Journal of Addiction Medicine最新文献

Clinicians have prescribed benzodiazepines for a range of symptoms and conditions since the Food and Drug Administration approved chlordiazepoxide in 1960. Between 1969 and 1982, the benzodiazepine diazepam was the most prescribed medication in the United States. Since then, recognition of benzodiazepine's risks-such as falls, psychomotor and cognitive impairment, withdrawal, benzodiazepine use disorder (BzUD), and suicidality-and limited data on long-term safety and efficacy have created challenges for clinicians and patients, including when and how to safely taper these medications. In 2025, 10 professional societies, including the American Society of Addiction Medicine (ASAM), released the Joint Clinical Practice Guideline on Benzodiazepine Tapering. This commentary explores implications for addiction treatment.

Objectives: Most persons with opioid use disorder (OUD) are not receiving effective treatment with medications. A lack of understanding and misinformation may impede an individual's decision to begin or continue medications for OUD (MOUD). This study explored the understanding of the role of naloxone, and sources of information related to buprenorphine/naloxone products among people who use fentanyl (PWUF) and clinicians.

Methods: Qualitative study utilizing semi-structured interviews with PWUF and clinicians providing buprenorphine care. Participants were recruited via flyers and word of mouth (PWUF), and direct emails (clinicians). Interviews were audio recorded, transcribed, and analyzed using a rapid qualitative analysis process, which consists of creating templated summaries separated by domains to formulate themes.

Results: Forty-three adults (28 PWUF and 15 clinicians) from Seattle, WA, participated in interviews between April and November 2024. The analyses identified 3 themes: (1) PWUF and clinicians both acknowledge confusion around how buprenorphine and naloxone work; (2) misconceptions may lead to adverse events, anxiety, and/or lack of interest in starting buprenorphine, especially in the setting of fentanyl use; (3) while PWUF had high regards for clinicians, the primary and most trusted source of information is people with lived experience taking buprenorphine/naloxone.

Conclusions: Findings suggest confusion and lack of information about the role of naloxone in buprenorphine/naloxone, potentially limiting medication uptake. The finding that patients mainly hear about buprenorphine/naloxone from people with lived experience should be incorporated into outreach strategies. Future efforts should increase involvement from people with lived experience taking buprenorphine in disseminating accurate information regarding MOUD.

Objectives: To assess whether states requiring public reporting of local opioid settlement expenditures make these data available in a detailed, consistent, timely, and analyzable format.

Methods: We reviewed state websites to extract information on the quality of reported settlement data across 7 dimensions: (1) interest earned on settlement funds was reported, (2) nonremediation spending was reported separately, (3) expenditures were tied to specific programs or activities, (4) expenditures were reported at the sub-county level, (5) expenditures for each local government were consolidated into a single report, (6) all entities in a state report in a combined tracker, and (7) data from the most recent reporting year were available. States were coded dichotomously (1 = criterion met; 0 = not met).

Results: Of the 21 states requiring local reporting, 5 (23.8%) report interest earned on disbursements, while most document nonremediation expenditures (n = 17; 81.9%). Over half tied expenditures to specific program activities (n = 12; 57.1%), and all but 3 consistently report the most recent year. Local governments in 17 states (80.9%) report all expenditures in a single report, and 12 states (57.1%) consolidate all local spending within a single public tracker. Two states (9.5%) have not yet made these data publicly available.

Conclusions: Among states with reporting requirements, there is substantial variation in the quality and detail of settlement expenditure data. Strengthening reporting standards and enforcement of standards would support rigorous research and enhance accountability for ensuring that funds are allocated in alignment with the goals of opioid remediation.

The psychedelic substance, ibogaine, has garnered growing interest among policymakers, researchers, and the public in its potential use for opioid use disorder (OUD). Many states are allocating significant funds to investigate it further. However, some proponents of ibogaine are framing it in opposition to (versus complementary to) standard, mortality-reducing medications for OUD (MOUD). Although the path to OUD remission and recovery varies greatly among individuals, the stakes are high: "detoxification" from methadone or buprenorphine in favor of an as-yet unproven therapy like ibogaine could result in an increased risk of opioid overdose for some. The addiction medicine community should be aware of this potential risk and defend evidence-based care, even as treatments like ibogaine are developed for OUD.

Objective: Fentanyl is a major driver of the overdose crisis in the United States, yet little is known about the intentionality of fentanyl use and its correlates among people who use drugs (PWUD). We examined the intentionality of fentanyl use and associated factors among PWUD.

Methods: We recruited 246 PWUD in New York City in 2023. Participants completed structured interviews and provided urine samples for toxicology screening. Fentanyl use was classified as no use (negative in both self-report and urine toxicology), unintentional use (self-report negative but toxicology positive), and intentional use (positive in self-report with or without positive toxicology). We used multinomial logistic regression to identify factors associated with fentanyl use intentionality.

Results: Fentanyl was detected in 40.7%, while 26.0% self-reported intentional fentanyl use. Intentional fentanyl use was significantly associated with chronic pain (RRR: 2.21; 95% CI: 1.02-4.80) and higher Risk Assessment Battery (RAB) scores (RRR: 1.09; 95% CI: 1.01-1.18), and inversely associated with high cannabis use severity (RRR: 0.16; 95% CI: 0.05-0.61). Unintentional fentanyl use was positively associated with older age (RRR: 1.08; 95% CI: 1.02-1.13) and negatively with moderate alcohol use severity (RRR: 0.25; 95% CI: 0.09-0.69).

Conclusions: Unintentional fentanyl use was more common among older PWUD, highlighting the need for targeted outreach and fentanyl education. Intentional fentanyl use, while reflecting awareness of the drug supply, was associated with chronic pain and elevated HIV risk behaviors, indicating a subgroup with greater health and prevention needs. Tailored interventions integrating harm reduction, pain management, and HIV prevention are needed.

Objectives: A recent case series suggested a possible syndrome associated with prenatal fentanyl exposure. We described, among a cohort of maternal-infant dyads affected by opioid use disorder (OUD), the prevalence of these observed infant features.

Methods: We used data from MAT-LINK, a surveillance system compiling electronic health record (EHR) information from 7 US clinical sites on pregnancies affected by OUD between 2014 and 2021. We described the prevalence of EHR-documented prenatal fentanyl exposure and infant features of interest (cleft palate, corpus callosum abnormality, foot positioning deformities, genital anomalies, microcephaly, micrognathia, toe syndactyly).

Results: Among 5053 maternal-infant dyads affected by OUD, 667 (13.5%; 95% CI: 13.0%-14.0%) had documented prenatal fentanyl exposure, including an over 20-fold increase from 2014 to 2021. Health insurance, prenatal care timing, and nonopioid substance exposures differed between dyads with and without documented prenatal fentanyl exposure. At least one feature of interest was documented for 406 (8.0%) infants, and at least 2 were documented for 0.7%. Among infants with at least one of these features, 18.9% (95% CI: 17.1%-20.8%) had documented prenatal fentanyl exposure, compared with 13.0% (95% CI: 12.5%-13.6%) of infants without any of these features.

Conclusions: In this perinatal OUD cohort, prenatal fentanyl exposure was more commonly documented among infants with at least one compared with none of these infant features. However, features were rare and contextual factors differed among dyads by prenatal fentanyl exposure status. Further analyses examining these infant features, while considering multiple exposures, are needed before substantiating a fetal fentanyl syndrome.

Background: Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors associated with appropriate postoverdose care is essential to addressing these gaps.

Methods: A retrospective cohort study of 1032 veterans who experienced a nonfatal opioid overdose and received care through the veterans Health Administration system was conducted. Data were extracted from electronic health records, including demographic, pharmacy, and clinical variables. The primary outcome was receipt of appropriate clinical response within 90 days postoverdose, defined as initiation of medication for opioid use disorder (MOUD), counseling for opioid use disorder (OUD), or a ≥25% reduction in morphine equivalent daily dose. A binary logistic regression model was used to examine factors associated with receiving appropriate overdose care.

Results: Of the total sample, 57.46% received an appropriate clinical response postoverdose, the majority of which reflected opioid dose reductions rather than initiation of MOUD or counseling for OUD. There were statistically significant differences between those who received appropriate clinical response versus not by rurality, marital status, substance use disorder and treatment, care access, bipolar disorder, and schizophrenia. In adjusted models, those with a documented substance use disorder had significantly higher adjusted odds of receiving appropriate clinical response (aOR=1.91; 95% CI: 1.38-2.63; P<0.0001). Black veterans had significantly lower odds of receiving appropriate clinical response compared with White veterans (aOR=0.71; 95% CI: 0.51-0.98; P=0.04). Other variables were not statistically significantly associated with appropriate clinical response in the adjusted model.

Conclusions: The primary response to OD was dose reduction and MOUD was profoundly underutilized. Future research should incorporate social determinants of health to better understand contextual influences on overdose risk and care access.

Objectives: Addictive behaviors are frequently associated with anxiety and depressive disorders. Adolescence represents a critical period of heightened vulnerability to both types of disorders. In recent years, a significant global decline in adolescent mental health-especially among girls-has raised concerns about the short-term evolution of addictive behaviors. Despite available data, this relationship remains poorly understood, warranting further research to improve prevention and care strategies.

Methods: This study analyzed data from a French cross-sectional observational study (DOPADO), which aimed to assess addictive behaviors among adolescents aged 13 to 18 years attending middle and high schools. Data were collected between 2018 and 2020 using electronic surveys, enabling the evaluation of past-12-month psychoactive substance use, associated risky behaviors, sociodemographic characteristics, anxiety and depressive symptoms, psychological distress, and quality of life.

Results: Among 4844 adolescents, half exhibited anxiety and/or depressive symptoms. These were associated with higher levels of substance use, increased risky behaviors, and impaired quality of life. A Principal Component Analysis revealed 3 distinct profiles: one with preserved well-being, and 2 with significant impairment. These were characterized by higher anxiety-depressive symptoms (especially in the second cluster) and more pronounced addictive behaviors and risky use (notably in the third cluster).

Conclusions: Our study highlights robust associations between anxiety/depressive symptoms, addictive behaviors, and quality of life. Several distinct adolescent profiles emerged with respect to mental health and addictive behaviors, each characterized by specific patterns of quality of life and functioning, underscoring the importance of integrated assessment, prevention, and treatment strategies in adolescents.

Objectives: Clinical guidelines recommend providing adjunctive psychosocial interventions with medications for opioid use disorder (MOUD); however, limited evidence exists regarding when and how to provide them. This 2-group unblinded randomized controlled trial evaluated the efficacy of an adaptive approach to providing cognitive behavioral therapy and peer support for individuals receiving office-based buprenorphine treatment.

Methods: Between September 2020 and May 2023, 125 patients who recently initiated office-based buprenorphine treatment at 2 federally qualified health centers in the Mid-Atlantic region and provided informed consent were randomly assigned (1:1) to treatment as usual (TAU; n = 63) or TAU plus adjunctive psychosocial treatment delivered using an adaptive algorithm informed by baseline characteristics, engagement, and responsiveness (TAU+Adaptive; n = 62). Assessments occurred at baseline and 3- and 6-month follow-ups. Primary outcomes were treatment retention and opioid use.

Results: No significant between-group differences were observed. Across conditions, about 30% tested positive for opioids at follow-up, and 40% remained in MOUD treatment at 6 months. Exploratory post hoc analyses indicated greater retention among participants prescribed a 24 mg baseline buprenorphine dose (46%) compared with those on 16 (24%) or 8 mg (26%). No serious study-related adverse events were reported.

Conclusions: Although the efficacy of the adaptive approach was not supported, high rates of treatment discontinuation and polysubstance use highlight the need for additional support for some patients. Findings also suggest that dosing strategies may need to be tailored to the increasing potency of the illicit opioid supply.