Journal of Addiction Medicine最新文献

Objectives: Approximately 3 million U.S. children live with a parent with an illicit or prescription substance use disorder (SUD) and may be at risk of witnessing an overdose. Parents with SUD offer valuable perspectives on how to facilitate conversations around overdose response. Our aim was to assess attitudes of parents with SUD towards discussing naloxone with their children.

Methods: Parents with SUD were recruited from SUD treatment programs, social media, and a research website to participate in semistructured virtual focus groups facilitated by peers with lived experience of SUD while parenting. The interview guide was informed by study teams' clinical experiences. We used an inductive thematic analysis approach; transcripts were double-coded.

Results: Fifteen parents identifying as mothers participated in 4 focus groups. Four themes were identified. First, most mothers had not discussed naloxone use with their children, yet felt it was important to prepare them to respond to potential overdoses. Second, mothers highlighted that normalizing naloxone education through comparisons to other emergency responses may reduce stigma and expand learning opportunities. Third, mothers noted that overdose response involves physical, cognitive, and emotional processing skills that are acquired at different stages of child development. Fourth, mothers shared that naloxone discussions often require disclosing their own substance use, which was identified as a challenging conversation that mothers were variably ready to navigate.

Conclusions: Mothers with SUD believed their children would benefit from naloxone education. Supporting parents navigating their own SUD disclosure and identifying developmentally appropriate tools are important steps in devising education strategies.

Compulsive use of social media, when it becomes problematic, shares behavioral similarities with substance use disorders. Moreover, preliminary imaging studies have reported structural and functional brain deficits that overlap with those seen in drug addiction, supporting an addictive dimensional component underlying problematic use of social media. Current evidence is consistent with the hypothesis that excessive or maladaptive reliance on social media can trigger or exacerbate symptoms of depression and anxiety, particularly among young people, further perpetuating its use and expanding its potential adverse effects. To better understand the potential negative public health outcomes from social media, there is a pressing need for increased oversight of algorithms and business models, coupled with rigorous research to better identify the at-risk populations and understand its consequences. This could help develop evidence-based prevention and treatment interventions for those who may develop problematic use of social media.

When opioid therapy for chronic pain was first promulgated in the 1980s and 90s, it was thought that addiction would be rare, would occur only in high-risk individuals, and should not interfere with the continued treatment with opioids for patients without opioid use disorder. DSM-5 OUD criteria were used as a means of separating out patients who had developed disordered opioid use from those who had not. This compartmentalization encouraged prescribers to refer those patients diagnosed with an OUD to addiction treatment, but to continue the focus on treating pain for others. But this binary approach failed to recognize that when a patient with chronic pain is treated with long-term opioid therapy, opioid need for pain may be hard to distinguish from withdrawal. This arises from the interaction of pain relief with opioid reward, which changes the motivations for continued opioid use in ways not always obvious to patients or prescribers. In this article, we propose that a syndrome of dependence develops during continued opioid pain treatment that should be considered distinct from POUD. Recognition of a prescription opioid dependence syndrome (PODS) allows for a more nuanced approach to the treatment of failed opioid pain treatment, especially in cases where neither continued high-dose opioid pain treatment nor evidence-based addiction treatment is a good option. We believe that recognition of this syndrome is a necessary first step towards improving treatment for the millions of people struggling with pain and opioid use.

Objectives: Extended-release naltrexone and once-daily bupropion (NTX-BUP) reduced methamphetamine (MA) use in the Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder (ADAPT-1, ADAPT-2) trials. Using a proof-of-concept machine learning technique, we created a classification rule using baseline characteristics to identify individuals who would benefit more from NTX-BUP than from placebo (NTX-BUP-preferred).

Methods: ADAPT-2 (double-blind randomized-controlled sequential parallel comparison design trial, n=147) and ADAPT-1 (open-label pilot study, n=37) were used as the training and validation data sets, respectively. Baseline characteristics were combined to create the classification rule, which was trained to predict the number of negative urine drug screens (UDS) during weeks 5 and 6 of the ADAPT-2 trial and optimized using the ADAPT-1 data set. ADAPT-2 placebo nonresponders rerandomized to NTX-BUP (n=80) were used as the test data set. The performance of the classification rule was assessed by the number of negative UDS during weeks 11 and 12 and the number of responders.

Results: NTX-BUP-preferred participants (who would obtain greater benefit from NTX-BUP than from placebo), when compared with all NTX-BUP participants in the test data set, had higher response rates (0.26 vs. 0.16) and number of negative UDS (1.09 vs. 0.76). Placebo-preferred participants (would obtain greater benefit from placebo than from NTX-BUP) had lower response rates to NTX-BUP (0.07 vs. 0.16) and number of negative UDS (0.46 vs. 0.76) compared with all NTX-BUP participants.

Conclusions: This is a proof-of-concept analysis that needs to establish generalizability. This classification rule could help improve treatment selection, clinicians' treatment decisions, and patient outcomes.

Objectives: The inpatient addiction medicine consult team at West Suburban Medical Center started administering long-acting injectable buprenorphine (LAIB) to hospitalized patients in response to low rates of patients continuing treatment with sublingual buprenorphine after discharge. The aims of this study are to understand patients' motivations to receive LAIB during hospitalization and their experiences with the medication after discharge.

Methods: We conducted semi-structured interviews with patients who received LAIB while hospitalized between August 2022 and April 2023. Inductive analysis was used to identify themes and develop the codebook. Two researchers independently coded each interview and refined the codebook with oversight from 2 senior members of the research team. After the coding team reviewed each interview together to arrive at a joint consensus, a third coder found concordance in a random sample of interviews. Finally, the entire research team met to discuss key themes.

Results: Eighteen participants were interviewed between March and May 2023. The following key themes emerged: (1) limited knowledge and access to LAIB before hospitalization, (2) the role of peer support specialists in deciding to start LAIB while hospitalized, (3) fears around an increasingly unpredictable drug supply and personal experience with overdose as motivations to receive LAIB, (4) benefits of LAIB in multiple areas of participants' lives, and (5) negative aspects of LAIB.

Conclusions: Our participants' overall positive experiences with hospital-administered LAIB should inform policymakers and payors to support the expansion of this model and the exploration of additional strategies to lower barriers to LAIB access.

Objectives: While treatment guidelines for opioid use disorder (OUD) are well-established, specific guidance for people who use fentanyl remains limited. This systematic review is the first to examine effectiveness and safety outcomes associated with opioid agonist therapy (OAT), specifically buprenorphine, methadone, and slow-release oral morphine, in this patient population.

Methods: Following PRISMA guidelines, we systematically searched EMBASE, Medline, PsycINFO, CENTRAL (all via Ovid), and Scopus from inception to April 2025 for studies reporting OAT for fentanyl-related OUD. Primary outcomes included OAT titration time, treatment retention, withdrawal symptoms, remission, nonprescribed fentanyl use, and mortality. Risk of bias was assessed using the Cochrane risk of bias tools. Results were synthesized narratively.

Results: We identified 180 studies for inclusion (sample sizes ranging from 1 to 150,000). Several reports described treatment success using novel strategies, including low-dose ("microdosing," Bernese method) and high-dose buprenorphine ("macrodosing"), and rapid high-dose methadone protocols that deviate from standard guidelines.

Conclusions: Emerging, yet primarily low-quality evidence suggests novel OAT induction strategies for fentanyl-related OUD are feasible and show a consistent direction toward positive clinical and safety outcomes. High-quality research specific to this population, comparing conventional to novel strategies, is needed.

Low-threshold buprenorphine treatment has been described as a general approach to office-based buprenorphine treatment that prioritizes access to care, flexibility, and patient-centeredness. Proposed principles have included same-day treatment entry, flexible policies and procedures, a harm reduction orientation, and availability in unconventional settings. This commentary, which summarizes critical insights from practitioners of low-threshold buprenorphine treatment, expands on these principles by describing clinical and social services that have been included in successful programs. Potential critiques of low-threshold buprenorphine treatment are also addressed. The main goal of the commentary is to describe the ideal components of low-threshold buprenorphine treatment that could inform the development, evaluation, and dissemination of these innovative programs.

Objectives: Posttraumatic stress disorder (PTSD) during pregnancy is associated with adverse consequences and has an estimated prevalence of 3% in community samples. The prevalence of current PTSD among pregnant women with opioid use disorder (OUD), a population at increased risk of adverse birth outcomes and other mental disorders, has been estimated at 16%-37% based on 3 small studies. We used the Centers for Disease Control and Prevention's MATernaL and Infant clinical NetworK (MAT-LINK) surveillance network to (1) further examine current PTSD prevalence among pregnant women with OUD and (2) compare characteristics of those with and without PTSD.

Methods: PTSD prevalence estimates during the current pregnancy were based on (1) presence of an ICD-9/10-CM code indicating PTSD (ie, extracted); (2) documentation of a PTSD diagnosis in abstracted data (ie, abstracted); and (3) PTSD identified by either source.

Results: Of 3315 pregnancies among women with OUD, estimated current PTSD prevalence was 14.7% (95% CI: 13.5-15.8) based on extracted data alone, 23.3% (95% CI: 22.0-24.6) based on abstracted data alone, and 25.9% (95% CI: 24.1-27.7) when based on either data source. Those with PTSD had a higher prevalence of most substance use and mental health disorders examined compared with those without.

Conclusions: These estimates underscore the substantial prevalence of PTSD among pregnant women with OUD and emphasize the need to screen for and treat PTSD and other mental health disorders in this population. Given that evidence-based treatments for PTSD have not been systematically evaluated in pregnant women, more research is sorely needed.

Objectives: Employment can provide structure and economic opportunity. We examined whether changes in employment status from treatment admission to discharge co-occurred with changes in methamphetamine use frequency over the same period.

Methods: The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Discharges (2017-2022) provided the data. Methamphetamine use frequency (daily use, some use, and no use in the past month) and employment status (full-time, part-time, unemployed, and not in the labor force) were reported at treatment admission and discharge. Changes in methamphetamine use frequency were recorded as a reduction or no reduction. Logistic regression modeled reduced methamphetamine use frequency as the dependent variable. Analyses included employment status at admission, discharge, and their interaction. An adjusted model estimated marginal probabilities of reduced methamphetamine use at discharge.

Results: There were 89,015 first treatment admissions. Individuals who gained full-time employment showed the greatest reductions in methamphetamine use frequency (75.7% [95% CI: 72.9-78.4] and 73.9% [95% CI: 72.2-75.6]), compared with 25.5% (95% CI: 25.1-26.0) among those who remained unemployed. More people completed treatment in the reduction group (45.2% vs 22.6%).

Conclusions: Results indicate that gains in employment status during treatment co-occurred with reduced methamphetamine use frequency. This is consistent with prior research linking stable employment to improved health and recovery outcomes. Integrating employment‑support services into outpatient treatment may complement existing interventions and support patient-centered goals. Future prospective studies are needed to establish temporal ordering between employment transitions and methamphetamine use changes and to evaluate employment-support strategies as an adjunct to treatment.

Background: Urine toxicology is a cornerstone of monitoring abstinence in substance use disorder treatment, yet commonly cited detection windows are based on studies in healthy volunteers and do not account for metabolic variability. Prolonged metabolite positivity is typically interpreted as continued use, which can jeopardize treatment engagement and erode the therapeutic alliance.

Case summary: We describe a 42-year-old man with severe stimulant use disorder whose urine toxicology remained positive for cocaine metabolites for 18 days, including 12 days after verified abstinence in a residential program. Laboratory evaluation revealed hepatic steatosis, and pharmacogenomic testing demonstrated a poor metabolizer phenotype at CYP2D6 and CYP3A5. Creatinine-corrected benzoylecgonine levels showed steady monotonic decline without fluctuation, consistent with delayed elimination rather than recurrent use. No cross-reactive medications or confounding substances were present.

Discussion: Cocaine metabolism depends on cytochrome P450 enzymes-particularly CYP2D6 and CYP3A isoforms-and nonspecific esterases. Impaired activity of these pathways, combined with hepatic steatosis and chronic stimulant exposure, can significantly prolong metabolite clearance. This case highlights the importance of distinguishing biological variability from behavioral relapse, especially in settings where misinterpretation may undermine therapeutic rapport.

Clinical implications: Unexpectedly persistent cocaine positivity should prompt consideration of pharmacogenomic variation, hepatic function, and confirmatory testing rather than immediate assumptions of relapse. Integrating biological, behavioral, and contextual data supports accurate interpretation and protects the therapeutic alliance.

Conclusions: Prolonged cocaine metabolite detection can reflect delayed metabolic clearance rather than continued use. Awareness of pharmacokinetic and pharmacogenomic factors is essential for accurate urine toxicology interpretation and patient-centered addiction care.