Pub Date : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.josat.2025.209833
Samuel W. Stull , M. Elaine Wakely , Elizabeth C. Saunders , Nicholas C. Jacobson , Lisa A. Marsch , Stephanie T. Lanza
Introduction
Humor can be utilized in adaptive ways (i.e., humor used to reframe negative events) to support mental health. Humor-based interventions can improve mental health, but minimal research exists on humor in people with addiction. We sought to examine whether and how people in recovery from opioid addiction utilize humor in their daily lives and whether they perceive it as supportive of recovery.
Methods
Qualitative semi-structured interviews were conducted in one study visit with people in recovery from opioid addiction receiving methadone (n = 11). Extant literature and a reflexive thematic approach informed theme generation and coding; codes were developed inductively and deductively using thematic analysis.
Results
Participants had been in recovery for up to two years. Humor was central in most participants' lives, but its role varied considerably. We identified the following themes: Dark Humor and Lived Experience (humor used to make light of a difficult past); For Humor, Timing is Everything (dynamic receptivity to humor); Good Vibrations or Distractions? (pleasurable and distracting qualities of humor); and Read the Room: Social Contexts Can Drive the Supportive Role of Humor (humor to facilitate social connections and conversations about addiction). Most participants expressed enthusiasm for humor therapy, but preferences about the type of humor and setting varied.
Conclusion
Humor was integral to participant's lives. Greater investigation is needed into how recovery identity may interplay with preference for substance-use-related humor, whether humor can lead to sustainable mood improvements, and heterogeneity in preferred timing and context for humor.
{"title":"A qualitative study investigating the role of humor in supporting recovery from addiction","authors":"Samuel W. Stull , M. Elaine Wakely , Elizabeth C. Saunders , Nicholas C. Jacobson , Lisa A. Marsch , Stephanie T. Lanza","doi":"10.1016/j.josat.2025.209833","DOIUrl":"10.1016/j.josat.2025.209833","url":null,"abstract":"<div><h3>Introduction</h3><div>Humor can be utilized in adaptive ways (i.e., humor used to reframe negative events) to support mental health. Humor-based interventions can improve mental health, but minimal research exists on humor in people with addiction. We sought to examine whether and how people in recovery from opioid addiction utilize humor in their daily lives and whether they perceive it as supportive of recovery.</div></div><div><h3>Methods</h3><div>Qualitative semi-structured interviews were conducted in one study visit with people in recovery from opioid addiction receiving methadone (<em>n</em> = 11). Extant literature and a reflexive thematic approach informed theme generation and coding; codes were developed inductively and deductively using thematic analysis.</div></div><div><h3>Results</h3><div>Participants had been in recovery for up to two years. Humor was central in most participants' lives, but its role varied considerably. We identified the following themes: <em>Dark Humor and Lived Experience</em> (humor used to make light of a difficult past); <em>For Humor, Timing is Everything</em> (dynamic receptivity to humor); <em>Good Vibrations or Distractions?</em> (pleasurable and distracting qualities of humor); and <em>Read the Room: Social Contexts Can Drive the Supportive Role of Humor</em> (humor to facilitate social connections and conversations about addiction). Most participants expressed enthusiasm for humor therapy, but preferences about the type of humor and setting varied.</div></div><div><h3>Conclusion</h3><div>Humor was integral to participant's lives. Greater investigation is needed into how recovery identity may interplay with preference for substance-use-related humor, whether humor can lead to sustainable mood improvements, and heterogeneity in preferred timing and context for humor.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209833"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.josat.2025.209832
Bridget Freisthler , Daniel J. Feaster , Charles Knott , Marc LaRochelle , John McCarthy , Svetla Slavova , Sharon L. Walsh , Jennifer Villani
Introduction
Efforts to reduce opioid overdose deaths in the United States have been stymied by the lack of timely and standardized population-level data for local, state, and national levels. The U.S. has a strong national need for linking opioid and other drug overdose surveillance data to service utilization data for overdose prevention and treatment to inform resource allocation and response planning.
Methods
We provide insight on the challenges of identifying, obtaining, and harmonizing administrative outcome data across four states using the collective experience from the HEALing Communities Study to test a community-engaged, data-driven, population-level intervention to reduce opioid overdose deaths. We also discuss the opportunities that arose from those challenges, as well as the relationships across state agencies that were strengthened.
Results
Challenges experienced by the research sites on obtaining administrative outcome data included issues around who owned the data, what level of data access and use was allowed, and difficulties related to the timeliness of the data, ability to harmonize the data elements, and lack of demographic data available for stratification. Opportunities arose from these challenges whereby research sites developed new partnerships with state agencies (including a key governmental official in the state administration), provided an additional layer of quality control for these data, and facilitated democratizing data so local communities could access them.
Conclusions
The overall lessons show the importance of adapting to external changes and maintaining strong partnerships to pursue shared goals. The HCS serves as an exemplar of how local and state jurisdictions can create comprehensive data systems for monitoring and responding to the opioid overdose epidemic.
{"title":"Establishing a public health surveillance system for the opioid crisis: The experience of the HEALing Communities Study","authors":"Bridget Freisthler , Daniel J. Feaster , Charles Knott , Marc LaRochelle , John McCarthy , Svetla Slavova , Sharon L. Walsh , Jennifer Villani","doi":"10.1016/j.josat.2025.209832","DOIUrl":"10.1016/j.josat.2025.209832","url":null,"abstract":"<div><h3>Introduction</h3><div>Efforts to reduce opioid overdose deaths in the United States have been stymied by the lack of timely and standardized population-level data for local, state, and national levels. The U.S. has a strong national need for linking opioid and other drug overdose surveillance data to service utilization data for overdose prevention and treatment to inform resource allocation and response planning.</div></div><div><h3>Methods</h3><div>We provide insight on the challenges of identifying, obtaining, and harmonizing administrative outcome data across four states using the collective experience from the HEALing Communities Study to test a community-engaged, data-driven, population-level intervention to reduce opioid overdose deaths. We also discuss the opportunities that arose from those challenges, as well as the relationships across state agencies that were strengthened.</div></div><div><h3>Results</h3><div>Challenges experienced by the research sites on obtaining administrative outcome data included issues around who owned the data, what level of data access and use was allowed, and difficulties related to the timeliness of the data, ability to harmonize the data elements, and lack of demographic data available for stratification. Opportunities arose from these challenges whereby research sites developed new partnerships with state agencies (including a key governmental official in the state administration), provided an additional layer of quality control for these data, and facilitated democratizing data so local communities could access them.</div></div><div><h3>Conclusions</h3><div>The overall lessons show the importance of adapting to external changes and maintaining strong partnerships to pursue shared goals. The HCS serves as an exemplar of how local and state jurisdictions can create comprehensive data systems for monitoring and responding to the opioid overdose epidemic.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209832"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.josat.2025.209836
Vanessa A. Palzes , Felicia W. Chi , Constance Weisner , Andrea H. Kline-Simon , Derek D. Satre , Asma Asyyed , Stacy Sterling
Background
Identifying individual-level factors that predict cessation of heavy alcohol use would inform the prevention, intervention, and treatment of heavy alcohol use. This study examined whether and how patient risk profiles and specialty treatment predict early, sustained, and stable cessation of heavy alcohol use, and whether there are differences by patient characteristics.
Methods
This electronic health records-based cohort study included 128,471 adults with heavy alcohol use (exceeded national daily or weekly drinking limits) in an integrated healthcare system between 6/1/2013 and 12/31/2014. Cessation of heavy alcohol use was examined over 1-year (early), 5-year (sustained), and 7-year follow-ups (stable), through 6/30/2022. Latent class analysis identified five patient risk profiles differentiated by type of heavy alcohol use and levels of health risk behaviors and comorbidities. Associations of risk profiles, specialty addiction or psychiatry treatment, race and ethnicity with cessation outcomes were examined with logistic regression.
Results
Approximately 65.8 % of the sample had early cessation at 1-year. Compared with patients in the heavy daily drinking and fewer health risks profile (DAILY), patients in the heavy daily drinking and more health risks profile (DAILY-R) had higher odds of early cessation (aOR [95 % CI] = 1.28 [1.23, 1.33]), while patients in risk profiles with heavy weekly drinking and substance use and mental health disorders had lower odds of early cessation (aORs = 0.40 to 0.77). Specialty treatment (versus no treatment) was associated with higher odds of early cessation (1.27 [1.18, 1.35]), which varied by risk profile. Hispanic/Latino patients in the DAILY-R profile had lower odds of early cessation than their White counterparts (0.84 [0.76, 0.91]). At 5 and 7 years, 60.7 % and 88.0 % had sustained and stable cessation after achieving the prior cessation status, respectively. Results of sustained and stable cessation were largely consistent with those of early cessation, but interactions with race and ethnicity were non-significant.
Conclusions
Specialty treatment may be effective for most types of patients with varying levels of health risks, across populations. Findings suggest that Hispanic/Latino patients with heavy daily drinking and more health risks may need tailored interventions in primary care to support cessation of heavy alcohol use.
{"title":"Relationships of patient risk profiles and receipt of specialty treatment with early, sustained, and stable cessation of heavy alcohol use across populations","authors":"Vanessa A. Palzes , Felicia W. Chi , Constance Weisner , Andrea H. Kline-Simon , Derek D. Satre , Asma Asyyed , Stacy Sterling","doi":"10.1016/j.josat.2025.209836","DOIUrl":"10.1016/j.josat.2025.209836","url":null,"abstract":"<div><h3>Background</h3><div>Identifying individual-level factors that predict cessation of heavy alcohol use would inform the prevention, intervention, and treatment of heavy alcohol use. This study examined whether and how patient risk profiles and specialty treatment predict early, sustained, and stable cessation of heavy alcohol use, and whether there are differences by patient characteristics.</div></div><div><h3>Methods</h3><div>This electronic health records-based cohort study included 128,471 adults with heavy alcohol use (exceeded national daily or weekly drinking limits) in an integrated healthcare system between 6/1/2013 and 12/31/2014. Cessation of heavy alcohol use was examined over 1-year (early), 5-year (sustained), and 7-year follow-ups (stable), through 6/30/2022. Latent class analysis identified five patient risk profiles differentiated by type of heavy alcohol use and levels of health risk behaviors and comorbidities. Associations of risk profiles, specialty addiction or psychiatry treatment, race and ethnicity with cessation outcomes were examined with logistic regression.</div></div><div><h3>Results</h3><div>Approximately 65.8 % of the sample had early cessation at 1-year. Compared with patients in the heavy daily drinking and fewer health risks profile (DAILY), patients in the heavy daily drinking and more health risks profile (DAILY-R) had higher odds of early cessation (aOR [95 % CI] = 1.28 [1.23, 1.33]), while patients in risk profiles with heavy weekly drinking and substance use and mental health disorders had lower odds of early cessation (aORs = 0.40 to 0.77). Specialty treatment (versus no treatment) was associated with higher odds of early cessation (1.27 [1.18, 1.35]), which varied by risk profile. Hispanic/Latino patients in the DAILY-R profile had lower odds of early cessation than their White counterparts (0.84 [0.76, 0.91]). At 5 and 7 years, 60.7 % and 88.0 % had sustained and stable cessation after achieving the prior cessation status, respectively. Results of sustained and stable cessation were largely consistent with those of early cessation, but interactions with race and ethnicity were non-significant.</div></div><div><h3>Conclusions</h3><div>Specialty treatment may be effective for most types of patients with varying levels of health risks, across populations. Findings suggest that Hispanic/Latino patients with heavy daily drinking and more health risks may need tailored interventions in primary care to support cessation of heavy alcohol use.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209836"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.josat.2026.209899
Davida M Schiff, Alexindra Wheeler, Daniel Lewis, Mishka Terplan, Shelly F Greenfield, Jessica R Gray, Elizabeth E Krans, Marcela C Smid, Frankie Kropp, John T Winhusen
Objective: Identify sociodemographic and substance use characteristics associated with pregnancy intention and explore the relationship between pregnancy intent and postpartum contraception interest among pregnant individuals with opioid use disorder (OUD).
Methods: Secondary analysis of baseline data collected in the Medication Treatment for OUD in Expectant Mothers trial, which evaluated injectable versus sublingual buprenorphine. Current pregnancy intention was classified as "intended," "mistimed," "unwanted," or "ambivalent." Postpartum contraceptive interest was categorized into highly effective, effective, less effective, or none. Participant characteristics and contraceptive interest was compared across intention categories using Fisher's Exact and Kruskal-Wallis tests.
Results: Of 155 participants who completed baseline screening, 137 (88%) did not report any contraceptive use prior to their current pregnancy. Twenty-eight percent reported intended pregnancies, 27% mistimed, 15% never wanted, and 30% were ambivalent towards their current pregnancy. Individuals reporting intended pregnancies disclosed less substance use in the past ninety days and twelve months compared to other categories. Forty-seven percent of participants desired highly effective contraception after delivery, 28% desired effective contraception, 4% desired less effective contraception, and 21% did not desire any contraception. Participants reporting an unwanted pregnancy were significantly more interested in sterilization, while participants reporting a mistimed pregnancy were significantly more interested in a postpartum long-acting reversible contraception.
Conclusion: Our findings that individuals with intended pregnancies report less recent substance use suggests that reproductive health decision-making may be difficult to prioritize during periods of active addiction. In addition, the lack of association between pregnancy intention and postpartum contraceptive interest underscores a need for novel ways to support perinatal individuals with OUD in family planning conversations that honor their reproductive autonomy, values, and desires.
{"title":"Association between pregnancy intention and postpartum contraceptive interest among pregnant people with opioid use disorder.","authors":"Davida M Schiff, Alexindra Wheeler, Daniel Lewis, Mishka Terplan, Shelly F Greenfield, Jessica R Gray, Elizabeth E Krans, Marcela C Smid, Frankie Kropp, John T Winhusen","doi":"10.1016/j.josat.2026.209899","DOIUrl":"10.1016/j.josat.2026.209899","url":null,"abstract":"<p><strong>Objective: </strong>Identify sociodemographic and substance use characteristics associated with pregnancy intention and explore the relationship between pregnancy intent and postpartum contraception interest among pregnant individuals with opioid use disorder (OUD).</p><p><strong>Methods: </strong>Secondary analysis of baseline data collected in the Medication Treatment for OUD in Expectant Mothers trial, which evaluated injectable versus sublingual buprenorphine. Current pregnancy intention was classified as \"intended,\" \"mistimed,\" \"unwanted,\" or \"ambivalent.\" Postpartum contraceptive interest was categorized into highly effective, effective, less effective, or none. Participant characteristics and contraceptive interest was compared across intention categories using Fisher's Exact and Kruskal-Wallis tests.</p><p><strong>Results: </strong>Of 155 participants who completed baseline screening, 137 (88%) did not report any contraceptive use prior to their current pregnancy. Twenty-eight percent reported intended pregnancies, 27% mistimed, 15% never wanted, and 30% were ambivalent towards their current pregnancy. Individuals reporting intended pregnancies disclosed less substance use in the past ninety days and twelve months compared to other categories. Forty-seven percent of participants desired highly effective contraception after delivery, 28% desired effective contraception, 4% desired less effective contraception, and 21% did not desire any contraception. Participants reporting an unwanted pregnancy were significantly more interested in sterilization, while participants reporting a mistimed pregnancy were significantly more interested in a postpartum long-acting reversible contraception.</p><p><strong>Conclusion: </strong>Our findings that individuals with intended pregnancies report less recent substance use suggests that reproductive health decision-making may be difficult to prioritize during periods of active addiction. In addition, the lack of association between pregnancy intention and postpartum contraceptive interest underscores a need for novel ways to support perinatal individuals with OUD in family planning conversations that honor their reproductive autonomy, values, and desires.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209899"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.josat.2026.209905
Bryan Hartzler, Meg Brunner, J Konadu Fokuo, Michael J Ostacher, Anna Pagano, Beth A Rutkowski, Ryelee A Vest, Carmen L Masson
A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations-with its domain of adoption corresponding most directly to the CTN's mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup-currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library-promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN's 25th anniversary, we also reflect on the value of this multi institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.
{"title":"There and back again: Continuing efforts via regional partnership to promote workforce awareness of scientific advancements in addiction care.","authors":"Bryan Hartzler, Meg Brunner, J Konadu Fokuo, Michael J Ostacher, Anna Pagano, Beth A Rutkowski, Ryelee A Vest, Carmen L Masson","doi":"10.1016/j.josat.2026.209905","DOIUrl":"https://doi.org/10.1016/j.josat.2026.209905","url":null,"abstract":"<p><p>A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations-with its domain of adoption corresponding most directly to the CTN's mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup-currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library-promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN's 25th anniversary, we also reflect on the value of this multi institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209905"},"PeriodicalIF":1.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209896
Ingrid A Binswanger, Onchee Yu, Paige D Wartko, Megan Addis, Jennifer F Bobb, Amy K Lee, Bobbi Jo Yarborough, Julia Arnsten, Joseph E Glass, Thomas F Northrup, Mark Murphy, Jordan M Braciszewski, Viviana E Horigian, Jo Ann Shoup, Annie Potter, Katharine A Bradley
Introduction: Primary care patients with opioid use disorder (OUD) may receive treatment in primary care clinics or co-located specialty addiction treatment practices. To help guide operational leaders in organizing OUD care delivery systems, we described rates of OUD medication treatment among primary care patients in PRimary care Opioid Use Disorders treatment (PROUD) trial intervention clinics and four primary care clinics not in the trial because they already had OUD treatment programs in place (exemplar clinics).
Methods: Primary care patients seen at six PROUD trial intervention clinics that implemented the Massachusetts model of office-based addiction treatment (PROUD clinics) and four exemplar clinics (two co-located specialty models; two primary care models with universal prescribing, in which all primary care providers were expected to treat OUD) were compared. Primary outcomes were person-years (PY) of medication treatment for OUD with buprenorphine or extended-release naltrexone during follow up (3/2018-2/2020) and changes from baseline (3/2016-2/2018).
Results: Baseline primary care samples included 109,196 patients in PROUD clinics and 101,631 patients in exemplar clinics. Baseline OUD treatment rates varied across exemplar clinics (range: 10.9 to 328.7 PY per 10,000 primary care patients) but were higher than in PROUD clinics at baseline (3.9 PY per 10,000), with exemplar clinics with primary care models (established 2005 and 2017) providing the highest treatment rates to their primary care patients. During follow-up, PROUD clinics nearly tripled treatment, to 14.4 PY per 10,000, whereas most exemplar clinics increased treatment by less than 10% but still had higher treatment rates (range: 12.0 to 359.4 PY per 10,000).
Conclusions: Primary care OUD treatment rates varied markedly. Exemplar clinics in which all primary care providers were expected to treat OUD had the highest treatment rates at baseline and follow-up, suggesting that universal prescribing is a promising approach to increasing OUD treatment in primary care.
{"title":"Variability in medication treatment of opioid use disorder in primary care: Comparison of PROUD trial intervention clinics and other exemplar clinics.","authors":"Ingrid A Binswanger, Onchee Yu, Paige D Wartko, Megan Addis, Jennifer F Bobb, Amy K Lee, Bobbi Jo Yarborough, Julia Arnsten, Joseph E Glass, Thomas F Northrup, Mark Murphy, Jordan M Braciszewski, Viviana E Horigian, Jo Ann Shoup, Annie Potter, Katharine A Bradley","doi":"10.1016/j.josat.2026.209896","DOIUrl":"10.1016/j.josat.2026.209896","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care patients with opioid use disorder (OUD) may receive treatment in primary care clinics or co-located specialty addiction treatment practices. To help guide operational leaders in organizing OUD care delivery systems, we described rates of OUD medication treatment among primary care patients in PRimary care Opioid Use Disorders treatment (PROUD) trial intervention clinics and four primary care clinics not in the trial because they already had OUD treatment programs in place (exemplar clinics).</p><p><strong>Methods: </strong>Primary care patients seen at six PROUD trial intervention clinics that implemented the Massachusetts model of office-based addiction treatment (PROUD clinics) and four exemplar clinics (two co-located specialty models; two primary care models with universal prescribing, in which all primary care providers were expected to treat OUD) were compared. Primary outcomes were person-years (PY) of medication treatment for OUD with buprenorphine or extended-release naltrexone during follow up (3/2018-2/2020) and changes from baseline (3/2016-2/2018).</p><p><strong>Results: </strong>Baseline primary care samples included 109,196 patients in PROUD clinics and 101,631 patients in exemplar clinics. Baseline OUD treatment rates varied across exemplar clinics (range: 10.9 to 328.7 PY per 10,000 primary care patients) but were higher than in PROUD clinics at baseline (3.9 PY per 10,000), with exemplar clinics with primary care models (established 2005 and 2017) providing the highest treatment rates to their primary care patients. During follow-up, PROUD clinics nearly tripled treatment, to 14.4 PY per 10,000, whereas most exemplar clinics increased treatment by less than 10% but still had higher treatment rates (range: 12.0 to 359.4 PY per 10,000).</p><p><strong>Conclusions: </strong>Primary care OUD treatment rates varied markedly. Exemplar clinics in which all primary care providers were expected to treat OUD had the highest treatment rates at baseline and follow-up, suggesting that universal prescribing is a promising approach to increasing OUD treatment in primary care.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209896"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-20DOI: 10.1016/j.josat.2025.209818
Abolfazl Sadeghi , J. Douglas Thornton , Tyler J. Varisco
Background
Buprenorphine is a cornerstone treatment for opioid use disorder (OUD), but provider disruptions can lead to gaps in care. We hypothesize that loss of access to a patient's primary buprenorphine provider, defined as at least a 90-day gap or a permanent stop in buprenorphine prescribing, contributes to a higher risk of treatment discontinuation.
Methods
Using a retrospective cohort design, we analyzed Texas Prescription Monitoring Program data (February 1, 2018–February 1, 2021). Patients were included if they had received buprenorphine from a single prescriber who then ceased prescribing for ≥90 days. We excluded patients receiving prescriptions from multiple providers in the 90-day lookback. Re-establishing care (≥1 new prescription from a different provider within 90 days) was the primary outcome. Logistic regression was used to identify factors associated with reinitiation of buprenorphine pharmacotherapy.
Results
Of the 1083 patients analyzed, 24 % did not re-establish care following a disruption in provider availability. Rural residence significantly lowered the odds of treatment resumption (aOR = 0.60, p < 0.05), while higher doses (>8 mg/day) and longer treatment episodes prior to prescriber cessation (>60 days) increased continuity (aOR = 1.70, p < 0.05; aOR = 3.29, p < 0.05).
Conclusions
One in four patients experienced an interruption in buprenorphine care after their primary provider stopped prescribing buprenorphine, with rural patients particularly affected. Telehealth and other policy measures could mitigate these disruptions, ensuring more consistent OUD treatment. Further research is needed to understand provider- and patient-level factors contributing to these outcomes.
丁丙诺啡是阿片类药物使用障碍（OUD）的基础治疗方法，但提供者的中断可能导致护理空白。我们假设，失去与患者的主要丁丙诺啡提供者的联系，定义为至少90天的间隔或永久停止丁丙诺啡处方，会导致更高的停药风险。方法采用回顾性队列设计，分析德克萨斯州处方监测项目（2018年2月1日- 2021年2月1日）的数据。如果患者从单一处方者那里接受丁丙诺啡，然后停止处方≥90天，则纳入患者。我们排除了在90天的回顾中接受多个提供者处方的患者。重新建立护理（90天内来自不同提供者的新处方≥1张）是主要结局。Logistic回归用于确定与丁丙诺啡药物治疗重新开始相关的因素。结果在分析的1083例患者中，24%的患者在服务中断后没有重新建立护理。农村居民显著降低了恢复治疗的几率（aOR = 0.60, p < 0.05），而较高的剂量（>； 8mg /天）和较长的停药时间（>；60天）增加了连续性（aOR = 1.70, p < 0.05; aOR = 3.29, p < 0.05）。结论：四分之一的患者在其主要提供者停止开具丁丙诺啡处方后，其丁丙诺啡护理中断，农村患者尤其受影响。远程保健和其他政策措施可以减轻这些干扰，确保更一致的OUD治疗。需要进一步的研究来了解导致这些结果的提供者和患者层面的因素。
{"title":"Gaps in buprenorphine access: Examining provider availability and treatment continuity","authors":"Abolfazl Sadeghi , J. Douglas Thornton , Tyler J. Varisco","doi":"10.1016/j.josat.2025.209818","DOIUrl":"10.1016/j.josat.2025.209818","url":null,"abstract":"<div><h3>Background</h3><div>Buprenorphine is a cornerstone treatment for opioid use disorder (OUD), but provider disruptions can lead to gaps in care. We hypothesize that loss of access to a patient's primary buprenorphine provider, defined as at least a 90-day gap or a permanent stop in buprenorphine prescribing, contributes to a higher risk of treatment discontinuation.</div></div><div><h3>Methods</h3><div>Using a retrospective cohort design, we analyzed Texas Prescription Monitoring Program data (February 1, 2018–February 1, 2021). Patients were included if they had received buprenorphine from a single prescriber who then ceased prescribing for ≥90 days. We excluded patients receiving prescriptions from multiple providers in the 90-day lookback. Re-establishing care (≥1 new prescription from a different provider within 90 days) was the primary outcome. Logistic regression was used to identify factors associated with reinitiation of buprenorphine pharmacotherapy.</div></div><div><h3>Results</h3><div>Of the 1083 patients analyzed, 24 % did not re-establish care following a disruption in provider availability. Rural residence significantly lowered the odds of treatment resumption (aOR = 0.60, <em>p</em> < 0.05), while higher doses (>8 mg/day) and longer treatment episodes prior to prescriber cessation (>60 days) increased continuity (aOR = 1.70, <em>p</em> < 0.05; aOR = 3.29, <em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>One in four patients experienced an interruption in buprenorphine care after their primary provider stopped prescribing buprenorphine, with rural patients particularly affected. Telehealth and other policy measures could mitigate these disruptions, ensuring more consistent OUD treatment. Further research is needed to understand provider- and patient-level factors contributing to these outcomes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209818"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-20DOI: 10.1016/j.josat.2025.209814
Shashi N. Kapadia , Kenneth Karan , Hao Zhang , Promi Chakraborty , Noa Krawczyk , Yuhua Bao
Background
Take-home methadone (THM) flexibility has increased since 2020, representing innovation in opioid use disorder treatment. There are no established approaches to measuring THM using insurance claims data. We proposed and validated candidate measures of THM.
Methods
Using 2020 Medicaid data from 4 states, we constructed treatment episodes for enrollees aged 18–64. Episodes started after July 1, 2020 and lasted at least 60 days. We labelled individuals as receiving THM if they received ≥6 consecutive days of THM in their 2nd month of treatment, as defined by presence of claims with a modifier code indicating THM (the “gold-standard” indicator). We defined 4 candidate indicators of THM based on intervals between in-clinic methadone administrations. We assessed performance of each candidate indicator against the gold-standard. We assessed the extent to which between-program variation explained total variation in measured THM.
Results
The study sample included 4836 episodes for 4801 individuals. THM was present in 14 % of episodes. Sensitivity of candidate indicators ranged from 65 to 100 %, with the most sensitive being an indicator that was true if any two adjacent in-clinic service dates had a gap of ≥7 days. Specificity ranged from 80 to 96 %, with the most specific measure being one requiring 2 consecutive intervals of ≥7 days that were of the same length. Between-program variation explained 38.6–48.3 % of variation in THM receipt.
Conclusions
Two indicators of THM using Medicaid data presented excellent performance when evaluated against a gold-standard indicator. Our approach can be used to assess uptake and outcomes of THM.
{"title":"Developing and validating measures of take-home methadone with administrative data","authors":"Shashi N. Kapadia , Kenneth Karan , Hao Zhang , Promi Chakraborty , Noa Krawczyk , Yuhua Bao","doi":"10.1016/j.josat.2025.209814","DOIUrl":"10.1016/j.josat.2025.209814","url":null,"abstract":"<div><h3>Background</h3><div>Take-home methadone (THM) flexibility has increased since 2020, representing innovation in opioid use disorder treatment. There are no established approaches to measuring THM using insurance claims data. We proposed and validated candidate measures of THM.</div></div><div><h3>Methods</h3><div>Using 2020 Medicaid data from 4 states, we constructed treatment episodes for enrollees aged 18–64. Episodes started after July 1, 2020 and lasted at least 60 days. We labelled individuals as receiving THM if they received ≥6 consecutive days of THM in their 2nd month of treatment, as defined by presence of claims with a modifier code indicating THM (the “gold-standard” indicator). We defined 4 candidate indicators of THM based on intervals between in-clinic methadone administrations. We assessed performance of each candidate indicator against the gold-standard. We assessed the extent to which between-program variation explained total variation in measured THM.</div></div><div><h3>Results</h3><div>The study sample included 4836 episodes for 4801 individuals. THM was present in 14 % of episodes. Sensitivity of candidate indicators ranged from 65 to 100 %, with the most sensitive being an indicator that was true if any two adjacent in-clinic service dates had a gap of ≥7 days. Specificity ranged from 80 to 96 %, with the most specific measure being one requiring 2 consecutive intervals of ≥7 days that were of the same length. Between-program variation explained 38.6–48.3 % of variation in THM receipt.</div></div><div><h3>Conclusions</h3><div>Two indicators of THM using Medicaid data presented excellent performance when evaluated against a gold-standard indicator. Our approach can be used to assess uptake and outcomes of THM.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209814"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-20DOI: 10.1016/j.josat.2025.209815
Sami Aftab Abdul , Huan Jiang , Cayley Russell , Tara Elton-Marshall , Farihah Ali , Iesha Henderson , Bernard Le Foll , Brooke Kinniburgh , Wayne Smith , Jürgen Rehm , Sameer Imtiaz
Background
British Columbia, Canada implemented a three-year pilot program on January 31, 2023 decriminalizing personal possession of select illegal drugs. The policy aimed to increase access to health and social services. This analysis evaluated the short-term impacts of decriminalization on clients dispensed opioid agonist treatment (OAT) medications and visits to supervised consumption and overdose prevention services (SCS/OPS).
Methods
Population-based data from 2015 to 2023 were sourced (Pre-decriminalization: Jan 2015–Jan 2023; Post-decriminalization Feb 2023–Dec 2023). Generalized additive models in an interrupted time series design were used to model monthly total and sex-stratified, age-standardized rates of clients and first-time clients dispensed OAT medications per 100,000 population, as well as crude rates of visits to SCS/OPS per 100,000 population. The models tested both immediate level changes (immediate effect at decriminalization) and trend changes (slope changes post-decriminalization).
Results
The models detected no association between decriminalization and changes in clients dispensed OAT medications (Immediate Change β [95 % CI]: −0.001 [−0.012, 0.011]; Trend Change β [95 % CI]: −0.004 [−0.011, 0.003]), first-time clients dispensed OAT medications (Immediate Change β [95 % CI]: 0.115 [−0.049, 0.279]; Trend Change β [95 % CI]: −0.006 [−0.048, 0.035]) or visits to SCS/OPS (Immediate Change β [95 % CI]: 0.048 [−0.100, 0.195]; Trend Change β [95 % CI]: 0.013 [−0.016, 0.043]). Findings for all outcomes remained consistent after stratifying by sex.
Conclusion
Decriminalization was not associated with changes in clients dispensed OAT medications, first-time clients dispensed OAT medications, or visits to SCS/OPS. These findings reflect only the initial eleven months following the implementation of the policy. Given the complexity of factors influencing service utilization, and the introduction of the second amendment which represents a significant rollback of the original exemption, longer-term evaluations are needed to more accurately assess whether decriminalization is contributing to its intended goals.
{"title":"The short-term impacts of the decriminalization of illegal drug possession on clients dispensed opioid agonist treatment medications and visits to supervised consumption services and overdose prevention services in British Columbia, Canada (2015–2023)","authors":"Sami Aftab Abdul , Huan Jiang , Cayley Russell , Tara Elton-Marshall , Farihah Ali , Iesha Henderson , Bernard Le Foll , Brooke Kinniburgh , Wayne Smith , Jürgen Rehm , Sameer Imtiaz","doi":"10.1016/j.josat.2025.209815","DOIUrl":"10.1016/j.josat.2025.209815","url":null,"abstract":"<div><h3>Background</h3><div>British Columbia, Canada implemented a three-year pilot program on January 31, 2023 decriminalizing personal possession of select illegal drugs. The policy aimed to increase access to health and social services. This analysis evaluated the short-term impacts of decriminalization on clients dispensed opioid agonist treatment (OAT) medications and visits to supervised consumption and overdose prevention services (SCS/OPS).</div></div><div><h3>Methods</h3><div>Population-based data from 2015 to 2023 were sourced (Pre-decriminalization: Jan 2015–Jan 2023; Post-decriminalization Feb 2023–Dec 2023)<em>.</em> Generalized additive models in an interrupted time series design were used to model monthly total and sex-stratified, age-standardized rates of clients and first-time clients dispensed OAT medications per 100,000 population, as well as crude rates of visits to SCS/OPS per 100,000 population. The models tested both immediate level changes (immediate effect at decriminalization) and trend changes (slope changes post-decriminalization).</div></div><div><h3>Results</h3><div>The models detected no association between decriminalization and changes in clients dispensed OAT medications (Immediate Change β [95 % CI]: −0.001 [−0.012, 0.011]; Trend Change β [95 % CI]: −0.004 [−0.011, 0.003]), first-time clients dispensed OAT medications (Immediate Change β [95 % CI]: 0.115 [−0.049, 0.279]; Trend Change β [95 % CI]: −0.006 [−0.048, 0.035]) or visits to SCS/OPS (Immediate Change β [95 % CI]: 0.048 [−0.100, 0.195]; Trend Change β [95 % CI]: 0.013 [−0.016, 0.043]). Findings for all outcomes remained consistent after stratifying by sex.</div></div><div><h3>Conclusion</h3><div>Decriminalization was not associated with changes in clients dispensed OAT medications, first-time clients dispensed OAT medications, or visits to SCS/OPS. These findings reflect only the initial eleven months following the implementation of the policy. Given the complexity of factors influencing service utilization, and the introduction of the second amendment which represents a significant rollback of the original exemption, longer-term evaluations are needed to more accurately assess whether decriminalization is contributing to its intended goals.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209815"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-31DOI: 10.1016/j.josat.2025.209831
Blake T. Hilton , Mia A. Haidamus , Victoria R. Votaw , Gerardo Gonzalez , Roger D. Weiss , Margaret L. Griffin , R. Kathryn McHugh
Introduction
Despite demonstrated effectiveness, medications for alcohol use disorder (MAUD) are underutilized. While studies have considered structural and provider-level barriers, little is known about patient-level factors associated with MAUD initiation. We aimed to examine stigma, knowledge, and beliefs about MAUD and their associations with intention to take them among a sample with severe AUD.
Methods
Adults receiving treatment for alcohol use disorder at an inpatient withdrawal management and treatment initiation program completed a cross-sectional survey (N = 171). MAUD knowledge (i.e., correctly identified medications for AUD), beliefs (i.e., perceived effectiveness), and stigma (i.e., internalized and perceived) in general and by medication type (i.e., naltrexone, acamprosate, and disulfiram) were assessed using a measure developed for this study.
Results
Knowledge about which medications are indicated for AUD was low, with the highest awareness for naltrexone (61 % of participants correctly identified this medication). Most (55 %) participants believed MAUD helps people recover, however approximately half were uncertain about the effectiveness of each specific medication type. Participants with greater MAUD knowledge and more positive beliefs about effectiveness reported greater intention to take MAUD (ps < 0.05). Stigma was low across all medications (mean scores <3 on a scale of 10), though a substantial portion of participants endorsed uncertainty about stigma.
Conclusions
Greater knowledge and positive beliefs about MAUD were significantly associated with intentions to pursue MAUD, yet many participants reported uncertainty in these domains. MAUD knowledge was low overall, as was stigma. Targeted efforts to enhance patient knowledge of MAUD could be a promising strategy for increasing medication uptake.
{"title":"Stigma and knowledge about medications for alcohol use disorder among treatment-seeking adults","authors":"Blake T. Hilton , Mia A. Haidamus , Victoria R. Votaw , Gerardo Gonzalez , Roger D. Weiss , Margaret L. Griffin , R. Kathryn McHugh","doi":"10.1016/j.josat.2025.209831","DOIUrl":"10.1016/j.josat.2025.209831","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite demonstrated effectiveness, medications for alcohol use disorder (MAUD) are underutilized. While studies have considered structural and provider-level barriers, little is known about patient-level factors associated with MAUD initiation. We aimed to examine stigma, knowledge, and beliefs about MAUD and their associations with intention to take them among a sample with severe AUD.</div></div><div><h3>Methods</h3><div>Adults receiving treatment for alcohol use disorder at an inpatient withdrawal management and treatment initiation program completed a cross-sectional survey (<em>N</em> = 171). MAUD knowledge (i.e., correctly identified medications for AUD), beliefs (i.e., perceived effectiveness), and stigma (i.e., internalized and perceived) in general and by medication type (i.e., naltrexone, acamprosate, and disulfiram) were assessed using a measure developed for this study.</div></div><div><h3>Results</h3><div>Knowledge about which medications are indicated for AUD was low, with the highest awareness for naltrexone (61 % of participants correctly identified this medication). Most (55 %) participants believed MAUD helps people recover, however approximately half were uncertain about the effectiveness of each specific medication type. Participants with greater MAUD knowledge and more positive beliefs about effectiveness reported greater intention to take MAUD (<em>p</em>s < 0.05). Stigma was low across all medications (mean scores <3 on a scale of 10), though a substantial portion of participants endorsed uncertainty about stigma.</div></div><div><h3>Conclusions</h3><div>Greater knowledge and positive beliefs about MAUD were significantly associated with intentions to pursue MAUD, yet many participants reported uncertainty in these domains. MAUD knowledge was low overall, as was stigma. Targeted efforts to enhance patient knowledge of MAUD could be a promising strategy for increasing medication uptake.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209831"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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