluate whether CB antagonists modified the antinociceptive effects of fentanyl in mice. RESULTS: Like rimonabant, the CB neutral antagonists AM4113 and AM6527 attenuated both the acquisition and the expression of fentanyl-induced CPP. In the tail withdrawal experiments, the CB antagonists did not alter fentanyl-induced antinociception and did not produce antinociceptive effects when administered on their own. CONCLUSIONS: These results add to a growing body of evidence that CB neutral antagonists can attenuate the rewarding properties of opioids while sparing their therapeutically desirable antinociceptive effects, providing support for further investigation of CB neutral antagonists as possible treatments for OUD.
Opioid use disorder and hospital readmission in the United States from 2010 to 2022: Primary reasons and the complex interplay of comorbid conditions.
Qeadan F, Thornquist R, McCunn A … +3 more , Tingey B, Moffett ML, Azagba S
Drug Alcohol Depend · 2026 Jun · PMID 42391781 · Publisher ↗
BACKGROUND: The opioid epidemic in the United States (U.S.) is a critical public health issue that has led to a sharp increase in opioid-related deaths, as well as significant implications for healthcare systems, includi...
BACKGROUND: The opioid epidemic in the United States (U.S.) is a critical public health issue that has led to a sharp increase in opioid-related deaths, as well as significant implications for healthcare systems, including increased readmission rates. This study examines how opioid use disorder (OUD), when not the primary diagnosis, influences the risk of hospital readmission among other primary health condition groups. METHODS: This retrospective study used data from the Nationwide Readmissions Database (NRD) from 2010 to 2022. Modified Poisson regression models were employed with Taylor-series linearization variance estimation to approximate relative risks (RRs) and 95% confidence intervals (CIs) to assess the association between secondary OUD status and all-cause, primary health condition (PHC)-specific, and substance use disorder (SUD)-specific readmission across five different PHCs (i.e., cardiovascular disease [CVD], respiratory disease [RD], mental health disorder [MHD], chronic pain [CP], and SUDs other than OUD). RESULTS: For all years and PHCs besides MHD and other SUDs, secondary OUD was associated with significantly higher risk of all-cause readmission (e.g. , CVD: 2010 aRR [95% CI]: 1.19 [1.11, 1.27]; 2022 aRR [95% CI]: 1.10 [1.07, 1.14]). The risk of RD-specific and CP-specific readmission was significantly higher for patients with secondary OUD than those without. For all years and PHCs besides other SUDs, secondary OUD was associated with significantly higher risk of SUD-specific readmission. CONCLUSION: Secondary OUD was differentially associated with hospital readmission across PHCs, with added risk when accompanied by select comorbidities. Findings support condition-tailored discharge planning, OUD treatment linkage, addiction consultation, peer navigation, and post-discharge follow-up.
Impact of medicaid waivers on medication for opioid use disorders in residential facilities: Evidence from twenty-five states.
Mullachery PH, Hodgkin D, Yucel R … +1 more , Stewart MT
Drug Alcohol Depend · 2026 Jun · PMID 42385582 · Publisher ↗
BACKGROUND: Medicaid Section 1115 waivers allow states to test demonstration programs with the potential to shape access to care for millions of beneficiaries. The Institutions for Mental Diseases (IMD) waiver enables st...
BACKGROUND: Medicaid Section 1115 waivers allow states to test demonstration programs with the potential to shape access to care for millions of beneficiaries. The Institutions for Mental Diseases (IMD) waiver enables states to use federal funds to treat substance use disorders in residential facilities, bypassing Medicaid's long-standing IMD exclusion. We assessed the impact of IMD waiver adoption on the use of medication for opioid use disorder (MOUD) by estimating cohort-specific effects among four groups of states that adopted waivers between 2016 and 2019. METHODS: We used Treatment Episode Data Set data. Data on the outcome, i.e., MOUD use among opioid-involved treatment episodes, and covariates were linked to data on waiver effective date, extracted from waiver approval documents. We used difference-in-differences to estimate models stratified by treatment setting (residential vs. non-residential) and adjusted for state-level policy indicators, and state- and year-fixed effects. RESULTS: MOUD use was low, especially among residential admissions, but increased over time from 5% in 2014-18% in 2019. In adjusted models, the cohort of states that adopted a waiver in 2016 showed higher odds of MOUD use in residential settings (OR=1.49, 95% CI: 1.21-1.84) relative to the comparison group. However, this pattern was not replicated for the later cohorts. Finally, waiver adoption did not have an impact on MOUD use in non-residential settings. CONCLUSION: In early adopter states, IMD waivers might have facilitated MOUD use in residential facilities, but their effects varied across cohorts.
Mental and somatic multimorbidity among individuals with alcohol use disorder: A sex-stratified registry study.
Scarth M, Bjørnebekk A, Bramness JG … +2 more , Abebe DS, Stavseth MR
Drug Alcohol Depend · 2026 Jun · PMID 42378780 · Publisher ↗
BACKGROUND: Alcohol use disorder (AUD) is a serious public health challenge associated with increased morbidity and mortality. While AUD is more common among males, the sex gap is narrowing; nevertheless, AUD remains und...
BACKGROUND: Alcohol use disorder (AUD) is a serious public health challenge associated with increased morbidity and mortality. While AUD is more common among males, the sex gap is narrowing; nevertheless, AUD remains underdiagnosed in females. Identifying sex-specific multimorbidity patterns could improve targeted screening and identification. METHODS: Using the Norwegian Patient Registry, we identified 67,358 individuals with AUD (31.2% female) and age- and sex-matched controls. We compared sex differences in the prevalence of the 20 most common mental and somatic diagnoses within and between the AUD group and controls. We analysed multimorbidity using upset plots and correlation networks. RESULTS: Females with AUD had higher overall multimorbidity than males (median 9 [IQR: 5-14] vs. 6 [3-11] diagnoses). Asthma, eating disorders, and dementia were overrepresented among females with AUD. The most common diagnosis combinations in females with AUD involved overlaps between mental and somatic conditions, particularly other substance use disorders or depression combined with soft tissue disorders, urinary tract infections, or medical abortion. Males predominantly showed within-domain combinations. Correlation network analyses revealed a distinct pain-related cluster linking mental and somatic conditions in females with AUD, but not in control females. CONCLUSIONS: Females with AUD experience a disproportionately high level of multimorbidity, with distinct patterns, often involving combinations of somatic and mental diagnoses. Pain conditions serve as important links between mental and somatic comorbidity, especially for females. These findings support further investigation into sex-specific screening protocols, recognition of distinct clinical contact points, and integrated treatment approaches for AUD.
Monitoring novel psychoactive substance trends on social media: Analysis of discussions and dashboard implementation.
Lakamana S, Das S, Spadaro A … +3 more , Wightman R, Perrone J, Sarker A
Drug Alcohol Depend · 2026 Jun · PMID 42378779 · Full text
INTRODUCTION: Novel psychoactive substances (NPSs), due to rapid emergence and evolving use patterns, pose a significant public health surveillance challenge. Traditional surveillance lags street-level reality, necessita...
INTRODUCTION: Novel psychoactive substances (NPSs), due to rapid emergence and evolving use patterns, pose a significant public health surveillance challenge. Traditional surveillance lags street-level reality, necessitating the exploration of novel strategies and data sources like Reddit for continuous NPS trend monitoring and presenting a public dashboard. METHODS: We mined data from 60,601 subreddits between January 2015 and June 2025 for seven NPSs (kratom, xylazine, medetomidine, nitazenes, tianeptine, bromazolam, and 2C-B) using keyword-variants. We performed Mann-Kendall trend tests to assess temporal patterns, computed correlations to compare post volumes with National Forensic Laboratory Information System (NFLIS) drug report counts (2015-2024), conducted cross-correlation analyses at ±2-year lags to identify lead-lag relationships, and created a public dashboard for data visualization. RESULTS: The dataset comprised 328,223 posts from 139,901 accounts. We observed moderate to strong correlations between Reddit volumes and three out of five NPSs with NFLIS reports: bromazolam (ρ = 0.81, p < 0.001), tianeptine (ρ = 0.48, p = 0.04), xylazine (ρ = 0.60, p < 0.001). Cross-correlation analyses indicated Reddit discussions preceded NFLIS reports for medetomidine (ρ = 0.93, lag = -2 years), bromazolam (ρ = 0.86, lag = -1year), tianeptine (ρ = 0.81, lag = -2years), and xylazine (ρ = 0.62, lag = -2years), suggesting Reddit discussions as a potential leading indicator. Co-mention of other substances with NPSs often matched known trends from retrospective data. CONCLUSION: Reddit-based surveillance provides timely and complementary signals to traditional forensic systems for NPS monitoring. Interactive visualizations and downloadable aggregated statistics are available via our dashboard.
A meta-analysis on the relationship between cultural identity and substance use among indigenous youth.
Fisher-Fox L, Spillane NS, Sizemore Y … +3 more , Johnson I, Hirsh A, Cyders MA
Drug Alcohol Depend · 2026 Jun · PMID 42364285 · Publisher ↗
BACKGROUND: The association between cultural identity and substance use varies across studies, highlighting the need to quantify this relationship and identify sources of variability. This meta-analysis quantified the re...
BACKGROUND: The association between cultural identity and substance use varies across studies, highlighting the need to quantify this relationship and identify sources of variability. This meta-analysis quantified the relationship between cultural identity and substance use among North American Indigenous youth, tested potential moderators, and described measurement approaches and tribal nation representation. METHOD: A systematic literature search identified 18 studies reporting a quantifiable association between cultural identity and substance use with samples of at least 75% Indigenous youth between the ages of 10 and 20 years. Random effects models were used to calculate pooled effect sizes (Pearson's r), and meta-regressions assessed for potential moderating effects of age, sex, measurement approach, and living on a reservation. RESULTS: Overall, there was no significant pooled association between cultural identity and substance use in Indigenous youth (r = -0.003, p = .86). Effects were similar across alcohol, tobacco, and cannabis. However, heterogeneity was high (I=72%), and funnel plot asymmetry suggested possible publication bias (p = .04). Age, sex, living on a reservation, and measurement approach did not moderate the overall effect (p's > .49). Tribal affiliation was largely not reported. CONCLUSIONS: This is the first meta-analysis to quantify the association between cultural identity and substance use among Indigenous youth. Although the overall pooled association was not statistically significant, this likely reflects limitations in how cultural identity is operationalized within quantitative research, leaving the question as to how cultural identity may impact substance use among Indigenous youth as of yet unanswered. Identifying which components of cultural identity are most relevant for Indigenous youth substance use will yield a better understanding of this relationship to inform the development of culturally sensitive interventions.
Examining heterogeneity in pathways between alcohol-related factors and drinking during topiramate pharmacotherapy: A person-specific analysis.
Piccirillo ML, Votaw VR, Witkiewitz K … +3 more , Roche DJO, Kranzler HR, Foster KT
Drug Alcohol Depend · 2026 Jun · PMID 42349050 · Publisher ↗
BACKGROUND: Treatment for alcohol use disorder (AUD) is complicated by person-specific heterogeneity in factors related to AUD risk, maintenance, and recovery. To advance precision treatment, it is important to study sou...
BACKGROUND: Treatment for alcohol use disorder (AUD) is complicated by person-specific heterogeneity in factors related to AUD risk, maintenance, and recovery. To advance precision treatment, it is important to study sources of variability in the determinants of AUD treatment response. METHODS: We analyzed interactive voice response data measuring nightly drinking, desire to drink, self-efficacy to resist drinking, and drinking expectancies from two, 12-week randomized placebo-controlled trials of topiramate for drinking reduction (N = 214). World Health Organization risk drinking levels were used to measure both pre-treatment alcohol use and treatment response (i.e., reductions in risk levels). Group iterative multiple method estimation was used to determine the presence and frequency of shared versus person-specific associations between alcohol-related factors and nightly drinking. Associations between indicators of person-specific heterogeneity and pre-treatment alcohol use severity or degree of treatment response were also examined. RESULTS: Few shared pathways between alcohol-related factors and nightly drinking were observed, indicating notable person-specific heterogeneity. Nightly drinking was most often associated with same-day self-efficacy, but only for a minority (i.e., less than 20%) of the full sample. Indicators of person-specific heterogeneity were not associated with pre-treatment alcohol use severity or degree of treatment response (p > .05). CONCLUSIONS: Patterns of risk for nightly drinking during topiramate treatment may be largely person specific. More research is needed to develop approaches that target person-specific risk to optimize treatment responses for all individuals receiving pharmacotherapy for AUD.
The impact of severe mental illness on treatment retention and all-cause mortality among people in opioid agonist treatment.
Gisev N, Santo T, Lappin J … +6 more , Lintzeris N, Gibson A, Larney S, Mills L, Degenhardt L, Jones NR
Drug Alcohol Depend · 2026 Jun · PMID 42341384 · Publisher ↗
BACKGROUND: Severe mental illness (SMI - psychotic and bipolar disorders) is common among individuals with opioid use disorder (OUD). This study examined the impact of SMI on opioid agonist treatment (OAT) retention, and...
BACKGROUND: Severe mental illness (SMI - psychotic and bipolar disorders) is common among individuals with opioid use disorder (OUD). This study examined the impact of SMI on opioid agonist treatment (OAT) retention, and SMI and OAT on all-cause mortality. METHODS: A retrospective cohort study of 14763 individuals receiving OAT for the first time in New South Wales, Australia, 2006-2017. OAT records were linked to hospital, mental health treatment, and custodial information. Multivariable Cox regression models were used to compare OAT cessation/retention and all-cause mortality among those with/without SMI, adjusting for potential confounders. RESULTS: There were 1989 (13.5%) individuals with SMI and 763 (5.2%) deaths. The risk of treatment cessation during a first OAT episode was 16% higher for individuals with SMI [adjusted hazard ratio (aHR) 1.16, 95% confidence interval (CI) 1.09-1.23]. Among those with multiple OAT episodes, differences in retention between those with/without SMI were most notable in the first three treatment episodes; this difference was attenuated between episodes four to five. Although SMI increased mortality risk [aHR 1.35; 95% CI 1.14-1.60] and being in OAT decreased mortality risk [aHR 0.24; 95% CI 0.20-0.29], OAT status did not modify the effect of SMI on overall mortality risk. CONCLUSIONS: Comorbid SMI and OUD significantly reduces OAT retention during early episodes of treatment and is associated with increased mortality risk. There is no differential treatment effect on mortality among those with and without SMI. Interventions to identify, support, and engage individuals with SMI in OAT are needed early after commencing treatment.
Does treatment status matter? An examination of daily approach and avoidance inclinations predicting drinking in individuals diagnosed with alcohol use disorder.
Schlauch RC, Dvorak R, Walsh B … +2 more , De Leon A, Davis J
Drug Alcohol Depend · 2026 Aug · PMID 42335742 · Publisher ↗
AIMS: Traditional craving models do not assess competing desires and account for craving as a function of attempts to change problematic drinking behaviors, thereby limiting the utility of the information obtained. The A...
AIMS: Traditional craving models do not assess competing desires and account for craving as a function of attempts to change problematic drinking behaviors, thereby limiting the utility of the information obtained. The Ambivalence Model of Craving defines craving as the coactivation of both desires to consume (approach) and to avoid consuming alcohol (avoidance). The current study examined the daily associations between approach/avoidance, and drinking in those diagnosed with alcohol use disorder (AUD), including how treatment status moderated such relationships. METHOD: Individuals diagnosed with AUD (n = 98) provided daily reports on drinking and approach/avoidance inclinations for 90-days. At the end of the first 30 days, participants were offered treatment. Multilevel negative binomial hurdle modeling was conducted to examine within-person effects of approach, avoidance, treatment status, and their interaction on drinking likelihood and quantity. RESULTS: A significant Approach×Avoidance×Treatment-Status interaction was found for drinking likelihood. On days not enrolled in treatment, higher approach was associated with increased drinking likelihood. On days enrolled in treatment, as avoidance increased, the effect of approach on drinking likelihood was attenuated, with such effects more robust at average and low levels of approach. Approach was also associated with a small increase in number of drinks consumed on drinking days; these findings did not vary by avoidance nor treatment status. Conclusion These findings reiterate the importance of adopting a multidimensional framework of craving that considers co-occurring approach and avoidance and suggests that craving processes may operate differently among individuals who are endorsing some degree of motivation for change.
Substance use, recovery capital, and social networks of adolescents recently initiating inpatient treatment.
Hennessy EA, George SS, Best D … +1 more , Litt MD
Drug Alcohol Depend · 2026 Aug · PMID 42335741 · Publisher ↗
BACKGROUND: A variety of personal and environmental resources (recovery capital: RC) support recovery for adolescents. Social identity theory suggests one's alcohol and other drug (AOD) use behavior is strongly influence...
BACKGROUND: A variety of personal and environmental resources (recovery capital: RC) support recovery for adolescents. Social identity theory suggests one's alcohol and other drug (AOD) use behavior is strongly influenced by social network behavior. This study examined how the level of pretreatment substance use was associated with RC and social network characteristics among youth entering inpatient treatment. Understanding these relationships may help inform initial treatment engagement and post-treatment transitions. METHOD: Participants (N = 108; Mage=17.1; 61% male; 70% White) completed standardized measures on admission to inpatient treatment: demographics, past 90-day substance use, recovery capital, and social network composition/behavior. Regression analyses were used to examine relationships between AOD use before treatment and (1) recovery capital and (2) level of identification with network groups. RESULTS: On average, in the 90 days prior to entry into treatment adolescents consumed alcohol on 20.3 days, used cannabis on 46.5 days, and used other substances (e.g., cocaine) on 17.3 days. The mean RC score was 36.8 (range 25-50). Being male and having more treatment days before baseline were associated with higher RC. Pre-treatment substance use was not consistently associated with RC levels. 70% of participants included at least one family or friend group who used AODs. Participants with a recovery group identified more strongly with that group than with substance-using groups (M=7.28 compared to M=6.63 for groups using substances heavily; scale 0-10). CONCLUSIONS: Adolescents appear to have flexible social identities and potentially risky post-treatment relationships, highlighting the need to engage them in recovery-supportive networks following treatment.
A random-forest approach for identifying classifiers for concurrent cannabis and tobacco use in US youth.
Ugoh M, Sokolovsky AW
Drug Alcohol Depend · 2026 Aug · PMID 42335740 · Publisher ↗
BACKGROUND: Nicotine and tobacco products (NTP) and cannabis co-use entail unique risks. However, research on the correlates of co-use is limited, focusing on small samples, subpopulations, or specific correlates, withou...
BACKGROUND: Nicotine and tobacco products (NTP) and cannabis co-use entail unique risks. However, research on the correlates of co-use is limited, focusing on small samples, subpopulations, or specific correlates, without holistically examining multiple risk behaviors. Using an exploratory, hypothesis-generating approach, this study aimed to identify classifiers of past 30-day co-use of cannabis and NTP using random forest regression in a nationally representative adolescent sample. METHODS: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS). Participants were 20,103 US adolescents in grades 9-12. Complete-case analyses included 8263 participants. The sample was 51.9% male and racially and ethnically diverse. The primary outcome was a binary indicator of past 30-day co-use of cannabis and NTPs. Classifiers included demographic, behavioral, and psychosocial factors. Random forest regression, including hyperparameter tuning, importance ranking of classifiers, and model robustness measures, were conducted in complete-case and multiply imputed data. RESULTS: Ten variables emerged as consistent and strongest classifiers of co-use, including past 30-day alcohol use (M=1.00; SD=0.00), ever having had sexual intercourse (M=2.36; SD=0.50), past 30-day binge drinking (M=2.64; SD=0.50), and alcohol or drug use during last sexual intercourse (M=4.00; SD=0.00). Models using imputed data achieved lower OOB error rates compared to the complete-case model. CONCLUSIONS: Among US adolescents, alcohol use and sexual behavior were the most salient classifiers of cannabis and NTP co-use. These findings highlight the importance of holistic examinations of multiple health risk behaviors.
Social vulnerability and prenatal cannabis safety messaging from cannabis retailers in California.
Young-Wolff KC, Simard BJ, Does MB … +10 more , Negusse R, Adams SR, Metz TD, Silver LD, Nugent JR, Ogden SN, Soroosh AJ, Voelkel JL, Pilato CE, Padon AA
Drug Alcohol Depend · 2026 Aug · PMID 42335739 · Publisher ↗
BACKGROUND: Prenatal cannabis use is increasing, and pregnant individuals often seek guidance from cannabis retailers. It is unknown whether budtender messaging varies by community social vulnerability. METHODS: This cro...
BACKGROUND: Prenatal cannabis use is increasing, and pregnant individuals often seek guidance from cannabis retailers. It is unknown whether budtender messaging varies by community social vulnerability. METHODS: This cross-sectional mystery shopper study included 505 randomly selected California licensed cannabis retailers (2/26/2024-1/28/2025). Social vulnerability within a 15-minute drive-time buffer around retailers was measured by the CDC Social Vulnerability Index (SVI; range 0-1; four domains: socioeconomic status, household characteristics, racial/ethnic minority status, housing/transportation). The primary outcome was a 4-category prenatal cannabis risk communication measure: clear risk messaging [reference], mode-specific lower-risk messaging, no clear safety/risk messaging, and safety-affirming messaging. Secondary outcomes included product recommendations, fetal or infant health risks, information sources, and guidance to consult a clinician. Logistic and multinomial logistic regression models assessed associations between SVI and outcomes; SVI was multiplied by 10, so estimates reflect odds associated with a 0.1 increase in SVI. RESULTS: Greater household vulnerability was associated with safety-affirming messaging (OR=1.26;95%CI:1.01-1.56) and no clear safety/risk messaging (OR=1.25; 95%CI:1.05-1.50) versus clear risk messaging. Greater racial/ethnic minority vulnerability was associated with safety-affirming versus clear risk messaging (OR=1.21; 95%CI:1.00-1.47). Greater housing/transportation vulnerability was associated with mode-specific lower-risk messaging versus clear risk messaging (OR=1.42; 95%CI:1.06-1.91). Citing warnings was more common in areas with greater socioeconomic vulnerability (OR=1.23; 95%CI:1.01-1.51). Other outcomes did not differ by SVI. CONCLUSIONS: Budtenders in more vulnerable areas were more likely to provide safety-affirming, mode-specific lower-risk, or no clear safety/risk messaging rather than clear prenatal cannabis risk messaging. Findings highlight the need for consistent, evidence-based communication in retail settings.
Missed opportunities for Hepatitis C Virus screening and care among persons hospitalized for injection-related infections.
McGonigle K, Catalanotti JS, Kattakuzhy S … +11 more , Rosenthal E, Traver EC, Brokus C, Carpenter J, Steck A, Eaton E, Reece R, Mai W, Notis M, Akselrod H, Kuo I
Drug Alcohol Depend · 2026 Aug · PMID 42330593 · Publisher ↗
Hospitalization provides an opportunity to improve the Hepatitis C Virus (HCV) cascade of care among people who inject drugs. Little is known about whether this potential opportunity is utilized. We conducted a retrospec...
Hospitalization provides an opportunity to improve the Hepatitis C Virus (HCV) cascade of care among people who inject drugs. Little is known about whether this potential opportunity is utilized. We conducted a retrospective chart review at four U.S. academic medical centers among patients hospitalized between 1/1/2018-3/31/2022 with ICD-10 diagnosis codes for both opioid use disorder and acute bacterial or fungal infection. Electronic medical records were reviewed manually to confirm injection drug use-related infection for inclusion in the study. Data abstracted from medical records included baseline HCV status at the time of admission; whether HCV antibody screening and confirmatory viral load testing were performed during hospitalization, and their results; follow up for HCV treatment within the same medical system after discharge; and response to treatment. A total of 1651 patients were included. Seventy-five percent of patients with unknown HCV status at the time of admission were screened for HCV during hospitalization, of whom 66% screened positive. Of those with a confirmatory ribonucleic acid (RNA) test, 62% had a detectable viral load (VL). Seventeen percent of those with detectable VL attended a follow up appointment within 12 months. Fifty-five percent of patients with known prior HCV infection were RNA tested, and 65% of those tested had detectable virus. Results revealed sizeable attrition along the entire HCV cascade of care and missed opportunities to engage people who inject drugs in follow up during hospitalization for other infections. Hospitalized individuals who inject drugs need targeted interventions to improve HCV screening, diagnosis, and care linkage.
Hippocampal volume alterations in opioid use disorder: Evidence for posterior vulnerability and heterogeneity.
Regier PS, McKinstry D, Stein JM … +9 more , Hager NM, Barash J, Miano T, Langleben DD, Manza P, Volkow ND, Shi Z, Wiers CE, Kofke WA
Drug Alcohol Depend · 2026 Aug · PMID 42330592 · Publisher ↗
Evidence is emerging that chronic exposure to opioids can impact brain structure, with preclinical studies demonstrating alterations in subcortical regions, including the hippocampus; however, corresponding evidence in h...
Evidence is emerging that chronic exposure to opioids can impact brain structure, with preclinical studies demonstrating alterations in subcortical regions, including the hippocampus; however, corresponding evidence in humans remains limited. The present study investigates whether individuals with opioid use disorder (OUD) exhibit smaller hippocampal volumes relative to controls and explores heterogeneity within the OUD group as well as associations between hippocampal volume and cognitive performance. Participants with OUD (n = 94) and controls (n = 40) completed a structural magnetic resonance imaging scan, and a subset of 18 OUD and 10 controls who completed a standardized neurocognitive battery. Hippocampal volumes were extracted using the Automatic Segmentation of Hippocampal Subfields (ASHS). Primary analyses examined group differences in bilateral whole, anterior, and posterior hippocampus. Exploratory analysis assessed heterogeneity within OUD (e.g., methadone-treated vs buprenorphine-treated vs no treatment) and associations between hippocampal volumes and cognitive performance. Individuals with OUD exhibited significantly smaller left and right hippocampal volumes relative to controls. When examining anterior vs posterior subregions, significant effects were strongest in the posterior right hippocampus. Exploratory analyses further suggested significant heterogeneity within the OUD group, with methadone-treated individuals exhibiting smaller posterior volumes relative to controls and buprenorphine-treated participants. In the neurocognitive subset, hippocampal volume was associated with episodic memory performance. These findings suggest that OUD is associated with smaller hippocampal volumes and that clinically meaningful heterogeneity exists within OUD populations, warranting further investigation into the mechanisms underlying these differences.
Testing a social mechanism of recovery high schools: Peer affiliation as a mediator of substance use outcomes.
Berny LM, Hennessy EA, Finch AJ … +1 more , Tanner-Smith EE
Drug Alcohol Depend · 2026 Aug · PMID 42330591 · Publisher ↗
PURPOSE: Limited options for developmentally appropriate continuing care represent a critical barrier for youth in recovery. As one of the few options designed specifically for adolescents, recovery high schools (RHSs) w...
PURPOSE: Limited options for developmentally appropriate continuing care represent a critical barrier for youth in recovery. As one of the few options designed specifically for adolescents, recovery high schools (RHSs) warrant investigation to better understand their effects and the mechanisms through which they operate. This study examined the long-term effects of RHS attendance and tested whether peer-level social change operates as a mechanism. METHODS: Data were drawn from a longitudinal, group-design study of RHS effectiveness. Twelve-month follow-up substance use outcomes were compared between 146 adolescents who enrolled in RHSs after treatment and a propensity score-balanced comparison group of 117 adolescents who enrolled in traditional schools. Time-lagged mediation models tested whether recovery-positive peer affiliation at the 6-month follow-up mediated these effects. RESULTS: Relative to the comparison group at the 12-month follow-up, adolescents who attended an RHS were less likely to have alcohol use disorder (OR = 0.31) or a drug use disorder (OR = 0.42), reported fewer cannabis use days (IRR = 0.62), and had higher odds of abstinence (OR = 2.53) after adjusting for baseline levels. Recovery-positive peer affiliation mediated the beneficial effects of RHS attendance on meeting criteria for a drug use disorder, cannabis use frequency, and abstinence. CONCLUSIONS: These findings provide robust evidence of the long-term beneficial effects of RHS attendance and indicate that some benefits result from improvements in recovery-positive peer affiliation. Improving access to youth-focused recovery supports that facilitate positive social network changes could help reduce relapse risk and sustain treatment effects.
Progress toward hepatitis C elimination among people who inject drugs in San Francisco, 2018 - 2024.
Hernandez CJ, Suprasert B, Baguso G … +2 more , Wilson EC, McFarland W
Drug Alcohol Depend · 2026 Aug · PMID 42322940 · Publisher ↗
BACKGROUND: Hepatitis C virus (HCV) remains a major cause of liver-related morbidity and mortality, with people who inject drugs (PWID) disproportionately affected. San Francisco has implemented elimination efforts throu...
BACKGROUND: Hepatitis C virus (HCV) remains a major cause of liver-related morbidity and mortality, with people who inject drugs (PWID) disproportionately affected. San Francisco has implemented elimination efforts through End Hep C SF since 2016. This study evaluated progress toward HCV elimination among PWID in San Francisco from 2018 to 2024. METHODS: We analyzed data from the 2018, 2022, and 2024 National HIV Behavioral Surveillance (NHBS) PWID cycles in San Francisco. Respondent-driven sampling was used to recruit PWID aged ≥ 18 years. Participants completed interviewer-administered surveys and underwent HCV antibody testing (2018, 2022, 2024) and RNA testing (2018, 2024). Temporal changes in HCV-related outcomes were examined using Poisson regression with robust variance to estimate prevalence ratios (PRs). RESULTS: A total of 456 participants enrolled in 2018, 527 in 2022, and 512 in 2024. Median age decreased from 48 to 41 years, and stimulant injection increased from 24% to 59%. Active HCV infection (RNA+) declined from 40% in 2018-11% in 2024 (aPR 0.86), while HCV antibody positivity declined from 76% in 2018-43% in 2024 (aPR 0.97). Self-reported HCV positivity decreased from 59% to 39%. Treatment uptake among participants reporting HCV positivity increased from 38% in 2018-60% in 2024 (aPR 1.08), while HCV screening declined over time (aPR 0.96). Black participants had lower HCV prevalence and steeper declines, while Native Americans had persistently elevated risk. CONCLUSIONS: San Francisco has made substantial progress toward HCV elimination among PWID, with marked reductions in active infection. Sustaining elimination will require renewed investments in screening, linkage to care, and harm reduction interventions.
Dezocine-mediated reversal of sufentanil-induced respiratory depression and its mitigation of adverse reactions: A clinical investigation.
Gui YK, Liu LF, Shan ML … +4 more , Wang JW, Yang X, Da X, Xu GH
Drug Alcohol Depend · 2026 Aug · PMID 42320228 · Publisher ↗
BACKGROUND: Respiratory depression (RD) is the most life-threatening adverse reaction associated with opioid drug use. However, previous studies have found that partial opioid receptor agonists can effectively reverse RD...
BACKGROUND: Respiratory depression (RD) is the most life-threatening adverse reaction associated with opioid drug use. However, previous studies have found that partial opioid receptor agonists can effectively reverse RD induced by opioid drugs. METHODS: Sixty eligible patients were randomly assigned to either the Dezocine group (group D) or the Control group (group C). Patients in group D were given sufentanil combined with dezocine (0.1mg/kg) within 10s. Patients in group C were given sufentanil combined with the same volume of normal saline. During intravenous administration, oxygen inhalation at 5L/min was also administered. RESULTS: The RD ED in group D was 0.486μg/kg (95% CI: 0.411-0.546μg/kg), while that in group C was 0.293μg/kg (95% CI: 0.252-0.336μg/kg). RD occurred in 12 patients in group D and 14 patients in group C. RD in both groups was mainly characterized by a reduced respiratory rate. There were no significant differences in the incidence or types of RD within the first 5 and 10min after administration (P > 0.05). When RD occurred, percutaneous oxygen saturation in all patients remained above 98%. CONCLUSIONS: Dezocine can partially reverse RD induced by sufentanil and increase the ED of RD induced by sufentanil.
Methcathinone self-administration decreases dopamine and serotonin transporter function in rats.
Magee CP, Nguyen K, Le BD … +3 more , Siripathane YH, Hanson GR, Fleckenstein AE
Drug Alcohol Depend · 2026 Aug · PMID 42314494 · Publisher ↗
OBJECTIVE: Methcathinone is a synthetic cathinone that has high misuse liability and produces its stimulant effects through acute actions on monoaminergic transporters, including the dopamine and serotonin transporters....
OBJECTIVE: Methcathinone is a synthetic cathinone that has high misuse liability and produces its stimulant effects through acute actions on monoaminergic transporters, including the dopamine and serotonin transporters. While direct effects of methcathinone on monoaminergic transporters have been studied in cells lines and rodent synaptosomes, the impact of methcathinone self-administration has not been reported. Since evidence suggests that investigator-administered drug and/or in vitro drug exposure do not necessarily model the impact of drug self-administration, this study tested whether methcathinone self-administration acutely affects striatal dopamine or hippocampal serotonin transporter function. METHODS: Adult male Sprague Dawley rats underwent 7 consecutive days of selfadministration (FR1; 240min/session; 0.18mg/10μl infusion of methcathinone or 10 μl saline). [3 H]Monoamine uptake was assessed 1h after the final session. RESULTS: Methcathinone was readily self-administered by male rats and rapidly decreases striatal dopamine and hippocampal serotonin transporter function. CONCLUSION: This pilot study contributes to a body of literature that MCAT has high misuse liability and affects DAT and SERT function. MCAT self-administration in rodents provides a model to investigate mechanisms underlying the neurochemical impact of this synthetic cathinone.
Estimating the daily milligrams of morphine equivalent of illicit fentanyl use in Los Angeles: Clinical and epidemiological implications.
Godvin M, Friedman JR, Molina CA … +4 more , Koncsol AJ, Romero R, Juurlink DN, Shover CL
Drug Alcohol Depend · 2026 Aug · PMID 42302710 · Publisher ↗
INTRODUCTION: The market shift from heroin to illicitly-manufactured-fentanyl in North America led to surging opioid mortality. However, limited information exists about the doses of illicit fentanyl regularly consumed....
INTRODUCTION: The market shift from heroin to illicitly-manufactured-fentanyl in North America led to surging opioid mortality. However, limited information exists about the doses of illicit fentanyl regularly consumed. We examined purity of fentanyl samples and estimate the typical daily oral milligrams of morphine equivalent (MME). METHODS: Leveraging community-based drug checking data from Los Angeles, we ascertained the purity of 509 samples of fentanyl collected between September 2023 and January 2026 using liquid chromatography mass spectrometry. We assessed typical consumption quantity and routes of administration among 47 respondents who reported regularly using fentanyl. We estimate bioavailability and MME conversion factors from literature. To estimate daily MME, incorporating all parameter uncertainty, we used a bootstrapping approach with 1,000,000 draws, with sensitivity analyses to assess the impact of factors including the correlation between purity and quantity. RESULTS: Among participants, the mean daily consumption of fentanyl was 1.07 g (95% prediction interval: 0.03g-4.00g). Illicit fentanyl products had a mean fentanyl purity of 12.47% (0.23%-38.80%), and the mean estimated bioavailability based on routes of administration was 50.82% (30.64%-76.75%). The mean estimated IV fentanyl to PO morphine MME conversion factor was 1 to 183.15 (71.85-294.21). The mean estimated daily consumption in our sample was 8887.55 MME (156.56 MME-41,761.30 MME). CONCLUSIONS: Under all plausible estimation scenarios, individuals consuming illicit fentanyl in Los Angeles on average use a quantity of MME several orders of magnitude higher than clinical guidelines or typical methadone doses. This likely contributes to high overdose mortality, high opioid tolerance, and more difficult methadone and buprenorphine induction.
Effects of virtual reality-based interventions on craving in substance use disorders: A systematic review and meta-analysis of randomized controlled trials.
Li J, Ding F, Chen J … +4 more , Ma X, Wang X, Hong Q, Li H
Drug Alcohol Depend · 2026 Aug · PMID 42284932 · Publisher ↗
OBJECTIVE: To systematically evaluate the efficacy of virtual reality-based interventions in reducing craving among individuals with substance use disorders. RESULTS: Nine randomized controlled trials involving 553 parti...
OBJECTIVE: To systematically evaluate the efficacy of virtual reality-based interventions in reducing craving among individuals with substance use disorders. RESULTS: Nine randomized controlled trials involving 553 participants (290 in the intervention groups and 263 in the control groups) were included, covering illicit drug, alcohol, and nicotine use disorders. Meta-analysis demonstrated that VR interventions significantly reduced craving in individuals with substance use disorders (SMD = -0.52, 95% CI [-0.78, -0.27], P < 0.05). This moderate effect size, considered alongside the distribution-based minimal clinically important difference threshold of approximately 0.5 standard deviations, suggests a potentially clinically meaningful improvement. Subgroup analyses indicated greater efficacy among individuals with illicit drug use disorders (SMD = -0.61). Interventions involving more than seven sessions (SMD = -0.60), session durations of less than 60min (SMD = -0.61), and VR cue exposure combined with neutral environments demonstrated comparatively superior effects. However, these subgroup findings should be interpreted cautiously due to the limited number of included studies. DISCUSSION: Current evidence indicates that virtual reality interventions may contribute to reducing craving among individuals with substance use disorder and demonstrate promising potential for clinical application. Although the included studies were generally of moderate-to-good methodological quality and the overall certainty of evidence was rated as moderate, the optimal intervention parameters have yet to be clearly established. Therefore, larger-scale and more rigorously designed randomized controlled trials are warranted to further confirm the clinical efficacy, stability, and generalizability of VR-based interventions.
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