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Background and aims: Addressing the opioid crisis requires opioid use disorder (OUD) prevalence estimates at the community level for targeted interventions. This study presents a new method that utilizes Medicaid claims data and publicly available data to estimate OUD prevalence at the United States (US) county level and compares it with other existing estimates.

Design, setting and participants: This study utilized data on OUD diagnoses among Medicaid beneficiaries in combination with national survey data, Census data and published literature to estimate the prevalence of OUD (including undiagnosed OUD) in each of the US state of Ohio's 88 counties for the years 2019 to 2021 among the population aged 12 years and older. Prevalence estimates were adjusted for misclassification in claims data and for variation in healthcare utilization among individuals with OUD.

Measurements: Counts and proportions of the population aged 12 and older with OUD at the US state and county level.

Findings: OUD prevalence for Ohioans aged 12 years and older was relatively stable at 3.6% [95% uncertainty interval (UI) = 3.5%-3.8%] in 2019 and 3.7% (95% UI = 3.5%-3.9%) in 2021. County-level prevalence estimates ranged from 0.7% to 14.2% in 2021. Southern counties generally had higher OUD prevalence than northern counties. The prevalence estimates were strongly correlated (Pearson's r = 0.88) with prevalence estimates for 19 Ohio counties from a previous study. Compared with the previous estimates, estimates from the current study tended to be lower for most communities but remained within the 95% credible intervals of previous estimates.

Conclusions: This approach for estimating opioid use disorder prevalence within United States communities by using Medicaid claims data and publicly available data is a robust alternative to methods relying on individual-level data or multiple linked datasets.

Background and aims: To evaluate changes in community consumption and wholesales of alcohol before and after alcohol restrictions were implemented in 2023, aimed at reducing alcohol-related crime and violence.

Design: Longitudinal observational study.

Setting: Alice Springs, a regional town in the Northern Territory, Australia, from December 2019 to February 2024.

Participants: The population of Alice Springs serviced by the wastewater treatment plant catchment, and wholesales data for Alice Springs.

Measurements: Community consumption of alcohol was measured by analysing a biomarker of alcohol consumption in wastewater before and after the alcohol restrictions were implemented. Quarterly alcohol wholesales for the region were also modelled.

Findings: After the restrictions, alcohol consumption in Alice Springs immediately decreased, with an average 26% decrease over 12 months [95% confidence interval (CI) = -31 to -22%]. No statistically significant difference in trend slope was observed. The largest decreases in alcohol consumption were for Mondays and Tuesdays, when takeaway alcohol sales were not allowed. Total alcohol wholesales decreased by 17% (95% CI = -31 to -22%), with greatest meaningful declines of 44% for the sales of spirits (95% CI = -50 to -36%).

Conclusions: After the implementation of the 2023 restrictions on alcohol sales in the Northern Territory, Australia, wastewater-based estimates of alcohol consumption in Alice Springs were statistically significantly reduced by 26% and this was sustained for one year until the end of the data series in 2024. Total alcohol wholesales were also reduced, with differences observed by beverage type.

Background: Canada's 2018 legalization of non-medical cannabis was positioned as a public health initiative, intended to shift cannabis use from criminalization to regulation. Since then, cannabis access and consumption have grown significantly but the systems used to monitor cannabis-related harms have not kept pace. Most national surveys remain focused on patterns of use rather than indicators of harm. Cannabis use disorder (CUD), a clinical condition with well-established diagnostic criteria, remains rarely measured, often misclassified, and largely absent from policy discussions.

Argument: Canada's current surveillance tools are not equipped to detect or track CUD. Major national surveys rely on outdated DSM-IV frameworks, use skip logic that excludes individuals with lower levels of use, and fail to assess key symptoms such as loss of control, functional impairment, or withdrawal. The primary mental health surveillance tool does not align with DSM-5 standards. Administrative health records often obscure CUD due to underdiagnosis, inconsistent coding practices, and the absence of validated case-finding tools. High-risk populations are often excluded from survey samples. As a result, CUD is underdetected, undertreated, and underfunded across Canada's healthcare and policy systems.

Conclusion: Canada urgently needs a modernized surveillance infrastructure that reflects current diagnostic standards, improves the sensitivity of survey tools, incorporates equity metrics, and enables the reliable detection of cannabis use disorder in clinical data.

Background and aims: Although buprenorphine-based opioid agonist maintenance treatment (OAMT) is effective, logistical, economic and stigma-related barriers limit access. Telemedicine-Assisted Buprenorphine Induction (TABI) may address these barriers. This study evaluated the non-inferiority of TABI compared with the Standard of Care (SoC) for buprenorphine induction.

Design: Open-label, two-arm, randomized controlled non-inferiority trial. The induction period lasted 7 days, after which all participants continued buprenorphine-based OAMT as routine care. Follow-up assessments were done at one week and one month.

Settings: Addiction treatment center, Chandigarh, India.

Participants: Adults with opioid use disorder (OUD) meeting ICD-11 (International Classification of Diseases, 11th Revision) criteria, recruited between December 2023 and August 2024. A total of 138 participants were randomized (SoC = 70; TABI = 68). The mean age of participants was 28.2 years. Most participants were male (98.55%).

Intervention: SoC involved supervised in-person buprenorphine induction for three days. TABI consisted of in-person induction on Day 1, followed by telemedicine-based follow-ups for Days 2-6. In-person review on Day 7 in both arms.

Measurements: Primary outcome: treatment retention at one week, using a 15% non-inferiority margin.

Secondary outcomes: abstinence from illicit opioids, withdrawal symptoms, cravings, quality of life, satisfaction, therapeutic alliance and medication adherence.

Findings: The one-week retention rate was 75.71% in the SoC group and 82.35% in the TABI group, with an absolute difference of 6.64% [95% confidence interval (CI) = -6.88% to 20.16%]. The lower limit of the 95% confidence interval for the difference (-6.88%) is above the pre-specified non-inferiority margin, confirming the non-inferiority of TABI compared with SoC. Both groups showed statistically significant improvements in withdrawal symptoms, cravings and quality of life over time, with no statistically significant group differences. Patient satisfaction, therapeutic relationships, adherence and side effects were comparable between groups.

Conclusion: This randomized controlled trial found that telemedicine-assisted buprenorphine induction was non-inferior to standard care for one-week retention in treatment among adults with opioid use disorder. As such, it offers a patient-centred alternative to standard care and has the potential to reduce treatment barriers and improve access in resource-limited settings.

Addiction welcomes letters that advance scientific discussion, clarify evidence and engage constructively with material published in the journal. Letters to the editor are a vital vehicle for scholarly exchange, and we encourage submissions from across the addiction research community.

Recently, however, we have received a number of letters that have raised concerns about authorship authenticity, and, in some cases, whether some of the content may have been generated using artificial intelligence (AI) tools. Some letters have been superficial, shown limited engagement with the relevant evidence or appear to have been submitted by authors without plausible expertise in the subject.

We will, therefore, continue to exercise editorial judgement where letters contain implausible phrasing or superficial reasoning. In such cases, we may contact authors to verify authorship or to request other clarifications.

These measures are intended to promote transparency and trust in scientific exchange and to ensure that Addiction continues to provide a credible forum for informed, evidence-based dialogue.

John Marsden: Conceptualization (lead); writing—original draft (lead). Molly Jarvis: Conceptualization (supporting); writing—review and editing (equal). Keith Humphreys: Conceptualization (supporting); writing—review and editing (equal).

Not applicable.

Background and aims: Food addiction is a dysfunctional chronic psychological disease. Family environment, a modifiable factor, has demonstrated considerable contribution to food addiction. Our objective was to analyze the relationship between family environment and food addiction.

Design, setting and participants: The study included 5554 participants aged 9-19 years enrolled in the School-based Evaluation Advancing Response for Child Health (SEARCH) in China. Our study used the first three waves of data.

Measurements: The exposure was family environment, assessed by Family Environment Scale-Chinese Version (FES-CV) at baseline. The FES-CV includes seven subscales: cohesion, active-recreational orientation, achievement orientation, control, intellectual-cultural orientation, conflict and organization. The outcome was food addiction status, measured using the Chinese version of the modified Yale Food Addiction Scale 2.0 at one year follow-up. A binary logistic regression analysis was used to examine the prospective associations between exposure and outcome. Latent Class Analysis was used to identify distinct characteristics of family environment. Mediation analyses assessed the mediating effects of psychological distress.

Findings: We observed that six subscales of family environment were statistically significantly associated with food addiction in adjusted model. Control [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.22] and conflict (OR = 1.19, 95% CI = 1.11-1.28) subscales were positively associated, whereas cohesion (OR = 0.82, 95% CI = 0.77-0.88), active-recreational orientation (OR = 0.91, 95% CI = 0.85-0.97), intellectual-cultural orientation (OR = 0.91, 95% CI = 0.84-0.98) and organization (OR = 0.87, 95% CI = 0.81-0.94) subscales were inversely associated. The clustering of family environments demonstrated that compared with children and adolescents in playful families, those in conflict-ridden families had a 1.92-fold greater risk (OR = 2.92, 95% CI = 1.86-4.58) of food addiction. Further, we observed that depression and stress partially mediated this association, with the mediated proportions ranging from 18.0%-21.0%.

Conclusions: There appears to be a positive association between a conflict-ridden family environment and food addiction among children and young adults in China. Considering family environment is a modifiable factor, improvement of family environment may be an effective strategy to reduce food addiction by enhancing the psychological well-being of children and adolescents.

Background and aims: Methamphetamine use disorder (MUD) is associated with significant impairments in impulsivity control, contributing to relapse and poor treatment outcomes. Transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) may be helpful in modulating these symptoms. This study aimed at [1] investigating the differential effects of anodal and cathodal tDCS on craving, affective impulsivity, and motor impulsivity; and [2] exploring the correlations between changes in affective impulsivity & drug craving, and alterations in resting-state electroencephalography (Rs-EEG) microstate parameters following tDCS interventions.

Design: A randomized, parallel, double-blind experimental study.

Setting: Two drug rehabilitation centers in China, from June 2022 to June 2023.

Participants: One hundred male participants (ages 33.7 ± 6.26 years) during rehabilitation for MUD.

Intervention: Participants were randomly assigned to anodal (n = 33), cathodal (n = 31), or sham (n = 36) tDCS conditions. tDCS was delivered at 2 mA (anodal and cathodal) or 0 mA (sham) for 20 minutes, twice daily for ten consecutive days. The central electrode was placed on the left dorsolateral prefrontal cortex.

Measurements: Primary and secondary outcomes were assessed at four time points: baseline (before intervention), post-intervention 1 (after two sessions), post-intervention 2 (after 20 sessions, primary time-point), and one-month follow-up (post-intervention 3). Primary outcomes were affective impulsivity and motor impulsivity. Secondary outcomes included drug craving, Rs-EEG microstates, and adverse effects.

Findings: Anodal tDCS statistically significantly improved affective impulsivity control after 20 sessions (estimate = -36.23, 95% confidence interval [CI] [-59.72, -12.73], p < 0.01) but not motor impulsivity control. Both anodal and cathodal tDCS statistically significantly reduced drug craving after 20 sessions (anodal: estimate = 3.36, 95% CI [1.15, 5.57], p < 0.01; cathodal: estimate = 2.62, 95% CI [0.34, 4.9], p = 0.02). Changes in affective impulsivity were statistically significantly correlated with alterations in Rs-EEG microstate parameters, such as microstate B coverage (r = 0.29, p. < 0.01, n = 100); however, there is a lack of clear evidence for correlations between changes in craving and microstate parameters.

Conclusions: Among methamphetamine users in rehabilitation, anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex appears to improve affective impulsivity control, but not motor impulsivity control, and both anodal and cathodal tDCS reduce drug craving.

Aims: The current study measured the extent to which different neurobehavioral indices of incentive-motivational salience attribution to alcohol cues predict alcohol craving and consumption in the natural environment.

Design, setting, and participants: Laboratory study at a university in Missouri, USA, followed by a smartphone-based 21-day ecological momentary assessment (EMA) protocol. Participants were emerging adults (N = 218-268 [52-56% female], age 18-20).

Measurements: Participants completed an alcohol cue approach-avoidance task while their electroencephalogram (EEG) was recorded. Behavioral measures (response time) indexed the strength of cue-activated approach vs. avoidance tendency. Cue-locked event-related potentials provided EEG-based neural measures of motivated attention (P3 amplitude) and approach-avoidance conflict (N450 amplitude). From EMA, measures of alcohol consumption dynamics (as indexed by estimated blood alcohol concentration [eBAC], g/dL) during real-world drinking episodes were obtained, as were measures of alcohol craving (7-point visual analogue scale) dynamics during and outside these episodes.

Findings: Different approach-avoidance task-derived behavioral and neural measures rank-ordered participants differently. Participants who approached alcohol cues more rapidly in lab subsequently showed steeper increases in craving (∆B ± standard error [SE] = 1.042 ± 0.499 point/hr), and eBAC (∆B ± SE = 0.046 ± 0.017 g/dl/hr), during real-world drinking episodes. Participants who avoided alcohol cues more slowly in lab also showed steeper increases in eBAC (∆B ± SE = 0.056 ± 0.017 g/dl/hr). Participants with larger P3 during alcohol cue approach in lab subsequently showed steeper increases in eBAC (∆B ± SE = 0.048 ± 0.017 g/dl/hr), as did those with smaller P3 during alcohol cue avoidance (∆B ± SE = 0.025 ± 0.017 g/dl/hr). Participants with smaller N450 during alcohol cue approach in lab subsequently showed steeper increases in craving during drinking episodes (∆B ± SE = 1.465 ± 0.607 point/hr). Tests examining lab-based neurobehavioral measures as predictors of craving dynamics during nondrinking moments, such as following incidental cue exposure, generally were inconclusive.

Conclusions: Incentive salience toward alcohol may influence alcohol seeking (including craving) and alcohol consumption through distinct behavioral risk pathways in different people.

Aims: To test the efficacy of a participant-referred "study buddy" intervention compared with standard retention strategies in retaining rural people who use drugs (PWUD) in longitudinal research.

Design: Multi-site, two-arm, randomized controlled trial.

Setting: Rural counties in Ohio, Oregon, and Kentucky, USA.

Participants: People enrolled in the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R²) study who were 18 years or older, resided in the study area, and used opioids or injected any drug to get high in the past 30 days between August 2020 and August 2022. Participants (n = 739) were 42% female, mostly White (89%) and non-Hispanic (96%), unstably housed (57%), and reported lifetime injection drug use (93%). The most common drugs of choice were methamphetamine (42%) and heroin (38%).

Intervention and comparator: Participants were allocated (1:1, stratified by site), to: [1] standard retention approach involving appointment reminders and contact information updates by study staff (n = 365), or [2] the intervention arm, receiving the standard retention approach and asked to recruit a "study buddy" (n = 374). Study buddies were invited to view a training video and instructed to encourage their intervention participant to attend follow-up appointments.

Measurements: Intervention, control, and study buddy participants completed interviewer-administered surveys at baseline and at 6 and 12 months. Outcomes included retention at 12 months (primary) and 6 months (secondary).

Findings: Retention was 50.3% at 6 months and 46.1% at 12 months. Only 23.5% of intervention participants recruited a study buddy. In intent-to-treat analyses, the intervention did not increase retention at 12 (adjusted odds ratio [AOR] 1.08, 95% confidence interval [CI] 0.79-1.47) or 6 (AOR 0.96, 95% CI 0.69-1.34) months.

Conclusions: Recruitment of self-identified "study buddies" did not appear to statistically significantly improve retention of rural people who use drugs in this longitudinal study at 6- and 12-month follow-up relative to standard retention approaches.

Background and aims: Female, Hispanic, and Black patients with opioid use disorder (OUD) are less likely to receive OUD medication treatment than other patients. The PROUD (PRimary care Opioid Use Disorders treatment) trial demonstrated that implementation of primary care (PC) nurse care management increases OUD medication treatment compared with usual care (UC). This study assessed whether the PROUD intervention's effect differed across sex, race and ethnicity.

Design: Secondary analyses of cluster-randomized implementation trial.

Setting: 12 PC clinics (2 per health system) in five states in the USA, randomized to UC or intervention, stratified by health system.

Participants: PC patients 16-90 years old.

Intervention: Three strategies to implement office-based addiction treatment (OBAT) by nurse care managers: (1) full-time nurse salary; (2) nurse training and technical assistance from expert nurses at Boston Medical Center; (3) ≥3 PC providers willing to prescribe buprenorphine. Nurses were trained in the Massachusetts model of OBAT which includes lowering barriers to OUD treatment, assessing and educating patients, supporting initiation of medications for OUD and providing ongoing medical management, in collaboration with PC providers.

Measurements: The primary outcome was a clinic-level measure of OUD treatment defined as patient-years of OUD treatment per 10 000 PC patients based on orders and procedures for buprenorphine or extended-release naltrexone from electronic health records and insurance claims (hereafter 'OUD treatment').

Findings: The mean numbers of patients seen by intervention and UC clinics at baseline were 18 485 and 22 557, respectively. Female patients comprised 60% of the total PC population in intervention clinics and 64% in UC clinics; Asian, Black, Hispanic or smaller racial groups comprised 61% of the PC population in intervention clinics, and 70% in UC clinics. Compared with UC, the intervention increased OUD treatment for male patients [adjusted difference: 13.7 patient-years; 95% confidence interval (CI) = 5.8-21.7], but not female patients (2.9; 95% CI = -4.3 to 10.2); effect modification test, F (1,14) = 4.77; P = 0.046. Exploratory analyses suggest that differences in the intervention's effect on receipt of any OUD treatment in female and male patients, rather than differences in the duration of OUD treatment, may account for findings. There was no significant effect modification by race or ethnic group [effect modification test F (4,44) = 1.50; P = 0.218].

Conclusions: Primary care clinics that implement office-based addiction treatment by nurses increase patient-years of opioid use disorder (OUD) treatment in male but not female patients. Exploratory findings suggest that differences in the proportion of patients treated for OUD, ra